Once in awhile, the residents get together and just laugh. We have to, with some of these patients. Here are a few stories from this past month's work: A kind resident goes to evaluate a woman that has presented for multiple times for drug seeking behavior, on the premise of chronic pain. She probably does have pain, at least from being so addicted to narcotics, but we don't want to prescribe anything because it's not good for her, and not good for the baby. As I'm leaving triage, I hear her shouting at my (male) colleague: "Bitch, you don't know my pain!" I enter the delivery room and greet a woman who is fully dilated and ready to push. I begin to give her my earnest speech about how to push with an epidural, how to pull your legs back and take a deep breath and curl up around the baby. This speech is complete with a demonstration that I think (hope) is helpful and I'm sure makes me look like a giant fool. As I talk, the woman sneezes and delivers her baby. In clinic, my friend was performing a well-woman exam, and asking about any changes to the patient's breasts. The patient says, "Well, they've gotten bigger..." and asks the doctor to measure her breasts to fit her for a different sized bra! My friend, being a kindhearted woman who used to work in a department store and thus is qualified to do this task, considers it but ultimately decides this is a doctor's office and refers the woman (in all seriousness) to Victoria's Secret. Do you document that referral on the chart? Meanwhile, on the antepartum ward, another resident is called urgently to evaluate a patient. She has had a cerclage, meaning her cervix has been tied shut in order to help her avoid premature delivery. It is much akin to the string tied at the base of a balloon. It appears that the cerclage has come out, as the nurse reports finding a long black string with a knot in it. The resident comes right away, and the nurse presents him with a paper towel spread between her hands. On the paper towel is a lone long black pubic hair, with a knot tied in it. He explains to the patient, Ma'am, the cerclage is fine. And no, I don't know how that hair had a knot in it. Over on labor and delivery, I am working with the most anxious patient in the world to push. I'm trying to distract her, to calm her, so we are talking about her horses at home, and shooting animals in the wild, and her latest hunting trip. (Let me say here that I do not have much to add to this conversation, as I am a liberal almost-vegetarian.) Nevertheless, I act interested as she says she'll just die if this baby is a city boy instead of a country boy. She pushes a little more, and I tell her I can see the top of the baby's head, and he has some hair! She asks me if by looking at the top of the baby's head, if I can tell if he is a Republican? The next delivery I have is normal, and uneventful, and to very nice parents. I hold the baby up and announce the arrival of their baby boy! Both parents start crying; the dad in joy, the mother in horror. What? I glance at their pink car seat, the baby's name written on the board. Oh. Yeah...this wasn't the Liliana they were expecting. The dad is ecstatic, and has already named the baby Jr. whatever his own name was. The mom asks me if I'm sure I got the right baby? I am sympathetic, even though this question is obviously answered as the baby is still attached to her via the umbilical cord. It's not often in this day and age that parents don't know what they are having, and even fewer times that it is not what they expected. On the postpartum visit the next day, she asked me if she could go home. Was she feeling okay? "Yes, and I need to get to BabiesRUs. I have a lot of exchanging to do." Medelita Guest Blogger: Dr. Anne Kennard. Anne is an OB/GYN resident in Phoenix. She has kept a collection of writings about medicine/becoming a doctor since her second year of medical school, and we're excited she's joining us as a guest blogger.
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