30 Something Baby Doc

I was seeing a patient today for her routine pre-natal care visit. She was about 35 weeks pregnant. She had no major complaint other that the usual TOBP stuff (tired of being pregnant). We listened her baby's heart beat and I measured her belly. Everything was normal and appropriate. I told her I would have her follow up with me for another appointment in one week. I directed her to the waiting room. A few minutes had past and she came in from the waiting room with concerned look on her face. She nervously asked me if I could be sure about her due date. She wanted to know exactly how far along she was in the pregnancy. Because she had an early ultrasound, I told her we could be pretty sure about her dating. I made bold move and asked her why she was so concerned about her pregnancy dating and was there a question about who who was the father of her baby. She said she was unsure about who the father was because she slept with her current boyfriend and ex-boyfriend in very close proximity (5 days apart). I told her if she was really concerned she could always do paternity testing. She said she couldn't do it because then her current boyfriend would know she was unfaithful. I tried to comfort her by explaining to her it may not be a big deal if both potential fathers looked alike (As I'm writing this post , I assure you I completely realize the ignorance of my latter statement). Unfortunately the patient said both gentlemen look totally different and as her due date approaches she becomes more and more anxious. I sat down with her and meticulously reviewed her dating. I was able to assure her with about 95% accuracy that she was likely 3-4 weeks pregnant already before she cheated on her boyfriend. So she could be fairly certain her boyfriend was the father. She felt a little better. I'll still try to avoid the delivery room when she's in labor (just in case) ;-)

Alright it's finally official. I just paid over $50 for a full tank of gas. $53.51 to be exact.

On the rare occasion when my nights on call at the hospital are extremely quiet, I view it as a gift from God. Last night was so quiet, it was almost unnerving but that still didn't stop me from sleeping most of the night.

This is a link to chilling pictures taken of the asian tsunami just prior to impact. The pictures were taken by British Columbia couple who tragically did not survive the impact. Their digital camera was destroyed but the memory chip was recovered. I found the most striking photos in the series were #4 and #5. Photo #4 shows a calm beach with off shore reefs that are partially submerged. The next photo #5 shows the same area of the beach after the tide draws back and exposes the previously submerged reefs that are then clearly visible in the photo #5. Small boats that were previously off shore are now grounded. Unfortunately the beachgoers didn't realize this was the only warning sign of the approaching tsunami and many ventured closer to the now recessed shoreline to investigate this dramatically low tide. In the distance you can see the approaching tsunami as a huge wall of water. Photo #8 and #9 are also very dramatic, they show a man standing in front of a reef, the reef must be about 10 feet high. Behind the reef you can see the approaching wave that must be 30 - 40 feet above that (a 40 - 50 ft wall of water!). I can't imagine what must be going thru that poor guys mind. Lesson to be learned : If your on the beach and you see the tide dramatically retreat, drop everything grab the kids and Fucking run like hell inland. (depending on the size of the tsunami, it still may be too late).

Jimmy, I'm glad you decided not to make a return trip to Thialand:-)

May God bless the souls of that couple and their family.

Murphy's Law is the only constant in obstetrics and gynecology. I was staffing labor & delivery today ...oh what joy! I was called to supervise a tubal ligation in the operating room being performed by a second year resident (who's surgical skills I trust). At the same time I was called to a labor room to supervise a delivery being performed by the chief resident (4th year) who I also have confidence in. The patient was pushing, the family and nurses were happy, the baby was close to crowning and all was well. Since the chief resident was very experienced and will be in a practice of her own after graduating in a few months, I decide to leave her alone to complete the delivery and I strolled back to the OR the supervise the less experienced 2nd year resident for the tubal ligation. I hadn't been sitting in the operating room for more than five minutes when I received a phone call. It was the nurse in the labor room I had just left. She was frantic and I heard multiple people screaming in the back ground (as well as the patient screaming in terror) I'm thinking to myself" What the F--K. " The nurse tells me I need to come to the room right away. So I'm running down the hallway dodging pedestrians and other obstacles. I arrive in the room and everyone is still screaming . I see the chief resident pulling on a very large infant's head that won't budge any further. The resident yells that she has a bad shoulder dystocia ( the infant's shoulder is stuck behind the mother pubic bone and only the head has been delivered. If this is prolonged the infant can sustain permanent brain damage. It can also result in prolonged nerve damage to the involved arm). I ran to get some gloves ("Here I come to save the day") I told the resident to cut a very large episiotomy. After she cut it I told her to reach in and grab the other shoulder, she tried but couldn't get a good grip. I made an attempt since my hands were larger (I knew one day they would be good for something) . I managed to grab the other shoulder and pull the infant out. The newborn perked up and started crying after 30 seconds. It was moving all arms very well.

Now if I had stayed in the room, everything would have been just fine and there would have been no shoulder dystocia. OBTW, the 2nd year resident completed the tubal ligation without any problems.

One thing I've noticed since I've been a staff attending is that during physician shift changeover in the mornings, the residents will occasionally make flippant and negative comments about the patient management decisions of other staff attendings in my presence. I usually remain quiet. I'm a fairly laid back attending. Part of me is flattered that the residents feel that relaxed around me to be so open. But chances are when I leave the room , they may trash me in a similar fashion........LOL.

Explanation to come later!

I was at the children's hospital the other day getting lunch, because the cafeteria food at the other hospitals will kill you quicker than cyanide. They had a new Mexican bar. The diversity was more than I could handle. There was a young guy working behind the counter who must have been a trainee. His older trainer was showing him the appropriate way to make a wrap a burrito. Unfortunate the trainer was yelling at the poor guy every 5 seconds regarding his inadequate burrito making skills.

Thank God I at least completed college