I usually bring my own food with me for my 24-hour shifts in the hospital. You would think hospitals would have good, healthy food, but you would be wrong.
This day was going to end up being one of those crazy story days when I would wish I was sitting on a beach in Hawaii.
It’s 7 a.m. and I walk in to take over from my now-exhausted associate who had just had an all-nighter (which is nothing like the ones we enjoyed when we were younger). She leaves me with three people to round on and one soon to be going to the operating room (OR) for an ectopic pregnancy. Ectopic means “occurring in an abnormal position or in an unusual manner or form.” In an ectopic pregnancy, the fertilized egg doesn’t develop in the womb, where it is supposed to, and most often develops in one of the fallopian tubes. The labor board shows we are fully booked, and the emergency room is also busy.
I go down to the OR to introduce myself to this unfortunate young woman who has an ectopic pregnancy. I get her mother’s cell number to call after I finish.
The laparoscopy (sticking several tubes into the belly to see what’s happening) starts off well enough. The problem is, once I get all the tubes in place, I don’t see the ectopic fertilized egg, which would look like a swollen, squishy, large red grape. The fallopian tubes, which connect to the womb and are where a fertilized embryo starts to develop, look normal. I finally find the ectopic deep in the pelvis stuck to her descending colon (bowel).
This is a very dangerous place for an ectopic. If I try to remove it surgically, I could easily tear into her colon and cause some serious damage. Sometimes the hardest thing a surgeon can do is stop, and that’s what I did. I would treat this woman with something called methotrexate (a chemotherapy) which should kill off the ectopic and save her colon. Long story short, it worked (took a couple of days) and she still has her colon.
As soon as I got out of the OR, I was called the labor and delivery department. A doctor was having some problem with a patient who just delivered vaginally. She was profusely bleeding. I really wanted a cup of coffee, but that would have to wait.
My job is that of a laborist or hospitalist. I also spend half my time in my own clinic seeing regular patients, unless I am here in the hospital. Think of me like a fireman. We are there just in case of an emergency. Some days are quiet and I can read, write, or just have my cup of coffee. Some days are like today, with crisis after crisis fueling an adrenaline rush. We are experienced (hopefully) to handle the most serious medical emergencies that can happen and with God’s grace help someone truly in need. Our hospital handles a lot of indigent patients and we are all they have.
This patient in particular was really bleeding and her doctor was a little overwhelmed, but he knew enough to ask for help. The patient’s pulse was starting to race, her bleeding looked watery as her blood pressure started to fall. I asked the doctor if I now had control of the case, since it was still his patient. When he gave control over to me, I called for a massive hemorrhage protocol. This sets off alarm bells for a call to action.
The problem with post-delivery bleeding is it can be life-threatening if not recognized and handled quickly. This patient was going into DIC (disseminated intravascular coagulation) which is where a patient uses up all own her own blood clotting material and has nothing left to stop her own bleeding.
A code was called. We started transfusions of packed red cells, plasma, platelets, and other necessary blood products. We gave her a number of medications to “clamp” up her uterus to help stop the bleeding. She ended up losing about 3 liters of blood which is a little over half her blood volume. The blood pressure finally started improving and her color came back to her. This woman survived because of the quick action the nurses and other doctors took. My job was just to direct the action.
Now I really wanted my coffee. My shift was still only just beginning. It starts at 7 a.m. and runs through until the next day at 7 a.m. This day was a strange one, but I did get a few hours of no calls. Did I say I wanted coffee? There was a new call down to the emergency department to see a 40-year-old woman with very heavy periods.
She was anemic (low blood count) but nothing too terrible. She had no insurance and my job was to make sure there was nothing life-threatening. This was an easy one. I wrote her a birth control prescription to control her periods and told her to eat food high in iron as well as iron supplements plus a few more for good measure. I'll never know if she actually filled them or not.
A laborist’s role is to handle emergencies, we aren’t there for routine medical management. We get several referrals a day to see patients in the hospital who need just that, routine medical care, such as ordering a mammogram, or discussing how to manage fibroids. Our health care system needs a lot of work, but my role is very specific. I have no way of following up on any routine requests.
The rest of the day was relatively calm until an active COVID patient needed a C-section at 34 weeks gestation. Her pulse oxygenation was deteriorating as was the fetal monitor strip. We had to act pretty quickly. I had to put on the monkey suit, full headgear with a power backpack for ventilation. It’s not the easiest operating in a spacesuit. I felt like Matt Damon in the Martian.
Mom and baby did well.
The rest of the shift entailed several routine emergency room calls and visits and two regular vaginal deliveries.
All in all, a busy shift with about four hours of total sleep until I handed the baton over to my relief.
Another day in the trenches.
John Bunyan, an English writer from the 17 century, said it nicely,
“You have not lived today until you have done something for someone who can never repay you.”
