Black Friday

November 28, 2009

Thanksgiving was great—Kathy Trotter even made a little dish of stuffing outside the bird for me, just like my mom does! We invited one of the Kenyan interns along, Samuel. He had his very first turkey ever, and we got to share stories of our different cultures for most of the evening, including learning about his 6 weeks spent at Duke doing surgery. He was overwhelmed by the number of commercials on TV and how many things you could buy, anytime, anywhere. I learned that you never put fresh pineapple into a jello mold—and brought jello soup as my contribution. I’m sure Samuel thought that was weird.

I was on call yesterday and last night, and today and tonight, then climbing mount Longonot on Sunday morning (10K ft). Last night I went in around 8pm to check on things in the labor ward, and saw one of our patients lift her leg while standing and push her baby’s head out. I grabbed some gloves and delivered the baby and then couldn’t deliver the placenta, but noticed that in the bed next to her, the patient wasn’t sounding so good on the monitor. So I handed off the first patient (who was HIV positive… glad I grabbed gloves) and had the nurse work on the placenta, while I printed an NST for the second patient, and realized the baby was in distress, so took her back for a cesarean section fast. I called my intern to help with the c-section, and when we got her started, the nurse came in asking for help with the placenta, which still hadn’t come out (now about 45 minutes later). So I sent my intern to help with the placenta, and I did my first solo cesarean section! It kinda rocked. Until there was a lot of bleeding, and every time I tried to stop it with another stitch, I caused more bleeding with my needle. It was pretty scary, thinking to myself “where do I get off doing a c-section by myself? Who do you think you are, Alyson?” Luckily I stopped the bleeding, got her closed up and ran to help with the placenta, which still wasn’t out… and the HIV positive woman had lost about 3 liters of blood in the process. So I ran for blood, and got the OR switched over for an emergent D&C to remove the placenta. I called for back-up on this one, and one of the OBs came in to help (thank God)—it was pretty tough, but the patient was glad for some anesthesia, and some blood, and she looks better this morning.

I got back to the labor ward, and realized that the patient I’d wanted to start oxytocin at 10am to help her contract more since she wasn’t progressing at all, was still not started on oxytocin at midnight, and was still only dilated to 4cm, same as 30 hours ago. I put her baby on the monitor and there was fetal distress, so, much to the dismay of our poor OR team who had also been awake all day, I took her back for a cesarean section too. I made it home around 1:30am, and slept until 3 when the dog barking next door woke me up… at least it wasn’t the pager.

Today is a rainy day—the first one in weeks. It’s nice though, to have a rainy Saturday on call. Reminds me of Seattle! Right now Vy, Dustin and I are hanging around, reading and drinking Kenyan coffee. Vy is also on call, and spent her morning giving intra-thecal methotrexate to a baby (chemotherapy into the spinal cord)—ah, family medicine. Hopefully today will be peaceful and I’ll get some rest for my climb tomorrow morning—we leave early to see the most animals and birds on the mountain. And maybe I’ll get in a nap today…