week 5 of OB/GYN

This past week, I got to rotate on the world-famous Gynecology-benign service. Which means “not gynecological malignant”. So no cervical cancers, endometrial cancers, ovarian cancers, or vulvectomies. I was relegated to the note-written-before 6:30 duties on the floor, rounding with the interns and the residents, many of whom made every effort to act like I didn’t exist, and getting shipped to all sites in the hospital for random consults regarding vaginitis, vaginal bleeding, endometriosis, pelvic organ prolapse and the like. Not to mention talking to a few wacky patients.

1) ER = Zoo

Overheard in the stall next to the OB section in the ER:

Physician (pulling curtain closed): Well, Mrs. Jones, I just talked to my attending. I understand you’re in pain because of the sickle cell, but I am only allowed to treat you for what you need, not what you want.

Patient: OK.

Physician: So that means…that I can write for the Percocet. But I’m not giving you anything else.

Patient: f*** that. (pulls curtain aside and storms out of ER)

2) Bacterial Vaginosis

Smells like time-released vomit. Either it actually smells like vomit, or it was actually the vomit in my mouth.

3) Banana bag

This is not a Banana Hammock — also known as a Grape Smuggler, for those of you who are harkening back to the tight swimsuits of the 1970s and 80s. It is a special combination of IV multivitamins that is given to people with nutritional deficiencies and has a bright yellow color. In most of the world, nutritional deficiency may be pandemic because of social issues — famine, war, etc.

In inner city ERs and hospital floors… most nutritional deficiencies come from alcoholism related to cheap booze — http://www.bumwine.com. Which means you “banana bag” the alcoholic patients even though the word makes you laugh. And it’s not really that funny, when you think of it.

4) Daddies

Me: So, Mrs. Smith, are there any diseases that run on your  father’s side of the family?

Patient: Huh?

Me: Does your father have any medical illnesses?

Patient (sigh): I don’t know what’s wrong with him.

5) Bloodless

There used to be an aerial skateboarding move called the “Boneless”.  During a jump onto a rail, you would plant the front foot and use the back hand to pull up the rear side up towards your body. It was popular in the 1980s.

There also seems to be a move, called the “Bloodless”, in the gynecological world, which consists of refusing blood transfusions on religious grounds while sitting in the pre-operative assessment area. It usually involves signing some paperwork and putting your hand on your haunches, explaining your position. Bloodless patients + vaginal hysterectomy = disaster waiting to happen.

6) Hot Scissors

Do not use ‘Hot Scissors’ when dissecting the broad ligament to reflect it during hysterectomy. Do use ‘Hot Scissors’ as a name for a blasé hipmonkey cock-rock band.

7) Fumes

“Smoking Crack” apparently is an official order field in my hospital’s archaic EMR system. Calling it EMR doesn’t do it justice — it is something out of  DOS programmer’s burnt-out-by-diet-cola brain that functions as an order/result retrieving system, rather than an exhaustive list of complete and relevant patient information.

Regardless, I looked up a patient’s active orders in the ER, and the following was written:

“…

EKG ORDERED STAT FOR TACHYCARDIA

SMOKING CRACK”

8) TOA

Not to be confused with T&A.

The drainage of a tubo-ovarian abscess isn’t something I thought would get me excited. But boy, did it get me excited.

9) The Scenic Route

The uterus, when viewed laparoscopically, looks a lot like a giant, pink, alien space ship. This is one of the things you realize as you are posted to “stay down there” on the lap-assisted vaginal hysterectomies and are forced to stare at the screen for hours, making sure you are able to move the uterus just as they want it.

“Staying down there” means you spend the entire surgery between the legs of the patient, with a sound and hemostat taped together — or an intra-uterine humidifier — running from the vagina into the cervix and into the uterus, around your fingers. Your job as assistant is to manipulate the uterus using the sound or the humidifier from its position in the vagina in order to aid the dissection that is happening above you. Upon command, the womb, in some sort of weird physical dynamism, wakes up and follows the pull of your fingers like a strange puppet, stretching out the round and suspensory ligaments like tentacles. Then you get yelled at because the uterus is not lateral enough as they are dissecting down the broad ligament.

10) ER = Zoo

I can’t imagine why anyone would decide to put speculums in drawers down in the ER OB rooms. Really, I can’t figure it out.