Thursday, October 01, 2009

When it's someone you know

There seems to be an unwritten rule that when you treat someone you know on more than a purely professional doctor-patient level, there will invariably be a complication or adverse event that almost never occurs otherwise. Your neighbour's kid is far more likely to develop anaphylaxis after you give him amoxil for his ear infection than the average patient, and if you have to do a lumbar puncture on a colleague's child, it'll probably be a bloody tap requiring a repeat in three days (even though you never get bloody taps anymore), and she'll definitely have a post-spinal headache, massively aggravating everyone's fears about meningitis. A fine needle aspiration done on a friend's lymph node is about a thousand times more likely to be lost by the lab than any other, and for some reason, it's almost impossible to successfully drip someone whose kitchen you've drunk tea in the first time round.

The Crater is one of those small-town hospitals where everyone gets real cosy, and we end up treating many of the other staff members, as well as their families. I've done rectal examinations on some of the cleaners, had sisters' nipples waved in my face, inserted a chest drain on one of the security guards (injured off duty), stitched up one or two of the admin folk, bandaged up sore nurses' knees, and have done some cosmetic mole and skin-tag removal on one or two of the clerks. As a team we've resuscitated, intubated and referred two of our sisters' mothers, one with a myocardial infarction and the other with a sub-arachnoid haemorrhage. On the whole, things have gone all right, but I always feel an added element of pressure when dealing with these people: maybe because their expectations of me just seem so much higher than the average patient's, or maybe because I know I have to look them in the eye every day if I mess up.

The place that stresses me out most of all though, is labour ward. Stressful at the best of times, this is taken to a whole new level when a sister's daughter is busy giving birth, which is something that happens quite frequently. I always find it harder to interpret the CTG or to feel calm about a bit of slow progress when I know it's a colleague's grandchild inside there just begging to get HIE and spend it's entire natural life in a wheelchair. Gah.

Last night, one of our casualties sisters became a granny for the first time. Her daughter was induced for having a prolonged pregnancy, and things went pretty well until the she was fully dilated. Then, all the midwives started stressing about the head that didn't really want to come down. There were no signs of CPD, so I told her to keep pushing (fingers crossed). Eventually it came low enough for me to cut an epis and apply a suction cap (anxiety attack just waiting to happen). She pushed, and I pulled, and after much screaming and straining a long head with bulging eyes appeared. But that was all. Let me tell you, of all the obstetric emergencies, shoulder dystocia is absolutely the most terrifying. It induces a cold sweat even in The Legend, who claims to have seen and done everything. I tried not to panic. The biggest labour ward sister leaned all of her weight just above the patient's pubic bone, while I wriggled a finger in down below the head and managed to hook it into an armpit. I pulled on this until an elbow and then a hand and then a whole baby appeared, bawling in a sea of meconium. It weighed 4.5kg, and was fine. Mom, of course, had a third degree tear, which I apologised about profusely, but fortunately know how to suture.

Sjoe, the drama.


Great post!! But 4,5 kgs...eina!!

...and they wonder why I don't want children...

Ah! Small town living - it's a blessing and a curse.
One of our doctors recently needed a colonoscopy, which he handled with good humour. His wife wasn't very impressed however when he came home with a bum covered in surgical marker graffiti.
He also had to put up with all his colleague's taunts after the post-vasectomy semen analysis was posted on the notice board.
On the other hand, my miscarriage was handled with the utmost sympathy, sensitivity and most importantly silence.
Gotta love that small town life :)

This is a great post. Shoulder dystocia is my least favourite emergency for obvious reasons. We call complications/problems in patients who are other doctors VIP-syndrome and heave a collective sigh of relief once they are safely delivered!

What an amazing and beautifully written post. Thanks for sharing!

All those times when I see this blog a name flashed into my mind, it is Dr. Morice ..
It 's a man a much more in woman's issues ..
I believe that all women should go to learn solution of their problems ..

Great write up, reminds me of the different hospital workers that keep bringing their "relatives" for me to see. A number of them not actually being related.

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Ah! Small town living - it's a blessing and a curse

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I can't wait to see your examples of how your handwriting has evolved! I am obsessed with the different forms that handwriting takes. I love collecting old postcards just to see the writing...
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