Wednesday i got my USMLE score. i am super happy with my results. i checked during clinic and felt pretty good for the rest of the day. i cant believe that much work and sacrifice is done and over and i have finally found out the result of my efforts!
Thursday, July 14, 2011
Wednesday, July 13, 2011
[It’s actually Nov 9 and i am going back to finish up writing about my last 3 weeks of OB/ GYN. its not that i didnt like the rotation and didnt want to write about it, it was the exact opposite. I loved it so much and was working so hard that i really had no time to write, and when i did have time, i was sleeping or enjoying the minimal outside hospital life i had. i hope i can incorporate all the details and feelings i had during this time but really, i dont think i will be able to because i really loved this rotation and am having a hard time trying to convince myself to NOT go into OB/GYN because as amazing as it is, the lifestyle is just so poor.]
Monday morning of this week started with a grunt as i pulled myself out of bed. I had just done my 24 hour shift and got home Sunday morning and then now i had to go back to work to another 5 day week. no bueno. It was just a clinic day and we ended really late, i didnt leave until 6:30pm.
Getting home around 7:30pm on Monday night, i ate dinner, showered, and went to sleep. I had to be at the hospital for rounds that started at 6:30am so i left the house around 5:30am. In the middle of rounds i left with Dr. S [a resident] to go into the OR to start an entire day of surgery. I was pretty excited given the fact that the last laparoscopic surgery i was in was rad!
The first surgery thing i did that morning was an exploratory laparoscopy on a female who they thought had endometriosis [it was the same procedure i was in last week.] the lady ended up not having any major endometriosis in her abdomen so we closed up. my biggest accomplishment was scrubbing in correctly and not looking like an idiot :)
The next 2 procedures were D&C’s [dilation and curettage]. Both were to make sure there were no products of conception left in the uterus after both women had missed abortions [aka a miscarriage, aka a NON therapeutic abortion.]
Then the big one came up. We were doing a total abdominal hysterectomy. Thus, we were taking out a woman’s uterus by cutting open her abdomen. reason for her surgery was that her uterus had become a very large fibroid and was causing a lot of post- menopausal bleeding and some major abdominal pain. The attending [Dr.W] and the resident [Dr.H] stood on either side of the body and i stood between the legs as they were spread apart in stirrups [i know this sounds gross but everything but the operating field are covered in blue sterile drapes so really it wasnt that bad.] We started the surgery around 2pm and i had no idea what i had gotten myself into. actually, the resident and attending felt the same way. we started dissecting down to the uterus and every time we cut or cauterized, the patient would bleed more. the fibroid had been there for so long and was so large that it had creating a million different new blood vessels to sustain itself. this thing was huge, it measured 19cm on ultrasound [to put this into perspective, your uterus should grow 1cm each week during pregnancy. thus, this ladies uterus was acting like she was 19 weeks pregnant].
The procedure took us hours. we had to be so careful every step of the way to make sure she didnt hemorrhage and all of us were exhausted. most of all, the attending. she actually got a really bad cramp in her arm and had to stop for about 15 minutes. this procedure takes a lot of muscle. im talking ripping open stuff, using muscles to get to the right location, etc. Dr. W was sweating like a pig [and of course we are under hot hot lights.] She must have gotten so dehydrated that her arms started cramping up and needed a hydration boost. we all joked about hooking her up to an IV and rehydrating her with some saline.
when we finally got the uterus out it was the most disgusting thing i have ever seen. it was huge. it also was extremely funny looking because it had an aborting uterine fibroid. she had let this thing grow without getting any medical care for so long that the middle of her uterus began to fibrous and it got so large and heavy that it began to DILATE her cervix and fall out. DISGUSTING.
Of course, we finally finished the procedure [even though i thought it would never end] and before we closed up the abdomen, Dr. W looked over at the resident and said, “let’s look around and find something cool for Dorothy to look at.” I was ecstatic. Mostly because she knew my name,this attending was a hardass and as cool as she was, she never really learned anyones name. But hey, she learned mine. point me!
I left the hospital at 7pm that day and didnt mind a bit. i was so freaking tired but it was a really great day. sadly, i had to be back at 5am on Wednesday to see my post-surgical patient’s before rounds. damnit.
I woke up late on Wednesday and got to the hospital around 5:45am. oops. i was talking to my patient who we did a TAH on and in comes the resident, we ended up talking to her together and doing a quick physical exam, then left the room. i got some major attitude from Dr. H. she pretty much scolded me for not being there earlier enough. “you are supposed to be there waaay earlier than me.” she kinda rolled her eyes and left and i felt like crap the rest of the morning. we had a pretty good relationship i thought so it was surprised. but hey, we all have our moments and i have to admit, i was really late that day so i guess i deserved it.
After rounds and lecture i went to clinic. there was a first year from UCR there that was shadowing [why he was spending his last remaining summer shadowing at a hospital i will never figure out...] He came in with me to watch a pap smear and pelvic exam and when we got out of the room he went, “wow, your really good at that.” i didnt know whether to be flattered or not. is that really something to be proud of? i guess...
This was the first day i had an inmate as a patient. she was a young girl named Mikeala and at first i was really hesitant to go in the room. she ended up being really cool and i kinda felt bad for her. she was pregnant and in jail, that cant be fun. even worse, we arent allowed to tell inmates any plans or dates of things [because of the potential of setting up a way to escape] so i couldnt even tell her her due date. bummer.
Tuesday, July 12, 2011
Monday, July 11, 2011
monday- early AM notes, home at 8am
-tues-was a pretty fantastic day. Tiring, but fantastic. It started at 4:45am when i got up and got to the hospital for 6:30am. I attended rounds and then at 7:45am headed up to the surgical ward to be in my first surgery [well, i guess 3rd if you are counting c- sections]. This was on a 26yo female who was having severe abdominal pains and was scheduled for an exploratory laparoscopy to rule out [or in] endometriosis. We started out by waiting for the anesthesia team to sedate the patient and then we set her up for how we wanted the body to be positioned during the surgery. Once that was done, I scrubbed in along with the resident and the attending. Again, I made myself look like an amateur. I am tellin you, getting into a sterile gown without looking like you are new at it is very hard to do... Process is you scrub at the sink, keep your arms up above your waist and walk into the OR without touching anything. You then walk to the scrub nurse who has already set aside your sterile gloves and gown. To my dismay, the attending and resident had already gowned and gloved so they just stood and watched me do it. Pressure was on. First the scrub nurse handed me a sterile towel to dry off...i messed that up and the attending pointed out the proper way to do it next time [i was still sterile at this point though, just didnt do it the “proper” way], next the scrub nurse holds out the gown and you put your gloves through [thats an easy part... a monkey could do that correctly], after that comes the gloves.....this is where the pro’s are separated from us retarded medical students. The nurse holds out the gloves so all i have to do is put my hand in it and go straight down quickly so my hands slips in. Sounds sooooo easy but i swear its not. Every time i have done it by fingers end up in different finger slots and i have to readjust it once my other glove is on. Oh wait, did i forget to mention that when i put on my first glove this time but ungloved hand hit my sterile gown and the attending made me take it all off and re-gown? :/ oops. Though i am making the attending sound like a hard-ass, i really shouldnt be because she is one of the most patient, kind and helpful doctors i have worked with [in fact, i have gotten really lucky because all of the attendings at the hospital are like her...or at least most!].
So after all this, we began the surgery and on my mind the entire time was “dont put your hands down, dont put your hands down, dont put your hands down.” See, when you are sterile, you are only sterile around your chest and down to your belly button so if you lower your hands too low or too high you become unsterile and that is bad...very bad. The other thing on my mind was, “that is fucking awesome.” We cut a small incision right under the belly button, stuck a needle into this woman’s abdomen to get to the peritoneum [where all your insides are], put some gas into it to blow it up and give us more room to work, and then stuck a camera down the hole. Then we cut two small incisions a little lower on each side so we could stick other tools. It is really that easy. Watching up on a TV monitor, I was so excited to see the uterus, ovaries, fallopian tubes, bowel etc etc. All things I have memorized the anatomy of and can finally but that knowledge to use! One of the coolest things i saw was when the turned the scope around to see the liver and you could see the ribs and abdomen above it. Basically, it was an inside view of the rib cage and it was gorgeous to see. The ribs were rising and falling with each respiration [being done by a ventilator since the patient was under anesthesia and a muscle blocker] and looking at all the arteries and such was just a really amazing sight to see [yeah im a science nerd, ill admit it].
So the patient ended up having endometriosis [look it up] and we cauterized a lot of it, took some pictures with the scope and then finished up. As we closed up the very minimal incisions with sutures the pt started to come out of her anesthesia and began moving her legs around. it scared the shit out of me. i was so scared she was gonna wake up at the end and yell at us that she could feel it all but she didnt...dont worry. she did look like she was in a ton of pain after the surgery though...even if the incisions are tiny and minimally invasive she still have people rummaging around her in inner pelvis...that cant be pleasant any way you do it.
After the surgery I walked with the team and the pt [in her gurney] into the post-op room. Talked with the resident a bit about the surgery and then was told to get some food and go to the clinic for the rest of the day. It was about 10am at this point [the surgery started around 8]. I went down to the clinic still wearing my scrubs and pretty much felt like a bad ass for the rest of the day [i realize how stupid that sounds but it pretty accurately describes my mood]. I was on such a natural high from the morning surgery and was in a really great mood. Everyone i talked to and every patient i saw must have thought i was on something.
One of the first patients i saw was a women who was in her first trimester of pregnancy and had brought her 4 year old daughter who was the cutest lil girl ever. I feel like i spoke so comfortably and confidently to both of them that the little girl started to become less shy and started asking me a ton of question and the mom become very relaxed with me. After spending a lot of time talking to both of them, I presented to Dr.R and when we decided to do a pap smear he said ok, go do the pap. I was nervous as this would be my first pap smear alone [without an attending though a nurse is always there assisting] but i was pretty happy that Dr. R trusted me enough and had enough of an opinion on me to think i was competent to do it alone [though that just shows that when you dont have insurance and you go to a county hospital you ‘get what you pay for’ sorta speak--- AKA, a medical student doing your pap smear by herself]. I ended up being able to do the exam myself and everything went well. I swear, scrubs make you feel good/confident [though they make you sweat a lot...these damn things dont let your skin breathe!]
things i learned:
i miss men-- seriously, 95% of people i see everyday are female. or as Anna would say, every day is Vaginaday
-tues-was a pretty fantastic day. Tiring, but fantastic. It started at 4:45am when i got up and got to the hospital for 6:30am. I attended rounds and then at 7:45am headed up to the surgical ward to be in my first surgery [well, i guess 3rd if you are counting c- sections]. This was on a 26yo female who was having severe abdominal pains and was scheduled for an exploratory laparoscopy to rule out [or in] endometriosis. We started out by waiting for the anesthesia team to sedate the patient and then we set her up for how we wanted the body to be positioned during the surgery. Once that was done, I scrubbed in along with the resident and the attending. Again, I made myself look like an amateur. I am tellin you, getting into a sterile gown without looking like you are new at it is very hard to do... Process is you scrub at the sink, keep your arms up above your waist and walk into the OR without touching anything. You then walk to the scrub nurse who has already set aside your sterile gloves and gown. To my dismay, the attending and resident had already gowned and gloved so they just stood and watched me do it. Pressure was on. First the scrub nurse handed me a sterile towel to dry off...i messed that up and the attending pointed out the proper way to do it next time [i was still sterile at this point though, just didnt do it the “proper” way], next the scrub nurse holds out the gown and you put your gloves through [thats an easy part... a monkey could do that correctly], after that comes the gloves.....this is where the pro’s are separated from us retarded medical students. The nurse holds out the gloves so all i have to do is put my hand in it and go straight down quickly so my hands slips in. Sounds sooooo easy but i swear its not. Every time i have done it by fingers end up in different finger slots and i have to readjust it once my other glove is on. Oh wait, did i forget to mention that when i put on my first glove this time but ungloved hand hit my sterile gown and the attending made me take it all off and re-gown? :/ oops. Though i am making the attending sound like a hard-ass, i really shouldnt be because she is one of the most patient, kind and helpful doctors i have worked with [in fact, i have gotten really lucky because all of the attendings at the hospital are like her...or at least most!].
So after all this, we began the surgery and on my mind the entire time was “dont put your hands down, dont put your hands down, dont put your hands down.” See, when you are sterile, you are only sterile around your chest and down to your belly button so if you lower your hands too low or too high you become unsterile and that is bad...very bad. The other thing on my mind was, “that is fucking awesome.” We cut a small incision right under the belly button, stuck a needle into this woman’s abdomen to get to the peritoneum [where all your insides are], put some gas into it to blow it up and give us more room to work, and then stuck a camera down the hole. Then we cut two small incisions a little lower on each side so we could stick other tools. It is really that easy. Watching up on a TV monitor, I was so excited to see the uterus, ovaries, fallopian tubes, bowel etc etc. All things I have memorized the anatomy of and can finally but that knowledge to use! One of the coolest things i saw was when the turned the scope around to see the liver and you could see the ribs and abdomen above it. Basically, it was an inside view of the rib cage and it was gorgeous to see. The ribs were rising and falling with each respiration [being done by a ventilator since the patient was under anesthesia and a muscle blocker] and looking at all the arteries and such was just a really amazing sight to see [yeah im a science nerd, ill admit it].
So the patient ended up having endometriosis [look it up] and we cauterized a lot of it, took some pictures with the scope and then finished up. As we closed up the very minimal incisions with sutures the pt started to come out of her anesthesia and began moving her legs around. it scared the shit out of me. i was so scared she was gonna wake up at the end and yell at us that she could feel it all but she didnt...dont worry. she did look like she was in a ton of pain after the surgery though...even if the incisions are tiny and minimally invasive she still have people rummaging around her in inner pelvis...that cant be pleasant any way you do it.
After the surgery I walked with the team and the pt [in her gurney] into the post-op room. Talked with the resident a bit about the surgery and then was told to get some food and go to the clinic for the rest of the day. It was about 10am at this point [the surgery started around 8]. I went down to the clinic still wearing my scrubs and pretty much felt like a bad ass for the rest of the day [i realize how stupid that sounds but it pretty accurately describes my mood]. I was on such a natural high from the morning surgery and was in a really great mood. Everyone i talked to and every patient i saw must have thought i was on something.
One of the first patients i saw was a women who was in her first trimester of pregnancy and had brought her 4 year old daughter who was the cutest lil girl ever. I feel like i spoke so comfortably and confidently to both of them that the little girl started to become less shy and started asking me a ton of question and the mom become very relaxed with me. After spending a lot of time talking to both of them, I presented to Dr.R and when we decided to do a pap smear he said ok, go do the pap. I was nervous as this would be my first pap smear alone [without an attending though a nurse is always there assisting] but i was pretty happy that Dr. R trusted me enough and had enough of an opinion on me to think i was competent to do it alone [though that just shows that when you dont have insurance and you go to a county hospital you ‘get what you pay for’ sorta speak--- AKA, a medical student doing your pap smear by herself]. I ended up being able to do the exam myself and everything went well. I swear, scrubs make you feel good/confident [though they make you sweat a lot...these damn things dont let your skin breathe!]
things i learned:
i miss men-- seriously, 95% of people i see everyday are female. or as Anna would say, every day is Vaginaday
Saturday July 9, 2011. My first ever 24 hour shift.
5am- Show up at hospital to write some progress notes. Rounds are supposed to start at 6am on Saturdays. The work day had barely started for me and i was immediately thrown into a delivery and assisted Jen, another PA resident. I have never been so glad to be wearing a gown and big boots as this baby came out with a wave of amniotic fluid. I am not kidding you, there was fluid everywhere....including jen’s hair. I immediately ducked behind her as the baby was flying out and saved myself the DISGUSTINGNESS of having amniotic fluid and blood in my hair. I kinda wanted to vomit. This is the first time i have ben grossed out by a vaginal birth [for a second i had decided OB/GYN was not for me...then i changed my mind when i saw the cute baby after]. When we finished up [she had to be sutured up a bit] we joined everyone for rounds.
6am-ish- Rounds were a little different than the ones i had previously been on before because this time we had a patient in the ‘incarcerated’ ward. Basically, an inmate from a local penitentiary had to have a C section and once she had delivered, she is sent to the 4th floor were all jailed patients go. To enter the ward you have to show your ID, go in one door which is locked behind you and then the next door is opened. I was very intimidated.... Each room door is locked and the patients are handcuffed to their beds. To enter a room you need to be accompanied by a guard and you can’t bring anything inside with you [they could stab you with your pen or strangle you with your stethescope...]. I just stood behind the group and kept quiet. I felt pretty safe though considering the guard with us was around 7 feet tall...and i am not exaggerating! As we were walking out of the ward I looked into one of the rooms and nearly peed in my pants when i saw a 20something year old guy just staring at me...he was standing on the other side of the door window tracing circles with his finger and looked like he was crazy...seriously mental. I looked away and walked as fast as i could haha.
After rounds I scrubbed in on a C/S with a resident and attending. The baby was breech [feet first] so she had to have the section instead of a vaginal delivery. It was pretty fun to see the doctors yank out this baby one leg at a time. During the section there is a blue sheet that hangs above the stomach so you cannot see the patients face. By the time we walked into the surgery room the patient had already been covered up. It was a nice suprise to see the mom after the C/S and realize that i recognized her from the womens health clinic that we work at. As we pulled the baby out dr. L yelled happy birthday! we all laughed.
We had another vaginal delivery soon after the C section and then had some time to relax and eat breakfast. As i am eating i hear a big commotion outside in the hall and when i get up and walk out people are running into room 2. I followed to see what was going on and then heard people shouting to get the crash cart. It was all very dramatic. I helped the nurse push the crash cart down the hall and into the room but by the time we got there the patient was fine. Her BP had dropped suddenly when her epidural was being placed [which is very normal] and the nurse couldnt find her pulse again so she thought she was going into cardiac arrest. The patient was fine but I dont think her cousin was....i could hear her down the hall shouting on her phone to family members telling them to ‘get their ass to the hospital’...she was both very loud and pissed off at someone and i tryed to calm her down but then gave up because clearly she was just overreacting.
Later in the day we had a patient come up from the ER that had been in a car accident and was 27 weeks pregnant. We observed her for 6 hours and then sent her home. She also was fine.
Then we had another ER consult, a 19yo pregnant girl got shot in the shoulder. We went down to the ER to see her and evaluate her. One thing, the ER is a great place...lots going on and lots of men around. Seriously, i feel like my standards have greatly fallen because if i just smell cologne i am attracted to someone...its kinda pathetic. Bad thing is, everyone is wearing scrubs so you never know if someone is a doctor or a janitor [no joke, i came into the hospital one day at 5am and the guy cleaning the floor was wearing scrubs] this makes it difficult to find a legit man...
So we get the patients fetal heart rate and see that her and the baby are doing well so we tell them to admit her to L&D when they are ready. Hours go by and we call down to the ER to see where the pt is and it turns out she left. They literally couldnt find her. She gave a fake name and peaced out.
We had 2 fetal demise patient this shift also. Both were full term pregnancies [38-40 weeks] and the parents were devastated. After delivery, it was found that one of the babies had the cord around their neck and the other had a very short umbilical cord that was not being perfused with enough oxygen. I didnt see either of them being born because i really didnt want to have to go through that. After, the nurses take the babies bodies and the hospital has pretty boxes to hold the clothes, lock of hair etc and then another little box of the babies footprints. it was all very respectful and everyone had a similar feeling of despair at the fact that there is no way to prevent these accidents from happening. 2 in 1 shift is a rare event and it made the afternoon a little less happy.
that night i was in another vaginal delivery but i did not get to scrub in since another intern did. i ended up helping the nurse with the newborn and i really loved it. right after the baby is delivered they are passed off to another nurse to go under the baby warmer and get all the goo wiped off of them. I was the first person to listen to his tiny lungs and try to count his really fast heartbeat [babies can have heart rates up to 160!] he was beautiful and although he wouldnt stop screaming, i kept thinking how much i love my job.
in another vaginal delivery that night we had to use the vacuum pump to get the baby out because it was not descending into the pelvis fast enough. imagine a little suction cup put on the babies head and a handle on the other end. it isnt used often but it does help when the baby is not coming fast enough and they start to get into danger. after delivery this kid had the worst cone head i have ever seen [dont worry, newborns have very pliable skulls and the shape will go back to normal]
the rest of the night was me writing progress notes on all the c section patients that were in the post-partum ward of the hospital. i was up checking on patients, looking up their labs, meds, etc and writing in their charts from 1am to 3:30 or 4am. After, i told the resident i was going to sleep in the call room for about an hour. I slept for almost 2 hours and then woke up at 5:15 because rounds on sunday were at 5:30.
i was exhausted.
i rounded on my patients and then the attending said i could go home. i asked if she was sure and the resident look at me and said "if the attending tells you to go home, get out of here." i laughed and left to get my stuff in the call room. i felt ok to drive so i came home, act breakfast and crashed until 4pm sunday. i ended up going to the movies and trying to take advantage of my 12 hour weekend. it was pretty rough knowing i wouldnt have a day off until the upcoming saturday.
it was a long 27 hours but man was it fun.
6am-ish- Rounds were a little different than the ones i had previously been on before because this time we had a patient in the ‘incarcerated’ ward. Basically, an inmate from a local penitentiary had to have a C section and once she had delivered, she is sent to the 4th floor were all jailed patients go. To enter the ward you have to show your ID, go in one door which is locked behind you and then the next door is opened. I was very intimidated.... Each room door is locked and the patients are handcuffed to their beds. To enter a room you need to be accompanied by a guard and you can’t bring anything inside with you [they could stab you with your pen or strangle you with your stethescope...]. I just stood behind the group and kept quiet. I felt pretty safe though considering the guard with us was around 7 feet tall...and i am not exaggerating! As we were walking out of the ward I looked into one of the rooms and nearly peed in my pants when i saw a 20something year old guy just staring at me...he was standing on the other side of the door window tracing circles with his finger and looked like he was crazy...seriously mental. I looked away and walked as fast as i could haha.
After rounds I scrubbed in on a C/S with a resident and attending. The baby was breech [feet first] so she had to have the section instead of a vaginal delivery. It was pretty fun to see the doctors yank out this baby one leg at a time. During the section there is a blue sheet that hangs above the stomach so you cannot see the patients face. By the time we walked into the surgery room the patient had already been covered up. It was a nice suprise to see the mom after the C/S and realize that i recognized her from the womens health clinic that we work at. As we pulled the baby out dr. L yelled happy birthday! we all laughed.
We had another vaginal delivery soon after the C section and then had some time to relax and eat breakfast. As i am eating i hear a big commotion outside in the hall and when i get up and walk out people are running into room 2. I followed to see what was going on and then heard people shouting to get the crash cart. It was all very dramatic. I helped the nurse push the crash cart down the hall and into the room but by the time we got there the patient was fine. Her BP had dropped suddenly when her epidural was being placed [which is very normal] and the nurse couldnt find her pulse again so she thought she was going into cardiac arrest. The patient was fine but I dont think her cousin was....i could hear her down the hall shouting on her phone to family members telling them to ‘get their ass to the hospital’...she was both very loud and pissed off at someone and i tryed to calm her down but then gave up because clearly she was just overreacting.
Later in the day we had a patient come up from the ER that had been in a car accident and was 27 weeks pregnant. We observed her for 6 hours and then sent her home. She also was fine.
Then we had another ER consult, a 19yo pregnant girl got shot in the shoulder. We went down to the ER to see her and evaluate her. One thing, the ER is a great place...lots going on and lots of men around. Seriously, i feel like my standards have greatly fallen because if i just smell cologne i am attracted to someone...its kinda pathetic. Bad thing is, everyone is wearing scrubs so you never know if someone is a doctor or a janitor [no joke, i came into the hospital one day at 5am and the guy cleaning the floor was wearing scrubs] this makes it difficult to find a legit man...
So we get the patients fetal heart rate and see that her and the baby are doing well so we tell them to admit her to L&D when they are ready. Hours go by and we call down to the ER to see where the pt is and it turns out she left. They literally couldnt find her. She gave a fake name and peaced out.
We had 2 fetal demise patient this shift also. Both were full term pregnancies [38-40 weeks] and the parents were devastated. After delivery, it was found that one of the babies had the cord around their neck and the other had a very short umbilical cord that was not being perfused with enough oxygen. I didnt see either of them being born because i really didnt want to have to go through that. After, the nurses take the babies bodies and the hospital has pretty boxes to hold the clothes, lock of hair etc and then another little box of the babies footprints. it was all very respectful and everyone had a similar feeling of despair at the fact that there is no way to prevent these accidents from happening. 2 in 1 shift is a rare event and it made the afternoon a little less happy.
that night i was in another vaginal delivery but i did not get to scrub in since another intern did. i ended up helping the nurse with the newborn and i really loved it. right after the baby is delivered they are passed off to another nurse to go under the baby warmer and get all the goo wiped off of them. I was the first person to listen to his tiny lungs and try to count his really fast heartbeat [babies can have heart rates up to 160!] he was beautiful and although he wouldnt stop screaming, i kept thinking how much i love my job.
in another vaginal delivery that night we had to use the vacuum pump to get the baby out because it was not descending into the pelvis fast enough. imagine a little suction cup put on the babies head and a handle on the other end. it isnt used often but it does help when the baby is not coming fast enough and they start to get into danger. after delivery this kid had the worst cone head i have ever seen [dont worry, newborns have very pliable skulls and the shape will go back to normal]
the rest of the night was me writing progress notes on all the c section patients that were in the post-partum ward of the hospital. i was up checking on patients, looking up their labs, meds, etc and writing in their charts from 1am to 3:30 or 4am. After, i told the resident i was going to sleep in the call room for about an hour. I slept for almost 2 hours and then woke up at 5:15 because rounds on sunday were at 5:30.
i was exhausted.
i rounded on my patients and then the attending said i could go home. i asked if she was sure and the resident look at me and said "if the attending tells you to go home, get out of here." i laughed and left to get my stuff in the call room. i felt ok to drive so i came home, act breakfast and crashed until 4pm sunday. i ended up going to the movies and trying to take advantage of my 12 hour weekend. it was pretty rough knowing i wouldnt have a day off until the upcoming saturday.
it was a long 27 hours but man was it fun.
Thursday, July 7, 2011
OB GYN Week 3
Monday- i had to be at the hospital from 5am to 8am just to write notes and then had the rest of the day off...kinda put a damper on the day [it was the 4th of july!]
Tuesday was a pretty fantastic day. Tiring, but fantastic. It started at 4:45am when i got up and got to the hospital for 6:30am. I attended rounds and then at 7:45am headed up to the surgical ward to be in my first surgery [well, i guess 3rd if you are counting c- sections]. This was on a 26yo female who was having severe abdominal pains and was scheduled for an exploratory laparoscopy to rule out [or in] endometriosis. We started out by waiting for the anesthesia team to sedate the patient and then we set her up for how we wanted the body to be positioned during the surgery. Once that was done, I scrubbed in along with the resident and the attending. Again, I made myself look like an amateur. I am tellin you, getting into a sterile gown without looking like you are new at it is very hard to do...
Process is you scrub at the sink, keep your arms up above your waist and walk into the OR without touching anything [some of us have been caught walking like this well after the surgery has finished just because we are so trained to do this during the surgery]. You then walk to the scrub nurse who has already set aside your sterile gloves and gown. To my dismay, the attending and resident had already gowned and gloved so they just stood and watched me do it... Pressure was on... First the scrub nurse handed me a sterile towel to dry off...immediately i messed that up and the attending pointed out the proper way to do it next time [i was still sterile at this point though, just didnt do it the “proper” way], next the scrub nurse holds out the gown and you put your hands through the arm holes [thats an easy part... a monkey could do that correctly], after that comes the gloves.....this is where the pro’s are separated from us retarded medical students. The nurse holds out the gloves so all i have to do is put my hand in it and go straight down quickly so my hands slips in. Sounds sooooo easy but i swear its not. Every time i have done it my fingers end up in different finger slots and i have to readjust it once my other glove is on. Oh wait, did i forget to mention that when i put on my first glove this time but ungloved hand hit my sterile gown and the attending made me take it all off and re-gown? :/ oops. Though i am making the attending sound like a hard-ass, i really shouldnt be because she is one of the most patient, kind and helpful doctors i have worked with [in fact, i have gotten really lucky because all of the attendings at the hospital are like her...or at least most of them!]
So after all this, we began the surgery and on my mind the entire time was “dont put your hands down, dont put your hands down, dont put your hands down.” See, when you are sterile, you are only sterile around your chest and down to your belly button so if you lower your hands too low or too high you become unsterile and that is bad...very bad. The other thing on my mind was, “this is f*cking awesome.” We cut a small incision right under the belly button, stuck a needle into this woman’s abdomen to get to the peritoneum [where all your insides are], put some gas into it to blow it up and give us more room to work, and then stuck a camera down the hole. Then we cut two small incisions a little lower on each side so we could stick other tools. It is really that easy. Watching up on a TV monitor, I was so excited to see the uterus, ovaries, fallopian tubes, bowels etc etc. All things I have memorized the anatomy of and can finally put that knowledge to use! One of the coolest things i saw was when the turned the scope around to see the liver and you could see the ribs and abdomen above it. Basically, it was an inside view of the rib cage and it was gorgeous to see. The ribs were rising and falling with each respiration [being done by a ventilator since the patient was under anesthesia and a muscle blocker] and looking at all the arteries and such was just a really amazing sight to see [yeah im a science nerd, whatevs].
So the patient ended up having endometriosis [look it up] and we cauterized a lot of it, took some pictures with the scope [looked like lil blisters everywhere] and then finished up. As we closed up the very minimal incisions with sutures the pt started to come out of her anesthesia and began moving her legs around. it scared the shit out of me. i was so scared she was gonna wake up at the end and yell at us that she could feel it all but she didnt...dont worry. she did look like she was in a ton of pain after the surgery though...even if the incisions are tiny and minimally invasive she still had people rummaging around in her pelvis...that cant be pleasant any way you do it.
After the surgery I walked with the team and the pt [in her gurney] into the post-op room. Talked with the resident a bit about the surgery and then was told to get some food and go to the clinic for the rest of the day. It was about 10am at this point [the surgery started around 8]. I went down to the clinic still wearing my scrubs and pretty much felt like a bad ass for the rest of the day [i realize how stupid that sounds but it pretty accurately describes my mood]. I was on such a natural high from the morning surgery. Everyone i talked to and every patient i saw must have thought i was on prozac.
One of the first patients i saw was in her first trimester of pregnancy and had brought her 4 year old daughter who was the cutest lil girl ever. I feel like i spoke so comfortably and confidently to both of them that the little girl started to become less shy and started asking me a ton of question and the mom become very relaxed with me. After spending a lot of time talking to both of them, I presented to Dr.R and when we decided to do a pap smear he said ok, go do the pap. I was nervous as this would be my first pap smear alone [without an attending, though a nurse is always there assisting/chaperoning] but i was pretty happy that Dr. R trusted me enough and had enough of an opinion of me to think i was competent to do it alone [though that just shows that when you dont have insurance and you go to a county hospital you ‘get what you pay for’ sorta speak--- AKA, a medical student doing your pap smear by herself]. I ended up being able to do the exam myself and everything went well. I swear, scrubs make you feel damn good/confident [though they make you sweat a lot...those things dont let your skin breathe at all!]
Wednesday Clinic- Saw an 18yo bipolar girl with a very flat affect. Made me a bit scared of my future psych rotation.
Saw a 24yo G4P4 who nearly jumped off the table when i barely touched her with the speculum. She was deathly afraid of anyone doing an exam on her yet she pushed 4 babies out of her vagina?
Met a crazy lady who told me the airplanes in the sky are spraying aluminum on all of us and making us sterile. Very nice woman but a bit off...
End of the day I say a very skinny, pale 45yo women who had severe menstrual bleeding. Severe enough to decrease her hemoglobin to 6.4. We did an ECC/EMB on her and then I recommended that she be admitted and transfused because she was feeling so weak and dizzy after. The doctor agreed and I helped convince the lady to stay and be admitted because i was scared she could harm herself by passing out when driving home....she looked as white as a sheep. It was scary to look at her. I ultimately built a lot of repore with her and convinced her to stay the night to get a blood transfusion. When I came back to the hospital on thursday i checked up on her labs and saw that her hemoglobin had dropped from 6.4 to 5.6 in 2 weeks. This is a pretty severe decrease....made me very happy and proud of myself that I got her to be admitted to the hospital and taken care of.
Thursday and Friday clinic I saw a bunch more patients but the one i remember the most is a young hispanic women who had recently been told she had a miscarriage. She had gone to the ER when she started bleeding and they told her the fetus was gone and to follow up at our clinic. She was very upset and crying to me and it was very emotional. I had a hard time consoling her because we were using a translator but ultimately i think i did a good job by explaining to her that 1 in 4 pregnancies miscarry and that it is a completely natural event. I hope she will be able to get pregnant in the future. I was more affected by this patient that i thought i would be. When i went into the ‘hang out’ room i guess i was noticeably sad because someone asked me what was wrong. It was hard to let the emotions go and move onto my next patient.
things i learned:
-i miss men-- seriously, 95% of people i see everyday are female. or as Anna would say, every day is Vaginaday
-i realize i need to learn spanish but i have also come to the realization that my patients will hopefully be trying to learn english also
-lots of women CAN'T afford their birth control pills, but they CAN afford to get their hair done, nails done, and a cute new cellphone?
- its really hard to stay up past 9:30pm these days!
Tuesday was a pretty fantastic day. Tiring, but fantastic. It started at 4:45am when i got up and got to the hospital for 6:30am. I attended rounds and then at 7:45am headed up to the surgical ward to be in my first surgery [well, i guess 3rd if you are counting c- sections]. This was on a 26yo female who was having severe abdominal pains and was scheduled for an exploratory laparoscopy to rule out [or in] endometriosis. We started out by waiting for the anesthesia team to sedate the patient and then we set her up for how we wanted the body to be positioned during the surgery. Once that was done, I scrubbed in along with the resident and the attending. Again, I made myself look like an amateur. I am tellin you, getting into a sterile gown without looking like you are new at it is very hard to do...
Process is you scrub at the sink, keep your arms up above your waist and walk into the OR without touching anything [some of us have been caught walking like this well after the surgery has finished just because we are so trained to do this during the surgery]. You then walk to the scrub nurse who has already set aside your sterile gloves and gown. To my dismay, the attending and resident had already gowned and gloved so they just stood and watched me do it... Pressure was on... First the scrub nurse handed me a sterile towel to dry off...immediately i messed that up and the attending pointed out the proper way to do it next time [i was still sterile at this point though, just didnt do it the “proper” way], next the scrub nurse holds out the gown and you put your hands through the arm holes [thats an easy part... a monkey could do that correctly], after that comes the gloves.....this is where the pro’s are separated from us retarded medical students. The nurse holds out the gloves so all i have to do is put my hand in it and go straight down quickly so my hands slips in. Sounds sooooo easy but i swear its not. Every time i have done it my fingers end up in different finger slots and i have to readjust it once my other glove is on. Oh wait, did i forget to mention that when i put on my first glove this time but ungloved hand hit my sterile gown and the attending made me take it all off and re-gown? :/ oops. Though i am making the attending sound like a hard-ass, i really shouldnt be because she is one of the most patient, kind and helpful doctors i have worked with [in fact, i have gotten really lucky because all of the attendings at the hospital are like her...or at least most of them!]
So after all this, we began the surgery and on my mind the entire time was “dont put your hands down, dont put your hands down, dont put your hands down.” See, when you are sterile, you are only sterile around your chest and down to your belly button so if you lower your hands too low or too high you become unsterile and that is bad...very bad. The other thing on my mind was, “this is f*cking awesome.” We cut a small incision right under the belly button, stuck a needle into this woman’s abdomen to get to the peritoneum [where all your insides are], put some gas into it to blow it up and give us more room to work, and then stuck a camera down the hole. Then we cut two small incisions a little lower on each side so we could stick other tools. It is really that easy. Watching up on a TV monitor, I was so excited to see the uterus, ovaries, fallopian tubes, bowels etc etc. All things I have memorized the anatomy of and can finally put that knowledge to use! One of the coolest things i saw was when the turned the scope around to see the liver and you could see the ribs and abdomen above it. Basically, it was an inside view of the rib cage and it was gorgeous to see. The ribs were rising and falling with each respiration [being done by a ventilator since the patient was under anesthesia and a muscle blocker] and looking at all the arteries and such was just a really amazing sight to see [yeah im a science nerd, whatevs].
So the patient ended up having endometriosis [look it up] and we cauterized a lot of it, took some pictures with the scope [looked like lil blisters everywhere] and then finished up. As we closed up the very minimal incisions with sutures the pt started to come out of her anesthesia and began moving her legs around. it scared the shit out of me. i was so scared she was gonna wake up at the end and yell at us that she could feel it all but she didnt...dont worry. she did look like she was in a ton of pain after the surgery though...even if the incisions are tiny and minimally invasive she still had people rummaging around in her pelvis...that cant be pleasant any way you do it.
After the surgery I walked with the team and the pt [in her gurney] into the post-op room. Talked with the resident a bit about the surgery and then was told to get some food and go to the clinic for the rest of the day. It was about 10am at this point [the surgery started around 8]. I went down to the clinic still wearing my scrubs and pretty much felt like a bad ass for the rest of the day [i realize how stupid that sounds but it pretty accurately describes my mood]. I was on such a natural high from the morning surgery. Everyone i talked to and every patient i saw must have thought i was on prozac.
One of the first patients i saw was in her first trimester of pregnancy and had brought her 4 year old daughter who was the cutest lil girl ever. I feel like i spoke so comfortably and confidently to both of them that the little girl started to become less shy and started asking me a ton of question and the mom become very relaxed with me. After spending a lot of time talking to both of them, I presented to Dr.R and when we decided to do a pap smear he said ok, go do the pap. I was nervous as this would be my first pap smear alone [without an attending, though a nurse is always there assisting/chaperoning] but i was pretty happy that Dr. R trusted me enough and had enough of an opinion of me to think i was competent to do it alone [though that just shows that when you dont have insurance and you go to a county hospital you ‘get what you pay for’ sorta speak--- AKA, a medical student doing your pap smear by herself]. I ended up being able to do the exam myself and everything went well. I swear, scrubs make you feel damn good/confident [though they make you sweat a lot...those things dont let your skin breathe at all!]
Wednesday Clinic- Saw an 18yo bipolar girl with a very flat affect. Made me a bit scared of my future psych rotation.
Saw a 24yo G4P4 who nearly jumped off the table when i barely touched her with the speculum. She was deathly afraid of anyone doing an exam on her yet she pushed 4 babies out of her vagina?
Met a crazy lady who told me the airplanes in the sky are spraying aluminum on all of us and making us sterile. Very nice woman but a bit off...
End of the day I say a very skinny, pale 45yo women who had severe menstrual bleeding. Severe enough to decrease her hemoglobin to 6.4. We did an ECC/EMB on her and then I recommended that she be admitted and transfused because she was feeling so weak and dizzy after. The doctor agreed and I helped convince the lady to stay and be admitted because i was scared she could harm herself by passing out when driving home....she looked as white as a sheep. It was scary to look at her. I ultimately built a lot of repore with her and convinced her to stay the night to get a blood transfusion. When I came back to the hospital on thursday i checked up on her labs and saw that her hemoglobin had dropped from 6.4 to 5.6 in 2 weeks. This is a pretty severe decrease....made me very happy and proud of myself that I got her to be admitted to the hospital and taken care of.
Thursday and Friday clinic I saw a bunch more patients but the one i remember the most is a young hispanic women who had recently been told she had a miscarriage. She had gone to the ER when she started bleeding and they told her the fetus was gone and to follow up at our clinic. She was very upset and crying to me and it was very emotional. I had a hard time consoling her because we were using a translator but ultimately i think i did a good job by explaining to her that 1 in 4 pregnancies miscarry and that it is a completely natural event. I hope she will be able to get pregnant in the future. I was more affected by this patient that i thought i would be. When i went into the ‘hang out’ room i guess i was noticeably sad because someone asked me what was wrong. It was hard to let the emotions go and move onto my next patient.
things i learned:
-i miss men-- seriously, 95% of people i see everyday are female. or as Anna would say, every day is Vaginaday
-i realize i need to learn spanish but i have also come to the realization that my patients will hopefully be trying to learn english also
-lots of women CAN'T afford their birth control pills, but they CAN afford to get their hair done, nails done, and a cute new cellphone?
- its really hard to stay up past 9:30pm these days!
Tuesday, July 5, 2011
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 :)
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 :)
Subscribe to:
Posts (Atom)