The night shift

The night shift. There's no other students. There's only one junior resident, one senior and one staff. I did 8pm-8am last night.

I saw a lady who went into labour at 24 weeks in her pregnancy. The baby was so tiny, 700g. The parents were pretty brave considering; they were taking everything with a strong face, even though I'm sure they were terrified. I mean, their newborn baby was so premature. It came out fighting, waving its arms and kicking its feet, it even tried to take a few breaths. The pediatricians took the baby straight into the resuscitation room to intubate it and get it to the NICU (neonatal intensive care unit). It had no 'meat' on it, no baby fat. I talked to the resident in pediatrics after, the baby was doing fine but these kids usually do okay for the first day and deteriorate after day 1.

I saw another baby born at 24 weeks during my last rotation. The mum had the baby come out, basically fall out, when she went to the bathroom. The baby was so hypothermic, temp was 31 degrees (premature babies under 2100g can't keep the body temperature up on their own). The baby passed away a week later.

Last night, around 2h45, I had a consult in the emergency room for a perimenopausal lady who had such a heavy period because of a fibroid that was basically making her bleed to death. She had passed out because she had lost so much blood. The messed up thing is that she came to the hospital around 16hoo. Our service only found out about her at 2h45!! She needed a blood transfusion because of the bleeding. It's not like we were so busy we couldn't have seen her earlier, we only found out about her at two in the morning. So here was the lady, basically bleeding to death in the hospital. She was still very pleasant with me, a real angel. People amaze me at how they're in such terrible situations sometimes and yet they still have it in them to be nice and polite. It's quite charming. There's also people out there who are monsters all the time, even when they aren't sick.

I helped repair a woman's vagina after it tore, very minimally, last night. The staff literally guided my hand through the whole thing, but it was still cool to stitch someone up. For the same lady, during her delivery, I applied "fundal pressure." This basically means that I stand beside the lady, put my hands on her belly and push down while she's pushing to help pop the baby out.

There's construction outside of my apartment right now. Oh! Oh! Guess what! There's construction INSIDE my apartment too! Honestly, I don't know how people work nights. Going to bed when the sun is up and waking up when it's setting is awful. Yeah, I know it's my first day, but I really don't think I could ever get used to this. Luckily, there isn't really an area of medicine where work is only during the night.

I also had to assess a lady with stage 4 ovarian cancer who was terminal, last night. She couldn't talk anymore, it sounded like she had bad pneumonia.

It's not all fun and games, but I'm still having a great time.

Obs

This week, I work the 11pm-8am shift at the birthing center and answering consults in the ER.

My first week in Obs, I almost got amniotic fluid all over my shoes, I got sprayed with umbilical cord blood and had maternal blood splashed all over my scrubs when the placenta came out.

We had a baby born on the bed just minutes after we saw a lady and decided she was nowhere near delivering. We heard the nurse screaming over the intercom for help, but by the time we ran back to the room, the baby was lying on the table between the mum's legs, still attached, crying.

I had one lady look at me halfway through my questions with fear in her eyes and saying to me "I NEED to push and I don't know why!"

I watched one dad start crying when the baby delivered and his first words with his daughter present were "oh fuck!" Minutes later, watching her on the resuscitation table he looks at the mum and points to his chest and says "that's mine!"

I've seen fathers scramble from the baby to the mum and back not sure who to pay attention to.

I'll have more stories for sure, probably even by tomorrow.

Off to work

Gyne

5:20: I rise from bed. Grumpy, but well rested since I went to bed at 9:30 last night. I make a pot of coffee, delicious, delicious coffee. Two bowls of cereal later, I shower, dress, groom, drink 2 coffees, read and print out a summary on endometriosis and head to the hospital

6:45: Arrive at the hospital, review the teaching case that we will go over this morning

7:00 - 8:00: teaching session on endometriosis (endometrial tissue normally lines the inside cavity of the uterus, sometimes we find it where it shouldn't be. It's been found in women's ovaries, tubes, ligaments, lungs, eyes, mouths, noses. So let's say it's in the nose, they get a nose bleed whenever they get a period. Thankfully it's rare in the nose, eye and lung; it tends to stay in the pelvis)

8:00 head to the gyne wards, rounds are over, divide up the scut and head to the OR.

9:30-11:30 watch a total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy. I don't get to scrub in because there's too many residents. I basically watched a woman's uterus, fallopian tubes, ovaries and her omentum (an extension of the tissue surrounding the stomach) be removed. Her ovaries are huge, they're bigger than any man's testicles but that's not good. She's menopausal, so her ovaries should be shivelled and small, and there's visible cancer eroding though the surface of both of them. After the uterus, ovaries and tubes come out, I go to the pathology lab with the surgeon to watch them measure everything and slice the ovaries open. It was pretty cool, but not very good news for the patient.

11:30 I head to the ER because I'm paged to see a woman with pelvic pain. I take her history, examine everything except her private bits (we have to be supervised) and head to class at 12:00. (don't worry, the resident ordered an ultrasound while I was in class)

1:00 No ultrasound for my patient yet. Things don't happen at the snap of a finger in our system. I collect more info from a patient's chart for a presentation on Friday for tumour boards

2:45 Head back to the ER to see the ultrasound results. Things look good. The resident and I basically decide that all we can do is examine her and get a culture to see if she has chlamydia or gonorrhea, but the patient took off. We wait a bit, going over the differential diagnosis and realize that she might have been abused, but we never got a chance to ask. We check the waiting room, she's nowhere to be seen. We document her disappearance and tell the unit coordinator to page us if she shows back up.

4:00 we get teaching from our chief resident.

5:00 head home to eat and prepare tumour board presentation

6:00 speak to the missus

7:00 buy coffee after remembering that I ran out this moring

7:30-9:00 prepare presentation. Wrap up as much as I can

9:30 Feeling sleepy... So sleepy... Feels so good

10:00 zzzzzzzzzzzzzz

Obs, Gyne

Let's see, what have I done in the last 4 weeks. I've scrubbed in on several c-sections, a hysterectomy, a few prolapse repairs (read we made sure a woman's uterus or bladder wasn't coming out of her vagina anymore), I've delivered a baby myself, and I've been called wonderful by one of my patients. I got to hold someone's uterus in my hands, I've felt blood pouring over my gloves (it's weird how warm it really feels), I've held a baby as it takes its first breaths.

Obstetrics and gynecology may not be a career choice for me, but it is a fun specialty. There's oncology, surgery, medicine, and you get to follow women throughout their pregnancies and deliver their babies. It's interesting, but there's other areas of medicine that also interest me. I suppose that's why I like family medicine so much, it means that I can do it all except scrub in on surgeries. I mean, if they had some kind of magical specialty where you could be a surgeon and family doctor, that would be cool, but the training would be forever and you'd never, ever, be proficient enough at anything at all.

So, maybe I'll do some deliveries as a family physician. Maybe I won't. At this point in time, I can definitely see why people go into obstetrics and gynecology as a specialty. It isn't just STDs and looking at vaginas all day long. That is part of it, and yes, I am getting a skewed view of what this specialty is, but it's not as bad as I thought it would be.

I still get more excited about family medicine than anything else. Anesthesia is in the back of my mind still and I'm planning on doing an elective in it to either get it out of my system or determine if that's what I want to do for the rest of my life. Either way, that will be a fun rotation. I still think that I want to do family the most.

I'll admit that I've been very lucky in terms of staff and residents. Everyone since day 1 has been wonderful, even during my pediatrics rotation. It's easy to get lost in the scut work that we all have to do: follow up on labs, fill out consults, paperwork paperwork paperwork; but really, if people can't see past that, they really don't know what they're missing. I think this is the best job in the world and honestly, I can't imagine doing anything else.

Every day, I fall in love with what I do more and more.