Postnatal Checks

Having been on obstetrics and gynaecology, I have had to do a fair few postnatal discharges as a resident.

These postnatal discharges are quite repetitive I must say, in that it’s always the same questions. You find out how they delivered their baby, what blood group they are, whether they are rubella immune or not, what complications arose in labour etc.

With any woman that has had a 3rd or 4th degree tear, they have to had opened their bowels before they are allowed home. In addition, they must be getting regular laxatives (usually lactulose) while as an inpatient.

Around the time of Christmas, I see a woman who had a 3rd degree tear. She hasn’t passed bowel motions for the last 5 days. Reading through her notes, she’s been seen by previous residents, even had a general surgery consult in regards to exclude any anal dysfunction. I panic at the prospect that I have to see her.

I eventually decide that I need to see her everyday, after looking at the anus, and noting normal anal tone. She tells me that she’s starting to get abdominal pains, and I think I can feel the poo in her tummy on palpation. Poor thing.

For the next 3 days, I see her every day, always asking if she has pooed yet, and if she has passed wind yet. Still no. It’s about 2 days out from Christmas. The patient informs me “I really do hope that I pass a bowel motion soon. My wedding anniversary is on Christmas.”

I make light of the situation (it’s too good to pass) “Oh goodness. I sincerely hope that you won’t be in hospital waiting for a poo on Christmas and on your wedding anniversary!”.

Pumping her full of laxatives, the patient questions my medical management. “Is there anything else you can do aside from just giving laxatives? I mean I’m really concerned something bad is happening”. I reassure her that the abdominal x-ray series has excluded a bowel obstruction, and that we are giving optimal medical management.

“There is no other alternative aside from either manual disimpaction or inserting a tube up your anus to flush the poo out. But with your 3rd degree tear, those aren’t really good ideas”. The patient almost faints after I explain manual disimpaction, wriggling my index finger. “How will the index finger get the poo high up out!!!???”

I think I was enjoying myself too much teasing this patient. Not in a mean way, but in a light hearted way so as to make the situation less serious.

After seeing her on the 3rd day, news gets out that she has some incontinence. Only a few mls according to the patient however. An hour later, and she has opened her bowels with a massive amount of faeces. I try to see the patient to congratulate her, but she seemed pre-occupied in the toilet. Unfortunately, I wasn’t able to see the patient as I had to rush off to the clinic. But I’m proud of the laxatives I gave this patient.

I feel happy for the patient. At least she doesn’t need to spend Christmas and her wedding anniversary waiting for a poo.

Medical Lexicons Thrown Around In Hospital

In medicine, there are essentially new words and terms to learn. It’s like a whole new language you have to learn.

Below are some of the more interesting terms and abbreviations we doctors throw around verbally and write in medical notes all the time:

 

BIBA – Brought In by Ambulance

I have just seen a 90 year old male BIBA, who came off his Harley Davidson doing 160km/h on the highway

DDx – Short for Differential Diagnosis

Med Student 1: Um, the medical notes have a heading DDx, and then just a list of medical conditions. What does DDx stand for?

Med Student 2: That stands for differential diagnosis – it’s essentially a list of the most likely medical diagnoses based on the history taken.

DRE – Short for digital rectal examination (same as PR)

ED Consultant: The patient in bed 3 hasn’t passed bowel motions in over 10 days. Let’s get one of our interns to perform the DRE on that patient *high fives the other ED senior doctors*

Drip – Cannula (a piece of plastic tubing inserted into the veins to allow blood access for administration of medications)

Intern (speaking to patient): Ok sir, I’m going to need to give you a stab to put this drip in

Patient: You’re going to stab me? That sounds really painful!

Intern: Oh, terribly sorry if I scared you. I meant I’m going to insert this needle into your vein, and leave behind a plastic tubing so that we can give you fluids.

Perf – Short for perforation

On review of the patient’s X-ray, free gas was seen under the diaphragm. The patient has probably got a perf, probably from his peptic ulcer.

PMHx – Short for Past Medical History

Med Student 1: I don’t get it. The notes have PMHx and just the patient’s current illnesses. What does it stand for man?

Med Student 2: Past Medical History. It’s just a list of the patient’s current illnesses.

PR – Short for per rectal (a rectal examination)

Intern (to another intern): Ugh, just had to do a PR on a patient who hasn’t defecated in 10 days after being co-erced by the consultant.

SOB – Shortness of breath

I saw a 55 year old gentleman that presents with acute onset SOB on a background of a 40 pack year smoking history…

Stat – Instantly

That 55 year old gentleman is severely dehydrated from diarrhoea! Give him a fluid order, STAT!