A day in the life of an on-call obstetric trainee
Lyndsey Forbes, Fellow in Paediatric Anaesthesia at the Royal Manchester Children's Hospital, shares a typical night shift with us.
And so it begins. I arrive at 20:00 for handover and there's an epidural to do in room one. The day person was asked at 19:55 so plays the relay epidural trick. As soon as I am scrubbed, get the epidural trolley set up, and start to paint the chlorhexidine on her back, there's that announcement, 'I need to push'. Still, I suppose that's one less dural tap.
A few minutes later I gatecrash the evening labour ward round. The obs reg knows me well and has already gone to the mess so he can present me with a large latte on my arrival; before proudly announcing what he has lined up.
It appears that every high-risk lady in the region has decided to appear tonight. It's OK though. I breathe a sigh of relief as I am told they have all visited the obstetric anaesthetic clinic. I go to the clinic letter folder to have a read as I am sure it will tell me what to do. Unfortunately, they only attended last week so the letters haven't been filed yet. It's okay though because as the first patient is wheeled in they start waving a very detailed six-page clinic letter detailing exactly what I should do.
Bloods, two big cannulae, an art line and an early epidural. They seem to be missing the final page of the letter as I can't find the bit that tells me what to do at 03:00 when their epidural stops working, they're going to theatre, declining any further attempt at regional anaesthesia and demanding a general.
Six hours, four epidurals and five sections later, I am called by the labour ward midwife in charge, 'we may or may not be going to theatre, not just yet but possibly at some point in the next six hours, can you hang around just in case'. Eventually, we get to theatre with our next patient and position perfectly for the spinal, but while I set my trolley up there's a contraction. 'Okay, okay, so if you just sit up straight for me. Okay, maybe need to tilt right again, okay, okay, a bit left, okay just a bit right again, oh, you've got another contraction have you?' After 30 minutes of doing the spinal position boogie and several spinal needles later, we mutually agree that I will swap the hyperbaric levobupivicaine for some isobaric thiopentone and suxamethonium, with an endotracheal tube chaser.
As per the norm, we end up with back-to-back sections. Thankfully my spinal this time is slick. I look like a pro, beautiful block and great chat with the parents.
All of a sudden panic ensues within the room 'Catch the baby! Catch the baby! Catch the baby!!' is all that can be heard. Followed by 'T-I-M-B-E-RRRRRRRR...' Dad has hit the floor. Luckily I catch the baby.
In the meantime, the student midwife has called 2222 and in charges the medical registrar, the medical F1, the ICU CT2 and a CCU nurse, all confused as to what exactly they should do in obstetric theatre. Immediately, they are informed by the theatre sister that they are not wearing a hat and sent on their way.
...And the end
It's 07:00, nearly time for handover, the end is in sight, the midwives have been rewarding me for every bleep with a shot of espresso. I start to feel a bit funny and decide to check my heart rate on my iPhone; 300 bpm and regular. Allergic to labour ward? Over-caffeinated? Has to be the former, surely, quick fetch the adrenaline. I am a self-respecting anaesthetist after all. 12 hours later: 11 double espressos, 10 trial of forceps, nine caesareans, eight spontaneous vaginal deliveries, seven epidurals, six fully and pushing, five third-degree tears, four general anaesthetics, three 'tricky veins', two dural taps and an anaesthetist in SVT.
This article was originally published in Anaesthesia News, June 2018.
Cartoon courtesy of Dr Eoin Kelleher, Trainee Committee.