Today started off a rush of drama in the tococirugia (labor & delivery). First off we had a mother in labor making a horrible racket. They couldn't get her under control so they finally gave up and took her into the delivery room. Trouble was...she was only at 23 weeks gestation. I wanted to slap her, because apparently she was so concerned with herself she didn't even stop to think what danger she was putting her baby in. I observed as the pediatric doctora and intern calmly received the baby and did what they could for 20 minutes. IMSS #110 is not equipped for a premature neonate of that extreme, and hence why the doctora was so calm. She received the baby knowing that after 20 minutes had passed she'd have to stop and let nature take its course. The worst part was that even though it was only at 23 weeks, it was obvious that with the right equipment this baby stood a very good chance of survival. It could have made it, but instead we left it wrapped up in a towel to stop breathing on its own. The whole situation upset me so much I had to leave the room. I made it to a chair and sat down but was so sick I still felt like I was going to pass out. I think it would be an understatement to say that I cannot handle neonatology.
After starting our day off as such, the drama didn't stop, but thankfully the next baby came with a miracle wrapped up beside it. The baby had somehow managed to flip around so much it had knotted its umbilical cord into a perfectly formed knot. At that point God must have stopped the baby in its tracks because with one more somersault that baby would have caused the knot to tighten cutting off his own life-support. When that baby came out and I saw the knot my jaw literally dropped open. Not only was the knot a rarity in itself, but the crisis that had somehow been avoided dumbfounded me. The baby had even been screaming before his tiny feet could emerge and presented with an Apgar of 8,9.
So like I said at the beginning.... drama, drama, drama!
On a personal happy note: I had learned how to start IVs back in Feb. during my surgery guardias and hadn't done it since. I mentioned this to one of the nurses and so she hooked me up. The patient I was given did not have any good visible veins, meaning there's an element of guessing that goes on, but I got it started without trouble on the first stick! The patient even said that I had a soft touch! Yay! for the random ego booster! After my success, one of the nurses exclaimed, "awwww, our little flowers are growing up!" I've been really lucky during my guardias to encounter nurses that are cool with teaching us doctors. Not all of them, but some of them have been really cool.
Hasta!
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