Tuesday, July 26, 2011
Perils of a gynaecologist.......Need some sunshine badly
My head is reeling badly.Perils of being a doctor........They seem unending.It is a mix of two consecutive sleepless nights and the daytime surgeries and the OPD and the queries of patients in need and of course the duties to be fulfilled as a mother,wife and human being myself.
One of my patient got admitted yesterday early morning with a leaking at term.It was very easy to Induce the labour and be free latest by night specially when I had a Total lap hysterectomy posted on a huge Lady of BMI 36 early morning today.Tried to resist my temptation and followed the guidelines.Give her time to go in labour spontaneously.Waited till night and then Induced the labour after a wait of 14 hours or so.Got a call at 1 in the night from the duty doc that she was getting some type 2 dips.Was easy to go and perform a caesarean.That would have meant at least I was free to sleep peacefully and be fresh for my morning case.The guideline bug said NO.Please change her sides and may be it settles down.And the baby's heart beats did settle down as they were variable ones.
5.30 am got another call from the duty doc.It is just a rim .I said OK,never mind I have to be there to start my TLH at 7.00 am ,so will be there anyways in time.6am again a call........mam doesn't look like a bandl's ring,head is low,it is occipito anterior and rim is still there but something is wrong.
Reached at 6 .45 am.she was fully dilated.looked like a Deep transverse arrest.Told the same to the patient.She wished a vaginal delivery come what may.Told her a high chance of failure of rotational ventouse.She was Ok.I regreted,I don't know how to use rotational forceps.
In the mean time the patient was under anaesthesia in OT and my other team member an accomplished GI surgeon was holding the fort there.Now it is just not that she is a high risk obese TLH patient but her insurance is under GIPSA.And her insurance company wishes me to do a TLH on her using best of instruments and best of expertise but should not charge more that Rs 73500 which is same as a conventional open hysterectomy.It isn't just medicine but also the business.I don't know how to provide my patients those services which they are entitled to when the cost of instruments and expertise involved is not covered in it.I am under too much of pressure.I speak loudly........one last time and now I will think how will I manage next time,the stress involved isn't worth it.
Yup so,in between the lady in labour........I tried 3 pulls of ventouse and the baby's head came down a little but no rotation at all.
Time for a caesarean in 3rd OT.patient and her relatives are disappointed.The OT in charge isn't too happy with me.According to him it is too much chaos created by me.Now how do I anticipate an emergency?I would be the last person to wish an elective case and and emergency side by side.Maybe shouldn't have followed the guidelines.Early morning.......staff isn't yet in full capacity.I am already boiling and then try to calm myself down.Just the beginning of the day.....
And there comes a massage from my team member.....When will you finish caesarean???The Lady for TLH has lots of gut adhesion and he needs me there......Ok ,I finish my caesarean and rush there.By that time he is already done with the adhesion and we start TLH.It ended peacefully after a pushing her visceral fat and guts falling all over the place.All through out I have to remind every one in the OT to be cost effective as well.Remember she is a 'GIPSA patient...........'!!
It is too much of a balancing........Guidelines,ethics,emergencies,insurance,colleagues and instrument failures as well........
Then I went for my routine round.And here I have my patient who delivered yesterday.She never complained throughout the pregnancy.Always used to ask me jokingly while in OPD......Doc ,what do all these pregnant ladies ask you/It takes them ages to come out of the chamber.And then she used to give a throaty chuckle.Same she did in her labour.Pushed the baby out with ease and confidence.Within an couple of hours of her delivery was moving around and today morning gave me a warm smile.Then followed her throaty laughter and she said.....'sab badiha hai!! When will you let me go'? Here was my sunshine.......