"You know it is a bad day when...

I believed it would be a good day. It was certainly too hot to do anything outside. With temperatures soaring into the triple digits, the rates of preterm labor soared also. Not to mention the rates of unassigned term patients who made it into my hospital in labor. So it was busy when I arrived. My feet were not off the ambulance dock before another five patients were added to the labor board.

The first was from an outlying community. No prenatal care. The baby's head measured thirty-six weeks and his femurs (leg bones) measured twenty-five. I only had a few minutes to contemplate the cause because she was in active labor, completely dilated and a double footling breech. In doing an emergency C-section we found a baby with almost no lung tissue who died 2 hours after birth. Maybe that is how I was suppose to know the flavor of the day. I was only 2 hours into my twenty-four hour shift.

The other deliveries were more routine. Two couples who were probably actually married to each other. Neither spoke much English but both had their emergency Medicaid paper work. Perhaps if I could learn more Spanish I could open a clinic for these people. We could swap outpatient services for prenatal care.

In this scenario, my grass would be cut, my house cleaned, and I would have a good solid roof over my head. The government actually pays for the delivery. This would all go well until all the John Kyl supporters figure out how to take these undocumented workers children's citizenship away. Then none of us will have our grass cut, our houses cleaned, or a stable roof over our heads. (And no, I did not see Senator Kyl making this statement on TV. I simply read about it the next day in the newspaper.)

One twenty year old I was delivering had three other children in the waiting room. Her mother had the eleven month old at home. A bright spot in the afternoon was the woman who begged us to transfer her to the county hospital. The ambulance would not take her there because it was 15 minutes further. Her car wouldn't start so her mother could not drive her. But she was only in early labor and she knew she would get her tubal at the county hospital because she had signed the paper work well in advance. This was to be her fourth C-section.

As the labor rooms emptied of deliveries and the day slowed, the emergency room got busy for me. I saw a woman miscarrying. No one, not she, her husband, her brother-in-law, or their three year old son, spoke English. This is less of a problem for me this year than last. Maybe I am learning some Spanish. I also am on a first name basis with most of the translators. I always use the translators for the surgery consent forms.

Three more admissions from the ER and I know who is having the worst day of their lives. It is not me. Not by a long shot. It is now 3 AM. In trauma room one, a family is surrounding the stretcher with a body on a ventilator. They are being told this 18 year old boy, their son and brother, will not survive. He stole a car. He was chased and he crashed. He is now likely brain dead. Oh, it will take another twenty-four hours for this to play out. With more neurological testing, organ donation, and the like. As I stare into the room from where I am writing admission orders for yet another gynecology patient, I feel a bit of their pain. Any "bad" in the rest of my day pale in comparison.