wednesday

Woke with the cat peering intently into my face, nose against the tip of my nose. Then late to work after discovering that the cat has been using the lounge room carpet as a toilet. He will spend his nights in the laundry for the next week or so.

In the clinic:
Abnormal cervix though smear report was ok. GP would like it checked. Everyone naturally anxious at these appointments so I just keep talking. People often ask about my family so I tell them about my children or anything from my past which might resonate or distract. I am not a very private person.
Labour ward is collecting women - two inductions of labour, a planned vaginal birth after Caesarian, and now another with bleeding and pain at twenty eight weeks. Meanwhile the clinic goes on.

Check after laser treatment. Waiting to find out if it is safe to try for a pregnancy. Pretty, but with a turned eye, which would have been prevented if she had been born here. Taking her folate tablets, but wants to know if her husband should be taking any tablets as well. Not been asked that before.

Heavy painful periods despite intrauterine hormonal treatment. Wants hysterectomy. In view of pain and tenderness and failed conservative management - agreed.

Heavy painful periods with fibroid but significant medical problems, not ideal but safer to do endometrial ablation. She would prefer hysterectomy but nearly at menopause so may not need to put her at risk. Arranged ablation.

Vulval itch despite oestrogen, steroid cream, swabs. Biopsy.












Must pay urgent tax bill but no time, wife usually does it. Secretary rings her in hospital - can she pay online with smartphone? Now one and a half hours behind in clinic and may need to go to labour ward.

Left ovarian mass, small, unchanged in six months, benign looking on ultrasound today. Review in six months.

Antenatal reviews by fifteen, and new antenatal patient for repeat VBAC, but concerned about size of baby. Last baby 4.5 kg.

Twins then triplets.

Wife has paid bills from her hospital room. She seems quite well if a little bright.

Finished clinic at eight thirty, without a break since nine am, after calling patients with results, and returning calls. Rising beta hCG after ectopic pregnancy -  will need methotrexate; good response to clomiphene -  can continue with current dose; severe dysplasia -  needs to arrange a day for laser treatment.Unexplained foetal death at seventeen weeks has just delivered, but no sign of the cause. Order tests but small chance of finding an answer.
No immediate problems in labour ward, so home until called in.