Read Online Assume the Position: Memoirs of an Obstetrician Gynecologist by Richard Houck MD - Free Book Online Page A

return until I heard her call out nicely and asked for me to help her, no matter how long she stayed in there and screamed.  I wrote my name on a piece of paper for her.  I let her know it was her call. Then I walked out, shut the door, and waited.  I didn’t permit anyone else to go in the room.  It took about a half an hour of what sounded like self-administered torture in the room before she asked for help, which she then got.  She permitted an exam, she got IV fluids, she got an epidural, she quieted down, and she got a healthy baby.  It was just not easy.
     
         One night at 5PM I came on call to the Labor and Delivery deck as Chief obstetrical resident for the evening to find a busy labor floor with 8 patients in labor, and a woman in the corner room of the labor and delivery suite, apparently in that labor room all day and cared for by other residents during the day.  She was in her early third trimester and in and out of lucidity all day.  She had a psychiatric history, and the staff had been waiting all day for a psychiatric consultation to come and evaluate her.  Almost exactly at 5 PM when the shift changed and I was now in charge, she went into shock with monitors beeping and blaring.  There were no signs of outward bleeding, but the fetus was now in serious distress as well.  A quick exam revealed her abdomen to be distended with no bowel sounds, vital signs unstable, in apparent hemorrhagic shock.  I quickly placed her legs up and out, and placed a needle and syringe into her abdominal cavity through the vagina. It returned fresh blood from the abdominal cavity.  The young woman was now in cardiac arrest.  A stat code was called, IV’s were started, blood and heart medication were administered, she was intubated and rushed to the operating room where an emergency surgery was performed to attempt arrest of the heavy internal bleeding from a ruptured cornual pregnancy, a form of ectopic pregnancy growing outside of the uterine cavity at the juncture of the tube and uterus.  These abnormal pregnancies, rare and catastrophic, often will grow unnoticed until late in gestation before rupturing with resultant hemorrhage.  It was the first and only time I ever did surgery on a patient in cardiac arrest, but it was a last and belated attempt to save her. If bleeding and vital signs could be stabilized, there was a slim chance of saving her life. It took me about five minutes to do an emergency hysterectomy, the fastest surgery I have ever done in my life.  What the residents caring for her had assumed was a ‘psych’ patient because of her varying states of consciousness and ramblings during the day turned out to be a woman going in and out of consciousness due to blood loss and shock.  She subsequently died on the operating table. This was just about the worst situation one could walk into to begin a night on call, but one never knows when the need to perform an emergency Cesarean Section or Cesarean hysterectomy will be necessary. Disasters like this were fortunately few and far between for both patient and physician, but always lurked around the corner in the world of obstetrics, which in a teaching hospital served to remind us all to be ever vigilant, a lesson none of us every forgot.
     
         Obesity is just a bad thing.  No two ways about it.  No matter what causes it, no matter why a person is obese, it only serves to make their own lives shortened and worse than whatever else life would have been for them.  And it certainly doesn’t make it easier as a physician to deal with obese patients. But in medicine, as in cards, one has to learn to deal the hand one is dealt.  One patient came into Labor and Delivery during residency weighing somewhere between 500-550 pounds, best guess, since there was no way to weigh her.   She said she had prenatal care elsewhere, but certainly not in our clinic and we were unable to retrieve any records.  If she hadn’t told us she was