A Day In The Life of an OB-GYN

Today is a pretty typical call day for me, and one of my goals for my blog is humanizing doctors by letting people know what our lives really look like, so here we go.

I wake up at 4:45 AM. Not because that was when I was supposed to, but because I’m 46 and insomnia related to perimenopause is real. My mind runs through the events of the day before and today’s plan, and I can’t go back to sleep.  I reset my 5:30 alarm for 6 AM (no workout today) and then drift off at about 5:15 again, and the reset 6 AM alarm wakes me way too fast. After a shower and getting ready for work, I’m in the kitchen by 7.  The rest of the house is still asleep – my husband is a SAHD and my kids are out for summer, so I enjoy a few minutes of time alone in my quiet house with a cup of coffee.  I’d like to say I read or meditated, but really I scrolled Facebook and checked e-mail. This is the calm before the storm. 

I head in to work at 7:30. We switch call at 8 AM, but take home call and my partner may or may not be there,  so sometimes I get a call that a patient has rolled in very dilated and have to drive in quickly.  I always try to make sure I’m able to leave the house if I need to at about 7:15. The hour between 7 and 8 is always the time we get phone calls from people who are just waking up, or the hospital calls with consults they held from the night before.  So I’m ready for whatever happens. Sometimes if I have a scheduled c-section I have to leave by about 6:45 so I can be there a few minutes after 7 to pre-op the patient.  

Today there are inductions only.  I go straight to the hospital to start rounds, and start my inductions for the day. Usually we have 1, maybe 2 inductions, but yesterday there were a few patients with issues who needed to be delivered today so I have three inductions– a fairly busy call day for us in my group.

I round on 4 postpartum patients and do H&P / exam / start inductions on 3 patients.  I see all 7 patients in about 30 min (because most of our postpartum patients are uncomplicated today – otherwise the rounds would have been split between morning and lunch) and then sit down for another 30 min to chart / do H&Ps in the EMR, do discharges, click all the EMR boxes.  

I head to the office at 9 to start seeing my office patients.  I have about 24 office patients on a given call day – 20 scheduled, and 4 work-in slots.  Sometimes it’s more and sometimes it’s less, but this is a usual day.  I schedule mainly OB patients on call because I may get called out to do a delivery and the pregnant patients tend to be a bit more understanding about waiting or being seen by one of my partners – they know it’ll be them who’s pulling me out of the office soon enough.  We also warn patients that they’re seeing the call doctor in case they don’t want the possibility of being delayed – they can see one of my partners who’s not on call if they choose.  

The morning goes pretty smoothly today – minimal phone calls from L&D, no ER emergencies, and no consultant phone calls from the MFM office.  These things are important, but break my rhythm and make me run behind. I leave for lunch at 12 and grab a bite at a place down the street.  That’s a treat today – I usually grab something quick in the hospital cafeteria on call because I’m finishing rounds at lunchtime on call days, or have a scheduled lunchtime c-section.  After lunch I run back by the hospital to check on my laboring patients.  I examine all 3 and see how they’re progressing. One is now 7cm and I figure I’m going to get called away from the office to deliver her mid-afternoon.  The other two are still 4 cm.  They’re likely to be later deliveries after office hours are over. 

I head back to the office, answer a few e-mails, check in with the practice administrator (I’m managing partner at my office and we discuss a couple of business items) and then it’s back to seeing patients for the afternoon.  I get a call at about 2:15 that my patient is completely dilated and the L&D nurses are going to start pushing with her.  My office is right across the street from the hospital and this patient has not had a baby before, so I can see a couple more patients before they’re ready for me.  I’m handed the chart for the 3^rd patient after that and then I get called for delivery.  I get to the hospital in plenty of time, we push a few more times after I get in the room, and then she delivers.  The magnitude of this moment is not lost on me.  I congratulate everyone, cover mom’s perineum so that the family can take pictures while dad cuts the cord, repair a pretty minimal vaginal laceration, and clean up / count sponges and needles / help with the QBL measurement / get weight and APGARS for my note.  I run out to the computer to do my note in the EMR, and print a copy of the note and face sheet for the billing people in the office.  I then run back over to the office because I’m behind now.  

When I get back to the office, my partners have seen the patients whose appointments were while I was gone.  I have another 3 or 4 patients to see and then I’ll be done at the office for the day. I finish up, do some notes I left open earlier in the day, watch a device training video for about 20 min that’s overdue and has resulted in me no longer being able to order that device until I get that done, and print out the certificate for that training to send to the practice administrator.  We touch base again about a few issues at the end of the day, and then I’m off to the hospital.  

It’s now 5pm and I still have 2 in labor in L&D.   I go over and get settled into the call room, check both patients, and then run out to get some dinner.  My husband often brings the kids out close to the hospital for dinner because I live too far away to be home when I have someone in labor.  We meet at a nearby quick place and I get to hug my kids and have dinner with them.  Then I head back to the hospital.  

I sign off on some labs / orders in the EMRs (both the office and hospital EMR in-boxes never end) and head out to check on labor progress for my 2 patients.  They’re changing slowly, but still progressing, so I head back to the call room.  I type the first part of this blog post, and then watch an episode of a show on hulu. I then head back out to the nurse’s station and hang out with the night crew for a while.  I have a triage patient to see while I’m out there – she’s not an admission tonight, but sometimes we’ll admit a patient for an issue that’s not labor, but requires observation overnight to sort out.  I then head back to the call room at about 11:30 to try to nap while I’m waiting for my patients to deliver.  I’ve got a full day in the office tomorrow, so I try to sleep while I can.  

I generally get a few calls overnight from patients through the answering service and/or from the ER. Nothing that requires me to get up and leave the call room, but I try to sit up and put feet on the floor so I make sure I’m fully awake while I’m offering advice / opinions on issues overnight. At about 2:30 I get a call that they’re ready for me for delivery.  The process takes about 45 min to deliver, repair a laceration, and do the note.  I check on labor progress for my other patient still in labor (still moving slowly, but changing) and then head back to the call room again.  I set an alarm for about 6:30 and try to fall asleep again.  I wake to my alarm and go out to see what’s happening – thankfully they’re pushing with my last patient of the night and are almost ready for me for delivery.  We deliver at about 7:15 and I do the repair / note and head out to my 8AM meeting in the office to start the next workday, which will involve seeing 24-28 patients in the office and will finish at about 5PM if I have no after office meetings that night.  

So if your OB-GYN looks tired, it’s because they likely are.  We love what we do.  It’s an honor and a privilege to be there for your baby’s birth – a day you’ll remember for the rest of your life.  But it’s also exhausting.  I’m on call every 4^thnight.  So at least one day a week and one weekend a month (from 8AM Friday to 8AM Monday) this is my day.  

A friend recently mentioned that she had a yelp review from a patient who complained that the OB looked tired when she came in for her delivery at 3AM.  Please show us some grace.  I’m pretty good at wiping the sleep out of my eyes and putting on the work face, but I’m human too.