Right at the end of the delivery, Dr. Hardcore asked whose turn it was next: it was mine. He said come on, you are going to break a lady's water. I have never broken the water before. It wasn't that hard to do, but I thought that I didn't get the sac because I didn't see or feel the water. Some ladies have a huge gush and some have very little. Dr. Hardcore check and I did in fact break the membranes. My gal was still in high school and she came to the hospital when she was 10cm dilated. After breaking her water, it was only 20-30 minutes before we got to meet her little girl. Her Mom looked scared. I don't blame her. Her daughter was so young and her life was changing dramatically. Since she was already dilated to 10cm, she could not have an epidural. She was in a lot of pain, but she handled herself with a shocking about of calmness and grace. When I broke her water, she was probably at zero station (baby's head is at the level of the ischial spine). She was pushing with the nurses to get the baby down to + 5 station (or +3 depending on which scale the practitioner uses). At +5, the head is visible, which is also known as crowning. My patient was starting to get a little tired, so Dr. Hardcore told her to try to relax and to not push during the next few contractions. So she tried to rest and I coached her about how she needs to push: put you hands on your thighs near your knees and pull them toward your chest, put her chin down into your chest, take a deep breath then hold your breath and push like you are trying to have a bowel movement for ten seconds. She listened so closely and she was so intense. When she was tired, I was afraid she might give up, but then I asked if she was having a boy or a girl. She said a girl. Then I replied, "I can see your little girl's head. Don't you want to meet her? She is almost here. You can do it. Hey Mama, let's meet your Baby!" There was a fire in her eyes and she said, "I want to push now!" From there on out, she moved that baby like a champ! Dr. Hardcore came back in and there was a beautiful baby girl in no time. My patient was concerned that she was going to tear during the delivery and unfortunately she did. With Dr. Hardcore's help, I got to help suture her up. I have never injected a patient with lidocaine before so not only did I get to practice suturing, I learned how to do this.
Next there was a c-section. She was a TOLAC (Trial Of Labor After Cesarean); however, her records from the previous cesarean had not been sent so she was no longer a candidate for a VBAC (Vaginal Delivery After Cesarean). The cesarean went well and despite having to have a cesarean rather than the vaginal delivery, the parents were beaming with pride over their beautiful baby girl. Following the first c-section, there was another planned c-section. She was a larger woman (400Lbs) and the anesthesia wasn't working well enough so she had to go under general anesthesia. Whenever Farley scrubs in for surgery something happens, the woman has trouble getting anesthetized or Dr. Hardcore stops for a vaginal delivery, and he ends up scrubbing in and standing in the OR for 40 minutes. Anyway, she wanted a tubal ligation, so after her baby boy was born, they completed the tubal ligatation.
After leaving the L&D OR, we headed to the main OR for the first patient of the day. When we got there, another surgeon was throwing a temper tantum that would rival any angry 2-year old. Even though Dr. Hardcore had the rights to the OR, despite being hours late--you cannot stop a delivery once the baby is crowning nor could the VBAC turned c-section wait--he let Dr. Temper Tantrum take the OR.
Shortly there after a Code Blue was called. It was in a part of the hospital that Dr. Hardcore's gynecological patients go. Dr. Hardcore was talking to a couple of CRNAs at the time the code was called. Out of nowhere, they were on the move and so were we. In the elevators, Dr. Hardcore said that the code was one of the CRNAs, who had a stroke our first week in the hospital. Every CRNA who wasn't in surgery, at least 3-5 doctors, and a handful of nurses were running the code. After an hour, they finally called his time of death. It was an extremely hard day for the hospital staff (and obviously, his loving family who we tried to comfort during the code).
After the code, we headed to the office for a few hours. I didn't get to go see a patient (there were two patients and SIX medical students...there are two other medical students who are suppose to be with Dr. Hardcore on the weekends during this rotation, but they had not showed up until today). Nonetheless, I had a great time in the office because there was a four month old baby who needed holding while her Mom had a procedure. I was happy to oblige. Oh, and this little baby was really pretty, with her curly hair in cute pig tails.
After being at the office, we rushed back to labor and delivery for another delivery. This mother was also young and nulliparious. The father of the baby had been killed a few months ago, so this was a very bittersweet day: the baby was a boy who was taking on his Daddy's name. The hallways were so packed with people waiting for this boy's arrival they threatened to call security, which resulted in the people spreading out further along the highway. This mom had a really hard time pushing out this baby and I thought that she was going to end up with a c-section because the baby's heart tracing started showing that he was stressed. Dr. Hardcore came in and used the vacuum on the baby and Mom was able to push him out. When we left Labor and Delivery, a woman at the end of the hallway yelled, "There is Dr. Hardcore!" The hallway burst into cheers and we all got high-fives. There were so many people in this hallway, that I felt like a college football or basketball player (like a ZAG!) running though the tunnel of screaming fans and getting bilateral high fives. It was an amazing feeling, even though I didn't do anything but cheer as Mom pushed the baby out. I thought it was awesome that so many people came to support this Mom and the paternal grandparents on such a bittersweet day.
Next, we headed back to the main OR to finally do the surgery on the pelvic pain patient. This was a laparoscopic surgery, which I have not seen yet. Dr. Hardcore was looking to see why she had pelvic pain and determine if the tubal ligation could be reversed. She had really good sized fibroids (benign leiomyomas) of the uterus which caused her pain. Unfortunately, she didn't have enough of her tube left to try and reverse the ligation. There are different ways to do the ligation and she had her tubes cauterized. This means that they tie off about 3cm of the tube then then cauterize both sides of this 3cm specimen. After they cauterize the tube, they put sutures in the new ends. In reality, this causes more of the tube to die. They need about 5cm of good tube plus good fembriae to reverse the tubal ligation (no one has gotten pregnant without at least 5cm after having her tubal ligation reversed). In case you don't know, the fembriae are the finger-like projections on the ends of the uterine tubes (Fallopian tubes) that encourage the egg released from the ovary to enter the uterine tube rather than to float away into the peritoneal cavity. At any rate, Dr. Hardcore really couldn't do anything for her because (1) he cannot do a myomectomy to remove the uterine fibroids without a consent to do so, which includes the fact that it could reduce her ability to carry a pregnancy and (2) he could not reverse the tubal ligation and he will have to refer her to a reproductive endocrinologist if she wants to try in vitro fertilization.
After that, Dr. Hardcore was suppose to have a D&C for a missed abortion (there was an intrauterine pregnancy, but the baby died and was not expelled from the uterus). However, the patient's significant other sneaked her in McDonalds so she couldn't have the surgery.
Then, we got to go home. It was just a typical day for Dr. Hardcore.
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