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December 1, 2013 Volume 77, Number 12
Residents’ Review: A Tale of Two Days Somnath Bose, M.B., B.S., M.D.


At 5:50 a.m. on a Monday morning, the alarm on my cell phone went off with an uncanny accuracy, giving a rude reminder that the weekend was over. Improving on my personal best of 20 minutes, and after breaking a couple of speed limits along the 10-mile drive, I just made it to work on time for the sign-out. Oh, did I mention this was my first day of my obstetric anesthesia rotation?

 

The overnight resident looked visibly tired as she narrated how she stayed up the whole night welcoming 15 new souls to this world. “It’s going to be a busy day for you guys!” she added, with a dour expression, before leaving. Oh, wow. What on earth did I land myself into, I wondered?

 

Meanwhile, our fellows started orienting us through a maze of paperwork, legalese and operational details, most of which were flying off at a tangent. The heady combination of caffeine withdrawal and catecholamine surge never had any favorable effects on my attention span, and I guess that was clearly visible on my face. We decided upon a quick therapeutic coffee break. The walk to the cafeteria is precisely two minutes, and no sooner did I pour coffee into my cup than the beeper went off.

 

Bemused, I look into my pager, which read, “We need a labor epidural in Pod 6 NOW.” It is common knowledge that pages which end in capital letters always mean trouble, so the cup of coffee had to be chucked into the trash as we hurried to labor and delivery. While we scrambled back, I tried to look into the notes I had taken during sign-out in order to figure out some details about our patient in pod 6. According to my scribblings from sign out, she was a young, otherwise healthy primigravida who had declined a labor epidural a couple of times during the night – determined to have a natural childbirth.

 

The scene inside the room was utter chaos. Her husband (in tears himself), a couple of nurses and three midwives were having a tough time trying to calm her down. She seemed to be a picture of absolute agony, sitting up in bed, hyperventilating, dry heaving and writhing in pain loud enough to drown the sounds of the fetal monitor. “We need an epidural right now. She has consented,” the obstetrician remarked.

 

“Get ready for the epidural, I shall be back with all the medications,” my fellow remarked as he disappeared from the room. Thankfully, I had already donned my gloves and was all set by the time our fellow walked in with our staff. I couldn’t help but notice that they looked the calmest of all while I could feel catecholamine levels reach a tipping point within me. A quick nod from them and I started getting my act together. At the pretext of reassuring her, my staff held her shoulders to position for the procedure, sounding ever so composed during this time. He kept cracking jokes, asking if she had plans for another child next year, even offering a discount on the epidural! Some distraction technique, I thought! Our patient, who had been howling incoherently in pain until now, responded to this question with an emphatic “NO!” She stated that she could never, ever bear this pain again.

 

I figured that my catecholamines had either reached a plateau or were depleted as I felt tremors and shakiness disappear from my hands. The epidural went in smoothly, and within minutes of administration of the local anesthetic, she said that she was feeling different – the look on her face said it all. The miracles of pharmacology, I thought. While I finished all the paperwork and made sure the fetal tracings were normal, I asked her if she felt any pain. She just smiled and shrugged, slipping off into a slumber. I gave myself a pat on the back as I stepped out of the room, when somebody from our team suggested “Coffee, anyone?”

 

Every time my alarm goes off at 5:50 a.m., I remember Bill Murray from “Groundhog Day.” So Tuesday was no different: the same 10-mile drive, breaking speed limits and making it on time for the sign-out. We started our day with postoperative rounds on the patients who had delivered the day before. I chose my patient from pod 6. Looking into her chart, I found that she had delivered the night before and was blessed with a healthy baby boy.

I entered her room to find a nurse handing over some pills. “Anesthesia is here,” she declared before leaving the room. I walked into her room and there she was, glowing with joy and the newly discovered pride of motherhood. The customary questions being over, I asked her if she remembered me from yesterday. “Of course,” she said emphatically.

 

“I couldn’t thank you enough. Maybe you should change your name to ‘comfort doctors’; that sounds more appropriate, I think,” she continued. Such an interesting thought. I didn’t know how to react to that and just thanked her and turned to the door.

 

I had almost stepped out of the room when she quipped “Hey, doc, by the way, I was discussing with my husband that it wouldn’t be a bad idea to have a little sister for our baby boy – maybe next year? Does that discount on the epidural still hold true?”

 

As I fumbled to make up an appropriate repartee, my pager came to the rescue as it read, “We need an epidural at bed 8 NOW.”

 

Acknowledgements:

I would like to acknowledge Sabri Barsoum, M.D., Director, Obstetric Anesthesia, Hillcrest Hospital, Cleveland, and M. Barry Jones, M.D., staff, Pain Management, Cleveland Clinic Foundation, Cleveland, for providing the inspiration to write this narrative.



Somnath Bose, M.B,, B.S., M.D. is a CA-3 resident, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

 

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