So working on Ortho nights has really opened my eyes. It kinda shocks me. It shouldn't but it does. I've always heard those horror stories about the ER docs. The ones where they call consults without having seen the patient or ignore them to let the consulting docs take care of them. I always knew that maybe those things happened in the "bad ERs" or when that one really dumb ER resident who was so lazy was on.
But being on this rotation showed me that that side does exist and it happens in my home ER. And it happens often. Consults that get made before resident has even looked at the patients. I saw it.
I saw a patient who had a broken leg, but the resident had not yet seen her. She had fallen weeks ago. She was scared and dirty, unbathed. She said her husband wouldn't let her come to ER, she had been dragging her leg around for weeks. She said after awhile it didn't hurt anymore. And we asked how she broke her leg, she thinks it broke before she fell. Her xrays show weak bones, necrotic and dying. And after hearing she had leg pain and seeing the xray, no doctors and no nurses went in the see the patient. She was waiting for HOURS before anyone saw her. And it needed way more than just an ortho consult. And the resident he was one of my upper levels, someone I had once respected-- he in no way apologized or admit he made a mistake instead he acted like it was a normal occurance. And indeed it was not all that uncommon. THis is just one of many stories like this that I have.
Situations like this make me understand how the consultants can not take us seriously. And also made me seriously question the quality of my program. I hate that feeling.
Thursday, October 31, 2013
Saturday, October 12, 2013
ER Intern: OB
Across the country, the ER OB rotation is notorious for being bad. Perhaps its because the personality of the OB and the ER is so different, or perhaps because all the waiting makes the OB residents more protective of (or impatient for) their deliveries. All I know is almost all ER residents complain about it or view it as a "vacation month".
For me, after getting off a joke month there was no way I was just going to sit around on this rotation. I made up my mind to be pushy and butt into the deliveries until I met my designated 10 deliveries required for graduation of ER residency. But when I showed up the first day and saw there were 10 students (mix of M3, M4, and auditioners) plus a family med resident and an anesthesia resident I knew the odds were stacked against me. I did what I could to play those odds, volunteering for nights only and on top of that only nights over the weekends to clear my way. But it was still hella difficult with even the ob residents resisting my help. I was banished to the "OB ER" (note this is not a true ER, just our nickname) where I drowned in vaginal bleeds usually resulting in dead babies and rule out labors for women who were simply sick of being pregnant. While I surprisingly found this area to be helpful since this is the type of patients I will be seeing in my own ER one day-- I also am required to get 10 deliveries and I was determined.
After lots of smiling about scut work and doing extra notes and other simple tasks to get a few residents trust, I got my first few in rapid-fire sequence. Finally! I caught 3 babies in the same night and felt triumphant!! Then I got put on the backburner because "you already got some deliveries" and the poor M3s will never get another chance blah blah.
In the end, I only got 8 of my 10 the other two I had to simply watch someone else do. But those last 5 i really had to sharpen my elbows and butt people aside or steal from students (which i try not to do).
As far as crazy stuff... I had no shortage of good stories despite my struggles for deliveries. And I must say the ones I did catch all seemed to be a story- there weren't really any normal married ladies having normal infants with a supportive husbands. It always seems like there is some drama. Someone cheated or they are too young or too fat or just plain crazy or the baby is not healthy or too young or there is an infection or the mom has a problem and emergent c-section is happening NOW.
For example, one young girl whose boyfriend SNORED in the chair while she was bleeding out. The postpartum hemorrhage was bad but then we looked at the dried off baby and took a picture. Look at that left leg... so white. Turns out he had a DVT (blood clot) in his leg. Was born that way.... say what??!?!
I got to see a surprise vaginal frank breach (butt comes out first instead of head) the risk of these is very high because they get stuck so often.... so usually they go to csection. But she was just pushing and oops, there is a baby on the bed, came out butt first and nobody was helping it! Good thing everything ended up okay!
I also saw a 3 minute shoulder dystocia (the baby's shoulder was stuck). This is a huge scary complication that still happens alot today. Usually from mom's who are diabetic or babies who are too big for mom's pelvis. This can cause death of baby and death of mom. This one resulted in 3 hands inside mom and an episotomy (cutting mom's vaginal opening all the way down to rectum). All of these things were terrifying, but incredibly informative. I remember thinking, Wow. This baby might not live through this. And then I thought, I could be watching this baby die and the mom could be next. Birth is scary. It terrifies me that so many people take birth control so lightly. Your body is never the same.
And overall, I don't consider my OB month a waste. Learned lots. Now scared to ever have kids myself.... Guess i better pick a guy who I'd trust to raise my kids without me. Scary.
For me, after getting off a joke month there was no way I was just going to sit around on this rotation. I made up my mind to be pushy and butt into the deliveries until I met my designated 10 deliveries required for graduation of ER residency. But when I showed up the first day and saw there were 10 students (mix of M3, M4, and auditioners) plus a family med resident and an anesthesia resident I knew the odds were stacked against me. I did what I could to play those odds, volunteering for nights only and on top of that only nights over the weekends to clear my way. But it was still hella difficult with even the ob residents resisting my help. I was banished to the "OB ER" (note this is not a true ER, just our nickname) where I drowned in vaginal bleeds usually resulting in dead babies and rule out labors for women who were simply sick of being pregnant. While I surprisingly found this area to be helpful since this is the type of patients I will be seeing in my own ER one day-- I also am required to get 10 deliveries and I was determined.
After lots of smiling about scut work and doing extra notes and other simple tasks to get a few residents trust, I got my first few in rapid-fire sequence. Finally! I caught 3 babies in the same night and felt triumphant!! Then I got put on the backburner because "you already got some deliveries" and the poor M3s will never get another chance blah blah.
In the end, I only got 8 of my 10 the other two I had to simply watch someone else do. But those last 5 i really had to sharpen my elbows and butt people aside or steal from students (which i try not to do).
As far as crazy stuff... I had no shortage of good stories despite my struggles for deliveries. And I must say the ones I did catch all seemed to be a story- there weren't really any normal married ladies having normal infants with a supportive husbands. It always seems like there is some drama. Someone cheated or they are too young or too fat or just plain crazy or the baby is not healthy or too young or there is an infection or the mom has a problem and emergent c-section is happening NOW.
For example, one young girl whose boyfriend SNORED in the chair while she was bleeding out. The postpartum hemorrhage was bad but then we looked at the dried off baby and took a picture. Look at that left leg... so white. Turns out he had a DVT (blood clot) in his leg. Was born that way.... say what??!?!I got to see a surprise vaginal frank breach (butt comes out first instead of head) the risk of these is very high because they get stuck so often.... so usually they go to csection. But she was just pushing and oops, there is a baby on the bed, came out butt first and nobody was helping it! Good thing everything ended up okay!
I also saw a 3 minute shoulder dystocia (the baby's shoulder was stuck). This is a huge scary complication that still happens alot today. Usually from mom's who are diabetic or babies who are too big for mom's pelvis. This can cause death of baby and death of mom. This one resulted in 3 hands inside mom and an episotomy (cutting mom's vaginal opening all the way down to rectum). All of these things were terrifying, but incredibly informative. I remember thinking, Wow. This baby might not live through this. And then I thought, I could be watching this baby die and the mom could be next. Birth is scary. It terrifies me that so many people take birth control so lightly. Your body is never the same.
And overall, I don't consider my OB month a waste. Learned lots. Now scared to ever have kids myself.... Guess i better pick a guy who I'd trust to raise my kids without me. Scary.
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