5:30 am - Alarm goes off.
5:35 am - Alarm goes off again. Unconsciously turn the alarm all the way off, turn over, and snuggle the sweet 2 year old boy who winds his way to our bed sometime between 12:30 and 4:30 am almost every night.
5:45 am - Second alarm goes off.
5:47 am - Finally roll out of bed into the shower.
5:50 am - Stand in shower, mentally plan the day, pray a bit to the call gods.
5:50-6:25 am - Get dressed and ready, pack overnight call bag, double check that CindyLou's Kindergarten homework is done.
6:25-6:30 am - DIET. COKE.
6:30 am - Leave the house before anyone else is awake, drive to work, eat Zon.e bar for breakfast, let air conditioner "blow dry" my hair.
6:45 am - Run the L&D board - check vitals/labs on all post-partum patients, write notes, tuck in (write H&Ps on, examine, check, and discuss the plan for the day) inductions/C-sections/Pgels. Feel a little happy about having two multip inductions, one of whom is already 5-6 cm dilated, and allow myself a little hope about getting home before the kiddos are in bed for the evening.
7:30 am - Scheduled C-section
8:30 am - 9:30 am - Office patients, OB checks, problem visits.
9:31 am - Call from L & D, Induction #1 is pushing
9: 35 am - Back on L &D waiting for delivery
9:40 - 10:15 am Delivery, repair, charting, pictures with new baby and family.
10:20 am - Resume office schedule, 6 patients waiting to be seen.
10:21 - 11:07 am - Frantically catch up.
11:10 am - 11:30 am Check on 10:30 NST for post-dates, notice irregular contractions, patient states she has been leaking fluid since 9 am, confirm ruptured membranes by speculum examination, write H&P, call L & D charge nurse, give verbal orders. Hopes of getting home for the evening? Unfortunately dashed.
11:31-11:47 am - Catch up charting, sign off labs, return patient calls, correspond with the nurses on 18 patient messages new since the beginning of the day.
11:50 am - Grab a stale raisin bagel from the Doctor's Lounge on the way back to L&D, check on labor patients, greet noon C-section, sit down and write H&P for noon C-section, gnaw on bagel.
12:00 - Scheduled C-section
1:00 pm - Back to the office, more labs to sign, more messages to return, eat frozen diet meal in 3 bites. More Diet Coke. Pull up L&D monitor strips on the computer, watch laboring patients from afar.
1:15 - 4 pm - Complete the scheduled patients in the office without interruption (yay!) Peek periodically on laboring patients via computer. All is well
4:01 - 4:25 pm - Call patient with CT results, large pelvic mass, likely malignancy. Discuss differential diagnosis, surgery options, answer questions.
4:26 pm 4:30 pm- Call GYN ONC colleague, discuss patient's CT findings, arrange consultation.
4:31 pm - 4:45 pm - Finish all charting, remaining labs, and straggling patient messages.
4:50 pm - Back on L&D, check on 2 remaining labor patients, accept with a bit of defeat that both deliveries are likely going to be later in the evening, chat with the nurses.
5:00 - 6:00pm - Evening rounds on my partners' post-operative patients for the day, "Wal-Mar.t orders" for the floor nurses, write notes.
6:01 pm - Go to car to pick up overnight call bag, left in the car in hopes that it would not be needed. Boo.
6:06 pm - 6:30 pm - Grab a call room, microwave some canned soup and steal crackers from L&D for dinner, keep one eye on monitor strips, one eye on the ER census via computer.
6:31 pm- 6:45 pm - Call Mr. Whoo, CindyLou, and Bean. Chat on the phone, say good night to the kiddos, sniff a bit about not getting to see them today.
6:46 pm - 7:15 pm - Lie on the call room bed, watch mindless entertainment news, wait for the nurses to change shift.
7:16 pm - Greet evening shift nurses, discuss patients and plan of care.
7:35 pm - ER consultation, admission for PID.
7:37 - 8:03 pm - In the ER, examining PID patient. Confirm ER physician's diagnosis, write admission orders and H&P, have lengthy discussion with tearful patient about her diagnosis.
8:04 pm - Stat page from L & D, patient (Induction #2) that was 5 cm @ 5pm is now complete and on the perineum.
8:06 pm - Arrive on L&D after running up the stairs, pant excessively.
8:07 pm - Gown, glove, prepare for delivery.
8:08 pm - Quick, easy, and laceration-free delivery of a healthy, "surprise" baby boy. I love it when patients wait to find out!
8:10 - 8:27 pm - Charting and chatting with L&D nurses.
8:30 pm - Check on post-dates patient, no cervical change since 5 pm, place IUPC and discuss pitocin augmentation.
8:35 - 10:30 pm - Back in the call room, pull up monitor strip on the computer, lie on call bed, flip channels, drift in and out of consciousness.
10:31 pm - Re-check post-dates patient, good cervical change since 8:30 pm, reassurance given to the patient.
10:35 pm - Find newly admitted PID patient on the floor, change pain medicine regimen, discuss admission orders with her nurse.
10:45 pm - Back in the call room, lights out, try for some rest.
11:45 pm - Call room phone rings, triage patient, 22 weeks with a UTI, who has had dysuria for 3 days, but confusingly (but unsurprisingly) picks the middle of the night to come in for it. Antibiotic prescription written, back to sleep.
12:48 am - Call room phone rings, another triage patient, possible term labor, irregular contractions, dilated 2 cm, have patient walk for an hour and re-check cervix, back to sleep.
2:00 am - Call room phone rings, walking patient with no cervical change, reassuring fetal strip, orders for Ambien and discharge home. Check on laboring patient's monitor strip and notice some early and variable decelerations.
2:05 am - Check post-dates patient, she is completely dilated, but feeling nothing due to super-epidural, decide to allow passive descent.
2:06 - 3:02 am - Chat with the nurses and laugh.
3:03 am - Post-dates patient calls out, "Feeling pressure."
3:04 am - Post-dates patient starts pushing with her nurse. Nurse reports back to me "this is going to take a while." Back to the call room, rest fitfully, peeking at the monitor strip approximately every 5 minutes.
4:17 am - 4:45 am - Called for delivery. Gown, glove, help deliver a 9 pound baby girl, get misty when Daddy starts crying. Collect cord blood for banking, repair perineal lacerations, leave the room to start charting.
4:46 am - Informed of triage patient's arrival, 30 weeks pregnant with possible premature rupture of membranes. Head to triage.
4:47 am - 5:07 am- Talk with patient, speculum examination reveals gross rupture of membranes, bedside ultrasound confirms AFI of 2 cm. Discuss implications with tearful patient and her husband, plan transfer to nearby hospital with Level 1 NICU and Children's Hospital. Orders for steroids, fluids, and antibiotics given.
5:09 am - Call on-call physician for nearby hospital, discuss the patient, transfer of care accepted.
5:15 am - Quickly write H&P on PROM patient, return to triage, discuss plans with patient's family which has quadrupled in size in the last 8 minutes.
5:25 am - Finish charting from previous delivery. Start rounding on post-partum patients, pray for 7 am to arrive, shake fist angrily at the call gods.
6:00 am - Watch PROM leave the unit with the ambulance squad.
6:05 am - Round on PID patient. She is feeling better, no fevers since admission.
6:22 am - Back to the call room. Shower. Clean scrubs. DIET. COKE. Pack up call bag.
6:45 am - Check out with the next call victim, finish post-partum rounds.
7:00 am - Officially off call! Ready for another full office day.