EPTI couldn't sleep. I should have known myself better than to be surprised by this. I had problems sleeping before the MCAT, various interviews, and Step 1. So why should I have expected a sudden display of slumber control the night before I'm supposed to be on call? I rolled around, walked around, used my computer, read something boring, drank water, lay down on the floor, counted sheep...to no avail. I think I finally dozed off around 3 am, to be rudely awakened at 5:30 by my alarm clock.
As far as I know, OB is the only rotation at my school that makes med students take overnight call. It typically means that we do our regular day of 6:30a to 6:00p and then stay through sign-out at 7:30 am the next day. Luckily for me, my post-call day also had a set of mandatory lectures running until noon. Furthermore, we were told that falling asleep or asking to sleep was B-A-D. Why taking a 1 hr snooze when there's absolutely nothing to do is against the rules, I have no idea.
The day itself passed without much incident. When the people on my team started leaving at 6 pm, I started to feel a knot in my stomach. I'm not even half done with my day and now I'm on my own. At 8 pm, I unknowingly did myself a favor by eating a salad for dinner. Believe me, you don't want to eat a giant slab of cafeteria-grade prime rib and garlic mashed potatoes while on call. I did that on my second call night, and let's just say I started questioning my career choices even earlier than usual that night.
What are the med students responsibilities while on call? Well, our first priority is to triage new patients just like during the day. This typically means seeing a blinking bar on the computer screen and picking up the papers from the nurse's station and seeing the patient before a resident gets there. We were told that this shows "initiative." Since this is Labor and Delivery, 80% of women are coming in with contractions. (One memorable triage was a drug seeker, the first one I've interviewed. Hysterical, thrashing, and making blood-curdling noises of absolute agony. Because she had come in like this before, we gave her nothing. 20 minutes later, she stopped screaming, calmly walked out of the room and asked to use the telephone. Then she left.) If there are no triages, you can check up on patients, follow residents around as they put out fires all over the place, or scrub in for C-sections if there are any.
Around 9 pm I asked my way onto a C/S, my first ever "surgery." I was pretty excited and plenty awake for the first time that evening. That was probably the high point of my first C/S.
"Did you guys learn how to scrub in?"
Umm, I guess so. We kind of had a nurse show us some stuff for 5 mins.
"OK then, go get ready."
Sure thing.
Wait, what? I have no f***ing idea what I'm doing. Why did I just say that I knew how to scrub in? The only thing I remember from that scrubbing presentation was that you should try to get there early so as not to hold up anybody. And I was already running late to get in. I had walked 5 feet into the OR when a nurse told me I needed a cap to be in here. Ok. Then I realized that I was wearing my white coat for no reason and had to ditch it on a random cart outside the OR.
(Sorry, for all these asides. I feel like I have to explain the white coat. Residents wear long white coats and look like doctors. Attendings often wear business casual attire with no white coat at all. Medical students are required to wear a short white coat that on many days feels like a scarlet letter letting the entire hospital know that we are pretty much useless. It looks really stupid. You'll have to trust me on this. This is just one of many reasons why medical education oftentimes seems like pledging for a frat.)
Ok, got my cap. Soaped and rinsed. Backed into the room with my palms facing toward my chest like you always see on TV. The nurse held out a gown for me to put my arms through. I got them through but I grazed a nonsterile cart with the gown.
"You're going to have to get a new gown. Just go slowly."
The entire story is a bit too painful to recall in exact detail. I'll just say that I had to attempt gowning three times with the help of a patience-wearing-thin-and-who-could-blame-her nurse, messing up on different tries the gloving and final gown tying. I am pretty confident that my experience was in the bottom 10% of all students in terms of competency, so please don't think this was a typical first time. The resident couldn't suppress a tiny smile of disbelief when I messed up the last time.
Anyways, the C/S itself was savage. They cut and rip and tear and stretch every layer of tissue from the skin to the uterus, all with brutal efficiency. I caught myself cringing inside a few times. When they finally make the incision in the uterus, the baby is squeezed out with what looks like immense pressure. The human body can withstand some pretty amazing things. Or at least babies can.
Obstetricians are incredibly good at tying knots. I have yet to learn how the specifics of tying, so this will surely become less amazing to me at some point. But for now, I marveled at their technique. Different angles, sometimes one-handed, sometimes two-handed. Sometimes with the use an instrument. Always blindingly fast. Keep in mind that they are tying thin threads with gloved (sometimes double-gloved) hands covered in slippery liquids of various origin.
The whole thing (from anesthesia to recovery room) takes maybe 90 minutes, but it felt a lot shorter. The mother is shivering too hard (from a combination of blood loss and hormonal changes) to enjoy her newborn to the full extent. There are good reasons don't videotape their C-sections for posterity. I got to retract, cut sutures, and staple the incision. My main responsibility was probably keeping my hands where people could see them. Just kidding, sort of. Joking aside, despite all the scrubbing snafus and the uncertainties of being in the OR for the first time, it was exciting to be in the surgical field and feeling like a part (albeit tiny) of the team. The stimulation of the C/S helped keep me feeling awake for quite a while.
I couldn't sleep. 3-6am was dead time. Nobody was coming in. The morning team wasn't here yet. There was nothing to do. Sitting in a comfortable chair was a mistake. Attempting to studying was a noble gesture and also a mistake. I somehow summoned the willpower not to succumb to those rookie moves. Really, walking around constantly and splashing water in my face was the only way I got through it. When my classmates started finally coming in, I knew that I had gotten through the worst part and the home stretch was all mine.
Walking home at 1 pm, after 30 hrs of no sleep, I felt strangely alive. There was definitely a sense of pride. You know that Scrubs episode where JD and gang are on call and running the hospital for the first time? I felt a smidgen of that. Maybe not this first time, maybe not the next 10 times, but someday I'll make a difference and maybe even save a life while the world sleeps.
