Day of stress

I'm not a big fan of days like today. Not only was it the first day of a new rotation for me (obstetrical anesthesia), but it was also my first day back from a two-week vacation. This is the first time I've had more than one week off at a time since I graduated from medical school. The longer break was nice, but I knew it would be tough coming back to work.

It was tough to get out of bed to hit "snooze" on my cell phone at 0450. It was tough to go back to sleep, so I just got up after lying there a few minutes. It was tough to stay warm at the outdoor 125th Street station as I waited 30 minutes for the 0539 train which never came. It was tough to change in the locker room since I'd forgotten my combination. (All I could remember was Uncle Paul and Aunt Betty's shed's combination. That'll teach me to offer to rake the yard!)

And then I showed up to the labor and delivery floor where the stars, misaligned as they were, had three--and only three--anesthesia residents showing up for their first day of OB anesthesia. My assignment was the toughest, at least from my perspective. As the resident covering labor and delivery, I received any calls from the OB residents requesting epidurals, evaluated patients for epidurals, placed epidurals, and followed up on epidural patients. (Notice a theme?) I was also the first person called for emergency c-sections, which I would then coordinate with the residents covering the OB OR's. Then there were follow-ups from the day before, and the ordinary confusion of learning new paper work systems, new places to get medications, new kinds of medications, new mazes of corridors and rooms, new nurses' names, new obstretricians' names, and different ways of documentation.

And finally, placing my first few epidurals in OB was not a small source of stress. I'd only placed 4 or 5 epidurals before, and the technique is trickier than doing a spinal since a catheter has to be threaded. In addition, there is the constant danger of pushing just a millimeter too far and puncturing the dura with a large-bore needle (a "wet-tap," colloquially), leading to a severe headache for the patient, frustration for my attending, and embarrassment for me.

While placing an epidural in one particularly obese patient on whom I had trouble locating any landmarks, I thought my needle might be against bone at one point of the procedure. "Just a little more pressure," I thought. With that, the needle leapt through the rather crunchy ligament its tip had been buried in and landed a few millimeters deeper. The tension emanating from my attending who was standing at my side was palpable. I withdrew the stylet...no gush of cerebral spinal fluid! The stars had shifted, Fortuna's wheel was spinning, the Fates smiled upon me. The needle was in the perfect place. I wasted no time in threading the catheter and getting out of there!

I was mentally exhausted by the time I walked in my apartment at 1700. Even though I'd only worked a little over nine hours, the constant multi-tasking and the newness of it all was draining. Given that most people really like their OB anesthesia experience, and given that most of the stress was learning the new system, I think things will get much better quickly. Before long, things will probably take half as long as they did today. We shall see by the end of the month how my perspective has changed on OB anesthesia.