77. Lonely

I'm not sure why Beth came in today.

Something about medications and supplements; unwanted facial hair and weight gain.  By appearance today she has no excess hair or weight. She takes birth control pills because they suppress testosterone production, testosterone being blamed for the mentioned excesses, and herbal supplements to suppress what used to be called premenstrual syndrome but now goes by the name of premenstrual dysphoric disorder.

I was in the middle of expressing caution about combining multiple prescription and herbal medications when she interrupted me with, "Do you think I can get pregnant?... I'm childless by choice, but all I have is my mother, and I see some of my friends who are unable to get pregnant, and think I could be pregnant for them.  That way I would have a family for when I get older, and they would have children..."

I didn't particularly want to play the role of a ballon-breaking realist, but I did point out that at the age of 48, she'd be unlikely to naturally conceive, and would probably not be accepted by any fertility specialist as a surrogate mother or womb.

She seemed to accept my explanation, I'm guessing that she knew the answer but would always regret if she didn't at least ask.

76. Boy's Day

Just off a 24-hr shift with four baby boys:

1:14pm, Aiden Quinn, 9lb 7oz, vaginal birth

2:11pm, Leolani David, 8lb 4oz, vaginal birth

10:09pm, Cooper Davies, 7lb 12oz, cesarean, and

4:17am, Bennett Rosario, 9lb 12oz, vaginal

Moms and babies all doing well.

75. Paper or plastic; Percocet or Dilaudid

In Her wisdom, Mother Nature boosts a pregnant woman's self-clotting mechanisms.  After all, when the placenta separates (or perhaps better said, tears off) from the uterine lining, a lot of big blood vessels suddenly open up and bleed.  So stronger clotting means less risk of postpartum hemorrhage (in the developing world the most common cause of maternal mortality).

But the clotting mechanism is a delicate balance.  Too much causes larger clots to form in veins, some breaking off and traveling to the heart, lungs and/or brain, where they can wreck havoc.  Beth is about 10 days postpartum (a cesarean--surgery and anesthetic agents also increase clotting) with a pulmonary embolus (PE)--several of those clots are plugging parts of both lungs.  So she gets heparin and other blood thinners to dissolve those clots, or at least keep new ones from forming.

PE hurts, but Beth tells us that Percocet helps that pain, though does not help the pain associated with her abdominal pain, unlike Dilaudid, which helps the incisional pain but not the chest pain.  Both are equally strong narcotics.  Go figure.

74: Hair

Mildred is 63 with a new diagnosis of uterine cancer. Uterine cancer shows early and more often than not surgical removal of the uterus is a total cure. Based on early evaluation her appears that it may be more advanced, requiring postoperative treatment, chemotherapy and/or radiation therapy.

She immediately expressed concerned about her hair: "I don't want to lose my hair.  My husband's taking blood pressure medicine so we don't do it anymore, but I still like to be his girl.  I can't lose my hair."