Week #2

Last week:

Monday- Was on L&D today, saw one delivery in the morning and then the rest of the day I spent practicing my sutures as it was a pretty quiet day. I induced several lacerations to my banana and then sutured it up good as new

Tuesday- Clinic day, dont remember anything too special happenin

Wednesday- I slept all day as I had night shift that started at 5pm. I tried to get as much rest as I could since I knew I would not be getting any sleep that night...

When i got to Labor and Delivery at 5pm I was on the move until 8am the next day. One of the patients I admitted around 7pm was a 29yo who had come to the ER because of severe abdominal pain....she then found out in the ER she was pregnant...36 weeks pregnant. How one does not realize you are 36 weeks pregnant I will never be able to figure out but she seemed really surprised. We asked why she hadnt noticed missing her periods and she said they were really irregular anyways and that she was spotting a little so didnt take notice...she also had us talk to her sister because she thought she was playing a joke on her and wouldnt take her seriously. I dont know if this patient was just in serious denial or what but it was a pretty ridiculous story... she must have thought an alien was growing inside her because at 36weeks those babies are kickin!

Soon after we admitted that patient we had a scheduled C- section and though I didnt get to assist, I got to watch the whole thing. One of the nurses asked if I had been in a surgery before and I totally lied and said yeah [so she wouldnt be worried that I would pass out]. She gave me a lil speech anyways saying “dont lock your knees and if you feel light headed or woozy at all just walk right out, no one will say anything so dont be embarrassed”-- she was obviously still worried i would pass out and probably just didnt want to deal with it if i did. I had no idea if i was going to faint or not...i had seen some bloody deliveries and such but really, i hadnt had to smell a cauterizer before so who knows how i was going to react... Well, i was fine. Didnt feel light headed at all...i kept taking deep breaths and reminding myself to not lock my knees but really, i felt fine. It was very good to know that I can handle surgery. It was amazing to watch them yank a new baby out of the uterus of this women and then spend about 20 min closing up each layer of muscle, skin and fascia that they had cut through. While closing, the attending tried to ask me a question about the embryological origin of something. I couldnt really hear what he said so i asked him to repeat the question and he said, “no, no i cant...” He obviously was trying to stump me with a question but was so tired that he didnt remember what he asked.. we all laughed about it and a second later a big squirt of blood hit me, the resident hit an artery accidently and sent a small amount of blood my way. It got all over my scrub shirt. The resident laughed and said, “see, thats what happens here when you dont get a question right.” I laughed and asked if there was any blood on my face. She looked up and said, “oh im sorry did you actually get hit by it? I wouldnt have made such an inappropriate joke if i had known that...” Again, we all had a good laugh at my expensive.

The next delivery I saw was the first episiotomy I have seen. The mom was pushing hard and doing well but the baby’s heart monitor was showing a gradual deceleration and the doctor began to get worried about the baby. She told the mom she needs to get the baby out with the next push or she would have to cut her. the mom flipped out pleading the doctor not to do it. unfortunately, the doc had to tell the patient that it wasnt a question, more of a statement that she had to do it because the baby was beginning to be in danger. The resident eventually cut a lateral incision and the baby came out with the next push...the newborn had the umbilical cord wrapped around her neck twice and the resident and PA quickly unwrapped it, clamped the cord and gave the baby to the NICU team. The baby ended up being fine and we stitched up the mom while her epidural still worked and everything turned out OK.


The next girl I admitted was a 17yo pregnant with her baby [you may think this is young but i have already seen a 16yo deliver her SECOND child]. She was writhing in pain and her bf just sat in the corner of the room texting on his phone. When i asked her what her pain scale was she told me 9.5/10 pain. I then asked if she was planning on getting an epidural and she answered ‘hell yeah’. She hadnt taken any lamaze classes and i dont think she prepared for this delivery at all. im pretty sure she had no idea that she wouldnt be getting an epidural until she was almost completely dilated which could take 10-12 hours in a first time pregnancy. i definitely was not going to be the one to break that to her....

Around 1:30am I started to write progress notes on all the vaginal deliveries and C sections that had happened that day up until midnight. There were 12. I had to look up all their labs, go see them, ask a few questions and do a brief physical. I didnt get done until around 5:15am. Luckily must of them were up feeding their babies. I was glad i didnt have to wake em up because honestly, who is going to be nice to a student doctor that wakes you up at 3am to ask you about your gas, bowel movements, and what birth control options you want?

Rounds were supposed to start at 6:30am but the resident, attending and I got pulled into an emergency C- section. I scrubbed in and assisted on this one. It was the cooooolest. Well, minus the fact that i made an idiot out of myself while the scrub tech was helping me gown up in sterile dressing. its a tricky process. even more tricky when you are being stared at by your attending, resident and the anesthetist. lets just say i didnt make it look graceful. i dont feel too bad though since i am still very new at this and i was being rushed since it was an emergency situation. Anyways, after cutting through all the abdominal layers we finally got to the uterus and after making a long vertical incision I saw a little ear pop out. It took me a second to gather what was going on and then the resident pulled the baby out and layed it down. The surgical tech handed me a suction bulb and i started to suction out the mouth and nose for any mucous. About 30sec after being yanked out of the uterus the baby finally realized something was different and started yelling his head off. It was an amazing site to see and an amazing feeling to know i was one of the first people to touch this new mini-human. The mom consented for a tubal ligation before the c section so after the baby was taken out and the uterus was sutured back up the next job was to ‘“tie her tubes.” i was pretty shocked at how quick it was to do it. They just tie a robe around the tubes, then cut off the part that is tied off. I looked at the resident and said, “thats it?” and she looked at me puzzled sayin,”yeah, what else do you want me to do?” Again, laughter ensued at my expense [im getting used to it].
The attending has to wait until everything but the outer skin is closed and then he steps out. I helped the resident close up the abdomen and then helped clean up the patient. At this point the anesthesia is wearing off and the new mom was awake [getting some morphine of course].
By the time i was done helping clean up and move the c section patient, rounds had already started so i sprinted to the other side of the hospital where the OB and GYN patients are. I met up with the other students, residents and the attending. They were already half way done but I wasnt worried, i was just with this attending in surgery so its not like he thought i was late because i was slacking off...

After rounds we have mandatory lecture from 8am to 9 and i had to stay. I “listened” to the lecture and then took a nap in the on call room until about 10:30am. I drove home, made breakfast and slept all day. Then got up, tried to read, and passed out again for the rest of the night. Sleep is precious.


Friday I was in the clinic, had a couple of interesting patients, learned a lot and got to go home a bit early :)