Obstetrics ward week
Posted on August 16th, 2008 by Rob.
Being a doctor is tiring and I?m afraid to say a little less fun than expected. My bleep never stops. I start work at 8am every morning and my bleep usually goes off before I’ve taken my coat off, adjusted my tie, and had my morning wee. It then goes off every five – ten minutes until I leave at about 7pm. I should finish at 5pm but I just don’t get all my jobs done. I feel that this might be my own fault. I haven?t found a natural flow to things. I start a to-do list each day and cross jobs off when they?re done. As people see me they quickly add as many jobs to my list as they can (midwifes, patients, SHOs and registrars). I just get started on a job and then my bleep goes and I have to apologize to the patient, go and answer my bleep, add the job to the list and then back to the patient. This was very exciting for the first few days but now it?s getting boring. I have so many forms to fill in. I?m hardly using anything that I learnt in the last 6 years ? I?m just filling in blood forms, writing the same old things in the notes, filling in TTAs (to take away (prescription)), and taking blood/putting in venflons.
In the last week I?ve made maybe three medical decisions on my own ? 1 yes this lady is constipated and needs and enema. 2 ? Her haemoglobin is low so let?s give her iron tablets. 3 ? This woman could get sick so I?ll call the registrar (times 100). The reg is always in theatre so I have to go down to theatre, and explain what?s wrong with the woman. He then tells me what to do and I go and do it.
The most fun I had was with a woman who had a caesarean section for twins. 5 days post-op the midwife bleeped me and said ? ?I?m just not happy?. This is a common midwife complaint. So I went down and had a look and her wound was oozing green horrible stuff. So I bleeped the reg ? he was in theatre. I went down and told him (I?d already taken the initiative to start antibiotics ? very brave of a young doctor as starting new drugs in any pregnant or breast feeding woman is dangerous. Anyway the reg said ? you better remove the sutures and lay it open ? very exciting ? So I went upstairs and on the ward cut open the stitches that were holding this poor woman?s tummy together. It was very smelly. I didn?t vomit (but almost). She?ll have to spend extra time in hospital and heal by secondary intention (new growth ? as oppose to primary intention where the two sides of a wounds stick back together. You can?t suture an infected wound.
On Tuesday we met my favourite member of staff so far ? Father Rodney is the cheerful, up beat Chaplin. He single handily tries to keep the moral of everyone high. It was Thursday when I first called Father Rodney. A 21 year old woman went into labour at 24 weeks gestation. 24 weeks is on the borderline of viability. The baby is alive on NICU where it has a 95% chance of dying. The neonatal doctors beat me to the room and explained the bad news to the family. I was next in. I had to explain that I was an obstetric doctor and here to look after mum only ? I know nothing about the care of babies. The baby was in a bad way but mum was also in need to care as she had lost lots of blood. The reg was (you guessed it) in theatre. He promised that he would be up as soon as he could. I needed to get IV access and start fluids to replace the blood loss, take bloods to make sure that she didn?t need a transfusion and start a drip of syntocinon. This is a drug that makes the uterus contact. She had a bit of placenta left in the uterus and it was making her bleed heavily. If the synto didn?t do its job she may have to go to theatre and that could end up in a hysterectomy which would end her chances of future pregnancies. It was all too much for her, her husband and her parents. It took me 4 attempts to get a line in ? she needed lots of fluids plus the synto drip fast. That means a very big needle ? little needles restrict the rate at which you can transfuse. However, this woman?s veins were just too small for the venflon. My flipping bleep going off every 2 minutes now ? the same midwife bleeping me until I answer. At last I remember Father Rodney. I bleeped him (almost in tears myself). After I finished the medical stuff he took over, meaning that I could answer my bleep to the stupid midwife that *urgently* needed me to fill in a form.
This was my ?ward obstetrics week?. Next week is ?gynae week?. I?m told that ?gynae week? is the hardest.
Tags: Obstetrics
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Perhaps your midwife friend would benefit from reading the facebook group – Bleep Etiquette – http://www.new.facebook.com/group.php?gid=5202063122 ?
As for your to-do list, my advice is to hide it. Show someone you have a list of jobs and they will surely add to it, no matter how large the list!
So how was Gynae week, Dr Rob?
We’re all eager to hear about it!