Bad Heart

I go on duty again tomorrow but the events from the last duty still lingers and despite the very very busy day, I went home the next morning with one of the biggest smiles of my life.

I will go out and admit it. Obstetrics and gynecology is not my cup of tea. It is not that I don't find wonder and joy in sharing in the event of bringing someone into this world nor is it not because of the prevailing perception in this country that OB-Gyne is not the usual department to find a male doctor. In fact, in medical school, the highest grades I got were in Obstetrics and Gynecology.

So why do I prefer not to be in OB?

A lot of things:

a. I can't take the suspense of the next IE, and the next, and the next.... (It could be 3 cm, then stepwise all the way to 10 cm, or it could be 3 cm and 10 cm the next minute)

b. Playing substitute husband, (since most labor rooms don't allow the spouses in during labor), and you get to be physically assaulted by the parturient for the next couple of hours. (kidding, it's actually part of the job, and it's not that bad, sometimes)

c. The stress of trying to get through to a writhing, screaming, breath-holding, gravid woman to teach them the right way to "push" (so I try to get through to them early in labor, when they're sane)

d. The crazy stuff that happens when someone says "Breech", "CS", "Prolapse", "Preterm", "Poor Variability" and "Decelerations"!

e. I get palpitations and feel my adrenaline go into overdrive with toxic and stressful deliveries (I remember once a woman got up on the delivery table and squatted down, refused any other help until she got a C-section, now that was stressful), as well as keeping with the need to deliver the baby safely in a clean, sterile environment (this includes transfers, birth in wheelchairs and hospital beds, cars, you name it), whew......

Which brings me to the subject of this blog, and of course, we have to give in to my loyal readership of two (my supportive girlfriend who is obligated to read this blog *wink* and a good friend who loves her adventure called life and loves her beach time).

As I was walking back to the labor room, a page over the PA system had requested a male aide to an Ob-Gyne's clinic, and said to myself, "Oh crap, another patient." I was already attending to another parturient who was carryover from last night's duty.
True enough, she came.

She was a 19 year old who seemingly had everything going wrong for her -- pregnant by her younger, 17-year old boyfriend who wasn't even there, congestive heart failure class IV made worse by her pregnancy, a platelet level of 70,000, HBsAg reactive and to top it off, a baby having fetal heart rate decelerations to 80 bpm.

I groaned. Of all the days my partner had to take a leave of absence. But there was nothing I could do. I now had two patients, the other had a low threshold of pain, and the other a heart in congestive heart failure. We had to find blood to boot.

I monitored her progress and talked with her. She was this bright young kid who was supposed to be in 3rd year college, and judging from her blood donors, had lots of friends and was getting the full support from her family. She had a ready smile and listened intently as I coached her into how she was supposed to deliver later. She was to have an epidural so pain wouldn't be an issue. Her cardiologist stopped by as well as a hematologist.

As the afternoon wore on, the first parturient became fully dilated and she was mounted on the delivery table, and had to leave her listening to her OB in the labor room. We had delivered a baby girl when they exclaimed we were mounting her as well. I said to myself, "Oh Crap, and double crap." We were still fixing the episiotomy when they carried her into the other delivery room. When we were done, I immediately ran and scrubbed in.

And then there were the decelerations all the way down to 60 beats per minute, with slow pick-up back to normal. The pediatricians already had their resuscitation table ready, O2 was running, the cardiologist and hematologist were in attendance.

Then finally the baby came. Slowly, ever so slowly she came out into the world, and cried almost immediately as she came out. She was small for her age but oh never did a cry sound so good. A smile came on the new mother's face. Everybody in that room smiled and time held for a couple of seconds as we cut the cord and handed her to the pediatricians.

Minimal bleeding, a 4 lb baby, a heart still in failure and thankful grandparents were what I met after. It was my pleasure to be part of that, no matter how toxic it was. To look in my patient's eyes and see thank you, well, call it naive, but I think that's what we, doctors, all ever need.

As of this writing, the patient is still in our ward, recovering and her baby doing OK in the nursery. I pass by during our daily rounds and they all smile back.

Though it's been 3 days removed from that day, the events still linger, and every time the smile still returns to my face.