On Call

I’m sitting in the hospital at 2am, and I'm actually pretty happy about that. We have a patient laboring down the hall, and she’s likely to deliver in a few hours. Delivering a baby is one of the more fun (and terrifying) parts of my job, and I don’t want to miss it. So that means I’ll be spending the night in the hospital.

I actually kind of like working nights. Granted, it kills my sleep schedule for the next three days, but it’s still pretty fun. The hospital has kind of a peaceful quiet to it at night, which is a rarity around here. It’s also when residents get to practice being a grown-up doctor. Of course, there are always supervising doctors on call, but they’re not always physically in the building. So it keeps me on my toes and forces me to think on my own. Again, fun but terrifying.

The call schedules for residents used to be brutal. We were essentially on call all day everyday. But 10-15 years ago, the feds started to lean hard on residency programs to start implementing duty hour limits. It seems like common sense, but there is a deeply ingrained culture in our field that new doctors need to see and do as much as possible during residency. There’s some truth to that, but clearly mistakes can be made after a couple of days without any real sleep. But don’t worry, patients. We’re now required to go home after just 28 straight hours in the hospital. Easy peasy.

Of course, a 28 hour stretch is not exactly OSHA compliant*, but it was the compromise between getting lots of experience and letting residents maintain some semblance of humanity.

*Interestingly, there is no such thing as an OSHA-compliant resident work schedule, since medical residency is one of the few hazardous jobs that don’t fall under the agency’s purview. In 2011, OSHA was petitioned by a watchdog group to start overseeing resident work conditions. But they denied the request after input from the American Medical Association and other industry groups. They decided (and probably rightfully so) that medical training is a very unique process, and is best regulated from within. And in defense of my medical overlords, there isn’t much evidence that limiting work hours actually prevents medical errors. Of course, decreasing the hours from unlimited to 28 still leaves plenty of room for fatigue. But the increased handoffs from one doctor to the next are far more likely to cause errors than a sleep deprived resident.

But back to the baby. It’s now 5am and I just delivered a healthy, happy 7-pounder. About a paragraph ago, I got a call from the nurse calmly but firmly requesting my presence. And when a Labor and Delivery nurse says now, she means now. So I ran-walked my way though the hospital to find the familiar tray of delivery tools set up and ready to go. I put on my gown and gloves, and got the patient into position. Many of you know that there is A LOT of biology happening at these deliveries, and the gown and gloves (and occasionally face shield) are critical. I try to not make each laboring mom feel like an ebola patient, but there are few grosser experiences than catching a face full of amniotic fluid. I’ve been lucky so far, but it’s only a matter of time.

I’ve performed about a dozen deliveries, and probably watched twice that amount. But only now am I starting to get comfortable with guiding one human being out of another human being. For my first few deliveries, I felt an increasing panic as the delivery got closer. Seeing the babies head was exciting news for the family, and awful news for me. There’s no turning back now. But I’m finally starting to get a feel for it, and now it’s closer to 50/50 excitement and terror.

This particular baby was probably a 6/10 on the difficulty scale. I had to do a small amount of work to guide the shoulders through the birth canal, but the baby came out without much trouble.

After each delivery, when the baby is safely out and the mother has stopped bleeding, there’s nothing quite like placing a new baby in his or her mom’s arms. And just like that, both she and I have forgotten the trauma of childbirth. But hopefully she’ll wait a year or two for her next one. I’ll probably be back in an hour.

Bienvenidos

I am a doctor.

You all know that, but it's good for me to remind myself that every now and then. Between the adventures at the brewery and the trip to Hawaii, it's easy for me to forget that I have a day job.

I haven't spent much time talking about residency here. And that's for a couple of reasons. First, this is a travel blog, and I shouldn't drift too far from the original purpose. But also because I've barely had time to breathe since starting residency, let along blog about it. That said, this month brings a good excuse to blend the two worlds. I'm spending August down on the US-Mexico border to work as an obstetrician at Nogales' Holy Cross Hospital.

For those of us that grew up in Tucson, you know Nogales as a gateway to debauchery, unrelenting crime, or boundless economic opportunities, depending on where you get your news. The truth, of course, is that Nogales is none of these. At least no more than any other rural southwest town.

Nogales, Arizona is a small border town of about 20,000 people. But just across the line is Nogales, Sonora. On that side, you'll find ten times the population, and dozens of maqilas. Those are the factories that many American companies use to manufacturer their goods using relatively cheap labor and low import tariffs guaranteed by NAFTA and other free trade agreements.

The maquilas, like Ambos Nogales (both Nogales'), have had a turbulent couple of decades. They were initially hailed as an economic revolution that would allow for cheaper US products, more jobs, and higher quality of life in Mexico. However, the facilities turned out to be far less revolutionary--but also far less catastrophic--than the various observers predicted. As China increased its cheap labor output, maquila production slowed. But as transpacific shipping costs increased, North American manufacturing became appealing again. Meanwhile, crime, or more accurately, the perception of crime, has devastated the once-booming tourism industry.

But while the major players tussle back and forth, there are still a quarter million people here that need healthcare either way. And that's my job this month. Holy Cross is a small Critical Access Hospital that provides care for people that have few other options. As the name implies, it's a Catholic Hospital that is part of the same Carondelet network that manages St. Joe's and St. Mary's hospitals in Tucson. I'll be working in the labor and delivery ward, taking care of pregnant moms and their new babies.

I've only been here for 48 hours, but I've already seen some incredible things (and delivered four babies). It's going to be a fun month, and I'll keep the stories coming every few days.

-M