Dr. Patrick Crocker - Letters from the Pit: Stories of a Physicians Odyssey in Emergency Medicine

Copyright 2018 by Patrick Crocker

All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review.

Print ISBN: 978-1-54395-332-9

eBook ISBN: 978-1-54395-333-6

I SINCERELY HOPE YOU ENJOY THIS BOOK. THE BOOK HAS BEEN INDEPENDENTLY PUBLISHED SO THERE ARE NO MAJOR PUBLISHERS INVOLVED, AND NO FORMAL PROMOTION OR MARKETING. I AM DEPENDING ON THOSE READERS WHO LIKE THE BOOK TO SEND A RECOMMENDATION TO FIVE OF THEIR FRIENDS. IT IS THROUGH YOUR CONNECTIONS ON SOCIAL MEDIA THAT YOU CAN HELP GET THESE STORIES TO INTERESTED READERS.

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THANK YOU.

P.C.

MY FIRST DELIVERY

Dear Jack,

I dont know nothin bout birthin babies. No quote could be more apt. I just finished my Obstetrics and Gynecology (Ob/Gyn) rotation. First month on the wards and I am delivering babies. What a neat experience. Actually, it can get pretty messy. I never will consider giving up my amateur credentials in gynecology, but delivering babies is something else. Nice, young patients for the most part, healthy babies delivered to smiling parents. Lots of happy endings. It is almost enough to make one consider doing it for a living. But as I said, I will keep my amateur credentials.

Picture this. Its seven in the morning and my first day on the Labor and Delivery floor (known in the hospital as L&D). Im standing around waiting for the resident whos training me to show up and orient me to the service. As a senior medical school student, you dont dare start anything on a new service without an orientation and your residents express permission. That would be stepping on the residents turf. In addition, you know absolutely nothing about practical medical care. Your resident will tell you what to do and what not to do. That should keep you out of trouble most of the time. He or she will almost be as good at this as some of the older, experienced nurses by their second year.

You always meet with the nurses after orienting. That is, if you are smart. There is no scheduled meet and greet. Its not required, but its essential for those with enough common sense to know you will need their help and wise counsel. Just admit youre clueless; they know it already. They can tell by looking at you. They know youre as fresh out of the box as your clean, white shoes. Valedictorian or class dummy, you dont yet have a clue about real-life medicine, and the nurses can smell it. A few well-spent minutes with them, a cup of coffee or two, and you can become golden. They will keep you out of trouble. Many of the residents never learn this little courtesy and they will constantly be watching their behinds as they recover from screw up after screw up -- all of it preventable. A good nurse can be your best friend, or your worst enemy. The sooner you understand that they are the other half of the care team and that you cant do your job without them, the better off everybody will be.

At any rate, I hadnt had the chance to seek out any of the nurses yet. Nor was that in the cards today. Within a few minutes of my arrival in L&D, I heard a loud cry for help from down the hall.

Help, we need a doctor in seven! someone shouts. My immediate response, of course, is to run to the phone and call one. A doctor, that is. I am serious here. I dont know anything practical about birthing babies. I did see a video about a year ago, but Ive never witnessed a birth in person. Just like reading about sex as a Boy Scout in a tree house. It isnt much like the real thing, and neither is a video for delivering babies. Again, a piercing call from that relatively young voice for help.

Im not a doctor yet, OK? A doctor is someone who knows the answers, can help no matter what, a wellspring of self-confidence and knowledge. I am still just me. I feel no different than the day I graduated from high school. Oh sure, Ive learned quite a bit about Ob/Gyn pathology, physiology of reproduction, embryology, etc., but nothing of any practical value for this situation. I may as well be a plumber. Id probably still be warm and cozy in bed if I were because plumbers dont work on weekends, and this is Saturday. I really want to run the other way, but you know me. I cant. So, I run down the hall to find a young nurse and a frantic patient in one of the labor rooms.

These are small rooms with regular beds where women suffer the first part of labor. Then when it is time to deliver, they are moved to the delivery room. Deliveries are supposed to happen in delivery rooms, not labor rooms. I guess nobody explained it to this patient because there she was, splay-legged on the bed with something bulging from her vagina. It kind of looked like a pale, yellow balloon about four inches across. Ive never seen anything quite like this. Im wondering silently if her guts are coming out. The nurse, not knowing whom she is dealing with, looks up expectantly and says, Doctor, she is about to give birth. Well Id pretty much figured that part out all by myself. I still want to call a doctor and stand in the background and watch one or two of these before I actually do one. At any rate, I am it this morning, and all I can do is try and deal with the situation until an RD arrives. RD stands for real doctor. In the firmest most authoritative voice I can muster (though probably not very reassuring), I say, Ill need the precip tray. This is a tray all set up with what you need to do an emergency, or precipitous, delivery. Id learned that much from the video, and in times of need, my memory usually doesnt fail me. Of course, the nurse is one step ahead of me. She points out that the stainless-steel tray now positioned at my patients left leg was indeed the precip tray. So much for bluffing.

By now, the nurse has figured out I am just a new intern or maybe even a student whos making this up as I go along. Nevertheless, in front of the patient, I am the doctor, and she is the nurse, and there is no question about our role-playing. I should have thanked her later for that little bit of courtesy because, without it, the charade would have certainly crumbled right there. The resident is still MIA, and my heart is beating so fast I wonder if its going to hop out of my chest. But I have no luxury of time, so I pull on gloves and a mask. No time for a gown. That mysterious bulge is growing with each contraction like some obscene balloon.

I get down close trying to figure out what to do next when, whoosh! Slimy water gushes onto my face. A bucketful. No joke. I am disoriented and surprised, and as nearsighted as I am, it takes a second to register that her bag of waters has ruptured, douching me in the face and covering my glasses. I can barely see through this coating of amniotic fluid. I am clearly in deep shit. Where in the hell is the frigging resident?

Somehow, I can still remember a few simple steps from the video and successfully guide the babys head outward. Fortunately, the baby is in the common LOA, or left occiput anterior, position. Textbook. But now I am panicked. The baby looks like a monster. Or maybe a gremlin-like mobster wearing a nylon stocking mask. The mouth, eyes, and nose are visible, but a thick membrane covers the entire head and face. What am I to do? I cant suction the babys mouth because there is no hole to get to it. I dont even know if I should let this baby survive, it is so deformed. What will I tell the mother, or for that matter, the dean of the medical school? Im sorry, sir, my first baby was deformed, and I didnt know what to do, so I let it die! I figure my career in medicine is over. I suppose if your first patient dies, surely, you fail on the spot. After some humiliating medical grand rounds where some gray-bearded expert lecturing in an auditorium explains your incompetent buffoonery to your colleagues, you probably get shipped back to where you came from. Maybe I can learn a trade; Ive always kind of liked the idea of carpentry. I already imagine telling my parents and wife that, starting next week, I will be framing condos in Orlando. But thank goodness for Mother Nature.