I've just completed three weeks of a six-week rotation in Obstetrics and Gynecology. It's been a mixed bag of emotions for me. The rotation is pretty hard. There isn't much of an orientation and you are thrown into direct patient care on Day 1, Hour 2. We all showed up on the ward after having our ID photos taken and were essentially told "Go."
Uh.. go and do what?
"See patients."
Ummm.. OK.
At first, 2 or 3 of us would tag-team a patient -- we figured there is safety in numbers. But by lunch, I was working solo and by 3pm, I had done a handful of pap smears and pelvic exams with very little if any guidance. Initially, the residents walked all of us through doing our first real pap, but after that, we were on our own completely. 30+ paps later, I feel almost comfortable, dare I say confident, doing them. Some patients, however, are a little more challenging. Like those that tip the scales at 400lbs. Had 2 of those already. Wow.
Much of my day is spent working in the Women's Health Clinic, evaluating and diagnosing patients with gestational diabetes, ruling out and looking out for preeclampsia, doing postpartum wound checks and physical exams, antepartum exams including pelvics and paps, using dopplers to measure fetal heart tones, and ordering labs, ultrasounds, etc.
The part I am the least fond of is diagnosing STDs like chlamydia, gonorrhea, trich, or BV, and then breaking that news to the patient. I worry someone's boyfriend, husband, or partner is in for a nasty fight. A few patients have broken down right there in the room. The look on a young woman's face when she realizes or thinks someone hasn't been faithful, and that he not only got her pregnant, but gave her an STD as well -- that's tough. I do counsel them that they could have had chlamydia for years and very well could have been asymptomatic and it was only just discovered because we routinely test for it. I try to tell them that they, in fact, could have gotten it from a previous partner. It's still hard, though. It's a county hospital, and the women I see are young, poor, and have little education. Some of these women are still in their teens and already have 2 or 3 kids.
Ive had some great days, too. I had one patient encounter where I told her she was cancer-free and she burst into tears and hugged me so hard she almost ruptured my spleen. That was realy cool.. except for the spleen part. I also had 2 patients ask if I could be their personal doc. I had to explain to them that I have another 2 years to go... it was a great feeling, though.
The attendings have been great, too. I have been pimped quite a bit, but it's been rather benign so far. I mostly get the questions right, and if I don't know the answer, they are great at explaining it, and then telling you politely to go home that night and read up on it.
I am rather tired, as we do work hard - mostly mental work. The work week is Monday - Friday 7.30am until whenever we get done (usually by 6pm), and sometimes we have day call on weekends or overnights. Tomorrow (Sunday), I am on call in Labor and Delivery from 5.30am until 5.30pm, and next week I have a few overnight calls (5.30pm until 5.30am) in L&D. Yesterday, I scheduled one of my patients for an induction tomorrow, so I may get to deliver her baby if I am lucky and she goes into labor while I am there. Other days we work the wards, handling obstetrical emergencies, seeing post-c-section patients, and discharging the mothers and babies who are healthy enough to go home.
Like I said, it's been hard and I am tired. The first two weeks, I pretty much came home and crashed into a state of unconciousness on the couch, or went hottubbing and then crashed on the couch. My feet were KILLING me from being on them 12 hours a day, but I am now getting used to it. Buying the proper shoes helped, too. Days when you can wear scrubs all day is nice, because you are so much more comfortable. Mostly, it's professional dress. Actually, I think what I am finding the hardest about working so hard is being emotionally available at the end of the day, or just being available in general. My schedule is a little erratic, and making plans means being flexible. Everything is "tentative." I don't like that, and neither do some others, but I, as well as they, have to get used to it. After all, this is the life I chose.
I am happy with my decision, and working with the patients, while exceptionally difficult, is rewarding and reinforcing why exactly I chose to go into medicine. I am loving every foot-aching, heart-aching minute of it and wouldn't trade this for the world.
Posted by LA at July 14, 2007 10:07 AM