48 hours in the life of an on-call gynecologist

An on-call weekend: 48 hours of being at any moment “on,” of being edgy, of being exhausted. This weekend included a full house of patients to see in the hospital, a patient list of three pages to be exact. As I went from patient to patient, room to room, each held its own unique story filled with the yin and yang of life. I realize too, this may be a vulnerable time for them, a time they feel weakened and tired of their medical issues or just the fatigue of childbirth, take a toll on them physically and emotionally. To help create order out of the disorder with the variety of patients before me at the hospital, I mentally organize them into groups. It allows me to organize my head for what each patient may need and ready my heart for their heart.

Hospital rounds

On the postpartum floor, I see new moms, exhausted moms, disheveled moms, moms happy to be away from the other children to peacefully focus on their newest one, moms with uncontrollable high blood pressure. And I see the sickest mom in the ICU because of a coronary artery dissection recovering from her c-section having delivered her baby a month earlier than it was due to save her own life. Teary, wanting to see her baby who was in the nursery, wanting to be out of the ICU and free from the monitors and lines coming out of her neck and arms. She’s lucky to be alive — probably not realizing how close she was to death.

On the GYN floor, there are two patients. Both have undergone robotic hysterectomies the day before. The older one is jumping out of bed ready to go home. The other, younger with four children at home, is crying because she didn’t realize she would be in pain. After reassurances that I wouldn’t send her home, I adjust her pain medications. The next day she is a whole new person.

Lastly, I move onto the antepartum unit with high-risk pregnant patients. Moms with pregnancy risks so great they require close monitoring in the hospital. One with blood vessels from the placenta haphazardly winding freely over the cervix rather than staying with the placenta — if the blood vessels bleed, the baby could die. Another with the placenta over the cervix rather than against the wall of the uterus — if this mom bleeds, both mom and baby could die. Two other moms with high blood pressure and diabetes that are severe enough to warrant being hospitalized and potentially delivered early if symptoms worsen. And lastly, my 22-weeker with a dilated cervix and a baby unable to survive delivery this early. She’s on bed rest, with a cerclage, a stitch in her cervix, to try to prevent early dilation and hopefully extend her pregnancy three more months so she can go home with a live baby. She had lost her previous baby at 19 weeks for the same issue.

Sunday night. It’s 1 a.m., my beeper goes off. Which complication from the high-risk moms awaits me?

Unfortunately, it is the 22-week mom, her water is now broken, and she is cramping. She is going to lose this baby too, just like her last pregnancy. I drive in on this frigid night to take out that stitch in her cervix. Now with her water broken, it is unsafe to keep it in. Her husband is there. He wants everything done for this baby. “Maybe there is a chance this baby could survive.” I have to explain to him there is no chance, and the neonatologist will not come to the delivery. After the cerclage is removed, we just wait. The patient is uncomfortable with the cramping and we give her an IV pump containing pain medication — she pushes a button to get pain meds as she needs them. Four hours go by, and she is now completely dilated. She doesn’t want to push, the only pushing she will do is for the pain pump. She doesn’t want to acknowledge she is about to deliver; she wants to be oblivious. I leave the room for 15 minutes, and the husband comes out to tell us the baby is coming. The baby is delivered within its sac, supposedly an auspicious type of delivery. It has a slow heartbeat. We take the baby to the warmer, break the water, clamp and cut the cord, wrap him in a blanket. Dad wants to hold him; mom doesn’t even want to look. In the warmth of his dad’s arms, the baby dies.

It’s now 7 a.m. on Monday morning and my shift is over, I need to leave to go to the office.

Office

Another group of patients, another group of unique stories. Pregnant ladies with concerns about bleeding and cramping over the weekend worked in, regular annual check ups, a breast lump, a teary patient because her husband recently died, a young college student with an infection. And then the phone calls, reviewing lab work. The last chart, a breast biopsy that reveals cancer. I just can’t make the call — I’m so drained, so tired, I know if I call her, I wouldn’t be there for her like I would want to be. The call will wait til tomorrow, and I set the chart aside.

Home

The house is quiet; no one else is home yet. I turn off my phone and curl up on the couch to sleep. I wake up an hour and a half later to the sound of my daughter coming into the house. I look at my phone and there is a missed call from my father’s doctor … my father had a stroke. In my post-call fog, I don’t know how to process this. My daughter finds me staring at the phone.

The intensity of being on call, being on for so many people and so many situations, everyone trying to find their way in the midst of life’s challenges, sometimes wanted as in a new baby, sometimes not as in the loss of a baby or a complicated pregnancy. For me, besides the obvious physical challenges of being available night and day, is the challenge to navigate my own emotions. I need to balance finding compassion but avoiding feeling swallowed up into the abyss of hopelessness or despair when I witness life tragedies.

An even greater challenge can be transitioning back to my personal life when my call ends and finding space for my family as well as for myself. I need to make time for both physical and mental rest to participate in and enjoy my life; sometimes not an easy task as a mother, wife and daughter. But recharging is crucial to clear my head, open my heart so that I can be fully present again when my next call starts.

Andrea Eisenberg is a obstetrician-gynecologist who blogs at Secret Life of an OB/GYN.

Image credit: Shutterstock.com

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