It is 3:00 AM on Monday and you are finishing a weekend call that began on Friday evening at 6:00 PM. During this period of time you have had only about 6 hours of sleep.
The intern on call phones you and relates the laboring patient on oxytocin you have been following has been 5 cm dilated for about 3 hours, and there are some worrisome changes on the fetal monitoring strip. You sleepily tell her to keep the oxytocin going but to check back in an hour.
Five minutes later the nurse caring for the patient urgently requests you to see the patient. Feeling groggy, you arrive at bedside and note the fetal heart rate pattern is now showing persistent late decelerations. Discontinuing oxytocin, giving a fluid bolus, and position change do not correct the situation.
Since the patient is remote from delivery, you proceed with a cesarean birth. Although this is a relatively uncomplicated primary cesarean delivery, you struggle to complete it and, during the course of the surgery, puncture your finger with a needle while suturing.
Following the case, you are able to sleep an hour or so despite interruptions for telephone calls. When awakened at 7:00 AM by your partner taking over call responsibility, you don't remember the substance of the calls. Prior to going home, you complete an elective scheduled laparoscopic tubal sterilization procedure complicated by some bleeding on one tube, managed with cautery.
On the drive home you doze off , with an accident being avoided when you awake as you drive over rumble strips. Just before going to bed, you recall that you forgot to check with infection control regarding possible HIV prophylaxis due to the needle stick.