long day

One of the toughest days of my life.For long periods the eye pain seemed unbearable and then would inexplicably improve.I arranged an appointment with the optometrist then cancelled it because I had to book theatre for the emergency pelvic pain case.My clinic was running late due to delays caused by sitting with hands over eyes for up to thirty minutes at a time between patients until able to cope with the pain enough to see the next client.Meanwhile laparoscopy was booked for seven and I would struggle to get there.Missing lunch and dinner helped.As predicted by my secretary I regretted the cancellation of the eye appointment when the pain became more severe again later.
My differential diagnosis included acute conjunctivitis,corneal trauma, shingles,iritis and acute glaucoma.The pain is still there but I am treating myself with antibiotic eyedrops in the hope that it is an infection which hasn't yet had time to respond.
My patient's diagnosis was still open but excluded any type of pregnancy complication since apparently the pregnancy test was negative.At laparoscopy I was surprised to find over 300 ml of blood in the pelvis with tissue and blood clot extruding from the end of the left Fallopian tube in what could only be a tubal miscarriage.After aspirating the clot and tissue there was no further bleeding presumably because the ectopic tissue had now been expelled .The pregnancy test was negative due to degeneration of the pregnancy tissue but a specific blood test will probably detect low levels of pregnancy hormone which should fall to virtual zero eventually to ensure that there is no remaining growing tissue in the tube.If there was she would have methotrexate chemotherapy.
After the laparoscopy there was another vbac patient to assess who then required Caesarian section before I could go home for dinner,still in pain.By now a fierce wind had developed which was just an interesting meteorological phenomenon until I had to avoid small trees and large branches dropped on the road.I was looking up at the overhanging trees as I drove wondering whether I could avoid a lethal limb and genuinely fearful for my safety.Finally arrived home at eleven thirty pm for sausage rolls and tomato sauce.After reading the newspaper for a while I looked up at the clock to find it was already two am,and now three am.
I wonder whether my patient with the stillbirth is in labour yet.
My eye is still sore.