29 January 2010

Never eat chinese food before surgery.

Life lesson. Trust me. Especially when you know all that greasy business is going to give you some pretty strong gastro-colic reflex. Sure, it feels awesome in the 5-10 minutes after you eat it and you feel like you're going to slip into a food coma, but don't.

Says my resident:

"We're going to be taking her to pre-op in less than an hour, be back then, ok?"

And I think, Oh God, what have I done to myself. I could go into all sorts of detail, but I'll summarize: FML. I got lucky and they realized my patient got hungry too and ate at 3PM, so they pushed the C-section to 11pm instead of 9pm. Quick! Drink lots of water!*

This is not the emergency c/s I was watching yesterday. I would post details about that, but they're sort of rare so I'll wait for a few weeks to pass until divulging. Half of the Ob/Gyn clerkship is over. Gyn better be just as fun as Ob. Although, I will say, it's not all fun and games. There are definitely a few difficult people. More on that later, too.

*: Cure.

17 January 2010

s---! f---!

2 weeks of ob/gyn are over (out of 8). This week, I just finished up with Ob-clinic, which ran from 830am to 1230pm (lame, I know). Most of the patients were just checkups.

Just go in there and ask them 4 questions, do 2 measurements, and that's mostly it.
1. Are you having contractions?
2. Are you bleeding anywhere?
3. Are you leaking any fluid?
4. Are you able to feel the baby move?
5. [Fundal height measurement]
6. [FHR measurement]

Pretty standard. There was one patient who had a fetus with multiple malformations but it was too late for her to have an abortion (so essentially, the fetus was dying inside the womb). They didn't let me go in (nor the R1). Nothing like L&D, where I felt I was doing something all the time.

You know what is fun though, is preceptor, which is nothing like PPS preceptor. PPS ruined the word "preceptor" for everyone at BCM. However, in Ob-preceptor, I get to do almost everything.

I remember once I was doing a pap smear, and everything was going just fine until I noticed a bit of bleeding.

My preceptor, let's call her TNML (as per her initials with a cypher) didn't say anything, except, "Oh, there's a little bit of blood."

So there I was, some woman in stirrups right in front of me, legs wide open, with a little bit of spotting coming out of the vault.** Still, a little bit of bleeding is to be expected. 

Then again, this was before I put in the wire brush to get an endocervical sampling. Of course, that thing came out covered with a deep red layer of blood, as if I had dipped it into a paint bucket. When I saw that bloody brush come out, I had the biggest bug eyes ever on my face and my eyes turned into the size of dinner plates.***

I felt like I was destroying that poor woman on the inside. I watched the nurse with an expressionless face put the bloody brush in the solution, inking it to a pink tinge. F.M.L.

I was told by TNML later that some spotting was normal, and that patient was excessively sensitive. Did I just start this story out by saying "preceptor was fun"? It is. The learning experience is fun.

Also, I'm starting to see my patients everywhere. What kind of a conversation are you supposed to have with them? (keep in mind, I'm on ob/gyn).
Also, it still sucks being a female.

*: Inner monologue will be in italics, centered.
**: "Vault", haha. It starts with a V, too!
***: I've had bigger bug eyes, like that one time post-placental delivery, a massive 200ml blood clot plopped out of a lady's... vault. Not only did I get massive bug eyes, but I also froze. The resident quickly intervened - "don't worry, that's normal"

11 January 2010

Multiple crises averted.

I was up this morning until 5am working on my proposal when I finally clicked SUBMIT. Anyway, right after that, a very large FML cloud appeared and it started raining. I left a few messages for some people and decided to sleep for about 40 minutes before heading to Ben Taub.

Except, my sleep latency was so short that I didn't set an alarm. Woke up at 632am. I had to be in BT by 655am. What followed was a series of emergency maneuvers I had only theorized of in my head.

I popped up and ran. It's a good thing my scrubs were already on my bathroom floor. Took a shower in 5 minutes, which is one of my all time lows.* Brushed my teeth while changing into my scrubs.

It's a good thing I have a checklist in my head of things to take - paper, pens, phone, keys, stethoscope, ID. Like a meandering stream that hasn't changed course in thousands of years, I was out the door within 10 minutes of getting up, popped my car in sport mode and raced out of my garage. I was shaking in my car since I had to sit still for a few minutes, having forgotten how cold it was from the morning Blitzkrieg.

I made it to the BT L&D floor at 650am. Incredible.

I feel like I should give an update. With the submission of my proposal this morning, all my battles have ended. (There are more on the horizon.)

5 wins, 1 loss, and 1 up in the air (I guess I'll find out about this proposal in a few months. It'll be epic fail, I'm sure). Can't have it all, right? Absolutely no regrets.

One of my patients sobbed uncontrollably for 10 minutes after finding out she had an STD and that she'd have to be admitted to the hospital (for another reason). Couldn't speak english, so I didn't quite know what to say. My corny jokes don't translate well. I was told to get a fetal heart rate reading. It was kind of difficult, actually. There wasn't much I could say, but there was a lot I had to do. She lit up a bit when I said "Puedes escuchar el corazon de su nino en esto machina". Very minor patient care win.**

My Spanish is pathetic. You know what's worse? Doing charades to get my message across. Like charades for.. flatus, or bowel movements, or urination, or valsalva manuevers. They have privacy screens for both the patient and the doctor.

That's all for now. Stay frosty, troopers.

*: I usually finish all the hot water in these cold winter days.
**: I'll work on it.

10 January 2010

Ob/Gyn more like OMGyn

How has it already been 9 days into the new year? Damn time flies by fast. I should probably give a day in the life of:

5am - Arrive at BTGH
5am to 630am - See patients.
645am to 7:20am - Round with resident team
730am - Board signout (shift change)
~750am - 6pm - C-sections, deliveries, filling in charts, seeing patients
630pm - shift change
630pm to 8pm - fill out paperwork, discharge patients

1. When I entered the room, one lady thought I was the nurse, hanging up the phone saying "oh sorry I have to go, my nurse is here..." She was a cute middle aged lady though. Great laugh. She told me I took my time with her and that she liked that. I walked out and my attending told me to speed up my histories, "make them under 10 minutes."

2. When finishing my afternoon clinic duties one day, I saw all my patients leaving at more/less the same time. Is it ok to be in an elevator with 10 patients, all of whom you've seen their hoohoos? No. I waited and chatted on my phone.

3. Saw a girl (21 y/o) with her 6th pregnancy about to go eclamptic on everyone. The attending (R.T.I.) had to intervene. It was glorious.

4. Saw a resident (R1) and heard about a member on my team being chewed out by upper-levels. Lame.

5. Had an Iranian woman tell her husband in Persian that my leopold maneuvers made her feel comfortable. I'm sure past the rugged exterior, there were a few dilated capillaries.

6. Got a short lecture on alloimmunization from a MFM attending. It was awesome. I could see myself doing MFM.

I've also been working on the "taking care of myself".

Cart full of food. And Armor-All.

The universe conspires against me on this whole scarf issue. I haven't been able to get one for years. I've told almost everyone I've wanted a scarf for years. Look at this atrocious situation. Absolutely ridiculous. Every other clothing item bin was totally full.

Left - things I have to do and things I have to buy
Right - Things I can throw in my bag extremely quickly in the morning that will serve as mini-meals for the rest of the day. Circles mean I need tupperware. Sandwich bag means, well, sandwich. The less thinking you have to do in the morning, the better.

Eat when you can, sleep when you can. Even in the middle of lecture.

After a week of ob/gyn, I now feel it's absolutely horrible to be female. So many problems. It sucks immensely. If you could help me out and leave a comment about a specific advantage to being a girl, that'd be great. kthx

I'm going to get back to kicking ass and taking names.