Second rotation as an intern: ED
Lesson learned: Some of us need no prompting to talk to our partners
Patient in the emergency department: a young woman with RUQ pain, normal labs, normal ultrasound, and trichomonas found incidentally on UA. After explaining that she has trichomonas, that trich is an STI, and that she should tell her sexual partner so he can get treated too, I'm about to do a pelvic exam when she suddenly gets up, walks over to the phone with her IV trailing behind her, and starts dialing with murderous jabs of her index finger.
"Pick up the phone RIGHT NOW!!!!" she says emphatically into the receiver. "WHERE are you???"
Then apparently the person on the other end answers.
The patient says, "I just got the biggest shock of my life. They told me I have a sexually transmitted infection and there's no way I got it from anyone else but YOU."
Pause as the person on the other end speaks.
Then the patient interjects, "No, you SAW my test results. I showed YOU mine and you KNOW I was clean. I haven't been with anyone but you in the last 2 years. WHERE did I get it from? From YOUR contaminated ass!"
Tell it to him, girl! Notify his contaminated ass!
Wednesday, August 15, 2007
Thursday, August 02, 2007
Never Turn Your Back on a Multip in Labor!
First rotation as an intern: OB
Lesson learned: Beware of precipitous deliveries from multiparous women!
Example 1: Woman, G4P3, being wheeled to L & D with intense contractions. Alarm goes off in her room, and I sprint over, only to discover 50,000 nurses crowded around her. The woman is still in the wheelchair and a head is coming out of her vagina! The nurses ease the woman onto the floor, the baby is delivered. Thirty minutes later, after we deliver the placenta and stitch up a second degree perineal laceration, the woman's chart is located. Under obstetrical history, it states the patient has a "history of precipitous deliveries x3". Ha! Make that x4.
Example 2: Woman, G2P1, with didelphys uterus and double cervix, arrives with her right cervix dilated 5 cm. After she has been registered and settled into a room, I leave for a few minutes. During the short span of my absence, her cervix has completely dilated and the baby starts to emerge--it's a footling breech! A nurse who happens to be walking by, notices what's going on, runs in and delivers the baby.
Example 3: Woman, G3P2, arrives in OB triage, moaning with intense contractions Q2-3 min. I check her cervix. She is complete/complete/+2. We wheel her bed immediately to L & D. She doesn't speak English but seems to understand my half-baked Cantonese. The OB fellow comes in and wants me to coach the woman through labor. I'm trying to tell her to "push like you're having a bowel movement" in Cantonese but I have a feeling that one syllable is off and I am mistakenly imploring her to "push like you have a big nose". Baby delivered quickly after 10 minutes of pushing, and luckily the real Cantonese interpreter appears. God knows I might have accidentally asked the father if he wanted to "cut the Empire State Building" instead of the umbilical cord.
Lesson learned: Beware of precipitous deliveries from multiparous women!
Example 1: Woman, G4P3, being wheeled to L & D with intense contractions. Alarm goes off in her room, and I sprint over, only to discover 50,000 nurses crowded around her. The woman is still in the wheelchair and a head is coming out of her vagina! The nurses ease the woman onto the floor, the baby is delivered. Thirty minutes later, after we deliver the placenta and stitch up a second degree perineal laceration, the woman's chart is located. Under obstetrical history, it states the patient has a "history of precipitous deliveries x3". Ha! Make that x4.
Example 2: Woman, G2P1, with didelphys uterus and double cervix, arrives with her right cervix dilated 5 cm. After she has been registered and settled into a room, I leave for a few minutes. During the short span of my absence, her cervix has completely dilated and the baby starts to emerge--it's a footling breech! A nurse who happens to be walking by, notices what's going on, runs in and delivers the baby.
Example 3: Woman, G3P2, arrives in OB triage, moaning with intense contractions Q2-3 min. I check her cervix. She is complete/complete/+2. We wheel her bed immediately to L & D. She doesn't speak English but seems to understand my half-baked Cantonese. The OB fellow comes in and wants me to coach the woman through labor. I'm trying to tell her to "push like you're having a bowel movement" in Cantonese but I have a feeling that one syllable is off and I am mistakenly imploring her to "push like you have a big nose". Baby delivered quickly after 10 minutes of pushing, and luckily the real Cantonese interpreter appears. God knows I might have accidentally asked the father if he wanted to "cut the Empire State Building" instead of the umbilical cord.
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