Saturday, August 02, 2008

Supervised Primary


I wasn't going to claim them, but on my paperwork review my preceptor crossed out "involved" and wrote in "primary" :). I realized why when I couldn't answer "so what did I do that you didn't do more of?" That sure did creep up on me.

Leaving tomorrow. Off call at 8am. I was really hoping to get another birth in there, one I'll be sad to miss, but that is looking less and less likely.

Thursday, July 31, 2008

Goodbye, July

In July, I:

Made my way through over 100 hours of clinic time, plus about 30? hours of labor support time.

Didn't take any time off call, at all. That's a first, a month entirely on call.

Made an interesting mistake on a cervical exam, messing up somebody's initial assessment. I thought I felt 7 and she must have been about 4. Later in labor, after her water had broken, I felt again and it was obvious that the ridge I was feeling was not, in fact, her cervix. I could still feel whatever-it-was and it felt like a 9 with a bit of an anterior lip at that point, but the internal os was obviously there and obviously 7, with the exterior os not much further open than that. I may not be comfortable doing another initial labor exam without follow up for a while after that mistake, although the poor client was actually not upset about it at all. As bad as it felt to suddenly realize I'd screwed up (when I did the second exam, that flash of realization was a real "oh SHIT" moment), I think I would have felt way worse if I'd had to tell this woman she wasn't yet to the same point I'd thought she'd been before.

Had a first episode of sticky shoulders.

Saw a bili level so high (25) that our statistics gathering program insists it is impossible.

Did a physical and pelvic exam for a woman who had a fibroid so big, her abdomen had a size mistakable for 32 week gestation at 11 weeks. It was the most interesting exam and pap I've done to date, by far.

Discovered that I actually like the preceptor I was a tad bit apprehensive about.

To and fro. Kids and meals. Go, go, go, go. As insane as this last month seems "on paper," I get 4 days off a week. We get friends in there (sometimes just lengthy phone conversations), and family outings. Laundry and good food. Life goes on. I am busy and happy, and learning learning learning. The kids are thriving on their schedule: three days with me (with someone held in reserve in case I get called), one day on a full-family outing, one day with Fran while I'm in clinic, two days with friends while I'm in clinic, and repeat. We rotate which friends they spend time with, and the kids really love that. No matter who they're going to be with any given week, they're excited about it.

Leaving soon for our trip to Hawaii, to visit family and for my sister's wedding. The level of excitement in this household is pretty incredible. Going off call 14 hours before the flight leaves, and hoping for no inconvenient overlap. Several women are postdates, and I'm now convinced that they're waiting for me to leave before they go into labor, just because the first rule of midwifery is that labor happens whenever it is least convenient. I'm hoping my need to pack spurs a veritable onslaught of women in labor (ok, not really...I'd settle for two of them!). I can pack fast and buy what I miss. Can't replace missing births with these women I've been seeing a lot of and getting to know.

Reading this post back, it doesn't exactly flow and doesn't entirely make sense, which is what I get for posting after 10pm on the last day of the month, after a full "week" of clinic. But ah well, off to bathe and to bed, editting be damned.