Sunday, October 23, 2005
Highs and Lows
It was the best of times. It was the worst of times. No, it really was. Getting to deliver the baby almost by myself was one of the best single experiences so far. So much so that I put in my rotation evaluation that every student should get to do a delivery that way. Contrasted to that, it was also one of the worst experiences thus far and I came closer to acting on my threat to drop out than ever before. Yes, I occasionally (frequently) make that threat.
I experienced what I wife tells me she has had to deal with almost her whole scientific career. I, myself, work hard not to conduct myself in this way but I have never experienced it until now: being discriminated against because of my sex sucks quite worse than you would think. When I described what was going on to my wife, she replied, “welcome to the club!” Being in the male dominated field of science, she deals with this behavior all of the time. So, here are a couple of examples for you. There are three students all standing next to each other who of which are women and standing on either side of me. There is a resident who is talking to us and she is continually making eye contact on either side of me, but never looks at me. Not even when she is addressing me specifically. I didn’t make much of it the first time it happen, although I thought it was odd. But when several of the residents were doing it on several occasions, I picked up on the pattern. Another example took place at clinic. I was working with several residences that morning seeing patients. I was around the corner turning stuff in to one of the nurses when I here in the distance, “Let’s go to lunch!” By the time I get back to the staff room, everyone is gone. In all of my other rotations, the residents are at least nice enough to make sure that you, as the student, know you are done and it’s time to go because we really aren’t given that information otherwise. And, before you think I’m making a mountain out of a molehill, which I may still be doing, I should point out that these are just two examples of what took place almost daily. With that said, I should make two observations: It is entirely possible that they just simply didn’t like me. It’s happened before where a person just decides right off the-bat that they don’t like me, but it’s usually not a group of people. So it may just be me and not a sex thing. Since I was the only guy most of the time, I don’t know that I can ask any of my classmates to see if they noticed the same thing. I should add that it also, certainly, was not everyone I dealt with. It was half. The resident that I had the most contact was as pleasant as she could be! And the resident that I had on my first night of OB was also awesome. All of the attendings were also perfectly nice, too and all of the male residents (all three of them) were also nice. No matter what the cause, it really did have strong emotional impact on me and has actually pushed me away from the field a bit. Well, that and some of the conversations that took place: which also lead me to believe that it was some strange sexual discrimination. Here is the conversation as it happen,
“Dr. XXX touched my shoulder yesterday!”
“Oh! He’s so drEAMY! Not that I would have sex with him or anything, that would be gross.”
“I know, he is dreamy, isn’t he?”
What?!? Do I really want to be in 9th grade again? I could not believe my ears! I was waiting for them to all bust into laughter that they were making a joke…but they were not.
It’s all behind me now. I had my self exam last Friday. There was also an essay exam where they provide a clinical scenario and you have to describe all of the steps you would take. I actually ran out of time at the end, which is unfortunate. I spent too much time at the front end thinking how I wanted to put it all together. I did practice a bit at home, but the scenario threw me for a bit of a loop. The strangest thing was after the exam, I had lost my voice! I have no idea what happened, but I could hardly speak. I had been nursing a Pepsi during the exam so it was not as though I was dehydrated, but it persisted into Saturday. I think I must have caught some little bug but I don’t know who from.
That night we went out to a Chinese restaurant in town called TK Wu. We went with a few of my Asian friends which is important because the food they dish out to the American’s is not NEARLY as good as the “other” menu. All of the M3’s had a shelf exam on Friday because this marks the middle of our M3 year! Hooray! We slept in a bit yesterday, I cleaned my office (some), changed the oil and checked the back brakes on the car (they started squeaking LOUDLY, but it turns out to just be a little rust build-up) while ML did the laundry and vacuumed. We are so domestic sometimes. This morning we had our traditional Sushi brunch. We learned the name of the waiter that always takes care of us (James), and then we took an hour walk in the UM Arboretum. Here are some pictures of our fall walk:
I experienced what I wife tells me she has had to deal with almost her whole scientific career. I, myself, work hard not to conduct myself in this way but I have never experienced it until now: being discriminated against because of my sex sucks quite worse than you would think. When I described what was going on to my wife, she replied, “welcome to the club!” Being in the male dominated field of science, she deals with this behavior all of the time. So, here are a couple of examples for you. There are three students all standing next to each other who of which are women and standing on either side of me. There is a resident who is talking to us and she is continually making eye contact on either side of me, but never looks at me. Not even when she is addressing me specifically. I didn’t make much of it the first time it happen, although I thought it was odd. But when several of the residents were doing it on several occasions, I picked up on the pattern. Another example took place at clinic. I was working with several residences that morning seeing patients. I was around the corner turning stuff in to one of the nurses when I here in the distance, “Let’s go to lunch!” By the time I get back to the staff room, everyone is gone. In all of my other rotations, the residents are at least nice enough to make sure that you, as the student, know you are done and it’s time to go because we really aren’t given that information otherwise. And, before you think I’m making a mountain out of a molehill, which I may still be doing, I should point out that these are just two examples of what took place almost daily. With that said, I should make two observations: It is entirely possible that they just simply didn’t like me. It’s happened before where a person just decides right off the-bat that they don’t like me, but it’s usually not a group of people. So it may just be me and not a sex thing. Since I was the only guy most of the time, I don’t know that I can ask any of my classmates to see if they noticed the same thing. I should add that it also, certainly, was not everyone I dealt with. It was half. The resident that I had the most contact was as pleasant as she could be! And the resident that I had on my first night of OB was also awesome. All of the attendings were also perfectly nice, too and all of the male residents (all three of them) were also nice. No matter what the cause, it really did have strong emotional impact on me and has actually pushed me away from the field a bit. Well, that and some of the conversations that took place: which also lead me to believe that it was some strange sexual discrimination. Here is the conversation as it happen,
“Dr. XXX touched my shoulder yesterday!”
“Oh! He’s so drEAMY! Not that I would have sex with him or anything, that would be gross.”
“I know, he is dreamy, isn’t he?”
What?!? Do I really want to be in 9th grade again? I could not believe my ears! I was waiting for them to all bust into laughter that they were making a joke…but they were not.
It’s all behind me now. I had my self exam last Friday. There was also an essay exam where they provide a clinical scenario and you have to describe all of the steps you would take. I actually ran out of time at the end, which is unfortunate. I spent too much time at the front end thinking how I wanted to put it all together. I did practice a bit at home, but the scenario threw me for a bit of a loop. The strangest thing was after the exam, I had lost my voice! I have no idea what happened, but I could hardly speak. I had been nursing a Pepsi during the exam so it was not as though I was dehydrated, but it persisted into Saturday. I think I must have caught some little bug but I don’t know who from.
That night we went out to a Chinese restaurant in town called TK Wu. We went with a few of my Asian friends which is important because the food they dish out to the American’s is not NEARLY as good as the “other” menu. All of the M3’s had a shelf exam on Friday because this marks the middle of our M3 year! Hooray! We slept in a bit yesterday, I cleaned my office (some), changed the oil and checked the back brakes on the car (they started squeaking LOUDLY, but it turns out to just be a little rust build-up) while ML did the laundry and vacuumed. We are so domestic sometimes. This morning we had our traditional Sushi brunch. We learned the name of the waiter that always takes care of us (James), and then we took an hour walk in the UM Arboretum. Here are some pictures of our fall walk:
Friday, October 07, 2005
OB
THERE’S NOTHING LIKE CATCHING A BABY FLYING OUT OF A VAGINA!
I’ve caught so many babies that I’ve lost count, but I suspect it is somewhere around a dozen. My mileage has certainly been different than many of my colleges with that respect. One of them just had their first vaginal delivery today. Yes, I will be using that word considerable in this posting so if it offends you, I suggest you see The Big Lebowski ASAP.
Turns out that the guy really gets the best side of the equation when it comes to baby making and baby birthing: Things are great when you make them and, when they pop out naturally (and they do pop), it is pretty easy going, too. Well, for the GUY that is. Epidurals certainly do help for a lot of the pain but when it comes to pushing the thing out and the hip bones are pushed to the opposite ends of the universe, well, there’s nothing that is going to touch that pain. The most interesting thing I’ve noticed, if you really pay close attention to the mothers’ face, is during the delivery they are in excruciating pain and discomfort. As though they could have never imagined how bad it could be. As though they would never go through it again: especially if it was their first time! But the moment you put the baby on mother’s stomach, you can see the change—almost instantly. It’s the look as though they’d do it all over again in an instant.
With that said, most of my deliveries have been mothers that have already delivered before (multips), so it’s not too surprising. By even the couple I’ve seen delivering for the first time (primips), you get that same expression. Thus far all of the deliveries I’ve seen have been uncomplicated.
The labor and delivery (L&D) rotation started last Friday night a week ago. I started on the night shift Friday till Monday. Since GYN-ONC was so rough (notice all of the acronyms? It gets worse!) that I really had no time to prepare. Trial by fire. I arrived just before 6p, when the evening rounds start—only done if you are having a change in the attending and chief staff. It’s call “running the board.” There’s a board with each room of the two wings. The East wing has 3 triage begs and 8 other beds for all of the high-risk patients. The West wing has about 25+ bed for the low risk patients. Running the board consists of debriefing the status of all of the high risk patients first, followed by all of the West side patients that are laboring and ending with the West side postpartums. The presentations can be very short like: Mrs. So A. So is 29 G3P1102 who SROM’ed clear at 5am now at 5/100/-1 with q3 contractions without induction. Translation: Mrs. So And So is 29 years old, been pregnant three times (including this one), had one term delivery, one preterm delivery, no miscarriages, with 2 living children, who had spontaneous rupture of membranes (her water broke) producing clear liquid at 5am, now with a cervix dilated to 5cm, 100% effaced (soft), the baby’s head is 1 cm above the ischial spines and having contractions every three minutes without pitocin. Most all patient descriptions start this way and then addition information is added if needed.
The philosophy is you should not be involved with someone’s labor if you have not met them beforehand. I was instructed to go meet “this” laborer right after rounds because she was going to deliver very soon. I walked down to her room and there was a bunch of people but I really did not know who all they were. The patient looked up at me and I introduced myself, “Hi! I’m the shiny new medical student and I want to watch you squish a baby out between your legs, if I may!” Maybe I didn’t say that, but I was being awfully cheery. She looked at me and said, “Well, I guess it’s really too late.” Then I realized what was going on when I heard someone say, “Push!” She delivered the head with that next push. The skin of the vagina gets stretch around the crown of the head, which is usually pretty cone shaped because of the birth canal, and then quickly pops around to the baby’s neck. It’s pretty darn quick! While the head is coming out, the doctor firmly places their dominant hand on the perineum (the space between the vagina and the anus) to help keep the skin from ripping, and the fingers of the other hand apply pressure to the back of the baby’s head to keep it from being drawn back in if the mother has to breath. Once the head is out, they reduce any nuchal cord (cord around the baby’s neck) by slipping it over the head and they started bulb suctioning the mouth and nose. Then they, well, torque the head downward to deliver the anterior shoulder (the one closest to the belly of the mother). Then they torque the baby’s head upward to deliver the other shoulder and the body just flops right out. It’s rather impressive how much torquing goes on! But they do it every time and the babies are all doing well. None of this is necessary in an uncomplicated delivery because babies pretty much deliver themselves. But, I think it does make the process go faster and with less tearing (there’s still plenty of tearing going on!). I watch all of this in amazement, with a touch of disgust, all the while being mortified at what I had done. I apologized after the delivery to the father and later to the mother. They didn’t seem to mind at all, which was good.
That delivery was right at 7p. As I recall, we delivered one more that evening and then two more around 5a.
We were also running the triage, which is basically the ER for pregnant women. I went in for my first triage patient to take a history as to what brought them in. They looked at me, kinda’ laughed and said, “We’re having a baby?” In reality, this is not an insane question because most people in triage are in trouble: they’re passing blood, they’re running a fever, etc. Remember, this is my first triage patient and, really, my first OB patient. I start asking my standard questions: How long have you been contracting? How frequently? Passed any fluids? ect. I notice their answers were almost medical. This whole time I’m looking at the baby’s heart rate (or fetal heart tones FHT). They tend to respond to contractions by either going up (accel) or down (decel). Up is better than down, but down can be okay if the timing is right. Well, I could see the digital read out for the FHT, but I could not see the strip for the timing with the contraction and her baby’s rate went from 150 (normal) to 81 (very low). I QUICKLY went got the pertinent details and calmly excused myself followed by RUNNING down the hall to get to a computer to page the resident (Katie)!!! “29 yo G1P0 SROM at 5p now with decel to 81, triage room 3.” I calmly went back into the room so see how she was and I got hit with, “you missed a lot of stuff in your H&P!”
“Oh, yeah?”
“Well, we’re both neurologist here. You forgot my family history, my social history, my meds and my allergies.”
“Indeed I did, why don’t you tell me about them.”
I cannot WAIT to see them in neuro and explain that NONE OF THAT WAS PERTINENT TO HER BABY’S DEMISE! I’ll be nice about it because she will be grading me. When the resident showed up, she moved all of the stuff out of the way and got to the strip and it turned out that the timing was good. The text books actually say there should not be any decels below 100, but that is not true in practice. Actually, the FHT only tells you if the baby is doing well. If it looks “bad,” over 50% of those babies come out great and the majority of the others do just fine. So it’s only a positive prognostic indicator. The following day I would triage two more neurologists.
Around 2a I had a page from the chief resident, “Let’s run the board! Chris” I showed the page to Katie because I had no f*cking clue what that meant, at that point. She said, “you better go! Chris wants to see you in the board room.” I scurried off from the West over to the East, opened the door to the board room and said, “what does running the board mean?” He and I talked about each of the high risk patients over the next two hours. I asked tons of questions, which initially caught him off guard but he really enjoyed it. Actually, I really enjoyed it. It was the first real teaching session I have received since starting OB-GYN, save all of the lectures. We spoke about many hypotheticals and got off onto many tangents. It was a bonding moment between the boys. He’s a couple of years younger than me so it was nice to spend some time with a peer. I think he looks decided like comedian Greg Proops, but he didn’t know who that was. Chris’ hair is a little toned down, but similar facial features.
Katie was a well seasoned resident and did a very good job directing me and helping me out that first night. The next morning, Divya took over, and proceeded to freak out during rounds because we had so many laborers on the two floors. There was a TON! It would turn out that by Saturday night Divya was back in the groove and doing well. That second night I triaged a person that was actually a Ph.D. research in the OB-GYN department and had lectured us. She was a really nice person and everyone wanted to deliver her baby. The resident on Sunday, Kirsten, commented during rounds, “This woman has more people who want to get their hands inside of her vagina than…” There was some truth that that. It would turn out that one of the residents that I had worked with on GYN-ONC would leave her current post on GYN-benign and deliver the baby.
Sunday was the pinnacle. I was in room 22 with Katie and we were examining this patient that was going to deliver within the next hour or so. All of the sudden I hear this staticy intercom turn on (I didn’t know the rooms had intercoms), “Uh, is there an Elliott Gozansky in the room?”
“Yes?!”
“Dr. Van de Ven needs you in room 23 right away, please.”
“Okay.” Turning to Katie, “You better go!”
I darted out of the room and into the next room. One of the patients I had been following was about to deliver. Dr. Van de Van has this calm, child-like, Swedish voice: “Elliott, put on your gloves.”
I scan through the glove box desperately looking for a 7.5, 8, anything I can get my hands into. I start to go for the sink, “Elliott, put on your gloves.”
I put them on as quickly as possible, but it seemed like it took forever. No gown, there was no time. The bed was not even broken down yet. (The beds are made to turn into a delivery tables.) I placed my hands in the right positions, he said, “Keep good pressure on the top of the head. I’m going to do a modified Ritgen maneuver” where he massaged the outside of the anus to help extend the head back. Pop! The head was out. I started the bulb suction and he reduced the nuchal cord. I torqued the head down and she delivered the anterior shoulder. I torqued the head up and she delivered the rest of the baby. No tears at all (but this was her third baby). I went to put the baby on the mother’s chest and Dr. VDV stopped me, said, wait a moment. This allowed the blood from the cord and placenta to go into the baby. There’s no real evidence that it matters in healthy children and most of the other docs don’t do it, but he does, so we did. I handed the baby up to mom. I don’t even think there was a nurse in the room to clean the baby off, but there must have been. By the time I had delivered the placenta, the baby was already nursing. I asked Dr. VDV how long she had been pushing. He said, “About 3 minutes.” There’s nothing like catching a baby flying out of a vagina! He looked up at the baby and said, “7 lbs 14 oz.” She was weighed a few moments later: 7 lbs 13 oz. Pretty darn close!
There was another delivery that stands out in my mind. It was a young girl who was delivering her second child. She had stopped receiving prenatal care early on because of school and was very afraid of needles, to the point that she did not get an epidural or any pain killers. After the delivery, they went to give her a shot, of RhoGam I assume, to keep her from developing problems if she was Rh- and the baby was Rh+. We did not even know her blood type! She could not take her eyes off of the needle even though her husband tried to get her to focus on him and covered her eyes. “No! I’m afraid it’s going to hurt! I don’t want any needles!” I just stood there in amazement of the human mind. How can you do away with rational thinking to the point that you’re afraid that a needle is going to hurt worst than pushing a bowling ball our through a 3 inch diameter hole? How does that work? She did not get that shot. When she wasn’t looking, she did get a few shots of lidocaine in her perineum where it had torn a bit.
I think I helped with a C-section on Sunday, too. I helped with another one yesterday. Monday was off and then started the day shift on Tuesday. The week was much slower than the weekend. I would have had a delivery yesterday but, during the day there are 3 M3’s and one M4 and one of the M3’s had not seen a NSVD (normal, spontaneous vaginal delivery) yet, so I “gave” it to him. Today was filled with lectures after rounds. Oh, that was a little disaster. I decided to try biking to one of the parking lots that had bus service starting at 5:45am. I got there at 6:15a which gave me 30 min to make a 10 min trip. It turned out that I would use all of that 30 min because the bus was so slow! I went to the floor where my Pt was and I could not find the chart. It was our over-flow rooms which I have not been to, yet. Once I got the chart, there was no paper for me to write a note. Of course I had to flip through it 3 times before I was convinced. Had to interrupt a chatty nurse to ask for a page, rush into the room and do my examination, then write a note. I was 2 minutes late to rounds and if looks could kill, the attending would have buried me three times over! I never got to reconcile what happened and I don’t think they really care what happened, just that I was late. What’s a little OCD between friends?
I’ve caught so many babies that I’ve lost count, but I suspect it is somewhere around a dozen. My mileage has certainly been different than many of my colleges with that respect. One of them just had their first vaginal delivery today. Yes, I will be using that word considerable in this posting so if it offends you, I suggest you see The Big Lebowski ASAP.
Turns out that the guy really gets the best side of the equation when it comes to baby making and baby birthing: Things are great when you make them and, when they pop out naturally (and they do pop), it is pretty easy going, too. Well, for the GUY that is. Epidurals certainly do help for a lot of the pain but when it comes to pushing the thing out and the hip bones are pushed to the opposite ends of the universe, well, there’s nothing that is going to touch that pain. The most interesting thing I’ve noticed, if you really pay close attention to the mothers’ face, is during the delivery they are in excruciating pain and discomfort. As though they could have never imagined how bad it could be. As though they would never go through it again: especially if it was their first time! But the moment you put the baby on mother’s stomach, you can see the change—almost instantly. It’s the look as though they’d do it all over again in an instant.
With that said, most of my deliveries have been mothers that have already delivered before (multips), so it’s not too surprising. By even the couple I’ve seen delivering for the first time (primips), you get that same expression. Thus far all of the deliveries I’ve seen have been uncomplicated.
The labor and delivery (L&D) rotation started last Friday night a week ago. I started on the night shift Friday till Monday. Since GYN-ONC was so rough (notice all of the acronyms? It gets worse!) that I really had no time to prepare. Trial by fire. I arrived just before 6p, when the evening rounds start—only done if you are having a change in the attending and chief staff. It’s call “running the board.” There’s a board with each room of the two wings. The East wing has 3 triage begs and 8 other beds for all of the high-risk patients. The West wing has about 25+ bed for the low risk patients. Running the board consists of debriefing the status of all of the high risk patients first, followed by all of the West side patients that are laboring and ending with the West side postpartums. The presentations can be very short like: Mrs. So A. So is 29 G3P1102 who SROM’ed clear at 5am now at 5/100/-1 with q3 contractions without induction. Translation: Mrs. So And So is 29 years old, been pregnant three times (including this one), had one term delivery, one preterm delivery, no miscarriages, with 2 living children, who had spontaneous rupture of membranes (her water broke) producing clear liquid at 5am, now with a cervix dilated to 5cm, 100% effaced (soft), the baby’s head is 1 cm above the ischial spines and having contractions every three minutes without pitocin. Most all patient descriptions start this way and then addition information is added if needed.
The philosophy is you should not be involved with someone’s labor if you have not met them beforehand. I was instructed to go meet “this” laborer right after rounds because she was going to deliver very soon. I walked down to her room and there was a bunch of people but I really did not know who all they were. The patient looked up at me and I introduced myself, “Hi! I’m the shiny new medical student and I want to watch you squish a baby out between your legs, if I may!” Maybe I didn’t say that, but I was being awfully cheery. She looked at me and said, “Well, I guess it’s really too late.” Then I realized what was going on when I heard someone say, “Push!” She delivered the head with that next push. The skin of the vagina gets stretch around the crown of the head, which is usually pretty cone shaped because of the birth canal, and then quickly pops around to the baby’s neck. It’s pretty darn quick! While the head is coming out, the doctor firmly places their dominant hand on the perineum (the space between the vagina and the anus) to help keep the skin from ripping, and the fingers of the other hand apply pressure to the back of the baby’s head to keep it from being drawn back in if the mother has to breath. Once the head is out, they reduce any nuchal cord (cord around the baby’s neck) by slipping it over the head and they started bulb suctioning the mouth and nose. Then they, well, torque the head downward to deliver the anterior shoulder (the one closest to the belly of the mother). Then they torque the baby’s head upward to deliver the other shoulder and the body just flops right out. It’s rather impressive how much torquing goes on! But they do it every time and the babies are all doing well. None of this is necessary in an uncomplicated delivery because babies pretty much deliver themselves. But, I think it does make the process go faster and with less tearing (there’s still plenty of tearing going on!). I watch all of this in amazement, with a touch of disgust, all the while being mortified at what I had done. I apologized after the delivery to the father and later to the mother. They didn’t seem to mind at all, which was good.
That delivery was right at 7p. As I recall, we delivered one more that evening and then two more around 5a.
We were also running the triage, which is basically the ER for pregnant women. I went in for my first triage patient to take a history as to what brought them in. They looked at me, kinda’ laughed and said, “We’re having a baby?” In reality, this is not an insane question because most people in triage are in trouble: they’re passing blood, they’re running a fever, etc. Remember, this is my first triage patient and, really, my first OB patient. I start asking my standard questions: How long have you been contracting? How frequently? Passed any fluids? ect. I notice their answers were almost medical. This whole time I’m looking at the baby’s heart rate (or fetal heart tones FHT). They tend to respond to contractions by either going up (accel) or down (decel). Up is better than down, but down can be okay if the timing is right. Well, I could see the digital read out for the FHT, but I could not see the strip for the timing with the contraction and her baby’s rate went from 150 (normal) to 81 (very low). I QUICKLY went got the pertinent details and calmly excused myself followed by RUNNING down the hall to get to a computer to page the resident (Katie)!!! “29 yo G1P0 SROM at 5p now with decel to 81, triage room 3.” I calmly went back into the room so see how she was and I got hit with, “you missed a lot of stuff in your H&P!”
“Oh, yeah?”
“Well, we’re both neurologist here. You forgot my family history, my social history, my meds and my allergies.”
“Indeed I did, why don’t you tell me about them.”
I cannot WAIT to see them in neuro and explain that NONE OF THAT WAS PERTINENT TO HER BABY’S DEMISE! I’ll be nice about it because she will be grading me. When the resident showed up, she moved all of the stuff out of the way and got to the strip and it turned out that the timing was good. The text books actually say there should not be any decels below 100, but that is not true in practice. Actually, the FHT only tells you if the baby is doing well. If it looks “bad,” over 50% of those babies come out great and the majority of the others do just fine. So it’s only a positive prognostic indicator. The following day I would triage two more neurologists.
Around 2a I had a page from the chief resident, “Let’s run the board! Chris” I showed the page to Katie because I had no f*cking clue what that meant, at that point. She said, “you better go! Chris wants to see you in the board room.” I scurried off from the West over to the East, opened the door to the board room and said, “what does running the board mean?” He and I talked about each of the high risk patients over the next two hours. I asked tons of questions, which initially caught him off guard but he really enjoyed it. Actually, I really enjoyed it. It was the first real teaching session I have received since starting OB-GYN, save all of the lectures. We spoke about many hypotheticals and got off onto many tangents. It was a bonding moment between the boys. He’s a couple of years younger than me so it was nice to spend some time with a peer. I think he looks decided like comedian Greg Proops, but he didn’t know who that was. Chris’ hair is a little toned down, but similar facial features.
Katie was a well seasoned resident and did a very good job directing me and helping me out that first night. The next morning, Divya took over, and proceeded to freak out during rounds because we had so many laborers on the two floors. There was a TON! It would turn out that by Saturday night Divya was back in the groove and doing well. That second night I triaged a person that was actually a Ph.D. research in the OB-GYN department and had lectured us. She was a really nice person and everyone wanted to deliver her baby. The resident on Sunday, Kirsten, commented during rounds, “This woman has more people who want to get their hands inside of her vagina than…” There was some truth that that. It would turn out that one of the residents that I had worked with on GYN-ONC would leave her current post on GYN-benign and deliver the baby.
Sunday was the pinnacle. I was in room 22 with Katie and we were examining this patient that was going to deliver within the next hour or so. All of the sudden I hear this staticy intercom turn on (I didn’t know the rooms had intercoms), “Uh, is there an Elliott Gozansky in the room?”
“Yes?!”
“Dr. Van de Ven needs you in room 23 right away, please.”
“Okay.” Turning to Katie, “You better go!”
I darted out of the room and into the next room. One of the patients I had been following was about to deliver. Dr. Van de Van has this calm, child-like, Swedish voice: “Elliott, put on your gloves.”
I scan through the glove box desperately looking for a 7.5, 8, anything I can get my hands into. I start to go for the sink, “Elliott, put on your gloves.”
I put them on as quickly as possible, but it seemed like it took forever. No gown, there was no time. The bed was not even broken down yet. (The beds are made to turn into a delivery tables.) I placed my hands in the right positions, he said, “Keep good pressure on the top of the head. I’m going to do a modified Ritgen maneuver” where he massaged the outside of the anus to help extend the head back. Pop! The head was out. I started the bulb suction and he reduced the nuchal cord. I torqued the head down and she delivered the anterior shoulder. I torqued the head up and she delivered the rest of the baby. No tears at all (but this was her third baby). I went to put the baby on the mother’s chest and Dr. VDV stopped me, said, wait a moment. This allowed the blood from the cord and placenta to go into the baby. There’s no real evidence that it matters in healthy children and most of the other docs don’t do it, but he does, so we did. I handed the baby up to mom. I don’t even think there was a nurse in the room to clean the baby off, but there must have been. By the time I had delivered the placenta, the baby was already nursing. I asked Dr. VDV how long she had been pushing. He said, “About 3 minutes.” There’s nothing like catching a baby flying out of a vagina! He looked up at the baby and said, “7 lbs 14 oz.” She was weighed a few moments later: 7 lbs 13 oz. Pretty darn close!
There was another delivery that stands out in my mind. It was a young girl who was delivering her second child. She had stopped receiving prenatal care early on because of school and was very afraid of needles, to the point that she did not get an epidural or any pain killers. After the delivery, they went to give her a shot, of RhoGam I assume, to keep her from developing problems if she was Rh- and the baby was Rh+. We did not even know her blood type! She could not take her eyes off of the needle even though her husband tried to get her to focus on him and covered her eyes. “No! I’m afraid it’s going to hurt! I don’t want any needles!” I just stood there in amazement of the human mind. How can you do away with rational thinking to the point that you’re afraid that a needle is going to hurt worst than pushing a bowling ball our through a 3 inch diameter hole? How does that work? She did not get that shot. When she wasn’t looking, she did get a few shots of lidocaine in her perineum where it had torn a bit.
I think I helped with a C-section on Sunday, too. I helped with another one yesterday. Monday was off and then started the day shift on Tuesday. The week was much slower than the weekend. I would have had a delivery yesterday but, during the day there are 3 M3’s and one M4 and one of the M3’s had not seen a NSVD (normal, spontaneous vaginal delivery) yet, so I “gave” it to him. Today was filled with lectures after rounds. Oh, that was a little disaster. I decided to try biking to one of the parking lots that had bus service starting at 5:45am. I got there at 6:15a which gave me 30 min to make a 10 min trip. It turned out that I would use all of that 30 min because the bus was so slow! I went to the floor where my Pt was and I could not find the chart. It was our over-flow rooms which I have not been to, yet. Once I got the chart, there was no paper for me to write a note. Of course I had to flip through it 3 times before I was convinced. Had to interrupt a chatty nurse to ask for a page, rush into the room and do my examination, then write a note. I was 2 minutes late to rounds and if looks could kill, the attending would have buried me three times over! I never got to reconcile what happened and I don’t think they really care what happened, just that I was late. What’s a little OCD between friends?
