Rotation roundup: obstetrics and gynecology

So my last obs call shift is officially over as of 8:00am this morning.  It’s a good feeling, outside of the typical hungover, post-call blahs.  Although it was about the weirdest call ever.  Why?

 

  • I slept 2 hours.  TwiceAnd I didn’t miss anything.  (For those who don’t know, getting 1.5 hours is about average for our group.)
  • I only delivered 1 baby, and at the very end of my shift.
  • I got to be 1st assist in surgery.
  • I was post-exam and post-OSCE.
  • I brought a novel.  And actually got to read it.  (The Casual Vacancy has been a refreshing change from Poe.)
  • I sat down for all three meals for 30 glorious, uninterrupted minutes.
  • I’m fighting a cold and actually felt better after my call shift.

Weird, right?

Anyway, now that I’ve put off writing this until the very last second, here’s my quick recap of an interesting 6 weeks on obs/gyne:

The where: Grey Nuns Hospital (Fun fact: this hospital has the highest volume of deliveries in the city!)

The good:  Let’s face it – delivering babies is pretty awesome.  Once you get over the overwhelming nature of birthing and get a handle on the right technique for doing it, it’s very exciting and awfully fun.  Rarely do you get to be involved with something so painful and stressful with such an amazing, joyful outcome.  I still grin like an idiot and feel this little rush of happiness.

There are some amazing people on obs/gyne when it comes to patient care and assertive confidence.  I’ve learned a lot on how to practice medicine like you mean it.  And the residents are very good about teaching and providing opportunities to learn.  (Colposcopy clinic is highly recommended if you get the chance!)

The patient population is much different than I’m used to – lots of times it’s young women who are generally healthy and don’t need a lot of care.  But the patients that are complicated… are really complicated.  Everything becomes tenfold more crazy when you’ve got a baby on board.  Your management often is completely different, your drug choice, even your physical exam.  (Note to 1st/2nd years: NEVER NEVER NEVER do a pelvic exam on a pregnant lady who’s bleeding without looking at a recent ultrasound first!!!)  Makes for an interesting challenge.

And if you like emergencies and excitement, there’s plenty of that, too.  Whether it’s doing emerg consults for suspected ectopic pregnancies or urgent C-sections for fetal distress, it definitely keeps you on your toes.

The not-so-good:  If you haven’t picked up on it already, obs/gyne is exhausting.  As in, I feel emotionally drained even just thinking about writing in my journal.  It may have to do with the high volume of people that we see, but 11-hour days are the norm, starting at about 6:15am.  And the 24-26 hour shifts on call take some mental gearing-up for.  And keep in mind, these are not seeing-1-patient-an-hour days.  These are busy-till-your-feet-ache days.  But you count down the number of call shifts and you manage.  Because you have to.  And because you do a ton of learning on call – there’s no substitute for being one of only 3 people in charge of so many patients.

I discovered that I may not like surgery as much as I thought I did.  It could just be the hum-drum of yanking on retractors as 2nd assist for almost everything, but surgery days feel long and tedious, especially big uro-gyne repairs.  There’s only so many times you get corrected for holding the sutures the wrong way before you start to feel run down.  Plus there’s a tendency for the staff to ignore your presence, so most of the time I had no idea what was going on.

On a related note, surgical specialties tend to attract a… particular personality.  Yes, it’s a generalization.  Yes, it’s not 100% true for 100% of them.  But for a large chunk of them, they tend to be wound a little bit tightly.  This is absolutely NOT A BAD THING, especially in a line of work where you need to be “on” nearly all the time.  But it can make for sub-par or even humiliating learning experiences.  It’s never meant as a personal affront, but the casual indifference is almost worse because it never comes with a correction or a suggestion.

The verdict:  I often had a good time, but not often enough for me to put this near the top of my list.  Some negative learning environments and high-pressure situations I felt pushed into… somewhat turned me off early on.  Maybe obstetrics call might be sorta kinda fun some day?

BONUS! Word to the wise:  eat and drink before every C-section, if possible.  You never know when your glucose levels are going to crap out on you.  Really press the nurses to page you for patients you’re following and technical skills you want to practice (this hospital has a rather bad reputation that way).  And NEVER feel guilty about getting sleep; don’t buy into the weird veneration of working like a maniac.

EXTRA DOUBLE BONUS!  About exams:  You will feel bad.  You may feel like crawling under a heavy rock and shriveling up there.  You may not finish every OSCE station.  But you will pass.

A new chapter starts in the morning… psychiatry ahoy!

 – Atalanta

Image courtesy of Stuart Miles | FreeDigitalPhotos.net

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2 Comments

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2 responses to “Rotation roundup: obstetrics and gynecology

  1. Nav

    Glad to know that I’m not the only
    One who feels utterly incompetent in the OR and always in the way.

  2. Just came across this, and had to comment as I’m currently taking students to the Grey Nuns. They LOVE it so far – and I LOVE the baby-friendly focus. What you said about eating & drinking before sections – that’s what the clinical educator for the OR told my students last term, when I took them for surgery. She said you never know when you might suddenly start to feel faint, so make sure your glucose levels are up there prior to going in.

    My experience as an LDRP nurse (up in my rural workplace) was that it took some time to get totally comfortable with most situations. It took me a good year to be really comfortable, and by the end of 2 years I felt like I could handle most things. It just seemed to me that you kind of sit around twiddling your thumbs (or in my case, checking FHR & V/S every 30 minutes) for hours, and then all of a sudden everything happens at once, and you have a lot of things to do very quickly. Now, having gone through that, I’m much more relaxed about the whole thing. I see the same kinds of feelings in my students – they’re always so worried that they’re going to do something wrong, or say something wrong, or miss something. But I keep telling them, the majority of these patients are healthy moms and healthy babies. All you have to do is your assessments and discharge teaching, and maybe help a little bit with breastfeeding. It’s a totally different focus, too – these moms are taking these babies home and caring for them for YEARS, as opposed to med/surg where people come in with a problem, we fix it, and they go home to their regular life.

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