Second week of OB/GYN

So I had L&D this week — basically a crash course in all things inpatient, since I had never worked on an inpatient service before. Even though it was technically inpatient, psych was not really equivalent to an inner-city hospital L&D service, which is more like a baby factory, ER and surgical ward put together.

The floor is organized into triage, labor, and postpartum. Triage is like an ER for pregnant ladies. Labor is labor — where the birth magic happens. Postpartum is divided into vaginals, high risk or low, and c sections.  Picture me scurrying through the halls of this floor, between the central nursing station with the huge screen of fetal heart monitors to watch and the labor rooms.

A few things:

1) C-section

I saw my first ever on Tuesday. This is one of the weirdest procedures I have ever seen. The entire objective is to reach the inside of the uterus in record time and extract the baby, which is sort of like the “prize” at the bottom of the cereal box. Record time is definitely what it was, as I was standing there holding the retractor and the bladder inferiorly after about 5 minutes of operative time. I saw the second-year resident reach “in” with her back towards me, blinked my eyes, and there she was holding up a large, grayish-blue goblin of a baby attached by its plastic-looking umbilical cord, reflecting the OR lights from above. The baby was instantly passed off to the nurse, without a cry. We cut the cord and extracted the placenta, and we went on with our procedure.  This included bilateral tubal ligation, inspection of some rather massive uterine fibroids, and profuse bleeding before we closed. I felt like I was underwater.I was profusely schooled throughout this procedure, but it was also my first procedure scrubbed in. So it was normal — and I made the scrub nurse my friend.

2) Delivery

A lot of 3d year medical students will say “I delivered a baby on my OBGYN rotation”. This gives the lay-person the mental image of the med student, sans intern or resident, with a nurse hovering in the background, standing in front of a dorsal-lithotomy positioned woman with Dr. J HotHands basketball grip gloves, waiting for a large slippery projectile to be shot towards them with impressive force — and then that they take care of everything themselves. What they usually mean, or are trying to hide, is that they merely “assisted” in a delivery. What they are not telling you is that most of the time they are surrounded by an army of nurses, midwives and…residents that do most of the work and impress upon you your lack of importance.

You are there for “the experience” (very Brown University), and some hands-on learning — but in no way are you running the show. Usually what happens is that you will help deliver the baby once the head has been delivered, and then you will bulb suction off the oral cavity to ensure adequate airway and prevent aspiration. And then, you wait for the best part…gentle downward traction on the cord to culminate in the delivery of the placenta, which incidentally bears a strong resemblance to the head of an octopus.

3) Judgment

In general, most people on the floors — nurses, interns, whatever, do not trust your judgment as a medical student (Duh). Part of it is because I am retarded and have really bad chemo brain, but part of it is also because it is part of being a med student. Getting your judgment challenged is “as third year” as it gets. Because of my mostly outpatient and non-medical previous rotations, I haven’t gotten a good taste of it, but on OB/GYN, this basically means constantly being reminded that you don’t know anything!

If this week was L&D day shift (a.k.a. Judgment Day),

next week is NightFloat (a.k.a. Judgment Night) http://www.imdb.com/title/tt0107286/

–please try to withhold your guffawing

4) OB Nurse vs. Chemo Nurse Battle Royale

I think Chemo Nurse has the moves, but OB Nurse has the grit. The mental image of these two delegates, hailing from their respective sections of the nursing world, duking it out in some sort of bizarre Steel Cage match is one of those things that you think about when you are falling asleep, and that’s about all I have to say about that.

5) Hours

In general, I feel like this week has been a long one. Waking up at 4:20 AM every day kind of sucks, but I don’t have it that bad since I live close to the hospital. I did go into the hospital yesterday after getting chemo on Thursday, which is kind of crazy, but whatever. Next week I will be spending the hours between 5 PM and 9 AM working the night shift on L&D. I will tell you if Cuba Gooding Jr. and Emilio Estevez make guest appearances as Baby Daddies.

6) Constraints

The vagina really is a pretty small opening.