Thursday, September 24, 2009

la la la

sorry folks, i've been a bit lazy. that's what REI does to a student...not so many patients, not so many surgeries...more time to just catch the ol' breath.

so far so good, we had adolescent gyn clinic on tuesday. that was really cool to get to see some of the kids and teens. what was sad was seeing little girls with genital warts. "her cousin got the same warts from taking a bath and sharing the wash towel with her daddy!" newsflash: you do not get warts from sharing baths. you do not get warts from using the same wash towel. shady. this patient though probably got it from her mom via the birth canal during her vaginal delivery. sadness.

today we saw a lady in clinic and her BP just happened to be over 200 systolic. yeah. that's bad. hypertensive urgency. no symptoms, thankfully. so we told her to go to the ER immediately after her appointment was over. she appropriately started to freak out a little, but we assured her that this was just urgent, she's not having symptoms, but she needs to get it fixed. i spent some extra time with her just telling her that she is allowed to have a visitor and that it would be fun to talk about the strange folks bumming around the ER, which made her laugh a little. and then i told her that she had a great personality and attitude and that she was going to be able to conquer her high blood pressure and control her weight. she was already aware of her problems, which is the first step. i really do hope she does well, and i actually feel like she is going to do well.

so yeah, at this point, i really feel like i may end up doing ob/gyn as a career. i know, completely different than peds, but i have REALLY enjoyed myself. i really like hearing about all the different women issues, and i like the idea of being able to be there for fellow women and help them out through their hard times. also, i can still see the peds patients because they got their own issues going on, and you don't have to do a fellowship to be a pediatric gynecologist. it's just a niche field. well, peds is the next rotation, so i feel like by christmas i may have my career choice already settled. i don't see myself doing surgery, family med, or psych. and none of the other fancy specialties (rads, derm, etc) appeal to me. so now it's between peds and ob/gyn. how about that.

it's funny how people change. i may even change my mind again. HA.

Friday, September 18, 2009

end of shift

no more night shift for me...finished with a nice shift. last night i assisted in a c-section, watched an epidural, put in a foley cath, and checked a cervix. plus the writing of a ton of notes. and then rounded on patients in the morning. i got the lovely task of taking of bandages...ripping tape off of people's skin at 5 am is probably not the best idea of the day. i definitely had some angry people at me, and i tried my best to just be gentle and to take breaks and let the patient tell me when they're ready to keep going. alas. i was going to take some staples out of a lady but she was wigging out on me so bad that i didn't even want to go there. the resident said i did the right thing, evidently that person had some documented "issues" so i'm glad i didn't go ahead and attempt the staples.

the saddest part about L&D is seeing the very young girls having babies. well, not all the young girls make me sad. just one in particular...this girl was 14, got pregnant at 13, and had suffered all kinds of abuses which are currently manifesting as a bazillion different psych disorders. (and if i had to go through what she did, i would have some major issues too. all of us.) the worst part about her situation was that her home life was just atrocious. the mom of the girl was all kinds of weird and an enabler of some of the abuse, and it just made me so sad to think that this girl and now this girl's baby probably will have zero chance in the world. ok, maybe not zero, but definitely a very slim chance of getting out of all the craziness and getting a decent shot. just sad. when i checked up on her this morning i made sure to tell her that she did a wonderful job during her delivery and that she should be proud of her beautiful baby, because who knows if the mom said anything. i instructed her to make sure that if she was ever hurting, to ask for pain medicine because the nurses don't just automatically give you some, you have to ask. when she said that she was going to try and breastfeed and use bottles for backup, i said that was a terrific plan and that i was glad that she was going to try breastfeeding, since it is best for baby. and then i left the room and she actually waved goodbye to me (she hadn't been doing that at all before). such a sad situation...wish i could have done more, but i did what i could.

so now i am regulating my body back to normal sleeping...today when i got home i slept until 2 or so and then woke up. hopefully i will go to sleep at a normal time tonight and be adjusted back without any problems.

next 3 weeks are going to be just gyn. i start off on REI, which is reproductive endocrinology and infertility. i think that is just going to be super fun. i know i'll miss the babies, but it's good to learn about everything, and since they force us to i don't really have a choice...ha. i hope i enjoy gyn though overall...i hear a lot of people love the ob part and then hate the gyn. i'm going to have to really jump in and try to experience all i can because if ob/gyn is what i want to do as a career, i got 3 more weeks to really "see it all" in a way. but then again, if i really hate it, well, alas. then peds is the next rotation. it's going to be so hard to decide, or maybe it will be super easy. i really do feel that if i did go into ob/gyn, then i would probably focus my practice on the adolescents. for some reason most of the patients i followed on L&D were the 14-20 range, and i really liked interacting with them. and i have thought about going into adolescent medicine before, so maybe that would be a possibility for me.

ha, and watch in 6 months or so that everything that i've ever thought about "what am i going to do with my life" just go out the window. i can always go to culinary school, right?

Wednesday, September 16, 2009

night shift

is not so bad. i feel like i've adjusted pretty well without too much trouble. the only problem is night shift is WHERE ARE ALL THE PREGNANT LADIES!? ha, for the last 2 nights there just have been not many pregnant womens! where they at? hopefully tonight will be bumping...i haven't had any opportunities to scrub in on a c-section or really assist with a delivery...and i'm getting antsy!

also, last night i was following a spanish speaking patient, her english was so limited that i had to break out my broken spanish to talk with her. i kept screwing up of course, and didn't know all the words, but managed to get through what needed to be asked. her family was really appreciative i think because i tried. and the husband knew more english and helped to translate once he got the gist of what i was asking. and we can get into all the arguments of "the foreigners in the US should learn english"...i 100% agree with that assessment. if you are here, learn some english! at least try! my family moved over here from korea and learned some english real fast...i go to visit foreign countries and i practice my phrases because i don't expect them to cater to me. but alas...it is the here and now, no use making people feel bad when they need help, and i'm so glad that i was able to build rapport with that patient. it just strengthened my desire to become working-fluent in spanish anyways. and she had a super cute baby! ha, and during the delivery she kept yelling DIOS MIO!!! love it! no translation needed there...

last night i got to check a cervix and i finally could appreciate the dilation and effacement...and i was accurate with my check! 6 centimeters! and felt baby head! very cool indeed. and i took out some staples from a c-section wound. taking out staples is fun!

so now i'm eating some granola and about to start reviewing a case to go over tonight. hopefully the ladies be all trying to deliver or something...i'm going to be really sad when L&D is over!

Sunday, September 13, 2009

baby!

i delivered a baby yesterday! on my own! the resident was RIGHT THERE to help, and at the end, he goes, "you can call that your first ever delivery". so exciting...baby was 4 pounds 11 ounces, not heavy at all...no fear of dropping, ha! and IMMEDIATELY started wailing as soon as she was out in the real world. good stuff. it's really fun to know that you're the one who the baby (theoretically) sees first outside the womb...and also to be able to tell the new mom congrats and good job!

and now i can get up in c-sections without the faintest feeling of wooziness. the other day i got to suture some of the fascia! that was fun, really was.

and also yesterday i saw a urethral prolapse in a little girl. craziness. it was the "biggest one" the attending had ever seen. so i wonder if that will ever happen again, seeing one that big.

so now my count is 5 c-sections and assisting on 4 deliveries, 1 being solo! woo!

i love the rush of someone saying ROOM ___ IS DELIVERING! you run down the hall, get geared up, and BAM, here's the show! and it's definitely not as nasty as i'd thought it be...i mean, it is pretty gross if you think about it, but not so bad. but i love the excitement and the action and all that fun stuff. plus during c-sections when the baby's out everyone gets excited and starts squealing in high-pitched voices, the mom gets all happy and all that. then while we're closing up, you just hear snores from mom. ha. why you so sleepy when you didn't do any work to get the baby out? it's just funny to me. the moms who vaginally deliver don't zonk out post-delivery, not until everything is said and done and whatnot.

so yeah, i'm REALLY loving this rotation so far, if you dear reader can't tell. bump medicine, i could never do that now after having experienced something else.

today i get to study for my test tomorrow and then somehow ready my body for night shiftage starting tomorrow evening. so yeah, test at 8 am, and then go home, sleep (?) and be ready for action at 7 pm. supposedly, all the craziness happens at night, so i'm super stoked! so i think i'll just try to stay up as late as i can tonight, sleep a little, and test, and then sleep more. hope it works.

Thursday, September 10, 2009

staples!

today i scrubbed into a c-section, made it all the way through, STAPLED AT THE END, and then was on a surgery high for the next hour or so.

i think i'm going to make it through surgery, perhaps.

also, more babies. we had a trisomy 18 today. unfortunately, the baby did not make it, but the nurses dressed the baby up and did the footprints and took photos for the family. and i think in the end the family spent some time with the baby. always good for closure. i thought the whole situation was so sweet, and the work the nurses did for the family was excellent.

and with that, i'm off to bed. 12 hour shifts are hard on the body. switching to nights next week is going to be tough as well. at least i'm enjoying myself and learning a lot. i'm really liking ob!

Tuesday, September 08, 2009

babies!

scrubbed in on a c-section today for TWINS! lots of blood and gore. and i almost made it to the end! i'm so proud of myself. only got queazy once the uterus was nearly done sewed up. a heckuva lot longer than i thought i'd last. and amniotic fluid smells bad. and literally the uterus is flipped OUT of the body for the sew up at the end. then they stuff it back in.

frylime does not want a c-section!

but the c-section was totally cool to watch. TWINS! and i got to retract! haha...and wipe away blood!

then later on i got to witness a delivery up close and personal...i think the next one i go into i'll get to do myself! super exciting!

bedtime now...just have to say that ob so far is great and giving peds a run for its money...we'll just have to wait on the gyn part...alas. that's where i hear a lot of people are turned off. we'll see.

Wednesday, September 02, 2009

it's getting better

ok, so i haven't had to see more bloody mess, but today i did my first ever cervical check! and i felt a whole lotta baby HEAD. how nice. at least i wasn't like my friend (hee hee) and totally miss the vagina and head towards the anus...she redeemed herself on her second try, no worries! i really never had a clue in how deep your hand goes up in there to check for dilation and effacement...and it's definitely not as scary as i thought it would be. had no hesitations when my intern was like "gloves on, here's the jelly, and check that cervix for me". nothing like the "gotta check your bottom for blood in your stool"...maybe because things are meant to go in vaginas and not anuses?

so as of today, i'm still undecided as ob/gyn as a career...i really like the IDEA of being an ob/gyn doc...but i don't know if i'm cut out to do it as a career. the residency, from what i've seen so far, is pretty intense. the interns are basically pooped on constantly, and everyone who is above you seems to be a little too eager to point out your flaws. i know everyone will get critiques, but today i witnessed an incident that if it were happening to ME, i would have been like GET OUT OF MY FACE. or something like that. or i would have probably taken it, like i saw the residents do (while being admonished by the attending for not a big reason), and grumbled and giggled to the med student (like the upper level did, ha!) and went and fixed the problem. it makes me wonder if all ob/gyn residencies are that intense, or if it's just my program in particular. at the very least, ob/gyns are VERY different than internal medicine folks. alas.

a look on the bright side, i really enjoy reading ob/gyn things...it's just really interesting. so with that, i'm going to start reading up on maternal/fetal physiology...joy!