More OB

This is a new iteration of a post I began to write Friday night on my last overnight shift, while NO babies were being born (I think I've mentioned a few times how dead my night shifts were, but it was actually pretty ridiculous how slow it was).

My Ob/Gyn rotation is over -- the clinical aspect of it, anyway. We have lectures and study time this week, and an exam on Friday, but I'm not going to be seeing any more vaginas for a while.

Notable body fluids I came in contact with over the last 7 weeks (skip down to the next section if you are easily disturbed):
-The mucous from the inside of an ovarian tumor
-Urine. It would be nice to be able to pee prior to giving birth, so that when the doctor pushes down on your abdomen to help deliver the placenta, pee doesn't shoot out everywhere. But not everyone gets what they want in this world.
-Blood, most notably from vaginas. Vaginal deliveries are necessarily bloody, and that's easy enough to deal with. The most shocking thing that occurred, however, was when a woman had a placental abruption practically all over my feet. I have never seen so much bright red blood appear out of nowhere before. Needless to say, that became an emergency C-section, and we got the baby out just in time, with a 1-minute Apgar of only 1 (the 5-minute Apgar was 5 and the 10-minute one was 8, so the baby's doing well).
-Amniotic fluid, both the clear and meconium-filled kind. And I didn't just come into contact with it so much as had it burst all over and at me on multiple occasions. When a woman is laboring and you are preparing to deliver her baby but her membranes haven't broken, be sure you're wearing full waterproof protective gear before standing anywhere near her spread-open legs. And if you don't have your gown and gloves on all the way but a baby is sliding out, go ahead and catch with your ungloved hand still inside the sleeve of the gown (the wristband of which is the only non-waterproof part of the whole getup) and think about the 98.6-degree amniotic fluid soaking your arm. At least it's sterile, right? And finally, if you are ever acting as second assist in a C-section, you'd better be damn sure to wear a face mask that includes an eye shield, because when the surgeon cuts through those membranes with that scalpel, a steady stream of fluid is going to be shooting right at your face. Quick reflexes come in handy!
-Vaginal discharge during my first pelvic exam. And not just any vaginal discharge. The most disgusting, watery, pooled-at-the-back-of-the-vagina-and-dripped-out-the-end-of-the-
speculum-while-I-was-taking-the-Pap-sample-and-fell-on-the-floor kind of discharge. I don't even know what that liquid was, but I'm pretty sure it had something to do with the fact that she had a BMI well over 35 and her thighs didn't normally ever separate to let the stuff out. Are you disgusted? I was, too. My resident even offered me the chance to back out of it before I did it (just based on the patient's general body habitus she could tell it was going to be a bad pelvic exam), but congratulated me once I was done.
-Stool. Not coming from any laboring women's rectums (which I have seen before, just not in these past two weeks), but from many a colostomy bag on the oncology floor. Disgusting. At least I never did actually have to touch it, not even the bags, but looking at it was definitely enough.
-Fat. Fat patients are not fun to do surgery on, especially when your role in the surgery is to retract the fat. But hey, what else are third-year med students really good for?

Notable craziness I encountered:
-I saw at least three of my clinic patients on the labor floor, which was really cool. They were so excited to see a familiar face and didn't even care that I wasn't a doctor (see previously recounted story here). I almost got to deliver one of them (stupid shift change) and showed another the first glimpse of her baby on ultrasound (there had never been so many screams of joy coming from a room!).

-Had a patient abrupt all over my feet (in case you didn't read the story above), which was beyond crazy. She came in at 35 weeks with no prenatal care (bad), complaining of lower abdominal pain. Her fetal heart tones (FHT) were in the 140s (good), and then we took the monitor off to get an ultrasound. We saw a couple clots in the placenta on the ultrasound, but everything else looked normal and the intern told her she suspected round ligament pain and was just going to recheck the FHT and send her home. But the FHTs were in the 100s (very low for a baby, and not good), and we were sure we were picking up the mother's pulse instead, despite moving the monitor all over to try to pick up the baby. All of a sudden, the patient moaned something about something not feeling right, and we all looked at her pelvis and saw at least a pint of blood splashed all over the gurney, the floor, and very close to my shoes. Yikes! She started crying, the nurses started running around, I started having a silent heart attack, and the intern kept calm and got things going (at least, she looked like she was calm; she told me later she was having the same heart attack I was). So back for an emergency C-section we went, and although the baby came out just in time (Apgars of 1 at 1-minute and 5 at 5-minutes; not so great), everything turned out OK. And I got to staple her incision shut, yay!

-I clipped one side of a woman's tubes. It was pretty cool that I got to do that, but it is now time once again for my standard plea for anyone I know to never go to a teaching hospital unless you have a strange, rare disease or are in imminent danger of dying. Because really, do you want ME doing half of your tubal ligation? And sewing your skin shut? Even if I did a pretty good job of it, by all accounts? I didn't think so. I still have occasional palpitations that I didn't put the two clips close enough together, or that I didn't clip one of them all the way. At least it's not MY name on the operative report, so she can't sue me when she gets pregnant again (which I sincerely, honestly, 100% hope she does not!).

-I delivered four placentas in all, but no babies. I had no expectation of catching the first baby, it being the first one, but the second one tricked me by slipping out before we were gowned up, thereby causing the chief to admonish me to finish gowning while the intern exposed herself to the full onslaught of unprotected blood and amniotic fluid. I guess the department carries insurance for harming residents, but not med students. Oh well, I did sort of help catch that baby with my ungloved hand (see above). Yay, placenta delivery. The third baby popped out with just the nurses in the room, but the chief popped his head in, looked at me and said, "Why don't you deliver the placenta?" Yay, gowning up for a placenta. The fourth woman delivered at home with EMS on the scene (you shouldn't come to the hospital too early, all you "I'm having contractions every 10 minutes, help!" patients, but you can't wait too long, either!), but they were nice enough to bring her in to have us deliver the placenta. That night, the labor deck was so dead that I jumped at the chance to deliver the placenta, and got my wish. I had no help whatsoever and next to no supervision. As I massaged her fundus and tugged gently on the cord dangling between her legs, I was overwhelmed for a minute with pride that they trusted me enough to do the job by myself. Then I realized that this was one of the most menial jobs there was that actually still involved touching another human being, and there was pretty much nothing I could do to screw it up, and since the baby had already been born, none of the residents even cared to poke their heads in. It's nice to have your place in the order of things reaffirmed every once in a while, you know.

-And lest you think my life as a third-year medical student is a complete waste, I did manage to teach some of my patients a few things. Like on Saturday, my last morning, when I rounded on K.T., an 18-year-old who had had an emergency C-section three nights previously at 28-and-5-weeks' gestation for breech presentation, active labor, and an incompetent cervix (when they pulled the baby out, they flopped it on her pelvis while they dealt with the cord, and I got to suction its nose and mouth. Yay.). A day earlier, she had spiked a mild temperature so we checked a urine sample, which showed she was dehydrated and had either a UTI or skin contamination. We talked about a bunch of stuff, then I turned the conversation to the urine:
Me: So, we checked your urine and it shows that you're dehydrated and maybe have a UTI. You should probably stop drinking so much Sprite and try drinking some water instead.
K.T.: OK, I'll try. You know, there was blood in my pee.
Me: Yeah, I saw that. Did you clean yourself really well before you peed in the cup?
K.T.: Yeah. There was also tissue in the blood.
Me, thinking: It's normal for post-partum women to pass bloody tissue from their vagina (aka lochia). This sounds like a non-clean-catch urine specimen.
Me: Are you sure the blood came from your pee, or did it come from your vagina?
K.T.: It came from my pe -- wait, what do you mean?
Me: Did the blood come out in your pee or did it come from your vagina?
K.T.: What do you mean? There's two different places?
Me: Um... Yeah, you have TWO holes down there...
K.T.'s sister: You know, one's where the pee comes out and the other is where the blood comes out!
K.T.: Looks confused
Me: Here, let me draw you a picture...
... See, this is where the pee comes out (pointing to blue arrow), and this is where blood and babies come out and penises go in (pointing to green arrow).
K.T.: WHAT?!!? I have two holes down there?
K.T.'s sister, cackling uncontrollably: You don't know your own cootch! You don't know your own cootch!

There you have it, folks. I complained that medical professionals didn't do enough patient education, so I get to educate. Some people operate, some people save lives, and others do 4th-grade sex ed at 5 am on a Saturday to teenagers who have been pregnant three times and still don't know where pee comes from.

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Despite all the dire warnings that I was bound to hate my first rotation, I actually pretty much liked it all around, crappy hours and all. Ob/Gyn is definitely on my short list of career possibilities, so we'll see what the rest of the year does to change my mind.