Confessions of an Intern

Week Twenty-eight

This is my night-float week on OB. I came into this week with plenty of trepidation, as I am alone in the OB ward to be available to see pregnant women who come in to be checked to see if they are in labor, or because they have 'discharge'. Yuck...

Anywho...I've been dubbed the black cloud of night OB. First night, I delivered a 24 weeker, in the breech presentation (butt first), that had an abrupted placenta and died. In that sentence, every fact lends to the reality that the little guy didn't have a chance. Twenty-four weeks is the basic cutoff of viability under the best delivery circumstances. Breech presentation makes for a difficult delivery at any gestational age, but it makes it hard to deliver because the cervix doesn't dilate well. As an intern, I had contacted my supervisor, but when a baby comes, a baby comes. I had to handle it on my own. Fortunately I had gone through training on how to deliver breech and used that. Next strike against is the placental abruption. What that means is the placenta separated from the uterus, shutting down the baby's blood supply inside. All of these things together yielded a very sad outcome.

The hard part for me is that before I knew the baby was coming, we had checked fetal heart tones and the baby's heart rate was 140s (normal for a baby), and still did up to a point. Then when he started to come out, we weren't able to monitor him, because of how he was coming out. Regardless of this, the moment the placenta separated, that effectively was the end. As I held his tiny body in my hands and carefully tried to help deliver his little head, I knew his heart had stopped, as I could not feel its beat.

The next two nights brought more preterm drama, first a preterm premature rupture of membranes or PPROM. Basically, a woman's water broke at 27 weeks. The goal is to keep her pregnant as long as possible as long as she and the baby did not show signs of infection. The next night, she had a lot of bleeding and fortunately for me, my supervisor was present and delivered the preemie, who did as well as expected for their age. She had also had a partial abruption, which was why she bled.

I've about had it with drama at this time, but it gets better. My last night, we were so busy I couldn't make heads nor tails of myself. We had two c-sections and I did another delivery on my own. Plus side: my attending said I was competent to deliver on my own. She said she doesn't do that for interns very often. I guess I should feel honored. I had such an adrenaline rush, I couldn't sleep when I got home, and was up for about 36 hours. So...I conquered ob night float...doesn't mean I liked it.