anna in med school

The best things happen at night…if you’re a medical student, not so much if you’re a patient.  Apologies for the long runs without posts recently.  My excuse this week was night float–both uniquely invigorating and challenging.  I love night float because you get to do and see so much (but it does a number on my sleep-wake cycle).  In trauma surgery, it makes sense that a higher density of trauma happened at night.  Ob/Gyn is more of a mystery.  Why do more women go into labor or have third trimester bleeding or have seizures?  Why do more of them pick 12:04am as the time that they would like to be evaluated for a cramp in their right lower quadrant they’ve been having for the last three days?  (BTW, no judgment–if there’s a possibility of ectopic, ovarian torsion, etc., would much rather patients come in when they’re concerned rather than wait until the next day.)

So, I am now just a little terrified of all the rare things that could go wrong during my own labor and delivery.  Like making it through 18 hours of unmedicated labor only to have to be put under general anesthesia post-delivery for a retained placenta.  No skin-to-skin, no breastfeeding, no being on the same floor as my husband and child during recovery that night.  That would suck.

One of the things that is morbidly relieving to me is the number of emergent births I’ve seen of women who were not as far along in pregnancy as I, and their infants do well!  It’s not ideal, but when your water breaks at 26 weeks and you have a prolapsed cord (when the umbilical cord precedes the baby’s exit from the uterus, resulting in the baby’s blood supply being diminished or cut off), delivery by c-section is the only option–it’s just so wild that it works!

My favorite part of c-sections is when I get to support the head of the newly emerged infant and suction his/her mouth.  What a trip to be involved in helping force the kid to take the first breath!

I wonder if most pregnant women share this sentiment, but I feel strangely more self-conscious, bordering on insecure, now than I ever have before.  It’s the one time when it’s not only okay but encouraged to gain weight but, surrounded by annoyingly/inspiringly buffed-out mamas at my local suburban yoga studio, women who run marathons and deliver babies on the same day, and the latest spanx craze, I admit I still blush and don’t know quite how to respond when I get the almost daily “You’re HUGE!” or “You’re TINY!” comment–I think both are meant as compliments?  Or maybe just different interpretations of the obvious…

So, as I am settling into the third trimester, I asked John to take a few snapshots during a moment of comfort with my figure.  I had just returned from a yoga class and, though legs and arms were shaking, felt stronger and more capable than I had in several weeks.  (I’ve been feeling a little discouraged since what I think was likely my last run during pregnancy.  Supposedly it’s fairly common, but I think my rectus muscles are starting to separate and, despite various techniques to support the belly, running is no longer pleasant.)

D & E.  a.k.a. a surgical abortion.

I have a feeling a good number of readers are not going to like this post very much–come to think of it, I don’t think any readers are going to like this post.  Pro-choice, pro-life, ambivalent–no one is pro-abortion.  It sucks.

To make myself clear, what I’m about to write is not about my political opinion, only one experience.

I scrubbed into my first dilation and evacuation last week.  It was my choice to be there, I was under no obligation and I felt no pressure–well, I suppose I did feel some obligation, but it was entirely self-imposed.  As someone who is interested in this field, I think I owe it to the patients to be educated on the medicine.

The OR was peaceful but a little sad.  Everyone was respectful and considerate to one another.  There were no frustrations or irritations, no one felt hurried.

The procedure was impeccably clean and thorough.  The removal of the contents of the uterus was more challenging than I thought it would be to watch, though I’m sure far easier than it would have been to observe the D & E from earlier that day of an anencephalic fetus (one without a brain).  At this stage in the pregnancy, the “products of conception,” as we call them, looked like unorganized soft tissue–but I didn’t look all that closely.

The physicians in the room were everything a patient would want.  They were supportive without any judgment.  They listened and acknowledged that patient’s concerns.  They showed absolutely no agenda.  They provided excellent patient-centered care.  One of them told me about an experience he had one with a patient who chose to have a criminal abortion and presented to him in severe septic shock.  He decided then that he would not let that happen to another patient of his.  He’s received death threats; he’s been physically assaulted.  He could have retired by now, but he hasn’t.

On July 5th, I “delivered” a baby for the first time.  (“Delivered” in quotations because I had neither agency in the process nor understanding of what I was actually doing until I handed the infant to her mother.)

Here’s how it went down:

So, I see a group of midwives for my own prenatal care that delivers at the hospital where I’m rotating.  One of them recognized me, asked me how I was feeling and liking the rotation, introduced me to her patients, then asked if I’d like to assist on a birth.  Um, absolutely.

One of her patients, about my age, was in labor with her first.  She was in stage II of childbirth (the actual pushing part) for over three hours.  I held her legs, brought her ice chips, played tug-of-war with her using a balled up sheet, updated her family, and gradually got to know her and her husband a little through small talk between contractions.  When the head started crowning, the midwife guided my hands and showed me where to place pressure on her pelvic floor and at the base of the baby’s head.  Before I knew it, I was sliding the right shoulder out, then the left, and was momentarily holding this new person before the midwife instructed, “Okay, now give the child to her mother.”

The mom and dad were both total rockstars.  The best part I think was the transition between the mother being in the worst pain of her life to feeling absolutely nothing but pure love for this small human she just brought into the world.  She looked at me as I handed her her little girl, “Is she mine?!”  She didn’t even feel us sewing up her vaginal lacerations as she held her wailing child.

A few lessons for myself this October:

1. Stay at home as long as humanly possible.  I do not want spend hours piddling away on a hospital floor with my cervix 2cm dilated..
2. Bring DVDs.  First births take a long ass time.
3. Don’t tell anyone I’m in labor.  I want to worry about my child, my spouse, myself, and no one else.  (This woman above and her husband were texting back and forth with her mother in the waiting room between what seemed like every contractions because her mother was on the verge of total hysterics.)

I really don’t want to love Ob/Gyn.  It’s a tough life.  Brutal residency (the intensity of surgery with fewer residents and often less respect).  Horrible, often unpredictable hours (even as an attending).  So, so many lawsuits (btw, when people complain about the c-section rate in this country, I can’t help but think, “Then stop suing the pants off the providers, and maybe they won’t rush you to the OR quite so quickly.”).  One of the attendings, who has twin girls, on the Labor & Delivery Unit told me, “If I knew I wanted to be a mother and that I would like being a mother so much, I would have picked another field.  No question.”

Sobering, no?

I just finished my gynecological surgery week.  I caught the 5:05am train every morning in order to pre-round and be ready to round at 6:30.  I was in the OR by 7:30am.  My surgeons were generous, and they always let me leave by 7:30pm so I could catch the 7:46pm train home–they, of course, stayed until the end of their respective surgeries as late as 10:30pm, thereby missing any interaction with their families that day.  They also always let me break for lunch, a luxury they rarely gave themselves.  I didn’t formally study this week because I spent every minute at home preparing the three presentations I was assigned this week (ask me anything about gestational diabetes, fibroids, or stress urinary incontinence).

But I still loved it.  The surgeries were fascinating (and I actually got to participate!  Did you know that gyn surgeons use a tool called “the morselator”–it’s actual name!–in order to break apart uteri and remove them laparoscopically, piece by piece?  Dramatically reduces recovery time when you don’t have to make a larger incision!).  The surgeons are kind, sometimes a little funky.  The outcomes are often pretty great–fix a woman of her urinary incontinence, and she is one satisfied patient!  And there’s a wonderful mixture of high acuity and longitudinal care.

I have four more weeks on Ob/Gyn, during which I’ll rotate on ambulatory clinic, oncological surgery, and labor & delivery (night float).  At the end of those four weeks, even if everything goes smashingly, I’ll temper my enthusiasm.  The last week has been hard, but I am under no illusion that it’s even remotely reflective of the challenges of a career in Ob/Gyn.

This morning I spent over three hours “manipulating” a woman’s cervix.

Urogynecology is a wild field.  And patients LOVE their doctors.  Can you imagine suffering for years with urinary incontinence or vaginal prolapse…then you have a procedure and you’re cured??

Maybe I’m just feeling jaded, but it seems like there are so few procedures that can promise cure at such a high rate. Today was wonderful.

Two of our best friends let us borrow Meta, one of our all-time favorite pooches, for the last five days while they were out of town.  She’s wonderful–one of those dogs that is always at the door when you get home, curls up under your desk when you’re studying (makes studying so much more enjoyable!), gingerly accepts treats out of your hands with so much gratitude, and is always up for a hike or a snuggle…until she gets too hot in the 100-degree heat.  Then, when she finally escapes our loving grasps, she just looks at us like we’re completely crazy.

When John and I were driving home from the beach on Friday, we stopped in a Safeway that had a starbucks to get the token road trip lattes.  I saw a 2-pound container of blueberries on sale for $5.  Resisting the urge to drool and/or start eating them right there in the middle of the produce section, I made my way to the express line that was just opening up.  Two older gentlemen (friends, it seemed) with carts got there first.  The one with a portable oxygen tank wearing a nasal cannula looked at me, “That all you got??  Charles, let the woman go in front!  That all she got!”  I blushed, thanked him, and squeezed my way to the front of the line.  The cashier rang me up and I pulled out my wallet to pay, but I was interrupted by the same fella, “Oh honey, that’s on us!  You have a good weekend, mmmkay?”  I was touched and surprised, I just hope I did something to show my appreciation before I awkwardly waddled back over to John.  And they were the best flipping’ blueberries I’ve had all season!

Yesterday was one of those epic days spent almost entirely eating and walking, an excuse to really enjoy my city by showing it to wonderful friends (and New Yorkers and Bostonians are a tough sell!).  I feel like pregnant women have a perpetual battle between staying hydrated and not peeing every 10 minutes.  But yesterday was viciously hot, so I opted for the former.  As we passed a nearly empty pub on 2nd street, I decided to go for it.  When I sweetly asked the proprietor if I could use the facilities, he initially declined and said they were for customers only.  But as I turned to leave, one of the patrons admonished him, “Roy, what the hell are you doing?”  And I was stopped, “Oh, yeah.  Of course, help yourself.”  A moment later, while walking from the restroom to the door, I thanked him again and he replied, “Anytime.  And sorry.  I didn’t notice your…status…ya know, until you, like, turned sideways.”   Me and my “status” consider it a compliment.

People are not going to be so nice when the kid is out the womb, right?

Tomorrow’s my first day of my Ob/Gyn rotation.  I’ve been cautioned by friends to try not to freak out too much.