March 14, 2004 8:35 pm
It’s the first call night. It’s been an interesting day. I came in at 5:00 am and found the night resident. He told me to hop to it! I had to have notes written on all the post-partum patients before the morning resident was to come in. Of course, I had already begun and he was pleased to know that I had the notes all done. We had a lady come in. She was not quite in labor but the fetal monitor showed that the baby’s heart rate was decelerating. In a flash, we were all in the OR and the morning resident, to whom we had not even had a chance to say ‘Good Morning’ was doing the C section.
Things slowed down a bit after that. Outpatient got interesting. A Vietnamese couple came in. The woman was having some back and abdominal pain. This was her second pregnancy. She was only 20. I did an H & P on her. As we monitored her, it appeared she was in the beginnings of labor. The attending physician was contacted over the phone. He instructed us to admit her. We did. I began writing labor notes on her, monitoring her progress over the next couple of hours. I was called to outpatient to look at another patient. About 25 minutes later, as I walked back to the nurses’ station opposite the L & D rooms, I noticed activity in my patient’s room – the Vietnamese lady. I rushed in to find that the baby had been delivered, by the nurse. Things changed so fast that not even the resident could get there from the call room a few doors down the hall. I watched as he sutured a tear in her vagina. Babies can come so fast!
It’s a couple of hours later. I just checked in on the patient again. She is sitting up in bed, her husband beside her. Their little baby girl is in a warmed crib. They are eating sandwiches and watching ‘Men in Black’ on television – just another evening. Imagine that! It was a pretty picture.
Last Friday was not so pretty. We were in outpatient and saw a 33 year-old G3P0. She had got pregnant after 10 years, after having lost her previous two pregnancies at 9 weeks – one a placenta previa and the other a miscarriage. She came in, this time at 9 weeks complaining of bright red bloody discharge. We checked her and she was rushed for a stat ultrasound, where it was determined that her fetus was no longer viable. Of course, she was very tearful. We admitted her to the unit and in a couple of hours took her into the OR for a D & C. It was kind of ironic. The D & C was being done by a 3rd year Ob/Gyn resident who was pregnant herself. A female medical student who was in call and myself, who stayed behind to watch this procedure were in the OR with her. When the anesthetic began to wear off in the OR after the operation and as we wheeled her into recovery, she sobbed uncontrollably “You took my baby. My baby’s dead. I want my baby. Why did this happen to me?” I had spoken to her for some time, comforting her before the D & C. She cried, believing that she might never get pregnant again.
As I stood in the OR recovery room trying to pacify her as she sobbed inconsolably, I thought of that verse from the Bible “Rachel weeping for her children and refusing to be comforted, because they are no more.” Who says OB is always a happy specialty?
Sunday, March 14, 2004
Tuesday, March 09, 2004
First day in Ob/Gyn core rotation
3/9/2004 9:41 pm
Well, Psych is over and I was excited about getting started in ob/gyn. I was apprehensive about this rotation because: (1) I am a male and have limited exposure to female problems (no jokes, please!), (2) I do not have any children and have never witnessed a live birth and (3) I have not been around infants and small children a lot.
I arrived my first day at 5:30 am. Our scheduled time of reporting in was 6:00 am. However, I always find it useful to arrive in time to meet the night shift of nurses and get a heads up on what's cooking. We had one first-time mother (grava 1: Para: 1) ready to give birth. Since she had been there since midnight, it was decided to induce contractions with oxytocin (Pitocin). By about 6:30 am, the resident decided to induce artifical rupture of membranes (AROM). pardon the comparison but seeing the meconium-stained amniotic fluid flow out of the vagina was like watching Linda Blair vomit the green stuff in the movie 'The Exorcist'. By about 8:00 am, the baby's heart rate began to fall into the 80s. Interesting that for fetuses, normal HR is 120 to 160. Anything below 120 is considered bradycardia. Interesting contrast with adults where normal HR is 60 - 120 and anything above 120 is considered tachycardia. Anyway, after trying various things -- adjusting the position of the mother, discontinuing the oxytocin drip, a decision was made to do a C-section. Since this was my first day in the unit and I had never scrubbed in for surgery before, I was assigned the role of watching another medical student scrub in and told to observe everything she would do during the procedure.
The C-section was great. It was everything I had read and seeing the baby be drawn out of the opened uterus was the coolest thing I have seen yet. The resident did all the work, while the attending just helped. I had a great view and could see everything clearly.
We went to lunch afterwards and I had a pizza with lots of tomato sauce (I know, pretty sick of me, no?). The rest of the day was kind of slow. I developed either the beginnings of a cold or an allergic rhinitis and was sneezing all day. That was not so good. My first call is Sunday. It seems that in this unit, medical students are really encouraged to participate in delivering babies, procedures and the like. I am excited and looking forward to every day here.
Well, Psych is over and I was excited about getting started in ob/gyn. I was apprehensive about this rotation because: (1) I am a male and have limited exposure to female problems (no jokes, please!), (2) I do not have any children and have never witnessed a live birth and (3) I have not been around infants and small children a lot.
I arrived my first day at 5:30 am. Our scheduled time of reporting in was 6:00 am. However, I always find it useful to arrive in time to meet the night shift of nurses and get a heads up on what's cooking. We had one first-time mother (grava 1: Para: 1) ready to give birth. Since she had been there since midnight, it was decided to induce contractions with oxytocin (Pitocin). By about 6:30 am, the resident decided to induce artifical rupture of membranes (AROM). pardon the comparison but seeing the meconium-stained amniotic fluid flow out of the vagina was like watching Linda Blair vomit the green stuff in the movie 'The Exorcist'. By about 8:00 am, the baby's heart rate began to fall into the 80s. Interesting that for fetuses, normal HR is 120 to 160. Anything below 120 is considered bradycardia. Interesting contrast with adults where normal HR is 60 - 120 and anything above 120 is considered tachycardia. Anyway, after trying various things -- adjusting the position of the mother, discontinuing the oxytocin drip, a decision was made to do a C-section. Since this was my first day in the unit and I had never scrubbed in for surgery before, I was assigned the role of watching another medical student scrub in and told to observe everything she would do during the procedure.
The C-section was great. It was everything I had read and seeing the baby be drawn out of the opened uterus was the coolest thing I have seen yet. The resident did all the work, while the attending just helped. I had a great view and could see everything clearly.
We went to lunch afterwards and I had a pizza with lots of tomato sauce (I know, pretty sick of me, no?). The rest of the day was kind of slow. I developed either the beginnings of a cold or an allergic rhinitis and was sneezing all day. That was not so good. My first call is Sunday. It seems that in this unit, medical students are really encouraged to participate in delivering babies, procedures and the like. I am excited and looking forward to every day here.
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