Author: Becky Taylor
Editor: Antonia Clarke
The alarm wakes me from my slumber. It’s dark outside and I panic that I’ve overslept, but then I remember the clocks went back last week and it’s actually only 6pm. I did have good intentions of going to the gym tonight before work, but by the time the leaf-blower and the jackhammer next door had finally quietened down I didn’t get to sleep until about 12.30pm. Maybe I’ll go tomorrow, though it’s night four of seven and I’ve said that every night!
I roll out of bed into the shower and then crawl towards the coffee machine – the lights switch on! There are sad pickings in the fridge – husband (anaesthetist and resident chef) is not home from work yet, and there’s not enough time to get takeaway – so cereal it is. I justify that it is essentially breakfast time for me but make a mental note to self: remember to cook something tomorrow.
It’s seven twenty now so I’d better get going. I bump into my husband in the stairwell, say hello and goodbye (#medicalmarriages) and I’m on my way. And so it begins – the slightly disorganised (but standard) start to a night shift in the life of an O&G Registrar.
I arrive at work and head straight to the maternity unit. Greeting the junior registrar and the resident, we go to delivery ward to get the low-down from the day team.
Delivery ward is heaving when we arrive; all nine rooms are filled with women in labour, several ladies are waiting to be assessed, two women require a gynaecology review in ED and there is a woman with a confirmed ectopic pregnancy who needs to go to theatre. It is going to be a busy night!
We go through the board getting an update on everyone in the delivery ward and then go through the electronic handover to identify any new admissions or sick patients on the ward or in intensive care. Six of the women in labour are being induced, for reasons ranging from gestational diabetes to reduced foetal movements, and three have presented in spontaneous labour. Most are primiparous and everyone seems to be about 5-7cm dilated, so I know that in 3-4 hours babies will start flying out left right and centre. Time to tidy up everything else before the tsunami! An O&G Registrar always needs to think several steps ahead – a crystal ball would be a fine thing in this job!
We decide to divide and conquer. The junior Registrar and Resident head up to ED to see the Gynaecology cases and I head to theatre to meet the boss for the ectopic case. The patient is a 25 year old woman who presented to ED with two days of right iliac fossa pain and was found to have a beta-hCG of 1200. An ultrasound this afternoon showed a right tubal ectopic pregnancy, and although she looks well, her haemoglobin has dropped so she needs to go to theatre tonight. We scrub for the laparoscopy and note approximately 400mls of haemoperitoneum on entry. My pager has gone off three times already – and delivery ward want to know when we will be back to review the antenatal patients. Sometimes I wish I could be in three places at once! The right tube contains an ectopic pregnancy and is bleeding slowly from the fimbrial end, so we proceed to perform a right salpingectomy. The case takes about 45 minutes, I say goodbye to the boss, close and then head back to delivery ward.
On arrival the midwives have concerns about the cardiotocograph (CTG ) of a woman who is being induced for reduced foetal movements so I go and assess her first. She is now 9cm dilated and the CTG shows recurrent atypical decelerations with reduced variability for the past thirty minutes. I decide to perform foetal blood sampling to assess the baby’s condition and this comes back high at 6.0mmol/L. Category One Caesarean section! I tell the In-Charge midwife, quickly brief the woman on what we need to do to help her and her baby, obtain verbal consent, reassure her husband who is looking panicked and help transfer her onto the trolley to go to theatre (OT).
It never ceases to amaze me how quickly everyone pulls together in these situations: pagers are going off left, right and centre, people materialise from all corners to help transfer the patient, The Paediatric Registrar is called, Anaesthetics arrive, OT is abuzz with people prepping. I dash round to get scrubbed, meeting my junior Registrar en route. The patient is given a general anaesthetic and we deliver the baby eight minutes from when the call was made. It is a beautiful baby boy in good condition with the cord twice around the neck. Everyone breathes a sigh of relief. Good work team! The rest of the Caesarean is uncomplicated but as I start closing the rectus sheath I get a call from Delivery Ward about another pathological CTG on a woman who has been pushing for an hour. I unscrub, leaving the junior Registrar to finish and run back to the ward.
On arrival the CTG shows late decelerations which are taking longer and longer to recover. The woman is pushing well but I know a natural birth would still be some way off so she needs intervention or this baby is going to be very unhappy. I examine her and consent her for a Ventouse delivery. Paediatrics arrive and I debrief them on the situation. I set up for the instrumental delivery, apply the Ventouse and the baby comes over three contractions with an episiotomy. The baby girl is born onto Mum’s chest but is stunned and not crying, so we quickly cut the cord and transfer the baby to the Resuscitaire. I go back to deliver the placenta and reassure Mum that everything is going to be alright. After two minutes of CPAP the baby cries. Mum and Dad are in tears and even I have a tear in my eye; I don’t think I will ever tire of the privilege of being present at such a special moment in a family’s life. I start to repair the episiotomy and as I’m finishing the In-Charge midwife knocks at the door and asks me to attend the next-door room urgently as the woman is having a post-partum haemorrhage (PPH). “One of those night shifts” I think to myself!
The next few hours go something like this for the team: four normal vaginal deliveries, two PPHs, one forceps delivery, one shoulder dystocia, two more Ventouse deliveries, performed by the junior Registrar as I supervise, transfer of a 25 weeker with ruptured membranes from a rural hospital, two ED Gynaecology reviews and a whole lot of steps on the Fitbit! Come 7am we are all exhausted but everyone has delivered, mums and babies are all well and it’s time for a well-earned cuppa! We finish our notes and then do a quick debrief ward-round on all the women we helped to deliver overnight before heading upstairs to handover. “You guys look like you had a rough night” says my fellow third year. “Just a little” I laugh before collapsing into the chair.
If there was a quote to best sum up a night as an O&G Registrar it would have to be “expect the unexpected” (Perhaps Oscar Wilde had a sideline job as an O&G Registrar!). You can be quietly reviewing a 90 year old with post-menopausal bleeding in ED and then two minutes later find yourself sprinting across the hospital to attend a foetal bradycardia (apologies if I’ve ever run off from a conversation with you mid-sentence!), but that’s what makes it interesting. I love the variety of the work, the mix of medicine and surgery, the fast-paced aspects, the slower-paced aspects, the team-work and most of all the opportunity to be part of woman’s journey at such an important time in their lives. It’s tough, it’s tiring and when things go wrong it’s tragic, but it has to be the most rewarding specialty out there. You wouldn’t find me anywhere else.
Dos and Don’ts for O&G Night Shift:
- Be like my junior Registrar and meal-prep for an entire week when you’re on nights – cereal will only sustain you so long!
- Drink coffee – always and at every opportunity
- Be kind to everyone you meet – you don’t know what kind of day they’re having
- Get shoes you can run in and make sure they’re waterproof! Obstetrics is a messy business
- Live next to anyone who owns a leaf-blower or has a penchant for home renovations
- Drive home if you’re too tired – take a powernap first
* This is a work of fiction – any resemblance to actual events or persons is entirely coincidental.