During my obs/gyne rotation in clerkship, I was given essentially no responsibilities and nothing to do. There were PGY1 - 5s before me in the OR and in L&D. I was as close to being useless as a person can be.
Whenever a patient came into the ER for assessment, I jumped at the opportunity. It was rare I could go since the PGY1 wanted the experience, but every now and then I was lucky and a call came while they were in teaching or scrubbed in and I would *have* to go.
I met a woman who came in from the periphery with abnormal bleeding. So abnormal, her hemoglobin (normally low for her) was half of what it was the week before. She was weak, pale, tachycardic and hooked up to a cardiac monitor. Kind of a big deal.
I did the usual med student thing - history and physical, wrote an admission note and orders - after I paged my consultant to ask if we could bolus her fluids then transfuse her since she was hypovolemic and headed to shock. This was a direct transfer so we were responsible for her care and the ER docs are supposed to be hands off - stupid politics. This made sense to my consultant so he agreed then left me to finish the paper work.
This was my patient! I finally had a Gyne patitent!
*ahem*
She was eventually moved upstairs and started on some of the miracle drugs we try when attempted to make the bleeding stop. It slowed down, but not enough as she was still requiring multiple transfusions to avoid complications of her anemia.
The consultant asked me to set up angioplasty for her fibroids with the interventional radiologist. Easy.
The day she was going for the procedure she was terrified - she’d never had surgery before - and her husband wasn’t allowed in the room. I was bored. There was another 4 vaginal hysterectomies on the board which meant that I would not be able to get close enough to the patient to determine gender let alone do anything. So I asked if I could accompany the patient into the IR suite, better to feel like I was doing something by holding her hand than gossiping with the OR nurses.
The patient was happy to have me there and the IR doc loved teaching me what he was doing. I got to show off my mad “switch out the empty IV bag” skills and generally kept the patient fairly calm. She was given a large amount of valium and some morphine because the procedure was painful but it didn’t seem to be enough. She was, to say the least, dopey. And adorable (not a professional thing to say, don’t care, you would have said the same thing if you saw her). She kept going on and on about how cute the doc was “do you think he can hear me?” “Yes, he’s standing right beside you.” “Oh, don’t tell my husband *giggle*.”
When the procedure was done and our patient moved back upstairs, she was in an enormous amount of pain. She was given a pain pump but it was difficult to control the amount of pain. Lesson one, when a part of your body is dying from ischemia, it hurts like hell. The bleeding was slowing down but not as quickly as she and her family expected which was really disappointing for them.
Things did eventually get better, both pain and bleeding, and the patient’s mother started asking again about getting pregnant and if we thought the procedure had saved her fertility. At this point, it was still impossible to know, but we did save her uterus and stopped the bleeding so we had been feeling pretty good. Lesson two, our patients often have different goals of care than we do, even if it felt like we were headed the same way at the beginning. Patients can hear what they want to (so can we). Neither us nor the patient likes having uncertain outcomes, but unfortunately, there they are, everywhere in medicine.
Chatting with my residents the next week in the lounge, I mentioned how funny our patient had been. They all jumped on me. Not for being unprofessional, but because they were jealous of getting to see the embolisation. They had never seen one and weren’t entirely sure how the procedure was done. I was able to see how the arteries of the uterus are laid out in real time and how they differ when a fibroid is involved. Lesson three, everything is a learning opportunity. Pay attention to everything going on or you may miss it. Your busy work project may be another learner’s gold mine so don’t take any of your opportunities for granted.
Whenever a patient came into the ER for assessment, I jumped at the opportunity. It was rare I could go since the PGY1 wanted the experience, but every now and then I was lucky and a call came while they were in teaching or scrubbed in and I would *have* to go.
I met a woman who came in from the periphery with abnormal bleeding. So abnormal, her hemoglobin (normally low for her) was half of what it was the week before. She was weak, pale, tachycardic and hooked up to a cardiac monitor. Kind of a big deal.
I did the usual med student thing - history and physical, wrote an admission note and orders - after I paged my consultant to ask if we could bolus her fluids then transfuse her since she was hypovolemic and headed to shock. This was a direct transfer so we were responsible for her care and the ER docs are supposed to be hands off - stupid politics. This made sense to my consultant so he agreed then left me to finish the paper work.
This was my patient! I finally had a Gyne patitent!
*ahem*
She was eventually moved upstairs and started on some of the miracle drugs we try when attempted to make the bleeding stop. It slowed down, but not enough as she was still requiring multiple transfusions to avoid complications of her anemia.
The consultant asked me to set up angioplasty for her fibroids with the interventional radiologist. Easy.
The day she was going for the procedure she was terrified - she’d never had surgery before - and her husband wasn’t allowed in the room. I was bored. There was another 4 vaginal hysterectomies on the board which meant that I would not be able to get close enough to the patient to determine gender let alone do anything. So I asked if I could accompany the patient into the IR suite, better to feel like I was doing something by holding her hand than gossiping with the OR nurses.
The patient was happy to have me there and the IR doc loved teaching me what he was doing. I got to show off my mad “switch out the empty IV bag” skills and generally kept the patient fairly calm. She was given a large amount of valium and some morphine because the procedure was painful but it didn’t seem to be enough. She was, to say the least, dopey. And adorable (not a professional thing to say, don’t care, you would have said the same thing if you saw her). She kept going on and on about how cute the doc was “do you think he can hear me?” “Yes, he’s standing right beside you.” “Oh, don’t tell my husband *giggle*.”
When the procedure was done and our patient moved back upstairs, she was in an enormous amount of pain. She was given a pain pump but it was difficult to control the amount of pain. Lesson one, when a part of your body is dying from ischemia, it hurts like hell. The bleeding was slowing down but not as quickly as she and her family expected which was really disappointing for them.
Things did eventually get better, both pain and bleeding, and the patient’s mother started asking again about getting pregnant and if we thought the procedure had saved her fertility. At this point, it was still impossible to know, but we did save her uterus and stopped the bleeding so we had been feeling pretty good. Lesson two, our patients often have different goals of care than we do, even if it felt like we were headed the same way at the beginning. Patients can hear what they want to (so can we). Neither us nor the patient likes having uncertain outcomes, but unfortunately, there they are, everywhere in medicine.
Chatting with my residents the next week in the lounge, I mentioned how funny our patient had been. They all jumped on me. Not for being unprofessional, but because they were jealous of getting to see the embolisation. They had never seen one and weren’t entirely sure how the procedure was done. I was able to see how the arteries of the uterus are laid out in real time and how they differ when a fibroid is involved. Lesson three, everything is a learning opportunity. Pay attention to everything going on or you may miss it. Your busy work project may be another learner’s gold mine so don’t take any of your opportunities for granted.
Yes - those kids in the photo are playing on a pile of manure - likely looking for the pony.
No comments:
Post a Comment