Sugar Walls, Week 2

I wrapped up my second and final week of ob/gyn -- it was difficult, if for no other reason than it was two weeks of nights ONLY. I wanted to flush that gyn pager down the toilet. I was responsible for rounding on all the gyn service patients all night long, and every fifteen minutes I'd get the same page:

Nurse: "Doctor, the patient in room x is having vaginal pain."

Me: "She just had surgery."

Nurse: "And it's hurting her."

Me: "Give her four milligrams of morphine."

Nurse: "Not until you write the order."

Me: "Fine, I'll be up in a minute."

I'm going to turn these women into morphine addicts just so I can get some sleep.

But I do have one order I love to write: "discharge vag packing, discharge to home."

Back to the obstetrics part (warning, it's not for the faint of heart):

I find it interesting that after two weeks of ob/gyn, I, as an ER doc, am supposed to know how to deliver a baby if they come into the ER in labor. I suppose, however, that nature took care of it for hundreds of thousands of years before doctors came along and co-opted that duty, but regardless, babies seem to pop out. On the other hand, before the advent of modern medicine, childbirth was the number one cause of female mortality. The truth is, if someone comes to the ER in labor, then a) that baby had better deliver itself as mother nature intended, or b) there'd better be a separate ob/gyn service in the hospital on call. Sure, I can do the basics, but if the shoulder gets stuck, I don't have a lot of knowledge or resources of my own.

And what a messy procedure birthing is. Push push push push push. Ladies, before you go to the doctor in labor, it makes sense to give yourself an enema if you have time. Because with all that pushing, most women will also -- if it's in there -- take a dump. Then baby comes out facefirst in mommy's poo, and then mommy inadvertenly urinates all over the back of baby's head -- welcome to the world! No wonder they always come out crying.

I'm really not that insensitive -- I do still marvel at the process of giving birth. It's unreal to me how much work you women go through to have one. There's so many potential complications, not the least of which is that most of you end up tearing at least part of your vagina as the baby comes out. I even saw one woman tear straight through to her rectum.

THEN the placenta comes out about ten minutes later. The baby is beautiful, fine, but the placenta is just nasty. It's an alien-looking blob of tissue, replete with vascular tentacles enrapturing it in spirals and swirls. It's half enclosed by a gray membranous sac, and it spills out into your hands or a hospital bucket. It's hot and steamy, and it looks quite like an oven-fresh pizza. I am absolutely dumbfounded and viscerally sickened when I think about how some human cultures used to eat it -- I can't even eat my real lunch after a placental expulsion.

Being pregnant, I've realized, is no joke. Hrmph, you women say, I could have told you that eons ago. Fine, I get it, I'm a man (somewhat), so I don't have to deal with that aspect. Recently, there was one very interesting patient on the ob service.

She was thirty years old, and it was her second pregnancy. She was 37 weeks into it, technically full term, but still a few days to weeks short of where we wanted her to be exactly. She was brought in by ambulance because her husband said she was just "acting funny." Actually, it was more like she was on crack -- running around, manic, obsessively cleaning, talking with pressured speech. This was nothing necessarily too new -- apparently she had had this type of behavior in the past intermittently. Her five year-old son had a strange but calm look on his face as his eyes rolled around with a sigh; he seemed to be thinking, mom's on crack again.

Not quite.

As it turned out, she was hyperthyroid. One's thyroid hormone is responsible for the general state of metabolism and mental functioning, similar to how your car has an engine that just kind of makes it run at its baseline at all times -- you either have a good engine, a slow one, or sometimes one that's just a bit too fast. And if your thyroid level is too high, it can be toxic, a condition called thyroid storm (sounds like a superhero, doesn't it?).

So this woman is squirming around and can't sit still. It is actually very dangerous to be in thyroid storm, so it requires immediate action -- especially if she's pregnant. But there's a somewhat comical side to this -- this poor patient is out of her head, is unaware of what she's doing, running around with doctors and nurses trying to keep up with and catch this pregnant lady running all around the floor. She won't stay in bed, she keeps vomiting up her anti-thyroid medication, and she won't shutup. We threw a nasogastric tube in her to give her her medicine, but she ripped it out. Now picture a bunch of doctors and nurses holding her down, squirting an oil enema in her butt filled with medicine, and then trying to keep her buttcheeks clenched together for five minutes for the medicine to absorb.

Finally she calms down -- a little. Enough to have a baby, anyway. So baby comes out, and the little tyke, slippery though he may be, is cute in that nascent-but-ugly kind of way that newborns are.

Now it's 5am. I get to go home at 6am, and actually, that's the beginning of a two-week vacation period for me, woohoo!

So of course guess what happens at 5:45am? MY FUCKING PAGER GOES OFF FOR ANOTHER CONSULT. MOTHERFUCKER!

"Fine," I say to myself. "You know what? I'll just bang this consult out real quick -- she's 25 years old, barely pregnant, a little vaginal spotting. Check her pregnancy hormone, ultrasound her, have her come back in two days for a re-check, just like all the others. I'll be fifteen minutes late, I can deal with that."

Now you know what comes next: the consult becomes complicated.

First, she's 250 pounds. Fat is the enemy of all doctors at all levels of training -- gross anatomy in med school is exceedingly difficult when you have to dissect through layers and layers of fat, and when you're attempting to find a vein to catheterize an IV line, you're also in a similar quandary. And I had a fair amount of difficulty actually finding her vagina. There's only one place it could be, but just believe me when I say that it isn't always quite so easy.

In goes the vaginal ultrasound probe and there goes my only-fifteen-minutes-late mantra. I had no idea what I was looking at -- funky uterus, funky ovaries, even funky bowel with pre-formed shit swirling around in it. Sigh. Call the chief.

"What the fuck is that?" says the chief under her breath to me.

"Shut-up! *I* said the SAME thing!" I told her.

"No way!"

"Way!"

Now the patient chimes in: "What's going on down there with you two?" We felt like schoolgirls being hushed.

Two hours later, my angry ass is wrapping up her admission to the service -- more blood, more tests, more this, more that. That's two hours of my vacation time GONE -- two hours of a bloody mary or a ketel tonic I could be drinking. Yes, at 6am. I deserve it.

Turns out, she had a ruptured hemorrhagic ovarian cyst, but her baby was fine.

The cap on this 11th-hour admission was that the med student wheeled this 250-lb woman in her stretcher over my big toe. Throb throb throb.

Nothing a bloody mary won't fix.

I finish rounding on the gyn-oncology patients. It's a sad sight, really. On our service, there's a 19 year-old girl with advanced, invasive, metastatic cervical cancer. There's another woman with spinal mets from her uterine cancer that was just picked up incidentally. And another woman my age who did the right thing: got her pap smears once a year, every year, didn't drink, didn't smoke, took her vitamins, no family history of cancer, no risk factors. Despite this, however, she developed an aggressive cervical cancer that has eaten away most of her belly and now is leeching at her liver. She has about six or nine months more to live, and she has a two-year old son at home. And finally, another woman on our service has advanced ovarian cancer; she's cachectic and pale, yet her belly is so big and round with cancer and fluid that it's impeding her ability to breathe properly.

I wrap up the morning, put on my coat and scarf, sign out to the morning team, and I'm on my way out the door. In the lobby, I pass by one of the ER nurses I know well -- her name is RoseAngelie, and well, to put it bluntly, she's fresh-off-the-boat from the Philippines. Lovely woman, really, but a mouth like a sailor (she tells me she has "known" many sailors in her homeland; I guess they give their own type of English lessons). I swear, the other nurses call her "Flip," and though she has no idea why, she loves that nickname.

"Hey bitch!" she says to me in a stuttered accent.

I keep walking. "Hey RoseAnglie."

I'm about ten feet away from her, and despite the heavy foot traffic in the lobby of the hospital, she shouts, "Are you still a pussy doctor this week?"

I turn red FOR her, yet I don't stop my beeline for the front door escape hatch from the belly of the beast.

"Yes!" I shout back.

I'm twenty feet away so she's even louder now. "MAKE SURE YOU SHOWER! YOU DON'T WANT TO STINK LIKE PUSSY ALL DAY!"

Mortified though I may be, I know that she does have a point.

Off to bed. After a long shower.