OB/GYN: surprise suprise?

oh where to start. So i guess i can say,  this rotation is way different than i thought.  I had hear horror stories about the nurses, the hours, the patients, etc.

But thus far its none of those. It's this fabulous mix of CHILL non-asshole surgery, acute run-down-the-hall deliveries, family practice like clinics with plenty patient education, and really hilarious personalities. Not to mention you still round on your pre and post op patients and laboring ladies. Plus you get to psych your patients, deal with their social issues, and do plenty of internal medicine while still getting some resolution (delivery).   And i like ob/gyn (surprise, surprise, i know... i like everything) but really this is the only rotation thus far where I feel like my personality fits with the others without trying. Which is saying something, since my humor is hard to find. I'm pretty sure I might have peed my pants laughing the second day. I mean what else can you do when your resident is trying to describe to you someone's cervix and she acts it out.... with her face....

anyhow. it might just be limited to the particular people in this program. And its only been 1 week. And i've become so jaded against surgery that maybe i won't like that aspect.

As far as stuff I've seen, there are more c-sections than vaginal deliveries probably because many people just can't handle pain and the other half is because the doctors don't want to get sued so if anything at all looks weird, they go to the OR. I've seen several congenital problems (nothing major) as well as a lady with Noonan Syndrome (very intense, webbed neck and all-- baby's status still unknown). I delivered a placenta and helped circumcise (they call it the 'weenie whack').  Oh, and I have a pretty decent rate of being able to guess the STD from the smell during the pap. We bet on it - friendly like and whoever loses has to bring in a dessert, donuts, brownies, etc at the end of the week. Yeah i've done LOTS of speculum exams. And it doesn't really phase me at all  anymore when instead of shaking hands with a patient after introducing myself, i just stick fingers in her vagina. You know, whatevs. There's baby in there and sometimes you can touch it.

Speaking of babies. Here is a picture of one that I got to actively help deliver. The baby docs (remember as OB/GYN's we take care of mom&fetus then mom after delivery, NOT the newborns) were all worried about these 'pimple' like lesions on the face. They thought it might be something congenital. (for those of you non-medical people google image 'blueberry muffin baby' that's what happens when someone gets rubella when pregnant). This is obviously not rubella but other infections like the flu can cause problems for baby. GET A FLU SHOT LADIES!

And things are going so fast up there that you really don't have time to question how long you've been there. I'm often like, what do you mean its 3pm? I haven't even had breakfast yet! However, when its slow.... its painfully, palpably slow and its hard to keep myself awake.

The OB/GYN rotation at the hospital is divided by weeks to give you full exposure to all aspects of the specialty.

• week 1 - days at labor and delivery (what i just finished) usually 4:30am-6pm
• week 2 - night shift on labor and delivery 
• week 3 - Gyn surg 
• week 4 - days at labor and delivery at a small time hospital

interspersed in there is at least 1 24 hour shift and several days of clinic where you go to see your prenatal and gyn visits as well as contraception counselling, holding prenatal and lactation classes, etc.  And... i'd say probably 60% of your patients actually WANT to learn what you have to say.

Its like hope got breathed back into medicine.

I guess we'll see what i have to say after my week of nights...

total witnessed baby count: 11

fam medII: 'real' doctor

so today the doc decided she was going to give me the laptop computer with the medical record and prescription pad and set me off on my own. I felt very cool and confident. All the med assistants started making fun of me because I blurted out 'i feel like a real doctor' at lunch, which i hear i will never live down.

So the last patient of the day was particularly tough. She was a 70 y.o. african american woman and it was her birthday today. She complained of abdominal pain and diarrhea for 3 years. She claimed to have 'lung fluid' and several hospitalization for which the doctors told her 'nuthin about nuthin'.  She was referred to a GI specialist and was told  she had an infection but now it was gone. This is why she cannot return to the GI doctor because he was treating the infection, not the pain. And she gave me the impression it had not occurred to her to ask about her pain when the GI doctor came in. And also she has a raging yeast infection because of the pills and she doesn't want to take them again. Also she says sometimes she feels very short of breath.

So after a lengthy, confusing story on both our parts I decide to try to call the hospital and GI guy to get her records and discover she has also had a mass that was discovered and is benign but undetermined in her appendix. She was also referred to a cardiology for CHF but she was never told where to go, could not get ahold of the GI doctor who referred her and was confused by the automated phone messaging system of the cardiologist. So she just never went.

She also tells me that she needs something for her blood pressure. I take it and it is 160/98 today. So I decide we are going to put her on hctz and omeprazole. Check to make sure she has a rescue inhaler, she is not a smoker and never had asthma... strange i know. I also decide to write down the address, phone number of both the cardiologist and the pulmologist I am refering her to as well as the phone number at the clinic AND the names of her medications. That way I can feel comfortable that she is understanding things. We decide to do another BP check in 1 month and i show her the girl at the counter to make the appointment. 

I go to get a drink of water and not 3 steps away, I notice she's not responding to the girl at the counter and she's staring at me.  So I turn around and tap her and ask her questions to which she does not respond. Then i notice she's looking to the right and I start calling her name and trying to get her to look at me or move her eyes to the left, for which I am unsuccessful.  At this point i know something is wrong. I grab a chair and sit her down only to realize she's not moving her left side. Not at all. So I pull up her arms and her left just falls.  And all I can think is OMG she's having a stroke! So i tell the med assistant to call 911 and another girl to see if there are any other doctors in the house.  But i know everyone else has gone home.  I check the BP again and its 180/102.  And I decide to check pulses, listen to her heart, which all sounds ok... maybe a bit fast.

So they tell me, all the docs have gone home and i'm the only one left.  And everyone is looking at me and i'm like "well i'm not a doctor" and then i realize that despite my lack of experience... i'm it for this lady for the next 5-10 minutes until the paramedics get here.  And it was CRAZY to feel that much responsiblity for my patient.

One of the MA's asks if she's faking, and i decide that's a good point. So i take off her shoes and do a babinski test on her feet. This test will tell me if her upper nerves are functioning. And she has a positive one on the left. And you can't fake that, not that I thought she was in the first place. But i covered my bases-- for the first time EVER. 

It was so weird to be the one everyone was looking at. I assigned jobs to people and made all of maybe 2 decisions-- but i still totally made them!  Like putting her on O2 and sitting her in a chair and NOT giving her aspirin. And it was AWESOME!!!

So the paramedics show up and everyone tells them to talk to me. And I am telling them literally everything i can remember that I know the neurologist would want to know and he isn't writing it all down! And i'm somewhat annoyed because they are going to ask, but at least I told him so maybe he'll remember.  I thought briefly about asking them to take her to my hospital so I could go too and help continue her care. But then i remember its like 4:30 and we need to get her in for a CT stat and its maybe a bit selfish to ask them to drive an extra 10 minutes out of their way.

So in summary. I was a 'real' doctor today. and it was totally B.A.!!

And I wish I had more experiences (even fake ones or momentary ones where docs had my back) as a student where people are looking at me with that 'what do we do' look because man that is going to be HARD to get used to.  For a brief second or two I thought, maybe i should do family med because I don't know what I'm doing... nobody should be putting me in charge of anything.  But hopefully it turns out okay. I wonder if i'll ever get to know the end of this lady's story.

Fam Med II: Rashes & secret code

So we see large amounts of strep throat, coughs, colds, ear infections, occasional pneumonia and other viral upper respiratory infections.  I struggle with the latter, because I never know when to give an antibotic (for a bacterial infection) and when not to (viral).  Every time the doc pressures me into making a guess I always guess wrong. Its a bit frustrating actually. But basically we always use Augmentin (amoxicillin/clavulinic acid for those of who don't know brands).  And I can now do a flu test and rapid strep in my sleep (not that it was hard to begin with). I'm actually surprised I'm not sick myself.

We also see lots of rashes. So i thought i'd share the fun, because i know NOTHING about derm and sorta wish I did. So this rash (on the hand) looks circular to me. It wasn't raised or itchy. And the doc thought it was simple eczema. I wasn't sure but I guess that we'll find out if she comes back in a week. Also the rash to the left that looks almost like pimples is on an 8y.o. I know the picture isn't the best, but the doc thought it was moscullosum... an extremely infectious rash caused by a special virus. Usually spread in daycares or around the genitals as an STD.


We also see TONS of depression. As a matter of fact, I think I see more depression than I did when I was on psych. People always come in for a 'med check' but its really not.  And then I say anything else? they say well... I have had trouble sleeping. But they don't mean sleeping. Sleeping is a code word. It means if you dig deeper they are depressed. Maybe a good 1/4th of all patients I see are people who want to talk about this. And about 1/3 of those patients do not complain of being sad but rather uncontrollable rage/irritability.  It gets messy. Especially trying to convince patients that depression/psych meds don't mean they are crazy.