SO there is one day every so often all the residents in one particular specialty has to go to a special conference for skills tests out of the city. This leaves the hospital without a single OB/GYN resident. This means that of course-- the shit will hit the fan, because teaching hospitals run on the backs of residents. There is an in-house resident at ALL times for almost every specialty and the attendings are only called when the resident is in over their head or for approval of high level procedures. Without the residents, the attendings suddenly become responsible for everything-- something they aren't used to. This means they pull together all the students on the service and make us handle the little day-to-day details while they handle the bigger things. Things like yes, you can give tylenol to this patient with a fever or no, she cannot have any food before surgery (etc etc). These are things that we learn through out the month. Now I am almost done with OB/GYN and the other two students are new in their first three days. This means that not only are the nurses asking us questions but the other students are asking me questions, which the nurses notice and then start assuming i'm in charge. BIG MISTAKE. Not because i messed up (that i know of-- which i was scared out of my mind about) just because suddenly i was getting all the calls. And now I understand why docs think nurses can be annoying. When i was in charge, the nurses didn't ignore me anymore they just started trying to pander to my ego, which was very confusing. Telling me I was gunna be a great doctor and how i knew so much blah blah... which would be nice if this same nurse hadn't just complained to the attending last week that i kept getting in their way and not doing anything useful. Weird. And then they started asking me just ridiculous questions. When i put in an NPO order they call me and ask is jello considered a food? Is a cough drop? They page me overhead to ask if i can come look at this lady because she has this new rash, so i come down and find out she's had it for 4 days and there is already an antifungal written for it. I wondered if they were doing it on purpose but it was so many different floors i don't think it was. Anyhow, despite all that it was neat because i felt like i got a small taste of being a resident. I got to make tiny medical decisions and it was at least for this one day AWESOME !
It was a crazy day. We had 7 births that day with 1 attending, who was running about like crazy. I got a phone call that we have a life flight coming in 5 minutes of a 19 y.o. who is 24weeks pregnant (remember that 24weeks is the bare minimum number that fetus can survive outside of the mom-- not guarenteed survival but possible survival). She is having vaginal bleeding, abdominal pain, and of course she had done cocaine yesterday. Awesome right? So she gets here and the baby's heart rate is in the toilet (i don't know much but i know the baby is tanking) and this girl is screaming her head off because she is scared out of her mind. And she rolls in and we just divert her down the hall to c-section. We didn't scrub we didn't put on hats, we ran down the hall to the OR. Where we ripped off her clothes, started prepping her for surgery while the doc put on gloves. At this point she's clinging to me with all her 90pounds of strength and screaming. The nurses and doc are screaming for anesthesia who is not here and they page them stat overhead. but the baby's heart rate is falling and now mom's heart rate gets questionable and anesthesia still isn't here. So the doc decides she's going to cut without anesthesia -- she makes the first cut and the girl is like freaking out. Of course she doesn't let me go so they put the blue sterile sheet on top of me. Finally anesthesia comes running up and they freak out until the doc sternly tells em to put her under NOW. And then they intubate and i get out of her grasp and next thing i know that baby is whipped out-- most purple baby i've ever seen. 2pounds 3 oz. And baby had to be intubated. I still don't know whether or not the baby made it because as OB/GYN we are responsible for the mom once birth happens, not baby. The mom made it.
But i had to leave the OR because I had to manage the other 3 ladies in labor who were quite literally delivering now. I had to go from room to room to check them and make sure baby's head wasn't falling out. And of course with one check i saw the nose and almost delivered the baby on my own. It was terrifying because here i am trying to be calm trying to coach her through the pushes, the breathing, and the contractions, nervously exchanging glances with nurse and making her run for the doctor, while i have my hand on the baby's head and PRAYING that nothing would go wrong because I wouldn't know what to do... Luckily the doctor came in just as the head popped out. She left me to deliver the placenta while the woman across the hall delivered. The rest of the women on the floor musta heard about it or maybe there is some crazy hormone we don't know about but man those babies just came out one after another after another after another. So i assigned the other medical students to one laboring patient each. And the PA student who was new. And then ran about trying to transfer patients to post partum and manage the nursery transfers etc. It was exhausting and exhilarating at the same time. And i am sure now, that I could do OB/GYN and like it.
Last patient of the day is a bigger girl who presented to ER for abdominal pain of what she thought was appendicitis. And low and behold the ER doc did an Ultrasound to see if the appendix was inflammed and oh, there is a baby. And oh she's in full term labor. And somehow she didn't know she was pregnant. And when i went down to talk to her, she's was eating a big mac and talking, "this happened last time with my last baby. I thought the movement was indigestion. Isn't that funny?" Half way through the exam, the boyfriend brings her 2 more big macs. Only patient i've ever seen eating big macs DURING labor. Like for real. Plus she didn't know she was pregnant. That was also weird.
The big question is now is what do i think of ER. Do i like ask much as OB/GYN or vice versa? Anyhow. sorry this was so quick.
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