Waiting for the other shoe to come down hard

(Title stolen from an Everclear song "out of my depth")
******WARNING CONTAINS LOTS OF MEDICAL JARGON********* --> I'm just too tired to make it easier for the non-medics.

This is a tale of how one would rather not have night duty start. You walk in and get your handover, all the while wondering who the strange man sitting in the nurses station is. You read his name tag, Oh great, he's the new consultant you haven't met yet. You introduce yourself, and try to subtly ask why he's there (he's not on call, and according to the board - none of the patients are his). Bad answer. The trial of scar with the poor CTG trace is a GP Ob pt, but this doctor saw her once in clinic because they were a trial of scar. He's here instead of the oncall obstetrician because the oncall obstetrician wanted to transfer the patient to a bigger hospital. Mmm.... Not a good start. Instrumental delivery follows. 4th degree tear - I organise theatre, call an aneasthetist etc. Bub has temp, tachypnoea, tachycardia (at night O&G covers paeds as well, so this is my problem). Bugger. I ring the paediatrician. He gives me a few instructions. Before I hang up, a midwife asks to speak to him. I didn't know the other lady had delivered. Turns out, bub#2 is not doing so well, that's my job again. I go to the SCN. Bub took 20 minutes to pink up. Bugger. Mmm.. Bub's in 85% O2. I now have to wonder what the paediatrician actually knows about this child, as i haven't spoken to them. I call them. Just keep going he says. Lovely.

Another midwife comes and gets me. They need you in theatre now. Super, bye bye sick babies. Even though he doesn't need me, I'm scrubbing in for my "educational benefit". He seems a nice consultant, I don't mind. We're 3/4 the way suturing up... Are the lights supposed to do that? I mean it's nice we still have the overhead spotlight, but why are all the other ones gone and the computers off? The generator kicks in.... for a moment... then it quits again.... Then the lights come back on... for 10 minutes... then they fail again... then they're back *deep breath* they stayed back. It feels so much safer to be in a hospital that has electricity. Consultant mumbles something about how this is Australia, this shouldn't be happening here - too true (although it's better then the time at the PAH when the generators failed to kick in for 15 minutes and people had to be ventilated by hand).

I come back upstairs. Bub#2 is having a few problems, can't get adequate O2sat readings from the monitor. SCN nurses trying to wean down the O2 by sight. They want me to call the paediatrician again. I call him. The minute I'm on the phone the sats monitor starts to work. They're happy. He says continue. Mmmm.. Resps are 80... they were 44 before... That's okay he says, the sats are okay.
Chat with the midwife for a few minutes. Come here to write this entry.

The entry got saved as a draft as I got paged away again. The title is no longer relevant. The other shoe has dropped.

Bub#2 now has developed some further signs of resp distress (grunting, recessions, tachypnoeic, nasal flaring) and O2sats aren't as good. I call the paediatrician: Please come and assess this baby, we are no longer happy with it's condition. He's a lovely man, of course he will come and assess the baby. Good. We keep it in oxygen.

I go to labour ward to assess and antenate with a problem that has nothing to do with her pregnancy and should really be dealt with in emergency. However the policy is that they come straight to us on delivery suite if they're pregnant, regardless of how irrelevant the complaint is. I get the lowdown from the midwife, then I walk in and introduce myself to the patient. A midwife immediately runs in and says "you're needed in SCN urgently". bugger. I half-run down the hall. Bub#2 is bleeding from the mouth and nose. I'm not a paediatrician, but this doesn't seem to be a good sign. It stops, well that's a good start. The nurse reports the initial bit was a spurt related to crying. She's concerned bub's about to have a pulmonary haemorrhage (secondary to the hypoxic insult at birth). The level of her concern was made obvious to me when she started getting all the intubation equipment out "Just in case we have to call a paediatric MET". I ask how far away the paediatrician who is on his way in lives - "a long way". They ask me to remain in the nursery until he arrives - just in case. We do everything in our power to keep baby calm - we're all thinking if bub cries this is going to be a very bad night. Paediatrician arrives, I have to go back to the ward to assess the pregnant people.

I sort out the lady with the unrelated to O&G problem - admitted to the ward. Meanwhile a VBAC arrives. For some reason I'm not really allowed to see her (she has her special midwife coming in). I gently suggest to her midwife that it is policy that she have a bung. I am told to wait outside and they'll talk to me. I go get the IV trolley ready - she's getting a bung. I won't even mention the issues I had trying to get the appropriate people notified. I put a bung in. The woman wants her midwife, I get her and leave. Baby born.

*insert filling out dull paperwork for a bit*

I swing by SCN, paediatrician is explaining to mum that an xray has showed HMD. We're keeping bub here. There has been no further bleeding and I think we're putting it down to "it happens", but I'm not sure.

I slowly plod back to the HMO room to finish this blog entry.

*sigh* I blame myself. I told matthew I would be okay to drive home after this shift so long as I got some sleep. I told him I'd already seen my quota of pts in the first two nights, so I thought tonight would be a nice one. Really could I be anymore dumb?