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Obstetrics rotation
I have mixed feelings about starting off with OB this year. It has a nice bit of symbolism – starting off with babies being born being a nice and clichéd metaphor for this year. On the other, labor and delivery is like very few rotations in that the people who come here are usually healthy. All we’re doing as health care providers is witnessing normal physiology and helping it along. As you might expect, however, normal physiology is quite unpredictable. It doesn’t care what time of day it is. The nurses and residents in L&D seem perpetually overworked. In spite of this, a birth is always a happy moment. In a delivery room, there might be a nurse who has to scrub away natural “fluids” that got past the collection bag; a resident who has been up for 30 hrs and is running on fumes; an attending that got called at 3 am and has been on the warpath. When the delivery starts, that’s all that matters and it’s impossible (and would be pretty messed up) to play Debbie Downer at any point.
I caught my one and only baby by accidentally being in the right place at the right time. There is a midwife who works only one day a week, and I happened to run into her right as she as about to deliver. This woman is an amazing teacher and all the residents have been telling the students to try to deliver with her.
“What are you doing? Go introduce yourself to the patient! Hurry!”
Before I knew what was happening, I was gowned and gloved and right in the thick of things, i.e. between the legs and inches away from the baby’s head. With the midwife’s direction, I put one hand on the emerging head and pushed down hard. As it continued to come out, we maneuvered the head sideways to deliver the rest of the body, which is covered in blood, mucus, amniotic fluid and God-knows-what-else. (Note: If you didn’t know, women tend to pass bodily fluids and solids during labor.) This being the woman’s second pregnancy, she sensed that the finish line was near and started pushing accordingly. Just like that, the baby popped out into my hands. After drying the newborn and sucking fluid from its mouth, I placed him on the mother. I can be a pretty cynical guy, but that was a moment of pure joy even for me. I can’t come close to imagining what the mother was feeling.
To digress a bit, I also can’t imagine how any woman would want to give birth after witnessing labor. It literally looks and sounds like torture. The vagina is pulled and stretched and manhandled until it looks like it will rupture, and the nurses are telling you to push MORE. The pain is horrendous when you stop pushing and excruciating when you do. The husband, the sonuvabitch who did this to you, is holding your hand and sputtering the same reassuring banalities over and over again. And when you look down, you just might see a newbie medical student who looks slightly less competent than Dr. Nick, and he’s the one delivering you.
Anyways, after we cut the cord and deliver the placenta, it’s pretty much over. There is a collective mental sigh of relief and everyone is congratulating the woman and the family. I have been grinning like an idiot this entire time and am hoping that the family doesn’t start thinking I’m a weirdo. We check that the placenta has three vessels, weigh the baby and evaluate his APGAR. In a few hours, when the mother is feeling well enough, a nurse will wheel her over to the delivery button. When she presses it, a few measures of Brahms’ lullaby will play in the entire hospital, and even the dying patients in ICU will know that someone is experiencing ultimate happiness at this exact moment.
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Wow awesome story. I sometimes wish that I wasn't born with a more scientific mind instead of a psychological one. Also considering what you have seen I think that it is safe to say that a child being born could possibly be the best form of birth control lol.
So because you are a student/resident right now, basically all you do is walk around the hospital and wait for doctors or other nurses to call on you for some help or do you have other responsibities such as like administering medication or taking blood etc? I would be really interested in knowing what the daily tasks of the residents are because I think most of us will probably just think of the show scrubs and base our opinions of what you guys really do off of that.
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I wonder if you'll have any mothers wanting to keep the placenta to eat. There was a TIME magazine article with Joel Stein's wife doing that ...
Do you do the APGAR twice in a span of a few min?
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On July 24 2009 05:28 kidd wrote:
Wow awesome story. I sometimes wish that I wasn't born with a more scientific mind instead of a psychological one. Also considering what you have seen I think that it is safe to say that a child being born could possibly be the best form of birth control lol.
So because you are a student/resident right now, basically all you do is walk around the hospital and wait for doctors or other nurses to call on you for some help or do you have other responsibities such as like administering medication or taking blood etc? I would be really interested in knowing what the daily tasks of the residents are because I think most of us will probably just think of the show scrubs and base our opinions of what you guys really do off of that.
I second this entire post.
Curiousity peaked. :D
And congrats on helping the lady deliver...talk about being thrown into the fire.
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He's not a resident ... just a student ... doing what's called "rotations" or "clerkship". And yeah he probably has to do the patient interviews to get past medical history, do physical examinations, etc. Almost everything is run by the attending I think?
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On July 24 2009 05:11 radar14 wrote:
an attending that got called at 3 am and has been on the warpath.
HAHAH Isn't that the truth. My residency has been much like that.
Man those guys can flip the hell out on residents/students if they get called in late at night. I've gotten the bad end of that stick many a time.
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That's pretty amazing, and I find your last line really awe-inspiring. Great read.
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I'm glad some of you enjoyed it and am more delighted that some of you felt nauseous.
On July 24 2009 05:28 kidd wrote:
Wow awesome story. I sometimes wish that I wasn't born with a more scientific mind instead of a psychological one. Also considering what you have seen I think that it is safe to say that a child being born could possibly be the best form of birth control lol.
So because you are a student/resident right now, basically all you do is walk around the hospital and wait for doctors or other nurses to call on you for some help or do you have other responsibities such as like administering medication or taking blood etc? I would be really interested in knowing what the daily tasks of the residents are because I think most of us will probably just think of the show scrubs and base our opinions of what you guys really do off of that.
I am a student. After 4 yrs of school you become a resident. Residency lasts for anywhere from 3-7 yrs. Students mostly pre-round on patients and then report to a resident or attending. So when there is a new admit, students are expected to take the initiative and see him/her. They then can read up on that patient's diseases and follow up with them. Every once in a while, a resident or attending will teach you something new, but it's usually informal and just being in the right place.
On July 24 2009 06:49 lac29 wrote:
I wonder if you'll have any mothers wanting to keep the placenta to eat. There was a TIME magazine article with Joel Stein's wife doing that ...
Do you do the APGAR twice in a span of a few min?
Yes, you APGAR twice.
On July 24 2009 09:18 lac29 wrote:
He's not a resident ... just a student ... doing what's called "rotations" or "clerkship". And yeah he probably has to do the patient interviews to get past medical history, do physical examinations, etc. Almost everything is run by the attending I think?
The attending is available, but usually all the residents just ask the chief resident if they have questions. At least that's how it is in OB. Really, you only bother the attending with complicated problems during the day.
On July 24 2009 10:59 Jayme wrote:Show nested quote +On July 24 2009 05:11 radar14 wrote:
an attending that got called at 3 am and has been on the warpath.
HAHAH Isn't that the truth. My residency has been much like that. Man those guys can flip the hell out on residents/students if they get called in late at night. I've gotten the bad end of that stick many a time.
sounds like fun. What residency?
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EPT
