Last Day of OB

On my last day of OB/GYN, because nothing is easy, it was meant to make sure this day will be long.

I walked into the unit at 630 (always a thrill) to be met with one patient, who had just been admitted. Said patient is nowhere near delivering and will probably not deliver before I leave. Grand. I figured I would attempt to document some of the things that I have seen and/or done lately.


C-section due to breach presentation. The baby came out looking very funny, with a flat head and his feet up by his ears (from the breach).


A resident who took five minutes to even get sterile gloves on his hands. All medical students wrestle with the sterile gloves at least once, but this dude is a resident, and the scrub tech was putting his on for him--and he still had issues.


Ambiguous genilatlia. In what turned out to be a baby girl with 21-alpha-hydroxylase deficiency. The neonatologist would not assign a sex to the baby due the ambiguity.

A whole host of normal deliveries. Why is that just when you think you're getting the hang of things it's time to go. I am just starting to get the hang of being in the Delivery Room and what to expect.

I enjoyed OB, more than I thought I would. Having said that I still don't think I want to do OB. I thought the rotation was very well-organized, so it went by quickly. I feel like I learned a lot, and, barring any serious complications, I could deliver a baby on a plane.

Bring on the crazy people in psych next week!!!!

There's no business like show business

One of the attendings on the OB floor at Chicago Hope Hospital enjoys singing...endlessly. Oh, he whistles, too. If I'm tired, cranky, annoyed, cantankerous, or just plain grumpy, it can get on my nerves. More than one of my fellow students shares my sentiment. More than once we have been sitting around the corner from the desk, and the Human Karaoke Machine starts whistling and/or singing (a particular favorite of his during the holiday season was "The Prayer"). After HOURS of this we are grinding our teeth, wishing death, pain, blunt force injury, or just simple layngitis. We have sat there grinding our teeth to a fine powder Shut up! Please shut up! Just willing him to button it for an hour of peace and quiet.

Today reached new lows. Beginning the morning with a selection of his favorites from Phantom of the Opera, Les Miserables, and what I think was supposed to be "Send in the Clowns." I wondered how much worse things could become when I was answered. The Human Karaoke Machine started singing "There's No Business Like Show Business." Then, because we just weren't suffering enough, one of the nurses joined it. And then, just to throw some salt in the wound, he starts singing "Besame mucho," and be damned if another doctor doesn't start singing too.

Shoot.me.

Night Call

Last night I had another night shift. Frequently on night shift it is quite quiet and I am able to abscond to the call room and get at least two or three hours of what is amusingly called "sleep." Not last night. Last night, I walked onto the floor, and saw a full board. Half of whom were likely to deliver. Here we go! I settle in and prep myself for a busy night. Sure enough, it was busy. I had at least four admissions, and four deliveries. 

The first delivery was going something like this: Normal delivery...normal delivery...normal....HOLY CRAP BABY PROJECTILE BABY!!! The mother had elected not to receive an epidural, and seemed bound and determined to get the kid out. Out it came...like a cannonball. I definitely was not ready for that. 

Later, there was another delivery, relatively straightforward, with no notable complications. Afterward I was starving so I went to grab some food, and I come back to find a baby being pushed out. Curses. 
The funniest part was this exchange, with a Spanish-speaking patient.

Midwife: That's probably the hymenal ring tearing and bleeding here.

Me: Isn't it a bit late for that??

Nurses die laughing. I'm not sure had it not been three in the morning I would've made that joke right then and there.

After more admissions, and perhaps another delivery?? It was about 515 in the morning, and I was starting to wonder how I was going to be able to last another hour and fifteen minutes. Right about that time We ehard somebody yell NURSE!...Just when you're wondering how to stay awake one more hour...a father come storming out of the room yelling HEY, THE BABY CAME OUT...And just like that I'm wide awake...This mother had elected to receive an epidural, and apparently it was so effective and she dilated so quickly she did not feel herself contracting the baby right out of her uterus. We all jumped up and sure enough, there was the baby just sitting there on the bed, crying. I quickly grabbed some gloves and took care of the cord and cord blood (seemingly my role). After that it was about thirty minutes until my reliever was due, and I read and chatted. I had started to get rather annoyed with one of the nurses in particular who would not stop talking, and loudly at that. But I kept my mouth shut and stayed in the corner, wanting to smack her and ask her to please shut her trap. I mean c'mon...people are sleeping and more importantly, sleep-deprived medical students are annoyed. 

I went home and hopped in the shower (it's absolutely necessary to rinse off the hospital grime and shtook) and promptly went to sleep. I slept far later than I intended, past two o'clock. Now I'm hoping that I don't have difficulties getting to sleep tonight. In the hopes that it helps, I plan on going for a run for about thirty minutes. 

Back to overnight kvetching...

Tonight is the first of what promises to be many overnight calls over the next five weeks for OB. It feels quite strange to be at the hospital at night (or at all rather) without Awesome Partner. We were partners for six months, side by side throughout the day. Awesome Partner has finished her scheduled rotations for now at Chicago Hope Hospital, and I remain. I miss working with her, because we worked well together. I made my way to the call room to deposit my things--not to sound lazy but I am not staying awake overnight if I don't need to, so if I can catch a few hours of sleep to guanratee I'll function the next day, I'm going to make use of the facilities provided--and the smell of the hallway took me straight back to working overnights during Internal Medicine, and all those quiet hours walking the halls and doing admits with Awesome Partner.

...here's to you Awesome Partner. Stay tuned for more kvetching...

OB/GYN

Yesterday was my first day on OB/GYN, but all we did was sit through a day of orientation. As mind-numbing as that sounds it was preferable to the way I was introduced to surgery, when we basically had a twenty minute crash course and then were left to figure out what we were supposed to be doing, and then yelled at for not knowing what we should do.
One of the other students in the rotation has had the exact schedule as I, and we by far have done more rotations and knew the hospital whereas everybody else who came through had done at most one. It was an odd feeling, and we left the hospital feeling "like fourth years," and like we had actually accomplished something. It was a nice feeling because not too long ago I didn't know a thing.

Today was my first day on the floor, and quite frankly it was a bit boring. I got good practice filling out H&Ps, determining fetal heart rates, and gathering a whole new type of history. In twelve hours I saw two deliveries, ten minutes apart. The other OB student and I spent much of the rest of the time listening when we could to the attendings, trying to learn whatever we could, and basically just standing around. I spent a good hour pretending not to listen to the doctor and midwife talk about hospital politics and other such stuff trying to pick up a thing or two, and get a feel for who's who in the department. Afterward, just as it's time for another student to arrive and assume the evening call, the doctor turns to me:

Doctor: "So how many deliveries have you done?"
Me: "I've been in the two today. This is my second day.''
Doctor: "Oh well!!! Then it's time for you to do one! See one. Do one. Teach one!"
Me: "That sounds great."

So we talk about the patient that she was sticking around to watch, and I said I was waiting for the next student but that since I am post call tomorrow I'd be happy to stay for a while to assist in the delivery. We talked for a few minutes about fetal heart monitoring and accelerations and decelerations, and the doctor then said she was going to go check the patient. In one hour she went from 4cm to 8cm, and 90% effaced, with an IUGR, so the doctor said we're ready to push. She told me I could scrub in and I did. As the baby was coming out the doctor had me come finish the pushing. I held the head and caught the baby literally as it came out. Then, having seen previous deliveries, I went for the clamps for the umbilical cord, and ended up cutting the cord as well because the mom (who was alone!) didn't want to do it.

QOTD

First day of OB/GYN, and already I have the best quote of the entire rotation:
"Almost all of your patients are going to be women who are pregnant and healthy -- well, actually they will ALL be women, whoops!"