A more mundane update of the last few weeks

I almost did a whole c-section as the lead surgeon, but for a bit of a tricky presentation (baby was not just butt first, but its little feet were sticking right out the incision) and some unusual bleeding. But the stuff that was “garden variety” was all me. Not perfect or with any finesse by any means, still.

I also had a teeny tiny shoulder dystocia (not in the c-section). It resolved very quickly and was quite straightforward. But I called it and I ran it and, I think, I kept a rather smooth head about me as I did it. Teeny, tiny. I mean wee. Really. But still, I saw it, I called it, I addressed it.

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Delivering babies is a fun job, no other way of looking at it! I enjoy working on L&D and I’m so glad that I’m gaining some confidence and some competence in that realm. This last rotation, I managed some things that were more complicated than I would have been able to handle in my first rotation - a few bleeding problems, some babies that needed help coming out, some labor patterns that looked not so great, some breech cesarean deliveries and evaluating and making recommendations for when my upper levels needed to take over and being able to give them a comprehensive report of the patient I needed their help with. I admitted one woman to the antepartum unit (we call it MFM, for the high risk pregnancy specialty) because the upper levels were handling emergencies. She ended up being a lot sicker than I anticipated and while I had lots of support from faculty in the management of her case, it was so stressful I was giddy with relief when things calmed down and I was able to hand her off to the usual high risk care team. I will be able to take care of these patients soon, but not yet! So far, I’m happy to report that my compassion is intact - when we get patients with really complicated situations - polysubstance use, undiagnosed pregnancies in the 3rd trimester, trauma, etc, things that make patients “difficult”, I find that I’m still able to engage with them and talk about their needs in ways that compassionately frame their circumstances.

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I really like living alone. Granted, it’s been 2 days. We’ll see how I feel in another 8 or 9. I’m especially grateful to have a dog while living alone. Bear gives me a little bit of a frame for my evening. Tonight I worked late, writing notes & orders for some afternoon excitement that got away from me. When I got home, I got a warm greeting, made some dinner and fed him. Then we went for a tiny walk. After a shower, I sat and watched TV while playing with various dog toys. Now we are in bed and we’re both ready to sleep, I think. I aspire to some meditation & shrine time during this break as well. I know I’ll get there, and I’m looking forward to it.

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The OB rotation is sort of the “why we are here” part of residency. Most people become Ob/Gyns because of the delivering babies part of the job. It is a big draw as a med student and really is (for me) the best part of this specialty. But I’m finding that the rotation itself is a rough experience. By its nature, Labor & Delivery is an unpredictable place, you never really know how your day is going to go. Will you be doing surgery? Planned or at least anticipated? Super urgent? Very tragic? Will you be delivering a baby? How will that go? Shoulder dystocia? 3rd degree laceration? NICU transfer? Maybe all of that, maybe none. Who will show up in triage? Will they be admitted? How sick will they be?

And the workspace is a loud, busy shared room - 8 or 9 computers, a conference table, right by the nurses station. Residents, attendings, midwives, community docs, regular rounds & huddles for all the teams to be in good communication. And for some reason playing music is the norm. Honestly, it’s a miracle I can get *anything* done in this space. I’ve got ADHD, hearing problems that are exacerbated by background noise and prevent me from wearing earbuds or ear plugs and I’m an introvert (albeit an outgoing one) and though the work is exciting and inspiring, this rotation also drains me in a way that none of the other ones do. They all drain me in different ways, this is just how this one does.

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My kids are spending a bunch of their break in California with their dad. They are about halfway through their trip and it has been just me and the dog. I’ve had a few busy nights but mostly I’m enjoying coming home from work and vegging out. I thought maybe I was getting a cold but some soup and early bedtimes seem to have nipped it in the bud (fingers crossed).

This solitude has given me an unusual space to think and feel. I’m *really* good at compartmentalizing, at protecting myself from hurt and getting shit done. Being busy taking care of my kids, my patients, my obligations to my education and my household are great distractions. Being here alone is giving me space to feel, to react to my life. My life is right now is exactly the way I have chosen for it to be: residency, divorce, single parenting, the whole nine yards. The things I lost, the things I’m grieving for, they were gone before I said yes to the things I have now. But I haven’t really processed that loss in any real way. I’m too busy keeping the trains running and I’m too good at keeping the sadness boxed up.

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The kids came back and I was so happy to see them, despite how much I enjoyed my Me time during break, I’m keenly aware that parenthood is a limited time offer. I can see the end of this part of our relationship and I’ll miss having them around, they are really great people. They come home on a redeye and the next day we drove down to Florida to see my parents. It was a loooong drive but when you go from 29 degrees to 70 degrees, some miles are worth it! We made the trip home over 2 days, stopping at our friend’s home in South Carolina, pretty last minute and very graciously received. Bear probably had the best time of all of us, there were dogs everywhere he went, and he had a great yard and some choice digging time in Florida. He’s filthy and exhausted now, fortunately it will be very boring around here for a few days and he’s going to the groomer on Saturday!