Many residents complete the one month, optional obstetric rotation at Fairfax INOVA Hospital during the CA3 year.  Fairfax is ranked third nationally in the number of births in a year, providing a fast pace and a wealth of experience for our residents.  Read about a recent day there.

A day at Fairfax

6:20 am I leave the condo that is provided by our department.  The condo is 9 miles from hospital but with traffic around Washington D.C. it takes about 20 minutes to get there.

6:50 am I walk into the Fairfax INOVA Hospital and get a copy of the Cesarean sections scheduled for the day.  There are 7 scheduled C-sections, which is about average for the day’s elective schedule.  I then go to the preoperative area to meet my first patient, who is scheduled for 7:30.  She is a G3P2 having a repeat C-section.  I examine her and complete her anesthesia consent and then go present her to one of the three OB Anesthesia attendings who are on each day.  I am excited to find that one of them is Dr. Kang who was a resident at UVA two years ago.

7:15 am I have just a couple of minutes to grab a quick bite to eat from the physicians’ lounge (free breakfast and lunch every day—awesome!).

7:30 am I arrive in the OR, which is already set up.  My patient is brought into the OR with the circulating nurse.  I place her spinal anesthetic with little difficulty (surprisingly, due to body habitus).  The surgery goes well:  healthy baby, happy mom.  I take patient to recovery room at 8:20.

8:30 am Go to preop my next patient (scheduled for 9:00).  She is an interesting case.  She is a G3P2.  She has had two previous C-sections, each with a spinal.  Unfortunately, she developed a post dural puncture headache with each previous spinal, and both required epidural blood patches for treatment!  In discussing the case with the attending, Dr. Garg, we decide that, given her history, the best plan to avoid a dural puncture would be to place an epidural for her section.  Patient agrees.  

8:50 am We go back to OR and I place epidural and being administering epidural bolus local anesthetic.  We have to remind obstetrician that we need a little longer before we can start due to the fact that we are using an epidural and not a spinal.  We eventually obtain a T4 level and we proceed.  Patient does quite well and has her third baby—a boy this time!  (On post-op check the next day, she is absolutely thrilled that she does not have a headache, she is sitting in bed, holding baby, and so grateful!)

10:10 am Now I go to pre-op my next patient.  She is a 37 year-old G2P0 having a C-section for breech position of her baby.  I spend a good amount of time counseling her as this is her first C-section.  We go back to the room at 10:30 as scheduled.  The spinal is easily placed and all is well.

11:20 am I take a few minutes to grab lunch from lounge and then go pre-op my next patient.

12:00 This is now the fourth C-section of the day and the patient is expecting twins.  My attending, Dr. Kang and I discuss the implications of twin Cesarean delivery before proceeding.  Her spinal anesthetic was placed quickly.  My patient’s blood pressure dropped significantly after the spinal was placed, but we were able to fight off the nausea and her blood pressure was back to baseline in a timely manner.  The C-section went well: Two healthy baby girls.  We were out of the room by 1:00 pm.

1:05 pm I sit down and talk with Dr. Mauney and Dr. Garg to do a mock oral board exam.  They have a patient with a placenta increta (the placenta attaches improperly to not only the uterus but other abdominal organs) tomorrow, which they are planning to do in the main operating room and not on labor and delivery where I am.  We discuss the anesthetic concerns of this case, which include massive blood loss and develop a plan.

1:20 pm It is time for me to go and preop the 1:30 C-section.  There were originally two C-sections planned at this time, but one was cancelled due to the patient successfully having a vaginal delivery the day before.  I do the 1:30 case with Dr. Garg.  Spinal worked well.  Baby healthy, mom and dad happy and of course, so is the anesthesia team.  We are out of OR at 2:30 pm.

3:30 pm I provide the anesthesia care for the last scheduled C-section of the day.  I do this delivery with Dr. Bank.  Our patient is 5 foot even and 240 pounds.  Placing this spinal anesthetic is a little challenging, but with some good coaching for positioning, it goes well.  I have definitely realized that positioning is everything! 4:45 pm It is time for me to be relieved out of the OR for the day.  I am still in a C-section as things are moving a little slower than usual, but the baby is out and healthy and spinal is working nicely.  I give report to a CRNA the anesthesia team has sent to relieve me.   5:00 pm I turn in my phone and take a sneak peak at the schedule for tomorrow—only five scheduled C-sections.  I walk to the car reflecting on my day:  five spinals, one epidural and seven healthy babies, not too bad.  Makes sitting in Northern Virginia’s five o’clock traffic worth it!

Jennifer Conde, CA3