Thursday, December 10, 2009

A Typical Call Day, Ob/Gyn Style

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.

10 comments:

  1. Wow, that is one full 25.5 hour day on call! I'm impressed. And most importantly :-) you reminded me that I forgot to mention the repeated opportunities I take throughout the day to DRINK DIET PEPSI, I think I'll go have one now.

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  2. I love this post! I can relate to the relief palpable in the words "Officially off call!" I, too, frequently shake a fist at the call gods, who never fail to rain extra misery upon you when you try to plan something on a call day. Exhausting, but rewarding. Congratulations for coping so well!

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  3. Do your consultants (I think you call them attendings?) attend ALL births, even normal vaginal births? Or are these all private patients? And you have to be on site during your call period? Not at home within a reasonable distance? Your day sounds an awful lot like mine as a registrar (resident) and I do most of it unsupervised. Do you have a resident on site overnight?

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  4. Thank goodness for great OB/Gyn's like you. I am tired just reading about your day. :)

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  5. T ~ Thank you! Luckily, I only have one call day like that a week. The rest of my days are much more manageable. I have never liked the taste, though I love the smell, of coffee. So DC is my caffeine delivery mechanism of choice! :)

    FD ~ I got tired typing it all out! ;)

    gcs15 ~ Thank you, I loved your post, too. Will comment more on that below...

    Juggler ~ Hi! I meant to post a little introduction blurb, so thank you for allowing me the opportunity to clarify! I am one of 5 physicians in a private practice group. We deliver out of one hospital in a more suburban area (20 min south) of a large city. In general we have about 60-80 patients due every month, and are the only ones responsible for their care. There are no residents based in the hospital, as it is not a primary "teaching hospital." Sometimes we do have residents do electives with our group, though, but that is rare, and only one at a time. We take call one day a week and one weekend (Friday, Saturday, and Sunday) a month. As for being 'in house,' it certainly is not required, per se, more of a personal choice. For me, if I have actively laboring patients, I feel more comfortable remaining on site, so the better to be immediately available. Another caveat for me, is if I need to stay in the hospital after a certain (late) hour, I tend to just stay there and get a modicum more sleep. If there are no active labors, I do try to go home and stay there as much as possible. I live about 15 minutes away. I can remotely view L&D computers from home, as well. Call is a lot less busy for me here than when I was a resident, but, it is still L&D, with great potential to be up all night, every night. Good luck with your training!

    Anon~ Aw, thank you! At least every day isn't like this anymore! It used to be worse!

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  6. What a day. I'd love to do this for a day one day - I put off OB/GYN until one of my last rotations because I didn't think I'd like it at all, then found myself really liking OB.

    When dads cry...or actually, any time I see men cry, game over for me.

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  7. My doctor stayed on site when I delivered... it made my day, my week and I still think fondly of my OB-GYN. Thank you for what you do!

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  8. Great summary of a typical call day! The only thing different about mine is instead of 7am: off call, ready for the office, it's OFF CALL! ready to run home, relieve the sitter and spend a day with a toddler until 7pm bedtime! BRING IT ON!
    Great job!

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  9. Omg! I had no idea this is what you go through. You truly are angels. Im trying to decide on a new career path but wow dont know now.

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