Thursday, January 18, 2007

Two weeks down...

The belief that Ob/Gyn is the most time-intensive and busiest of the third year rotations is a myth. Friday I got to leave the hospital at 10:00 am, and (aside from the on-call day) have never left later than 4:00. Of the three hospitals students from my school rotate through for Ob/Gyn, this hospital is supposedly the busiest—another myth. The students at the two other hospitals seem to have much busier schedules than we do. Here, there is a lot of down time. After we round on our patients from about 5:45 to 6:30, except for the two students in L&D, we have nothing to do until clinic starts at nine or until there is a surgery (there isn’t always).

This week not much has happened. I’ve seen a couple OB patients in clinic, asked them all the same questions. I’ve been in two other surgeries, one removal of fibroids and one hysterectomy. I was in clinic for four hours one day, only saw two patients, and had to leave for the pelvic exam because the patient didn’t want a male in the room—I can completely understand this, and would probably feel the same were I a woman, but having said that it is a little frustrating since this is the one point in my career I will have to learn how to properly do a pelvic exam—if I don’t learn it here, that does not bode well for the women I will see as a physician who need pelvic exams (rare as they will be if I go into surgery). The thing I was mostly frustrated by was that this is a free clinic and patients have to agree to allow students and males to treat them in order to be accepted—they shouldn’t agree to be seen by males if they’re not going to actually allow it when they have been accepted to the clinic.

Today, I did actually get to help deliver a baby—I actually had my hands on the head and was pulling. That was a good experience. And it was nice to actually do something after literally sitting around doing nothing but study for ten hours straight.

Tuesday, January 09, 2007

First call night

My first call night ever is over. This week I am on the gyn service, so the morning was spent in the OR—I saw two mesh repairs of prolapse causing stress incontinence. I couldn’t see a lot as I was standing outside the field of vision holding retractors for much of the time. It was interesting, but I think I am definitely more drawn to abdominal type surgeries. The doctor was very patient which was nice. The intern made a mistake in the procedure that wouldn’t have harmed the patient, but could have resulted in having to start the procedure all over again (though in the end that wasn’t necessary thankfully) and the doctor was totally calm about it as opposed to hitting the ceiling which unfortunately many surgeons would have done.

In the afternoon I went to clinic, where my presence was totally unncecessary as there were already many students there. I saw one patient who was spanish speaking. I was actually able to communicate fairly easily which surprised me as it’s been a long time since I studied spanish. After clinic I went to L&D with the other on-call student, and everyone else went home.

Nothing much happened at first, so I went to write post-op notes on the two patients whose surgeries I had seen, as well as one of the other student’s patients. The only issue was that one of the patients had low blood pressure and wasn’t making much urine. One odd thing about this hospital is it seems like the nurses think students are doctors—they would give me reports on my patients and ask me questions that they actually expected me to have an answer for. One even asked me if I was a resident even though I was clearly wearing a very short white coat—I guess it must be because this is not an academic hospital, but there are still loads of students here year round.

On L&D students are expected to write update notes on patients every 2-4 hours depending on how active the patient’s labor is. We also do history and physicals on all new patients coming in. Around eight I was sitting writing out an H&P when a resident when running by. As we were told to chase after any resident we see running, I followed—I got into the patient’s room (apparently she had just gotten up there two minutes before), and almost as soon as I walked in a baby just popped out. I didn’t realize deliveries could be that fast. Later in the evening, I went in to check up on a patient and the nurse in the room told me she was about to deliver, so I stayed and gowned up when the intern came in—this time I actually got to see the whole delivery. It looked like something from a science fiction movie. At first, one could just see a bit of hair, then a face slowly emerged—very bizarre looking.

Later, I did an H&P on a woman at 28 weeks who had an incompetent cervix—she had had five pregnancies before and all were miscarried. The baby was a breech presentation (feet first), so the doctor decided to do a C section. By far the bloodiest operation I have ever seen—it was crazy. The intern made the incision, opened the uterus, then suddenly the attending was pulling out this tiny little baby.

Around 1:00 I had a half hour before my next note so I layed down in the call room, got up to write more notes, then went back to sleep for forty minutes (the pain of having to get up almost makes it not worth the sleep), then got up to write more notes, but on my way I got a page saying one of my patients (who I thought was hours away from delivering) was giving birth. Again, the baby popped out almost as soon as I walked into the room—unfortunate, because this patient didn’t have a private doctor so I probably would have been allowed to do most of the delivery—oh well, I don’t think there’s going to be any shortage of deliveries in the next five weeks.

I went back to the call room at about four, but I do not have the skill (yet) of getting up and going to sleep multiple times a night—once I’m up, it’s really hard for me to go back to sleep—plus I was planning on going back to the floor at five, and I don’t trust myself to wake up, so I watched TV (slim pickings at four in the morning let me tell you) since I hadn’t brought a book to read aside from study materials (rookie mistake that I won’t repeat—studying after midnight=fifteen minutes per sentence). At five I went to round on my patients, though I just got vitals and wrote skeleton notes at first because I feel bad waking people up before 5:30. My two surgical patients were both already awake and doing well, so I took out the packing the surgeon had put in, and they should go home today. Then I went to see the C-section patient and one of the deliveries I had seen, both were doing well. The vaginal delivery should go home tomorrow, the C section in a couple days. Then at 7:30 I got to go home—I tried to get a cheeseburger on the way home since I was starving and craving meat, but the barbarians at the fast food restaurants only serve breakfast at that time, so I had to have egg rolls at home. Then I slept until about 3:30. Tomorrow I’ll go back at 5:30.

Saturday, January 06, 2007

Thursday was orientation to the hospital, it was by far the most overwhelming first day I have gone through in third year—fortunately, everyone else was just as overwhelmed. In the afternoon I saw two clinic patients for prenatal visits. I got to find the fetal heart tones with the doppler which was kind of neat. Friday two students had to go to clinic, and two to L&D. Since we all had lecture in the afternoon, the chief resident went over some things with us in the morning, then told those of us not in clinic and L&D we could leave to study. I know several students who can never believe residents really mean it when they say to go and will hang around for a while—I have never had this problem.

Next week I will be on gyn—on Monday there will be 14 surgeries to divide among students. Monday will also be my first official overnight call ever—should be interesting. I am more optimistic about this rotation than I was at the beginning of third year. It's still not really a career option for me, but I think it will be a good experience. Its procedural aspects are reminding me how much I liked surgery.

Wednesday, January 03, 2007


2007 already—amazing. My break was very nice, though it went by far too quickly. Yesterday we had our professionalism/patient centered care seminar (which did in fact last all…day…long…) which was pretty much as I (and 95% of the other students) expected it to be—the waste of a perfectly good day. At least I got to talk to some people I haven’t seen since third year began what with rotations being what they are.

Today I had orientation to OB/GYN which I shall be doing for the next six weeks. I’ll be at a private hospital with ten other students, and will switch between OB and GYN every week. Call will be every six days. One good thing is that the way the call schedule works out I will actually get four free weekends, and most are at the end of the rotation when I will be most tired. Full weekends just help so much—I could almost tolerate any schedule if I could just have two whole days off a week—one to get housework done/run errands and one to just completely relax. It is going to be a pain in the rear trying to figure out what we are supposed to do—as a group we are going to have to divvy up labor/delivery, clinic, surgeries, etc. It’s going to take a good week if not more to get things running smoothly, especially since many of us will only have a day and a half (we have lecture Friday afternoons) to work before the weekend.

I think I feel more clueless about OB/GYN than I have about any other rotation. Medicine and peds were both based at least in theory off of things we learned about the first two years, though surgery was less so. Pretty much all we learned about as far as OB/GYN goes the first two years was the hormones involved in cycles and pregnancy. It sounds like there will be no end of deliveries on this rotation though, so I should be pretty comfortable with them in a couple of weeks.