BE WARNED: This is a self-serving blog entry. Read at your own discretion and risk.
This is a peek on how my schedule goes. This is not on a regular basis though as there are times it will be worse than this, or sometimes lighter. More often than not, I don’t get a light schedule. I’m not saying I am the busiest doctor in town nor the one with the most number of patients. No, that would be a lie.
1:30 am… I received a call from one hospital informing of a referral for pedia care (meaning, I will be the pediatrician of the baby that will be delivered). The mother is a first-time pregnant (nulligravid/nullipara) and was admitted at two-cm cervical dilatation. With that internal exam finding, I was expecting the mother will be giving birth, following normal labor progress, the next day, perhaps afternoon.
5:45am… The hospital called that the mother is already 9cm to fully dilated, and will be wheeled already to the delivery room. The station of the presenting part wasn’t mentioned however. So I told the caller that I will try to come over as soon as I can. I wasn’t expecting the mother would deliver this soon, unless it was a precipitate labor (meaning, faster than the expected). As I was prepping to go out, I received another call, this time from another hospital (hospital B) that a previously admitted mother with severe hypertension will be scheduled for cesarean section at 7:00 am. I was asked if I could be around, to which I said yes. Even though I knew there was a call from hospital A for normal delivery, I confirmed my presence in the cesarean delivery as I have anticipated, with the rapid labor course, the baby will also be out quickly. I then arrived at hospital A and to my dismay, the mother is still in the labor room, able to smile when talked to. (I could have slept a few more minutes had the referral been proper). Looking at the clock and it was already 6:15 am, I had to make a drastic decision. I called up my colleague to come and catch the baby for me, anyways the baby is expected to be term and well. The preterm baby would be riskier one thus I decided to attend to her delivery instead.
6:42 am… I talked to the obstetrician that I have called my friend to catch baby in my behalf as I have to be present at the cesarean section at hospital B, who needs more my care as a neonatologist. I then drove myself and as I was negotiating traffic, I got a call from hospital A that there’s a direct delivery (the pregnant woman I saw walking earlier towards the delivery room). So I told the nurse that since my friend is already there, she will catch the baby in my behalf. (Whoa… 3 deliveries in one morning, that was just great).
7:12 am… the preterm baby came out. I attended to her and finally got her stable at about 9am. I provided continuous nasal positive airway pressure though as she has respiratory distress syndrome due to deficiency of surfactant. (Surfactant is that substance that diffuses gas-water tension inside our lungs, so that the alveoli wont collapse. In cases of deficiencies such as in prematurity or genetic lack of it, the alveoli tend to collapse. If so, air wont be able to enter it, there will be no gas exchange and thus leading to an agonizing death).
9:30 am… I arrived home. Since there was still time, I decided to grab some nap before I prep and go out for work. Anyhow, there are few inpatients I need to visit this day.
12:30 pm… I arrived at work and discharged some patients. I consulted those who were at my clinic – some were for problems, and some for their scheduled vaccines.
3:30 pm… I was able to finish outpatient consultations then decided to visit the two babies born at hospital A.
5:30 pm... I proceeded to the gym for my regular workout. I received a text from one hospital that my preterm baby is having occasional desaturations (low oxygen readings), and so I instructed the nurses to adjust the ventilator settings accordingly. Baby was noticed to have improved but retractions began to appear.
7:30 pm… I concluded my gym workout, then I proceeded to another venue for my ballroom dance training (we will be joining a competition on April 10th).
11:00 pm... We ended practicing so I went home to have my dinner and shower.
1:00 am… I went back to the hospital B to check on the premature baby. Baby seems to be deteriorating as far as breathing is concerned. Because of this, I decided already to insert an endotracheal tube into her trachea so that respirator will now do the breathing for her. I had the x-ray repeated and showed progression indeed of the underlying condition. I explained to the father that there is now a need to introduce surfactant into her lungs so her breathing would ease up. (It maybe late but it might still provide relief to the baby. It has to be purchased from outside hospital though as it is not a regularly available medication just like any other antibiotics. Parents had to decide as the said medication is not that cheap as well).
Intubation (not the actual patient; photo courtesy: google.com)
3:30 am... Surfactant finally arrived. I instilled it immediately. Baby’s breathing improved dramatically. I tried to wean off the baby from the respirator.
4:30 am… Feeling starved, I went to a fastfood to have some snacks.
5:00 am… I got home and slept. I prayed that I hope there would be no phone calls to wake me up.
9:30 am… My phone rang. There’s a referral of a potential premature baby to be delivered under my service (hospital C). The mother has blood pressure of 220/140 and needs to be brought down to a safe level. I couldn’t go back to sleep anymore so I started prepping. Had a light breakfast.
11:00am… I drove back to hospital B to administer the second dose of the surfactant. Ensuring that the baby is stable, I drove to my office to consult patients who came, and ended at 3:30pm. Then I proceeded to do my rounds at another hospital.
5:00 pm… I was able to finish work. Feeling still tired and sleepless, I decided to go home and take some rest. Upon arrival, I received an SMS from hospital B, referring a patient for co-management. The baby is full term being treated for pneumonia but was co-managed as the respiratory problem doesn’t seem to respond with the antibiotics being given.
7:30 pm… I went out to assess the baby being referred. Then, proceeded to our ballroom dance training.
11:30 pm… We concluded our training so I proceeded home, took my shower and slept. Again, I prayed that hope no phone calls will awaken me while I take my rest.
Most of those in my timeline are tweeting they’ve packed already, they’re about to check-in at the airport, that they’re on their way to their vacation. On my end I woke up with a bad news. My preterm baby cannot tolerate the weaning from the respirator. In fact, I had to increase again some settings for her to be comfortable. As it was holiday, and I had no outpatient consultation, I decided to go out quite late to do my rounds. I first checked my preterm baby, addressed all that she needed and ordered some things to be done the next day. After which, I went to the other hospitals to discharge the two babies born two days ago.
3:30pm… I decided to meet my friend and rest a little before working out. I got a call from hospital B, referring a parturient (pregnant mother about to deliver) whose cervix is 2-cm dilated (in beginning labor). The resident informed me that she will update me at about 5:00 pm of the next internal exam (IE) findings. I asked this update so that I could decide if I could still workout or wait for the mother to deliver instead.
5:00 pm… The cervical dilatation remained the same, meaning the labor didnt progress, so I decided to work out. Unfortunately, I didn’t bring my workout shoes. I stayed at the car instead and waited for my friends to finish. Also, another referral of a mother admitted due to rupture of the bag of waters came.
7:00 pm… The cervix remained at 2-cm. Labor was augmented by incorporating some medication to the mom’s intravenous fluid (IVF). Me and my friends went out for dinner.
9:00 pm… Mother’s cervix is now 8-cm dilated. This means, following normal labor progress, the mother should deliver in two hours. (When active labor has began, 4-cm dilated, on the average, the dilatation will increase by 1 cm/hour until full dilatation — 10-cm).
10:00 pm… 9-cm dilated, station 0. (Station refers to the position of the presenting part, ex, baby’s head if cephalic presentation, in relation to the mother’s pelvic bones. Crowning means you can already visualize the baby’s head without necessarily parting the mother’s vulva). I was confident therefore that after one hour, the mother will deliver.
12:00 am… Still there was no call for delivery. I decided to still stay up as any moment I will be called to the hospital already… I was online, talking with friends.
1:56 am… I got bored. So I decided to sleep. I changed clothes. As I drew the sheets over me the hospital finally called. The mother was scheduled for emergency CS delivery for failed medical augmentation of labor.
2:47 am… Baby came out. Im glad this baby was full term and had no problems. Then I tried to check on my premature baby as they’re in the same hospital. Made sure my preterm baby is stable as well. Asked for update on the other parturient and with still no progress of labor, I was confident she will deliver at least after lunch.
3:30 am... decided to drop by a convenient store to buy some snacks, then drove home immediately. I had late snacks, then dozed off. Again, I prayed for no phone calls
9:30 am... I was awaken by a referral call from hospital B about the progress of labor, priming me of a possible cesarean delivery if IE findings won’t improve by noontime. Sheez, I could at least relax for few hours. When I checked my SMS, still the premature baby’s update wasn’t favorable. I had been tweeting with friends until by 11:30, I decided to prep as I am anticipating indeed a cesarean delivery.
12:30 pm… The hospital called to confirm the cesarean delivery will take place immediately. So I drove off to the hospital.
1:06 pm… The baby came out. Good thing too that she is well, except that the bag of water broke for almost 17 hours from baseline. So I worked up baby. After baby finished suckling I drove off and rounded my other patients at other hospitals.
2:30 pm… Lunch finally! After which, I decided to pay a visit at one church to thank the Almighty for everything.
5:00 pm… I went home and had a whole body massage treat. (Yay, finally something self-serving). Then had dinner. The rest of the night was unremarkable until Saturday.
I did my routine rounds and I was done by 2:00 pm. I got a call from another hospital (hospital D) of a mother about to deliver again for pedia care. I had my workout, then dinner with friends followed by coffee as night cap. At 11:00, the parturient at hospital D was scheduled for cesarean section. I attended the baby’s delivery and got home already by 1:30 am.
I did not compose this blog to solicit your pity. But thanks for reading it. Until next time…