The flu

I once heard from a patient, "You know you have the flu when your hair hurts." Well my hair hurts today, not because I have the flu but it certainly seems as if everyone else does.

I received my flu shot for the common seasonal flu over a month ago. Now city officials say all the current flu circulating is the swine variety. This is a problem since there is no vaccine. The hospital asked for 7,000 doses. They received less than 700. Pregnant employees in the emergency room and women's and children's services were the first to be vaccinated. Other pregnant employees will be next.

Flu is a dangerous disease in pregnancy. It can lead to pneumonia and hypoxia, a fancy word for too little oxygen. As you can imagine, too little oxygen is not good for mother or baby. We have had several mothers and mothers to be in the intensive care unit. So far we have not had a maternal death but we have come very close - twice.

I try not to think about getting the flu and I must admit, I am more afraid for my sons than for myself. The young seem to be very vulnerable to this virus. One patient who was in the ICU for two weeks is the same age as my oldest. He is not pregnant but he has an underlying medical condition. I will not hestitate to give him an antiviral should he or anyone in our household comes down with the swine flu.

Another world

Here I sit in front of the computer screen. It seems I must have been transported to this location on an alien space craft. I could swear I drove here in my Honda but it has been such a weird twenty four hours that now I am not sure. My shift began with a woman from another city dictating her care to the nurses. Carrying a preterm infant, she is here as a transfer patient for the maternal fetal medicine service. In addition to her problems with this pregnancy she is bipolar and moving into a full blown manic episode.

In the room next door, a patient is withdrawing from cocaine. She swears she hasn't had any cocaine in months but it some how got into her urine on the drug screen. She is in labor, probably due to the effect of the cocaine on her placenta. Her baby is doing alright and is full term, so my hope is she will be able to deliver vaginally.

Next, a call comes from the emergency room. A cashier from the local WalMart arrives short of breath. After a complete work up is preformed, the only abnormality which can be found is her hemoglobin of 2. Normal is 12. Even though she is not having her menstrual period and doesn't complain of heavy menstrual periods, it is decided this must be a gynecology problem.

So it goes, on to the woman with the abdominal wall abscess from poor hygiene, the parolee with pelvic inflammatory disease, and the teenager pregnant with her third baby. I have been doing this for several months now and yet, I still feel as if I am in a foreign country, if not on another planet. The people I see are not like the people I when I am elsewhere. The language I speak here is somehow different. This worries me. I am not sure I want to go back to my old life in private practice but I wonder when this will feel like a place that I belong.

Day of hopelessness

I am just past my worst day yet. The crowning blow came on my way home. A call from one of the neonatologist informed me that a baby I delivered at midnight had just died. This past 24 + hours has left me with no faith in medicine, humanity or any shred of hope that God exists.

It began with a 41 year old diabetic found unresponsive and hypothermic by her 7 year old daughter. In a coma from a combination of her adrenal crisis, diabetes, and a pneumonia, she was brought to the emergency room by ambulance. We did an emergency C section for a 3 pound 11 oz baby who is doing better than her mother.

Next I had a 19 year old having her third baby. This one has gastrochesis. The bowels are outside the abdomen. The first surgery was last night after he was delivered. It will take at least one more to get the intestines back in. The mother, as I said is 19. She has a one year old and a two and a half year old at home.

The baby that died was the second child of a 34 year old who is married to a software engineer. They have a two and 1/2 year old at home. The baby weighed almost 3 pounds but has no lungs due to loss of amniotic fluid at twenty weeks of pregnancy. I would sleep but every time I close my eyes I see that baby's feet sticking out of the patient's vagina as I am making the decision to do an emergency C-section. Because the feet were in the vagina and she had a uterine fibroid, I had to make an incision in the top of her uterus. This will complicate any future pregnancies.

All this was interspersed with my usual steady stream of pregnant women with no prenatal care, several normal deliveries, and trips to the emergency room. I have one woman who is living in the hospital because she has lost her job and health insurance due to her placenta previa. Her two year old is living with her sister. I don't know what they will all do after the baby comes. There are thirty beds at Major Medical Center with can be filled with the same type of situations at any given time. The hospital gets them on emergency medicaid and gets paid. Yet, we (the country) have not solved the real problem.

The problems are so much deeper than that. These problems of family, death, sex, and using one another will not be solved by Congress in some sweeping reform bill. I wonder if we have what it takes find solutions individually and collectively. Some days I hope that we do but today has not been one of those days.