Ob/Gyn Notes

The following are a few observations I've made the past several weeks during my Ob/Gyn rotation. To bring you up to speed, obstetricians/gynecologists are the doctors that deal with the cooter. Now, somehow, working exclusively with woman patients brings out the nasty in most of the residents in this woman-dominated field.

• Gyn residents are catty, very catty. All the rumors about the Ob/Gyn field being a sorority have so far held true. In front of patients they maintain sufficient professionalism; but behind closed doors (and just barely out of sight of others), the gloves come off and the hissing begins. They hope a difficult surgery will be assigned to Resident A so "she can fuck up and get in trouble". Then they revel in how much they "fucking hate" Resident B even though she doesn't even know it. During none of the seven rotations I have completed this year, have I once encountered a group of residents that gossiped with so much malicious enjoyment.


• Gynecologists are surgeons. While some choose lifestyle-friendly careers that entail performing Pap smears over and over again, the majority of them stick with doing what they love: operating. What's my point? Gynecologists, as surgeons, are trigger happy to cut you up. And the one thing they love to do are hysterectomies. So . . . if you ever go to the gynecologist with any problem more severe than a cold, expect to have your uterus taken out.


• Despite all my bitching and moaning, I am grateful for this rotation for two important reasons. First, I learned how to perform a pelvic exam correctly, and with the little bit of practice I had (roughtly 5 pelvics), I feel that I'm finally (minimally) competent enough to do one effectively. Next, more importantly, I finally learned how to tie one-handed knots. The general surgeons never taught me (in fact, some of them forbid us to tie one-handed knots! [as one of my interns succinctly put it, "surgery cocksuckers"]), and I thought I had forever lost the opportunity to be cool.

OK, time to practice knot-tying now ....

Grand Rounds

Still new to the whole (medical) blogging phenomenon, I've recently discovered something called Grand Rounds, a weekly complication of medical blog entries. It is hosted by a different med blogger each week. I'm not quite sure yet how an article qualifies (whether articles are selected, or the authors submit their own article), but some of the articles are very entertaining.

So as a means to start communicating with the outside blogging world, I'll try to link to Grand Rounds every week. This week's Ground Rounds -- aka Grand Rounds #83 (Vol. 2, No. 31) -- is up at the Health business blog.

Enjoy!

Creepy Clothes

Our county's coroner office is located very close to the hospital at which I work (in fact, during my second year of med school we spent one morning there -- a field trip, of sorts -- learning about the work that goes on there and then observing an autopsy; that morning presented some of the horrifying sites I'd ever seen, including a blackened skeleton of a person caught in a burning car.)

Also close to the hospital is a little used-clothing shop that has racks and racks of clothes outside, selling them for very cheap (for example, "12 shirts for $10").

I see this shop everyday as I leave the parking garage, and I finally put two and two together, realizing that this was an odd location for a used clothing store.

Ask anyone, I'm the biggest fan of inexpensive clothing. But this ... this is just a little too creepy for me. I'm not a superstitious guy, but I'd feel like I'd be next if I wore a shirt last worn by a guy shot in the head.

Miracle of Birth, Part 2

My earlier post might have been interpreted as being disrespectful to women in labor, but rest assured that that was not the intention. It was simply intended as a graphic description of the several deliveries I witnessed, and contrary to what might be implied, I am actually very impressed by the stamina and pain tolerance demonstrated by women in the midst of child birth.

Still, in retrospect, the birthing process was neither interesting nor appealing to me, and I found myself only enjoying those moments that involved the baby -- starting at the time delivery was imminent, to seeing the crown, to pulling the baby out, to handing it off to the pediatricians. In fact, near the end of every delivery I was so mesmerized by the baby's presence that I would follow it around instead of focusing my attention on its hemorrhaging mother ... something my team noticed, too, as they frequently needed to pull me physically back to the table.

To sum up: deliveries are gross, babies are cute.

Maria Gonzales

Throughout this entire OB rotation, it's been extremely hard for me to keep track of the patients on our service. After thinking it through, I realized why: it's because all our patients are the same.

Whereas in other clerkships and specialties you can keep track of patients based on their sex, age, or varying medical problems, that is close to impossible on this rotation. First, you can't go by sex because ... duh ... they're all women. You can't differentiate based on race because they're all Hispanic, which is the norm for this hospital (on a related note, because of this fact, the variety of possible names is drastically reduced since their first name is either Rosa, Maria, or Juanita, and their last name is either Francisco, Lopez, or Gonzales; pick one of those first names, then pick one of those last names; I'll guarantee you there is a patient on our service with that name).

(On yet another related note, most of them speak little to no English. Not a word of English. Actually, the only word I believe they know is "English", so that upon hearing us ask "do you speak English?" they hone in on that word and know to respond "no." What the hell?)

Next, age can't be used because all our these pregnant women are in their 20's, which, by the way, is quite disturbing, because all these 20-somethings are presenting for their 3rd, 4th, or 5th pregancy, indicating that their first baby was in their teens. Again, what the hell ... but that's another story.

And it was then I realized why, for the first time in third year, the residents on my team always referred to patients by their room number. (e.g. "16 needs to be examined" or "44 is in active labor"). It's not a practice they would be proud of, especially thinking back to their idealistic pre-med days when they had illusions about how they would practice medicine, but one that's necessary given how all our patients are pregnant-for-the-4th-time Maria Gonzales.

Miracle of Birth, Part 1

What cries and smells like poop?

A baby. A freshly-ejected-from-mama's-swollen-vagina, still-tethered-by-its-cord, slippery baby. In case you thought fresh babies enter this world as cute as they appear in their crib, think again. Birth -- contrary to popular belief -- is only beautiful in theory, for in reality it is a prolonged, painful, and sloppy ordeal.

It starts with a mother -- a clean mother -- feeling slightly anxious; she has heard it's painful, but unless she has experienced this already, she has no idea. The situation then escalates over many hours to full-fledged, unfathomable pain, punctuated by squirts of blood, poop, and other juices. The mother is screaming and squirming, probably regretful she ever got intimate with the father. With every painful contractions she's being yelled at to push -- performing the exact same bodily maneuver as during a bowel movement -- by people she has just met (i.e. hospital staff, not random strangers). Every muscle in her body clenches as she attempts to squeeze out an object that's twice as large as the opening through which it must pass.

This continues for hours. Despite all the pushing and agony and "progress", the baby only descends a fraction of a centimeter at a time. With luck you'll see a patch of hair, which is the top of its head. If she pushes more, the entire baseball-sized head pops out. More pushing squeezes out a hand, its body, and the other hand. Finally, you end up with a wrinkled little hairy prune of a human, which, surprisingly, doesn't cry much. It just stares right back at you.

(And don't forget the placenta ... that sustainer of life that resembles a large raw steak, clinging to mama's insides until it is vomitted from the vagina after the baby comes out.)

Yes it's definitely a miracle ... not because a new life just entered the world, but rather because the new mom still likes this creature that caused her so much pain, and also because women willingly endure this process again to have more children.