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...

Becoming comfortable with the uncomfortable

Today we learned/performed the male GU exam. An important exam, no doubt, but an uncomfortable one for the patient as well as the doctor sometimes. The male GU exam involves examining the genitals, feeling for hernias, and doing a digital rectal exam to check the prostate.

It was a lot easier/less awkward than expected.

First of all, our standardized patient was fantastic. He was completely comfortable teaching us how to do a proper exam, and I think his comfort level put us all at ease. Any man that is willing to go through 8 consecutive prostate exams by first year medical students is someone who really cares about us learning for sure. It was really helpful to have instantaneous feedback regarding our exam technique (too much pressure, too little pressure, try a different angle, etc...)

Afterward, we had a "debriefing" session with the urologist where we discussed how to handle different patient reactions during the exam (he's had people get so nervous that they faint), which is also a really important aspect to think about.

I have to say, it is SO nice to have the first male GU exam out of the way-- probably one of the most awkward experiences is past.

P.S. Heading out to Haiti in 4 days -- so crazy!

Firsts

Today was...exciting.

I did my first pap smear.

I drew my first blood sample.

I did my first IV line (ok, so that one was on a simulation mannequin)


I volunteer at the low-income health clinic fairly regularly, but I never have the confidence/comfort level to volunteer to do any of the more procedural based activities (pap smears, blood draws, etc.). I don't really know what was different today, but I said yes whenever someone asked me if I wanted to try something new -- and it was awesome!