pleasantly sore

Induction of labour for premature thirty four week twins with fulminating pre eclampsia and a premature thirty five week pregnancy also with fulminating pre eclampsia plus a previous Caesarian Section. The second case using a cervical double balloon catheter.I hope nothing else complicated arrives.Meanwhile colposcopy clinic and more antenatal patients.Pleasantly sore from last night's tennis, a surprise win so through to the losers' final next week.
Outside it's a cool clear sunny winter's day.

Next  patient: I delivered her last baby seven years ago.We catch up while I fill in forms and labels for Pap smear and cervical biopsies.She has bipolar illness, is on a number of medications, and has active hepatitis C from IV drugs. More than half of all people with her condition are alcoholic or drug users although she has been fine since her illness was recognized and treated.A lot of people with behaviour problems have undiagnosed bipolar disease but doctors are now more aware.She is a single mother of four as relationships are also difficult, but she is delightful and her children are well though one sees a psychologist. I take the biopsies and move on.
The twins are close to delivery.

Later: safe arrival of small but healthy girls but then heavy bleeding requiring intravenous oxytocin, rectal misoprostol, and eventually direct transabdominal intrauterine injection of Ergometrine. Blood transfusion already commenced.Then blood pressure high and a fever developing.
Now more than two hours behind in clinic.Everyone is surprisingly friendly despite the long wait and one new patient fails to arrive which helps.Still two in labour and the paperwork to do but relief is in sight.

Seven thirty home but will be back.

sunny day clinic
calmly the patients wait 
two babies survive