A Haiku: Gyn Surg

Uterus, pregnant?

No, big with fibroids, so large

Took out, now it's small

Hysterectomy

Alien head uterus

filled up with fibroids

Scraping uterus

 for too much bleeding, and so

biopsy will tell

Slippery Babies

So much has happened the last two weeks that it's hard to remember everything. Here are a few highlights:

- I have become a placenta delivery expert ;)
- I assisted in delivering 2 babies (with the resident's hand guiding mine)
- I solo delivered 1 baby (and didn't drop it)
- I got asked not to participate in a delivery of a neurosurgeon's wife by the neurosurgeon because his wife was "sensitive"
- I got yelled at by a nurse for trying to talk to a patient in the middle night (not the best idea in retrospect, haha)
- I've become comfortable taking an OB history
- I got to deliver the placenta during a c-section
- I got to close up the skin incision on a c-section -- twice
- I was complimented on my level of knowledge by a resident
- I helped suture a vaginal tear
- I saw a vaginal delivery with forceps
- I saw an episiotomy (the baby had made in through the pelvic canal but couldn't get past the perineum)

More about my solo baby delivery -- I had my hands on the baby's head, going through the maneuvers, but as soon as it was out, I got nervous, so I held it close to me instead of holding it in the proper position. Even though I wasn't 100% successful in catching the baby correctly, it was a good experience.

A few more notes about L&D:
--a lot of poop: I can handle blood fine, but feces/vomiting really grosses me out. Maybe L&D helped desensitize me a little bit to poop...maybe
-- GET AN EPIDURAL! Actually, you can't force patients to do something they don't want to, but after witnessing epidural vs. non epidural births, I 110% recommend getting an epidural. Delivering without an epidural does not make you a better mom, so why suffer? :) Even if the woman can handle labor, repairing vaginal tears with local anesthesia post partum is REALLY difficult because the woman can still feel the pressure of the needle.

L&D was the part of ob/gyn rotation that I was least looking forward to, but I actually ended enjoying it A LOT. Deliveries are exciting, c-sections are fun, and babies are pretty cute :)

Delivering Placentas

Yesterday I started the Labor & Delivery portion of my ob/gyn rotation -- the night shift.

It started and ended on quite an exciting note. As soon as I got there, a C-section was starting up, and I was told to scrub-in (a first!). I was right there in the thick of things -- holding the retractor, dabbing the oozing uterus with a lap, suctioning away blood from the peritoneal cavity. Needless to say, an exciting way to start this portion of my rotation.

Apparently, the ladies of Atlanta wanted to deliver babies last night. It started off with the C-section, then we had 3 more vaginal births, then a twin birth (vaginally, but in the OR in case things didn't work out), and another C-section for a 26wk fetus who wasn't getting enough blood perfusion through the placenta. Oh, and the twin birth, a singleton vaginal birth, and the 26wk C-section all happened at the same time around 5am!

I got to deliver 4 placentas (including the twin placentas -- cool!). I think at Midtown it's harder for a med student to delivery a baby since there are a lot of private docs who deliver their patients there. Hopefully, during my time in L&D, an Emory doc's patient will be willing to let me deliver their baby. Otherwise, I'll just become really good at delivering placentas ;)

"I Can't Believe Y'all Like Doing This"

First week of rotations is finished. How do I feel? Tired. Overwhelmed. Relieved. Behind. 

I've been lucky enough to start on the OB/GYN rotation, which means i get to experience a little bit of everything before being thrown into a rotation with a singular intense focus (medicine, surgery). The rotation is divided into three mini-rotations: 2 weeks of outpatient, 2 weeks of labor and delivery (one week days and one week nights), and 2 weeks of gynecologic surgery. Oh, and while we aren't in the hospital, we are supposed to be reading, studying, and preparing for our end of rotation shelf exam.

On Monday, we had our ob/gyn orientation day. We practiced delivering plastic baby dolls through plastic pelvises. We practiced scrubbing into the OR (I learned I wear 6 1/2 OR gloves). We practiced our pelvic exams on some plastic pelvises. And, we got to watch the miracle of life -- the vaginal delivery of a baby -- in an educational video (scary).

My first two weeks of ob/gyn is being spent in the outpatient setting, which means I get to do something a little different everyday. I started off on Tuesday in a Grady clinic in Bankhead working with a nurse midwife seeing patients for gynecologic and obstetric care. Another first -- giving a depo shot (form of birth control). The nurse midwife asked me "You want to give the next depo shot?" and as I was in the middle of my "uhh...." she said, "Yes, you do." and gave me instructions on where to find the needle and the medication. I also got to use the leopold maneuvers to feel the positioning of the baby in the uterus. Having never examined a pregnant patient before, my performance in this area probably improved about 200%. I also got to do a bunch of pelvic exams, pap smears, and history taking. I left feeling productive and confident. Looking back, this was the highlight of my week.

Wednesday is lecture day in the ob/gyn rotation, so I spent my day attending grand rounds, attending lectures, learning how to do a proper breast exam, and learning how to suture and tie knots.

Thursday, I spent a frustrating day in the infertility clinic. Although the material is incredibly interesting (I sat in on an IVF consult --- where the doctor explains the entire procedure to a couple), I felt useless and inefficient. There isn't much of a physical exam component in infertility counseling -- it's much more reliant on the history component. However, I didn't even have the opportunity to take a history. I just acted as a shadow for the resident or the attending all day long. To add to things, one of the doctors in the clinic was not ideal to work with. He never introduced himself, shoved me out of the way instead of asking, and never really tried to engage me in conversation or teach me anything. It is one thing to feel useless, it is another to feel treated poorly. In summary, infertility clinic day left me feeling angry, frustrated, and useless.

After Thursday's experience, I was pretty excited to be spending Friday in the Grady Urgent Care clinic. I expected to see spontaneous abortions, ectopic pregnancies, placental hemorrhages, ...emergency room type events. I expected it to be crazy busy. Instead, I saw three patients with lower abdominal pain. Yes, nothing too exciting, but still way better than the infertility clinic. It probably helped that I was working with a really nice intern and super laid-back resident. I got to do a few pelvic exams, take a few histories, and see some ultrasounds. As we were trying to find the cervix on a particularly heavy patient, she chimes in, "I can't believe y'all like doing this...it's nasty."

um...yeah. 

Here's to one week done, about a million to go...

Getting Oriented

Two weeks ago we had "Orientation to the Clinical Years" where we endured a week of powerpoint lectures on how to use a pager, how to wash our hands, how it's important to dedicate our lives to our patients...yet retain "balance." It felt like first year orientation all over again --- a little bit exciting, a little bit scary and overwhelming, and a little bit like a waste of time. We also got to practice drawing blood and placing IV's in each other (the fun part!). The week ended with us getting our Grady ID badges and being sent off with an inspiring speech by the dean.

I walked away from orientation with the clear message that "Your life is about to change -- get ready."

Let's hope I am.



P.S. A scarily accurate portrayal of the last two years of my life spent in the classroom: video