30 Something Baby Doc

I was seeing a pregnant patient last week for a routine prenatal visit . Her husband and sister were also present at her appointment. The appointment went well, we listened to her baby's heart beat which was very exciting for the patient and her husband. The patient also complained of a vaginal discharge with itching. I did a pelvic exam, collected some of the discharge and examined it under a microscope. Unfortunately she had a infection called trichomonas which is easily treatable but is classified as a sexually transmitted disease.

I went back into the patient's room and told her I had something personal and important to tell her. I asked her if she would like to speak with me alone given the nature of the diagnosis. Her sister quickly left the room , but her husband was insistent on staying and the patient agreed that he could remain present. I informed the patient that she had a sexually transmitted disease and that she and her partner would need to be treated. The patient was visibly shocked, but the husband was silent and restless in his seat. The patient then began to give her husband a piercing stare which made him appear even more uncomfortable . I then saw that as my cue to leave the room. Immediately upon leaving I heard the patient yelling at her husband and him making attempts to explain himself.

I'm always uncomfortable giving a patient the diagnosis of an STD while their partner is physically present. I view the latter as the worst way to disclose a partners infidelity. (not only has your partner cheated but they have also showed no consideration for your well being and neglected using condoms) . Injury to Insult

The rear brakes on my SUV were failing, so I had to make another expensive trip to the Cadillac dealer for service. I'm amazed at how a Cadillac dealership in the day time hours is a haven for wealthy retirees to reminisce about past glory while their cars are being repaired. If it wasn't for the retirees, athletes and overconsumptive young professionals (myself), Cadillac would be out of business. I was waiting for my brakes to be repaired and reading a chapter in He's Just Not That Into You (very entertaining book). There was a pleasant elderly man on my left and a very conservative and overly chatty elderly lady on my right. They were talking about past glory. Bush's address to the nation was on TV. Then the topic of conversation switched to politics. I held my tongue. The Elderly man mentioned he and his brother were born and raised republican, but after is brother moved to California he became more liberal in his views. The elderly lady then began to denounce liberals, saying, "I don't know what's wrong with those people in California, it's just horrible, they believe in killing babies, gay marriage, I hope they all fall off the country and find themselves in Hell"

I had to pleasantly remind her that our country would be a lonely place if the latter were to happen, because 49% of the U.S. voters would be roasting in Hell. OUCH

It's truly painful watching that man speak in public.

I haven't posted since Monday, what a disgrace. I promise I'll get back on the ball. My medical student lectures are completed, Finally.

I found myself in the middle of another very busy day at the office. I walk in a patients room, she was an attractive woman in her mid twenties. The patient was on her cell phone and I introduce myself as Dr.------- . The patient then completed her call by saying (loudly), " Oh girl, I have to go now, my sexy fine ass doctor just walked in. " I'm not indicating that I don't find it flattering that a member of the opposite sex finds me attractive, but the examining room is an inappropriate place to express this. This type of patient behavior makes me very uncomfortable and the intimate nature of the gyn exam makes it even more awkward.

Or maybe I'm just being to damn sensitive.

Teaching hospitals have come a long way since I was a resident. 2003 marked the beginning of a new phase in graduate medical education. The Accreditation Council for Graduate Medical Education placed work restrictions limiting resident physicians to 80 hours per week averaged over 4 weeks, a maximum of 24 hours per shift with at least 1 day off per week and at least 10 hour off between shifts. Prior to this residents commonly worked over 100 hours per week and 36 to 48 hour shifts were common. Many of the shifts were accompanied with no sleep. I recall when I was a second year resident during a busy 36 hour shift, I was called to the emergency room evaluate a young woman with abdominal pain. I was seated in front of the patient taking a detailed history, my eyes became very heavy and the next thing I remembered was the patient exclaiming," doctor! doctor, are you ok, I think you fell asleep". In fact, I had unknowingly taken a 5 minute cat nap in front of the patient (I'm sure this significantly increased her confidence in my medical decision making) .

The mandate for reduced work hours came as a result of increasing concern by the general public over the safety of both patients and physicians in training. The relationship between sleep deprivation and patient safety received a great deal attention in 1984 when resident fatigue and lack of appropriate supervision by an attending physician were implicated in the death of an 18 year old girl named Libby Zion in a New York city hospital.

I still see a major problem inherent to these new regulations. Although the physicians in training have restrictions on work hours, the supervising attending physicians (myself) have no such restrictions . We still find ourselves completing 36 hour shifts quite often. Would you fly with an airlines that restricted co-pilots from working long hours but their pilots had no such restrictions, and commonly worked long shifts without rest. The latter is quite confusing to myself. Food for thought.

I don't know if anyone remembers the 90's hit comedy "In Living Color" ,but there was a character played by Keenan Ivory Wayans who was a rehabilitated convict. This guy had an extensive English vocabulary consisting many complex words and absolutely no idea of how to use them appropriately. He attempted to portray himself as educated but usually sounded like an idiot....it was hilarious. He always started his monologues with the title of my blog.

I sometimes feel like this character. I believe that as I progressed through my medical career, my vocabulary and grammar suffered. To makes things worse, most of my close friends have excellent grammar.

examples of my poor word choices:

I'm at a nice restaurant, the menu clearly states that the steak is accompanied by your choice of sides, one being a "vegetable medley". I pleasantly ask the waitress for the vegetable melody.

I'm pointing out the fact that a certain person has lost touch with reality (delusional). I therefore describe the individual as disillusional (NO SUCH WORD).

I pointing out an individual's surprise to a certain event. I say," much to his chagrin" (wrong use of the word).

I need help! Maybe learning a new word every day is not so bad. My promise is to concentrate cleaning up my grammar and improving my vocabulary:-) Please hold me to it guys.

Sorry, my blogging has been on hold while I prepare several lectures for our medical students. I'm currently working on a new user friendly template. Thanks to Kelly for all her help with setting up my blog. She's "sweeter than apple pie"

I did my last delivery of the shift with one of the new medical students on the Ob-Gyn service. I let her do the entire delivery from start to finish. She did a great job and couldn't stop thanking me for the experience. I remember the fear and excitment of being a 3rd year medical student. A strong desire to appease your residents and attendings and an extreme fear of the unknown. It's experiences like for first deliveries that make it all worth it. I'm out!

It's 430 am, The temp outside is 7 degress, it snowing heavily and the babies are still coming. All is well:-) My 24 hour shift is drawing to an end. I think I'll be a good Catholic and go to Mass today.

I walked onto the labor and delivery ward this morning at 8 am to find all the labor rooms full. Including 6 different sets of twins all in pre-term labor. Patients were being diverted to other hospitals because we just didn't have the room. 5 nurses called in sick. What a way to start your weekend.

I work at a very busy county/university hospital is a major city. Most of the patients are indigent. Many patients have pregnancies complicated by poor pre-natal care, pre-term labor, diabetes, hypertensive and sustains abuse. We also have a very large non-English speaking Hispanic population. Within a 24 hour period there can easily be 10-15 deliveries, 2-5 cesarean sections, and other various surgical procedures, some are emergent. This is also a teaching hospital, therefore I am also responsible for the education of the resident physicians and medical students.

It can be a very stressful environment. I've entertained the idea often of going into a plush and lucrative private practice. Where patients are compliant with their health care. But I feel that the county hospital is where I am most needed. I'm grateful to God for blessing me with the ability to help others at such a personal level. Childbirth being the most important event in many people's lives. I feel this is the population that God wants me to serve. It's very special to see a healthy infant born from a high risk pregnancy. It's also a privilege to see the joy in the eyes of the parents. The latter reaffirms my belief that staying here is important. Our lives are finite, the recent tsunami disaster proves this point. Caring for others less fortunate than ourselves seems to me to be the only way to make sense of the short life that we lead.

12 hours into 24 hour shift an still counting.......Almost there:-) We kept a patient from nearly bleeding to death during the first 12 hours. I wonder what the second 12 hours has in store for us?

I woke up this morning at 230am (not intentionally) I couldn't force my self back to sleep. My alarm clock was set for 430am which made things even better. The latter gets me to the gym by 5am. No, I'm not crazy. Vigorous exercise at 5am is the only way I can survive a full day in my busy Ob-Gyn office. The workout was great, I ran 3.5 miles and lifted weight for a half an hour. I stopped at Panera Bread to pick up bagels for the entire office (it's best was to appease the office staff). I showered quickly and made it to the office by 830am. My first patient was scheduled at 8am along with about 50 other patients scheduled throughout the entire day...LOL On occasion 3-4 patients are scheduled into the same time slot. I hit the ground running seeing patients at a dizzying pace but still running an hour behind. All the while, I try to stay focused and addressing every issue the patient has ( I continually remind myself that this is how I would want my mother and sister to be treated). I also feel disadvantaged as a male Ob-gyn therefore I try very hard to maintain a friendly personable attitude to compensate. The latter works 98% of the time.

After 8 hours and 46 patients , my day was over. And what's my reward........A 24 hour shift in the hospital tomorrow. Where I must remain within the geographical confines of the hospital for a full 24 hours. It's a good thing I love my job