109 Hours... by JB

Wendi has been asking me to write a bit about my experience with residency thus far. I thought since I am currently awake and do not have to go in for the next day and a half, I'd give it a shot.

109 Hours. That's what I worked this week. I've just finished my month long OB rotation. It started off with a few days of "deck" (that's the labor and delivery ward) and a few days of clinic (just seeing OB patients for their regular check-ups). This averaged about 50-65 hours a week. These last two weeks I have been on OB nights. This is all deck time - about 6:30 p.m. to about 8:30 a.m - L&D for 14-15 hours a day. Add to that the fact that I had my own clinic on Monday afternoon and that I have to return all my patient's phone calls from during the day, and you get 109 hours for the week.

Yes, we have an 80 hour work week limit, but it is an average for the whole month. Since I was fortunate enough to get July 4th off and a "family day" that same Friday, my average was 79.8 hours per week for this month.

That is a whole lot of time.

THOUGHTS ABOUT OB AND OUR JOURNEY WITH INFERTILITY
This was a very strange way to start residency. Wendi wasn't real crazy about me spending the day with pregnant women and delivery babies while we have been trying for just that for so long. I think initially I had a difficult time with it. I had to chat with women that were complaining about being pregnant again. I had to sit with women that were so excited to find out they were pregnant. I had to deliver a baby and hand it over to the happy mom and dad. There were pangs of sadness and jealousy. Anger and frustration at how lightly they were taking this miracle and gift.

But I also quickly learned how bad things can go with OB. I thought, you know, I would love to have a biological child with Wendi, but I would never want her to experience the things I witnessed the last few weeks.

THOUGHTS ON OB IN GENERAL
Everyone who hasn't been pregnant (and a few who have been VERY lucky with their pregnancy experiences) has this idea in mind about having a baby. They picture the happy, chubby, little wife who is glowing with joy as she grows this little life inside of her. Suddenly, the time comes and they rush to the hospital and after a few hours of waiting and a little while of pushing a new baby is born. All the pain is washed away in the joy of the moment. Dad calls the family and everyone celebrates.

That's the ideal. Few people get that. If you are reading this and this is what you got. Really, be thankful.

A classmate who was on this rotation with me - she did the first 2 weeks of nights and I did the second 2 weeks - "caught" over 20 babies. Her experience was pretty good. She had few emergencies and now she really enjoys OB. I had a very different experience.

I "caught" 7 babies from a normal delivery while on this rotation. I would have caught about double that, but things often went bad at the last minute and I had to be bumped out of the way. Now I am very thankful there was someone with more experience there to bump me, but it was really about every other baby that had an issue. I had a bunch of shoulder dystocias (where the shoulder of the baby get's stuck on mom's pubic bone) that I would try to dislodge while the obstetrician jumped in to help. I had a bunch of babies that needed to be assisted out with forceps or vacuums - those usually ended up with pretty significant tears to mom's bottom. Then I had a few emergency c-sections since baby was doing poorly. After a rough night where the baby suddenly started acting poorly and we did a very quick forcep delivery and mom got a tear all the way through her rectum and baby was blue and we had to do chest compressions and intubation and then he started seizing and had to be life-flighted to the closest neonatal intesive care unit... after all that, the OB doc I was working with said it's amazing any kid makes it through a delivery.

I think I now have this idea of pregnancy as a woman incubating a parasite who tries to drain as much life and energy from her - causing nausea, vomiting, heartburn, constipation, headaches, high blood pressure, swollen limbs, abdominal pain, and maybe even seizures - literally. Then there is bleeding and threatened miscarriage or placental abruption and threat to baby and even mom's life at any point along the way. Then that moment when labor starts and the pain is unlike anything a woman has ever had. They try to be tough and "do it natural" like there is some club they can join or a plaque they get for not using pain medicine - because if they do there is a sense of guilt for not being a "real" woman. But if they do succumb to the pain and ask for an epidural, there is no guarentee that it will work. She has numb, floppy legs, and can feel every contraction or the right side feels just fine and the left side is on fire. But maybe she gets that pain managed just fine and then baby's head get's stuck or his heart beat drops and we have to rush to a c-section or we have to yank baby out with big steel jaws. Mom gets ripped to pieces down below and can't urinate right for 2 months. She starts bleeding like crazy after the placenta is delivered and we have to about stand on her belly and give medicine to stop the bleeding. But then baby is rushed to the observation unit because he is not breathing right and mom and dad are left in the room alone wondering if baby is going to live or not. Then finally after all that, baby is given back and mom is so sleep deprived from labor and worry that she can hardly stay awake but baby is hungry. Baby needs to be fed. Baby needs to be changed. Baby needs to be held. And then it is time to go home and this helpless newborn is her responsibility. No wonder post-partum depression exists!

Okay - so that was a bit depressing. But this is the stuff I am thinking about while seeing every patient. Wondering which one will be just fine. Wondering which one might crash. Wondering if I am watching all the right stuff to make sure that if anything goes wrong, it wasn't something I could have prevented. No wonder I'm exhausted!

IN SUMMARY
The truth is, I had a pretty good time. I was tired and worn out. But I learned a ton of stuff. I gained a whole lot of experience. I love patient care and my interactions with them. And the bottom line... this is why I went into medicine. To help people when they need medical care. To care for them as best as I can with the grace of God.

And by the grace of God, I am done with that crazy schedule for a while.

I'm going to bed!