Is this even interesting?
I can't even tell anymore.
But half of the time? Giving good medical care? Is nothing more than resource allotment.
You're the MFM attending of the week, responsible for all the high-risk patients in the hospital.
Yesterday, you admitted a patient at 20 weeks with a short and slightly dilated cervix, diagnosed incidentally on ultrasound that same day.
Her chances of losing this pregnancy are very high, regardless of what we do. She was counselled about her options, none of them good. They included expectant management, progesterone, termination of pregnancy, and a cerclage (a stitch around the cervix).
She chose the cerclage, after a long and comprehensive and very difficult discussion of how it could, in fact, make things worse, and would still be a long way from making things better.
Your condition for offering her the cerclage was an amniocentesis that ruled out infection, which she agreed to, and you performed yesterday.
It is negative.
The labor floor had three scheduled cesareans and two unscheduled ones today, and could not accomodate your cerclage
The night team says they'll try to do it for you, but no promises.
At 10 pm, you look up the patient - it hasn't happened. In general, this means it ain't happening tonight.
Maybe one of the c-section slots for tomorrow is empty, and you can use it for her? You look up the OR schedule for tomorrow.
Not only is the day overbooked, there is a SECOND cerclage coming in (12 weeks, prophylactic) that you will probably have to do.
This case, this 20 weeker? It has to happen. You start to plot. Maybe if they bring the 20-weeker over at 7:45, and you take Smoosh to the bus early, then you can get there before 8 and do it before...wait, no. What if the Bearded Economist takes Smoosh to the bus with the twins on the way to daycare, and then you can come in by 7, and sweet-talk the overnight anesthesia team into helping you get it done before signout. Yeah. That might work.
You call over to L&D. You ask to speak to your partner who's on call. You can't, because she's in the OR. Crap.
You ask to speak to the chief resident. You start to explain your plan.
"Wait." the chief says. "She's in the OR now. The 20-weeker? Yeah, OR 1. They're doing her cerclage tonight."
You gush with gratitude. You send a text of thanks to your partner. You go to sleep.