Friday, April 23, 2010

The quote of the day

"She is smart but.."

He didn't say anything else. I guess he realized how stupid this sounded. This is the FOB (father of the baby) talking. I am discussing how to spend the next three to four months in the hospital with an 18 year old mother to be. She has already lost one baby when she delivered prior to viability. This pregnancy is going to require a hospital stay and she has not yet graduated from high school.

These young parents are not typical of the ones I see. They have a laptop. She reads a novel every couple of days. I see no reason why she could not get her GED online. I did not ask him what he is doing in terms of work or school. He is here most days and they are from a town 70 miles away. Most women in this situation are here by themselves during the week, with husbands, parents, and even children visiting on the weekend.

I have great hope though. There is now talk on the unit, among the social workers, with the nurses about setting up study seasons for the GED exam. There may even be a nurse who gets her certification to proctor such exams. I would love for these young women to leave here with more than another mouth to feed.

A high school diploma, a GED, perhaps even a skill, might put them further along the path of being able to sustain themselves and their children without government assistance. A healthy baby, contraception, and a way to support themselves are worthy goals and we seem to be a few steps closer to providing all of these.
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Friday, April 9, 2010

Role models

I am very tired today. No, I was not up all night and I have not been terribly busy today, so I find myself drawn to reflecting here. I have been at this new job almost 14 months now. I am less tired than I was in private practice. I have days where I have a great deal of energy - usually my days off.

I am, however, constantly bothered by thoughts that I am becoming lazy. This afternoon I gave a great deal of thought to taking a nap. I have worked hard not to sleep during the day. I am constantly thinking of ways to be more organized, to get some writing done. I have several projects, one of which is this blog, that I wish to keep up.

It is difficult to write about events after the fact. While I have a vivid recollection of what I saw and heard for days or weeks, the emotions surrounding these events are less intense the following day. It is that emotion which can propel my words across the page. I was incensed today when a general surgeon refused to see a patient with free air in her abdomen (a surgical emergency) until I, the gynecologist had seen the patient for her total vaginal prolapse which has been present for years. She is in surgery as I write this. Consulting me and insisting I see the patient preoperative was a way to buy time. Time for what, lunch? The only reasonable answer I could come up with when I ask myself this question would be time for this 75 year old woman to die.

Free air in the abdomen on an abdominal X-ray means that her bowel has ruptured. It could be from an ulcer or cancer but there is no way around the problem short of making an incision, finding the hole, fixing it, and treating the cause. That is a question any third year medical student on her surgery rotation can answer. Of course this woman is in poor health, she has multiple medical problems, including heart disease and diabetes, and her family is extremely dysfunctional. The scene in the emergency room was one straight out of ... well, it was probably straight out of "ER."

I certainly hope I played my role better than most of the doctors on "ER" or even most of the doctors in this major medical center. I guess today my true job is to be a role model, especially since I am easily the oldest physician seeing this patient. I delivered the general surgeon's kids, which maybe the biggest reason he was willing to listen to me and take this woman to surgery sooner rather than later. I hope my residents and his remember this woman when they are in practice at Elsewhere General in a few years.
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Thursday, April 1, 2010

If this is so funny

then why am I not laughing?

Yesterday I discovered the hospital where I practice is "monitoring" this blog. I am not sure what monitoring means and I have tried to stay anonymous but it makes me nervous all the same. My "mouth" often gets me in trouble and that could be the case with what finds it's way to this space.

However, I am stiill going to tell you about my day. Before noon I had delivered a woman who was all of 23 years old. She has been pregnant 7 times, three children and three abortions. Now this seventh baby is here, healthy, and she did not want to talk about birth control when I visited with her this morning. She was distracted by the two older kids her mother brought up to the hospital for her to watch waiting on this baby to be discharged. The oldest child is in school. And no, she did not have her tubes tied because of the federal law that requires a 30 day waiting period after the consent for sterilization is signed. She was only seen at Major Medical Center once during this pregnancy. This is a problem universal electronic medical records would solve.

Another patient I delivered was 13 years old. That is right. Her birthday was 2 weeks ago. Yes, she was 12 when she got pregnant. By whom? That was the first question I wanted to ask but I waited until she was comfortable with an epidural to ask about the father of the baby. By this point I had already seen her genital warts and lesions of secondary syphilis so it was not a shock when she told me she didn't know who was the father of the baby. Yes, I suspect a boyfriend of her mother's but I was unable to seperate the two of them long enough to ask. Child protective services will do that this afternoon.

Finally, the last patient I want to tell you about weighs over 400 pounds. She is 33 years old and not pregnant. She needs to go to the county hospital where they might be able to help her but she "don't want to!" There is nothing I can do for her. In addition to her pelvic pain, she has diabetes and hypertension. All can be controlled with medication, which it seems she does not take except when she is in the hospital. Long term psychotherapy and bariatric surgery would be good places to begin. Judging by her blood pressures in the emergency room she will probably have a stroke before she is forty.

As I said, it seems funnier to me now that I am off and just reflecting on the day.
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