STI testing

There are pros and cons to testing. One con is that your results may not match your partner's.

TFLN

(214): Nothing says love like couples STD testing
(972): Nothing says breakup like the results


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I'm loving my Obs Gyne rotation

After having such a terrible experience in clerkship it's great to finally get what all the fuss is about. The nurses in town are amazing. They are teaching me tons and helping make this rotation a lot of fun. Now I know that I want to include some obstetrics in my future practice. That was something I hadn't considered until this rotation. This is what residency should be about.




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I'd rather be delivering babies

None seem to want to join us in the L&D. Instead, I quilt.


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Have you ever noticed

...when L&D staff get chatting and gesturing wildly, they keep their index and middle fingers together?

Risk of the job I suppose.


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I may have a new crush

There was a baby stuck in mom's pelvis this morning. It was pretty tense. Baby was OP, so instead of looking left or right she was facing the ceiling. After a failed attempt to reposition baby's head, one of the older docs came in. He brought his forceps.

It was like magic.

The tension in the room dropped. Baby was out in a very short time. It was one of the most amazing things I've ever seen.

I think I have a little crush on forceps. They're shiny an everyone was in awe of what they can do.

Amazing.


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My new definition of gross

Parents who kiss their freshly born baby after they've marinated in meconium full amniotic fluid.
Yes we wipe the kids off first, but still....Ew.




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Making friends

It's well known that the best way to get cozy with obstetrical nurses is to feed them.
When one of my nurses was a bit grumpy, I bought some candies and left them at her desk. Minutes later they were put on the doctors desk.
I found out later that this nurse was on a strict diet.
Because the best thing I can do to make friends is poke the bear with a pointy stick.
Oops.
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Not a busy night on call

I've seen only 3 women on my 24 hours of obs call. In between number 2 and 3 I went home, had roast beef dinner and a very long nap.

Going back in to see number 3, I was a bit groggy having just fallen into a good sleep.

When I went to introduce myself, I slurred my words "hi, I'm Dr. Impostrrrrrraaaaa..." and let it trail off. Quickly rebounded with, "so, what's going on with you?"

After much reassurance baby was ok, I get to go back bed.

Next time I'll practice speaking out loud after a good nap before chatting with a terrified patient.

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I delivered a baby!!!!

First one ever. Little tyke grabbed my hand on her way out.

Squeee!


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First day of obs

I finally found the cervix!!! Today was my third attempt ever in life. My first two tries to determine a pregnant woman's dilation failed. I had no idea what I was doing.

Today however ... 1 cm! 50% effaced! Mid way! And I was right.

I had been coached by a friend the night before and one of the nurses just before going in. They made it so easy for me!

I'd almost forgotten how joyful medicine can be.




This was a good day.


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The Learner's Perspective

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.

Yes - those kids in the photo are playing on a pile of manure - likely looking for the pony.

the morning after my last call shift of clerkship

what a crazy night

I can't wait to sleep

Considering dipping my feet in chocolate

Or maybe enrolling in a social niceties class.

I spent yesterday with my foot in my mouth or realising that I am not ever going to be a standoffish doctor.

In the morning, in front of a consultant I went on and on about hating this rotation. In my defence I didn't see him right away because he was behind a nurse in the elevator. Still mortifying. I know him outside of the hospital as well which for some reason makes it even worse.

There was an emergency that didn't follow protocol in a rapid manner. The nurses had been harping on it being someone else's fault. Likely the family medicine resident but they wouldn't listen to me who saw the miscommunication take place. I told our chief resident that a miscommunication that took place was as much the nurse's fault as the resident as the nurse came around the corner.

d'oh

Later in the day, I accidently told a patient's family she'd had a boy when it was supposed to be a surprise. The same patient had an incredibly stressful day. During one of the most stressful moments, I was at her head, stroking her hair and trying to keep her calm. Without thinking, I bent over and kissed her on the forehead. She seemed to need a familiar action. Regretted it immediately. The patient however told me later that she was very happy for it. It made her feel happy and good in the moment.

phew

I am an emotional person. I have always been an emotional person. I speak my mind, I tell people I love them, I get excited when they're excited, I cry when they cry. It makes me get too involved, I worry when others don't.

I think it also makes a difference when people are having a really bad day. That makes the rest of it worth while.

Awesome photo from Cute Overload, nothing to do with what I want to talk about today.

Despite the fact that Canada has "universal health care", not all our patients have access to this care. Women find themselves in a position of needing to choose between affording birth control and paying rent. I met one of these women who ended up pregnant, keeping the child and now has even more financial problems than if she had forgone her rent and bought birth control.

The Mirena IUD, one of the best options for women who are myopic in their health care choices, is the most expensive option at the initial outlay. It costs approximately $400. This is a one time cost and the Mirena lasts for 5 years. There is no need to remember to take pills daily or ensure his love is gloved to prevent a pregnancy. It's also a fabulous way to control heavy periods. The $400 is quite a bit for the woman who can't afford utilities.

Some docs are good enough to keep some of the samples given out by drug reps. This is disturbing on a whole different level. There is something to be said for beggars can't be choosers. If the birth control that may be the best choice for the patient (e.g. a mini pill, the nuva ring, mirena), is not available as a sample, then the patient gets the second (or third, or fourth) best option. Samples are given to the docs as good will from the drug reps to get their foot in the door, but also so that the docs can give them out to the patients who need them and see how they react and learn how the drug works.

New research out of Kingston shows that poverty plays a role in cancer prognosis. I assumed it would be because these folks are less likely to seek medical attention early, but one of the things they found was that patients presented at the same stage in their cancer. While it's true that we have universal health care in this country, we don't have universal access to healthy foods, education about our health and access to health promoting activities. The researchers are looking at "other factors such as tumour biology, presence of other illnesses, access to treatment, quality of care, or differences in nutrition, exercise and smoking may also play a role in survival".

first night of call on obs/gyne

First thing my resident said to me... "oh, you're the clerk? I thought you were someone important".

huh

Surprisingly it got much better after that. I helped deliver 5 babies, assisted a c section, a salpinectomy and did 3 crazy consults in the emerg. Fun!

old school

The outpatient obs/gyne clinic is cooled by fans and some in window air conditioners.

Because the patients you want feeling warm are pregnant and menopausal women.

just heading in

Obs/Gyn clinic starts at 1pm. I will not be there early. Not a fan of this rotation.