Confessions of an Intern

Week Twenty-five

I've finally started on the other rotation that has me scared spitless...maybe the rotation that scares me the most. Obstetrics, from here on out I will refer to it as Ob, despite the fact that I've given birth to three children of my own, frightens me. I think mostly it is due to two things: 1) I had very little experience with delivery during medical school and 2) My first month of residency, I took several classes on what to do when labor and delivery goes wrong, and what to do in those Oh $#it moments (which literally scared me so much that for several days I had nightmares about horrible deliveries). I usually don't get so hung up on that stuff, but for whatever reason the whole transitioning of a new life from their happy womb to the violent and sensory bombarded world really gives me pause.

One of my medicine attendings was with me at the end of my first ever! deliveries this week. After the event was all said and done, he made the very astute observation, saying, "I think somebody is a little less comfortable in L&D than on medicine." You think? I'll share the glorious event with you, protecting all privacy.

My first delivery takes place in an urban medical center where the majority of patients receive little or no prenatal care. This particular patient was not sure what her due date was, but she apparently wanted it to be "Today" that day. She was using her phone to calculate her last period -__- Really? Whatever. Anyway, she was nice enough, but rather disinterested in the whole thing. Didn't want an epidural, but did well with the single dose of pain meds she got. I was amazed how quickly things progressed from start to finish for her. She showed me that symptoms that typically go with certain presentations do not always hold true. She was having back labor, which is very often associated with a baby coming out sunny side up (looking at the doctor), instead of OA (Latin for occiput anterior, meaning baby is looking at the ground). I checked the baby's position and felt like the baby was in the correct position, and by the time my attending came to see how things were going, she couldn't tell. I was so relieved when it turned out I was correct.

Moving on, the delivery came about quickly, with most of our time trying to teach our mom how to deliver. She was fighting with all her might against us, and making it difficult to help her. Anyway, we finally got things moving the right direction by having her play tug of war during contractions. It kept her from arching her back the wrong way. So after a few of these pushes, I got to deliver the baby under the supervision of 3 other doctors...Yep, not one, but three. Two attendings and a senior resident. I was assisted by the mom, as when it came time for the final push, she decided to push all the way to the head of the bed as I caught the baby's head, and ended up that motion allowed for the rest of the delivery (I was sprawled up the bed, cathching baby...I don't even want to know what that looked like). The Baby Daddy...yes you heard right, that is the correct term adopted in our check outs...cut the cord and did a great job being supportive, the whole while a friend was dancing around making sounds of disbelief and answering texts and facebook messages on the computer. The mom really was very stoic and did a great job, despite not being able to get pain meds more than once (we are not barbaric, but we can't give IV meds right before birth, because the baby comes out and has trouble breathing). I was giddy with excitement. I did most of it with just verbal coaching. It was such a relaxed experience, fifty percent of my stress was relieved that day.

I have been informed my first week was really slow and that I was not getting a true feel for Ob by my second year senior resident. Before this rotation, I had confided my fears to him, and he tried to take me under his wing and show me the ropes. I did not feel alone those first couple of days, and he took the hint when I felt like he was hovering. I have been a little irritated, as he has a dry sense of humor and really often made me feel inadequate, but then not? I didn't get it. I think I was complemented when he told me I was doing ok at the end of the first week. On Thursday evening, he informed me I was doing a good job, but was slow. I replied, "I'd rather be slow at first, and do it right, than rush and do everything wrong." His answer was, "But you're slow." I am not that slow, and I know I will pick up my pace once I am more comfortable with things.

The achievements of my first two vaginal deliveries and first c-section assist were overshadowed by the preponderance of mundane clerical crap I have to know in order to do everything right. Here's a small taste:

1. We do not just work with faculty from our residency. We cover patients with two other OB groups. All three groups do things differently, as does each provider from each group...exponential chance of screwing up right off the bat.

2. Besides the attendings, some of the patients are assigned to other residents, so when I have one of them, I have to call their resident and the attending, so I am a go between. Calls take up time. So in a day, I may have to talk to 5-6 different attendings.

3. There is a ton of paperwork. Once I get it down, it is no big deal...I still don't think I've been shown all that I am supposed to do. It was not covered in orientation (why?)

4. Many of the patients are "no doc" patients. They either don't have a doctor, or come from another hospital for treatment. Again why? Got me. Anyway, we have many women who get all of their prenatal care at another hospital a mile or so away (I repeat, all of their visits), but decide when they go into labor they want to come to us. I would like to think it is because we are so good at what we do, but the attendings think that there are likely just as many that recieve prenatal care with our providers and go to the other facility. Who knows?

Written down, this doesn't seem like much, but all the mundane things get caught up in a whirlwind of women coming in for triage thinking they are in labor, or actually in labor or being induced into labor, and all of them need a ton of paperwork completed, in duplicate...Grrrrr. Half the battle of residency is learning that you are a low paid scribe, and someone else gets paid for the work you do.

I've had good moments this week...I did the best job sewing up "lacerations" on a chicken breast cut to represent tears that a woman might get in delivery. My attending told my second year sr resident to call me for help if he had trouble :) Hehe. I didn't drop a baby. That's a plus, right?

I've had bad moments. I took care of a woman who's baby was dead, and we tried for days to get her to go into labor, only to have the ultimate outcome be that she could not have any more children. (This one was cared for not by us, but the OB docs, we were there for monitoring and support). Made my heart hurt for her.

The week ended by the OB director telling me I should consider the OB track...I don't know. I love my family and want some me time. OB robs you of your life. I've got a few more weeks to go before I think of an answer.