Monday, March 21, 2016

Ob/Gyn...Oh my!

Hello good people...I'm currently in my Obstetrics & Gynecology rotation.  You know...women's health related stuff, lol.  So many guys are probably squirming already.  

It's my 4th week already.  I had no idea how many women at any given time in the Essex area were on the verge of having babies, just had babies, unfortunately some have lost babies due to miscarriages, and others are trying to start or expand families with IVF.   Not only are we focused on the obstetrics aspect of things but also women health concerns like HPV, cervical and ovarian cancer, benign tumors, fibroids, STI's, family planning and the like.  It's all going on here every day.  

It's a super busy rotation!  Busy is good.  Busy means my knowledge base is increasing exponentially!  Every night I'm praying that I'm retaining as much as possible.  What I learn during the day, I have to review during breaks or at night.  I'm constantly jotting down acronyms and other phrases I hear people using to go and find out exactly what they're talking about.  

My vocabulary must increase by 500+ words during each rotation.  Things I've never considered or realized I didn't know, I'm learning.  My mind is stretching.  My experiences are being enriched.  Im really learning to be a doctor....Every time I stop to think about that, I have to pinch myself because I'm really here...doing what I've wanted to do forever...and it's AWESOME!

Over here, midwives deliver babies in birth centers (or at home) if the moms have low risk pregnancies.  Totally different than what we're used to in the US, where the Doctors or Nurse Practitioners handle just about all of the prenatal care and deliveries. 

My current Consultant is a BOSS!  I love working with her.  She makes sure I'm involved, front and center....IN EVERYTHING!  She is an Obstetrics Consultant...caring for the pregnant mom's to be.  During clinic, she encourages me to see patients and present them to her...ask then questions and learn to perform examinations, high level ultrasounds, and fetal doppler scans while she's present.  During ward rounds, I'm there, interviewing and examining patients, and having the occasional rapid fire questions being thrown my way.  During deliveries I'm there.  If there's a C-section I'm scrubbed and assisting.  I'm learning it all and doing it all!  

For the high risk deliveries, Consultants are present on the Labor Ward if needed.  In case of an emergency or the midwives have concerns about mom or baby, they ring an emergency alarm.  The first time I witnessed one, I had no clue what to expect.  Everyone available on the Labor Ward rushes to the room where the alarm goes off, ready to spring into whatever action is needed.  My first call, I tried really hard to stay in the background, far out of the way of the folks who knew what they were doing!  Then, I was working a shift with my Consultant...the Boss!  The emergency alarm rings, I go to the call with everyone else, I attempt to stand near the back out of the way...I mean this woman is actively bleeding...and it looks like a fair amount of blood to the untrained eye.  

What happens next???? The midwife explains to the Consultant that the patient has a PPH--a Post Partum Hemorrhage...she recently delivered and has lost more blood than expected...and still bleeding...looks like she has a vaginal tear and her uterus hasn't quite contracted enough to stop blood flow after delivery.  Ok, the Consultant gets the details, surveys the situation, then calls me over.....whaaaaaaaa????...."D, come over and see this...let me show you what's going on...this is why the woman is still bleeding...this is how we know what type of tear is present...we'll check for uterine contraction like this...this isn't a life threatening situation...these meds need to be given to help uterine contraction...this is what needs to be done about the tear and who can handle it...All I could think was wow!  There are probably 15 people in this room who are all great at their jobs, ready to handle an emergency situation if warranted, and my Consultant took the time out for a moment of teaching!...while everyone looked on and waited to find out what they should do next.  Complete and total awesomeness!!!! 

The Gynae emergency clinic is just as busy.  I've partnered with one of the senior house officers there for many clinic shifts.  I'm taking histories, doing examinations, generating differentials and suggesting care plans...learning when people need to be admitted immediately and who we can send home...who needs an Ultrasound scan right away and who needs them scheduled later down the line...what types of miscarriages have occurred and how do we manage them--expectantly, medically, or surgically?  

In the clinic this past week, after taking a patient's history, doing and abdominal and VE, discussing my findings with my mentor who had been there by my side the entire time, determining what I thought may be going on and what we should was time to have the discussion with the patient.  I explained to her what her options were and the most unexpected thing happened....She asked me what I thought she should do....Me?!?  She felt comfortable enough and trusted me and my judgement enough to guide her to do what would be best for her.  And guess what?  I did!  

This is what my patients are going to expect from me as their Doctor...trusting me to help guide them to better health and well-being.  

I still sometimes can't believe it's all happening.  I'm in the thick of it all...Up close and personal...getting my hands dirty and feet wet...forming relationships...helping patients decide what's best...And I'm loving every minute of it!

And all you people think I do is travel the world...ha!!!!!!

Until next time...