I want more.

I love art, and one of my very favorite mediums is music.

Of course I can’t carry a tune with a five gallon bucket, and I’ve always been too impatient to learn to play any musical instrument with any sort of skill. But I love searching for and finding, or just by chance hearing that Perfect Song that pumps me up, makes me laugh, soothes, or expresses exactly how I’m feeling at the perfect moment. (I was lucky enough to discover The Black Keys during Gyn Onc last year – Yes, yes I have been living under a giant media-deprived rock – irregardless, fairly certain that was the essential factor in surviving until the next rotation.)

My brother and I have developed a habit of exchanging mix CDs of these Perfect Songs we find since I started med school. We send them to each other as gifts for birthdays, Christmas, and at random intervals just because we’ve accumulated enough of them or one of us really needs a new infusion. I’m not exactly sure how he feels about them, but not being a big accumulator of ‘stuff” myself, they are some of the most useful, meaningful, very best, and really my favorite of gifts to receive. (I’ll never forget my study buddy’s horror second year when he introduced me to the Drive By Truckers with “Nine Bullets” and “Gravity’s Gone”. I was busy falling in love with a new band at the time, but it still managed to register. Hah.)

So, my contribution to the Intern Welcome Basket this year was a mix CD. Initially I asked for input from friends for songs for the Perfect OB/GYN mix CD, needless to say the majority of the suggestions were not fit for general public consumption, but did give me a good idea of what the general population thinks of our specialty (and let me just say: #1. Yikes!! and #2. Really guys???!!). Luckily I have headphones or the radio on most of the time when I’m on my way into or out of work so I heard a lot of those Perfect (and not necessarily X-rated) Songs over the course of intern year and I ended up compiling a list of songs I thought embodied the ups, downs, and in-betweens of OB/GYN intern year.

I made a bunch of copies for the interns and one for myself, and listened to it constantly until a couple of weeks ago when in a fit of 5 am, sleep deprived, pre-coffee frustration/irrationality I tried to fix my car’s CD player by cramming two CD’s in to try and make the mix play. (Yes, yes I realized then, and still do, what a terrible idea this was, and have to reassure that I am a much better MD than user/fixer of technological equipmentry. Much better. I swear.)

That being said, here’s the mix:

1. First Day of My Life – Bright Eyes
2. Portions For Foxes – Rilo Kiley
3. Help I’m Alive – Metric
4. Blackout – Breathe Carolina
5. Land Down Under – Men At Work
6. Let’s Talk About Sex – Salt-n-Pepa
7. Push It – Salt-n-Pepa
8. I Wanna Be Sedated – Ramones
9. Over My Head – The Fray
10. I Need A Dollar – Aloe Blacc
11. Breathe – Anna Nalick
12. Paradise – Coldplay
13. Some Nights – Fun
14. Everybody Hurts – R.E.M.
15. Hold On – Alabama Shakes
16. Keep Your Head Up – Andy Grammer
17. Do It Anyway – Ben Folds Five
18. My Body – Young The Giant
19. Girls Just Want To Have Fun – Cyndi Lauper
20. I Love It – Icona Pop

I haven’t heard any the of interns’ reactions to the CD, or if they even actually got their copy as I was in the middle of my South American Medical Mission Adventure when they were supposed to have received it, but I really miss being able to play that CD. There is a Perfect Song for everything I am needing or feeling on my way into or leaving work if I can’t find it on the radio.

I just finished my first rotation of second year on L&D and the song I most listened to on my way home, and most wanted to hear before I completely ruined my CD player was #18. The lyrics of the chorus played through my head most nights as I walked out and drove home after the ruination anyway, “My body tells me no oh, but I won’t quit, ’cause I want more….’Cause I want more!”

It was, hands-down, the best rotation of residency so far.

I was exhausted most days, after 12 to 15-ish hours of non-stop L&D action – high-risk, high-volume, 5000 deliveries per year, one resident on at any given time and responsible for pretty much everything action – and I loved every minute of it.

I think, I have found my calling, and I absolutely loathe leaving it, even for an out-patient “vacation” rotation (followed by another Gyn Onc rotation, the very contemplation of which makes me nauseated even though, rationally and logically, I know The Worst Rotation Ever was primarily due to the The Most Giant A-Hole Chief Ever, so I’m going to not think about it until approximately 5 seconds before it actually starts).

Until I am happily running up and down your hallowed halls again L&D………..

The Daily Something: Working With Med Students

I love working with med students.

I remember very well what it is like to be a med student, and I cringe at all the horror stories I hear about how residents treat med students badly. Especially on L&D rotations. That is total crap. Med school is hard enough without someone taking out their frustrations and residency-related rage on some poor med student who is trying to learn, who we have a responsibility to teach, so they can go out and be a competent resident themselves soon. And hopefully not scare them out of a career choice just because we were an A-hole to them.

But I don’t love working with them because it’s my responsibility to. I actually enjoy the responsibility of teaching, of watching their knowledge expand before my very eyes, their brains soaking it all up like hungry, impressionable sponges. I love that they love that I make at least half an effort to teach, and include them as much as I can, if my evals from this year are any indication anyway. (They were awesome, literally, the biggest self-esteem boost I’ve had in my medical career to date, reversing at least some of the damage Intern Year has wreaked. Forget the diplomas, I may have those evals framed.) And fine, I love working with them because, frankly, I love having a buddy to hang out with in the trenches (so to speak). When we’re working all buddy-cop style, and I’m rambling on about how great OB/GYN is, I remember myself, and when I’m trying to make it fun for them, it always ends up being more fun for me too.

And also, of course, every time I work with them on L&D call it is invariably A Night Of Firsts. With the last med student, it was The First C-Section. I had them scrub in as third assist (this being The First for them, and all). It was a challenging repeat, the baby was (for lack of a better term) a Big Fella, and I got to be primary. So, I was too busy during the actual surgery to pay much attention to how the med student was faring (aside from the fact that they were right there with suture scissors and bladder blade at appropriate intervals, and didn’t appear to be faltering or swaying in any I’m-totally-going-to-pass-out-right-now sort of way).

Afterwards, when we left the OR to put in the post-op orders, I finally remembered my buddy and asked, “Oh yeah! Hey, So what did you think of your first C-section?!” To which my (completely reserved and apparently introverted up to this point) med student compadre replied, “What. Just. HAPPENED in there???!! OH MY GOD!!! There was just…like…stuff….coming out everywhere!!! And then, there was…like…a BABY!!! And it came out…and it was all, like……….”

(Best reenactment I could find of what med student compadre did at this point.)

I stopped, watching this graphic reenactment, and then I laughed. Really, really hard. For awhile.

I have done, or scrubbed on so many sections at this point, I forget what it what must look like to people who haven’t. There is a reason why it’s is my favorite surgery. Triple-bypass-multiple-transplant-sterotactic-robotic-Whipple’s got nothin’ on us. I mean, I’m always highly aware of this, but med students are Awesome for (graphically) reminding me of it.

I love working with med students.

How do I love thee L&D?

I had such a great weekend of call on L&D. Once again, I left so I tired I had to call someone to keep myself awake on the way home, but wishing I could just be on L&D until residency is over. And pretty much forever after that.

How do I love L&D? Let me count the ways……..

1. New Dads on Postpartum wearing hospital footies, pushing their babies around in their little hospital cribs, up and down the halls, every so slowly, ever so carefully. Stopping every few feet to ever so delicately adjust a blankie, or a onesie, or little baby hat.

2. Nurse Grumpy’s baked goods. I’m going to have to find a new name for her, because she is showing signs of slowly, infinitesimally, warming up to me. Probably because every time I see her I run to the lounge to look for the brownies or cookies she invariably comes with, and then return to lavish her with praise for being the Goddess of All Things Baked she most assuredly is (she is also a d*mn good nurse, but I’m usually too full of baked amazingness to get to all that).

The BEST chocolate chip cookies in the WORLD. I start drooling every time I think about them. Not even kidding.

 

3. Compliments from the nurses. There have never been residents at the hospital where I was on call before we started there last year. So there has been quite a bit of confusion as to who we (residents) are, what we do, and where we fit in. And honestly, a fair bit of resistance, and occasionally, the kind of passive-aggressive hostility nurses (Yeah, I’m a nurse too, I know how it works) can specialize in. Part of the awesomeness of last weekend was seeing the change in this dynamic that has slowly evolved since we started. Little things, like getting paged to see patients before the attendings, having gloves on the table before a delivery without having to get them myself or remind anyone of my size, and most telling of all, stopping outside a patients room to slap on some hand sanitizer, and inadvertently overhearing the RN telling the patient who I was, how nice I am, how good of a doctor I am, and how lucky they are that I am the resident on to help take care of them. These are really great nurses, and I understand and agree with the fact that their respect and praise has to be earned with consistent hard work, a good attitude, willingness to be a team player, and excellent and competent patient care. An endorsement like this, from one of them, means more to me as far the kind of doctor I am becoming than any kind of off-the-chart CREOG scores. It’s (really) good to (finally) be part of the gang.

4. Random conversations overheard at the nurses station. They routinely kill me. I never know what I’m going to hear, from in-depth explanations on ‘Vagazziling’ to spirited debates about gun control. The latter of which yielded my personal favorite quote of the weekend from one of my favorite funny girls/nurses: “Fine, if there’s a Zombie Apocolypse, I guess I would use a gun. Actually, forget it, if a Zombie Apocolypse ever happens, I’m just going to let one bite me and get it over with.”

5. Dads at the bedside right after a delivery, with silent tears rolling down their faces, too choked up with emotion to do anything but stroke their wive’s sweaty foreheads and gaze adoringly at her while she cuddles their gooey new progeny to her bare chest.

6. The Ladies In Labor. I had such great patients (I always do, but these peeps were especially, awesome), the labors weren’t all easy and the dynamics weren’t all hearts and flowers, but we all worked hard to manage labors, keeping things moving along, alternately encouraging, cajoling, kidding, coaching and teaching, and the deliveries were all great. To the best of my ability, and from what I heard from my patients, everyone had the best experience possible. And the board was empty at the end of at least one of my shifts. Doesn’t get any better than that.

7. And then, I was in the nursery doing circumcisions and one of the Dads I had met, helping manage his wife’s labor, but missing the actual delivery as I was in the middle of two others, spotted me. I returned his wave happily, and went back to work. Then I heard one of the nurses call me, “NurseMD, someone is here asking for you by name.” “Ahhh, kind of busy here, I’ll come talk to them in a few minutes.” She came over a few seconds later and said, “They just wanted to give you these.”

I don’t care how hungry I get, I am saving them forever, and never eating them.

Weekly Update: High Five! Edition.

I started off Monday by walking out of my front door and directly into a snow drift. Where just seven hours previously there had been no snow. Hello blizzard. I slid in my little car (with absolutely no tread left on the front tires, we’re talking like made-the-tire-guy-gasp-in-horror no tread, Safety High Five!) to the main road, and through several intersections before I decided that, even with my crazy-mad snow driving skills honed after a decade-plus of wintering in the Upper Middle States, hitting the interstate to drive 30 miles to clinic would be a Stupid Idea Of Epic Proportions.

So, I slip-n-slided to the nearest Big Giant Hospital affiliated outpost, sat in the parking garage and had a good cry (Yeah, I’m A Big Cry Baby, What Of It? High Five!). After I had (somewhat) collected myself, I Googled the nearest non-blatantly-shady-looking tire place that I could get to without having to go up any sort of incline, drove there, got yet another credit card (Fiscally Responsible High Five!), got some decent (d*mn) tires (finally), and afterwards, I went to clinic. Oh yes, I did.

That night I got pretty much no sleep, for no good reason (because I usually have four to twenty, very noisy, undergrad party animal reasons directly above my bedroom for not sleeping, A**hole Neighbors High Five!), and woke up exactly 24 minutes before CREOGs (the Big Annual OB/GYN Resident Assessment Exam) started the next morning (2 Minute Shower High Five!).

After taking all of the shelf exams (core clinical med student exams most people only have to take once) numerous times in med school, not to mention surviving second year which consisted of approximately 92.7% taking exams, I was not too worried about a little one-day test which included free lunch (Free Food High Five!). Plus, I had been told by pretty much everyone (aside from my program director, of course), not to sweat the test as an intern because the whole point is to show improvement over the four years of residency and kick @ss on the test in third year if I want to do a fellowship. Don’t stress over something in residency when I have 57 million other perfectly good things that I actually need to stress about? Done.

The test was not exactly a Super Happy Good Time, but turns out all the studying I’ve been doing for the rotations I’ve been on so I have some idea of what I’m doing when I have to treat real live patients, came in handy when I had to answer hundreds of questions about purely theoretical ones as well (Indirect Benefit High Five!).

With the test over and new tires on my car, I was free to spend the rest of the week freaking out about how frigging old I and my (apparently, literally) elderly ovaries are, and how I probably have a better chance of growing a second head than of giving birth some day. Yep, I am on REI right now (Infertility Freak Out High Five!)

Every day I am counseling women (significantly) younger and healthier than myself who just can’t manage to pregnant for no good reason. I know the stats people, and right now (officially in my early-to-mid-thirties), my chances of ever getting pregnant ain’t looking good, and get worse by the day (Who am I kidding? By the second.). The realization of which kind of makes me want to jump up and bust out of whatever stuffy, sterile little consultation room I happen to be sitting in at the time, and immediately get to work on getting knocked up. At least five times a day.

Because I have always wanted to have kids and I still do. But, I am a resident. And the reigning verdict on having a baby as a resident is that you have to: #1 – Be Rich, #2 – Have tons of people just sitting around ready and willing to raise your child while you are at work all the time, #3 – Be a Magical Pregnancy Unicorn who never gets sick, never misses more than 10 seconds of work (this includes your effortlessly popping that little miracle out and seamlessly handing it off to your Nanny Squad who have been on standby in the lounge for the last nine months, between consults), and in fact works harder while all PG, and ever afterwards.

At this point, I am the opposite of rich. As in, if the surgeon general starts putting warning labels on credit accounts, there will be no writing, there will just be a picture of my broke @ss. I don’t even have enough money to buy a used couch, and I have started to pray every time I buy a package of ramen noodles that my credit card won’t be rejected (Glamorous Doctor Life High Five!). Plus, my support people consists of my cat. Who, as far as I can tell, considers waking me up in the morning by sitting on face and hard-core licking her privates to be the absolute pinnacle of supportivity (Hey, It Got Me Out Of Bed In Time For CREOGs High Five!). I’m not even going to address the Magical Pregnancy Unicorn issue. Knowing my luck, I’d probably have a barf bag strapped on like a feed bag for 9 months, 8.75 of which I would probably be on Strict Bed Rest what with my PIH, GDM, VB, MSG, OMG……..(Just Being Realistic High Five!).

I just have to say, that this totally sucks.

It sucks that in this day and age, I and many other women are forced to choose between having a career or having a family. It sucks that I could have stayed a nurse and probably had three kids by now, but no, I chose to go on to medical school and be a doctor so I could do more to help other people, so now, by the time I can (responsibly) have a kid, I probably won’t be able to.

I realize that it was my choice, and after I made that choice my ex-husband said “Okay, then we can’t have kids because you won’t be around to take care of them.” And then divorced me. (Yep, Better Off Without Him High Five!) And then I kept right on going, I suppose the implications of which are now finally, fully setting in.

Because who thought, in this day and age, I would really have to be making the choice to have a career or a family? Obviously, not me. Sure, it was probably hanging around somewhere in the back of mind where I store disturbing things I would just rather not think about (Denial High Five!), but come on! Nahhhh, that will never happen.

Fast-forward five years, and here it is, happening. And regardless of how self-inflicted it may be, it still totally sucks.

Fast-forward to today (Fast-Forward High Five!), and I’m in my own clinic. And one of my very own patients, who I delivered with my very own hands, brings in her baby to get a picture with me. And brings me a picture, which I am instructed to display on my very own Baby Board. It is the very first picture I have gotten to display on my very own Baby Board.

And for the rest of the day, I don’t give a d*mn about choices (Having My Very First Baby Picture To Display On My Very Own Baby Board Is The Epitome Of AWESOME High Five!). I go home and lay in bed and watch stupid TV on Netflix and eat candy for a couple hours, and then I dance around like crazy in my fuzzy jammie pants to a song that makes me feel like me and my (elderly) ovaries are young and juicy and carefree all over again……

And then I go for a long walk, and it’s snowing again, and all I can think about is how it sparkles…..

And I listen to a hopeful song……

And I stay up too late to write a blog post. (On Call All Weekend High Five!)

QOD

Me: “And be sure to come back in if your symptoms continue or get any worse.”

Patient : “Oh, don’t worry about that doc. Suffering, is not my bag.”

~ (One totally groovy) LOL

Yet another reason why I love OB/GYN. Working with pregnant ladies and LOL’s.

Because Little Old Ladies, are Awesome.

Reasons #456 and 457 why I’m doing OB/GYN. OR, Fine, if I can’t be doing OB/GYN, I’m going to write about it.

I’m currently on another surgical rotation where, again, everyone thinks I’m pretty much nuts for going into OB/GYN. Until, again, I mention that I’m considering doing a fellowship in REI (Reproductive Endocrinology and Infertility). Then it’s all “Ohhhhhhh, well that’s smart. (i.e. Okay, maybe you aren’t a total nutter.) You’ll have office hours if you do that. Nine to five that’s the way to go! (i.e. Okay, maybe you won’t turn out like that poor sap I told you about who crashed and burned out after two years of general OB/GYN and now does corporate physicals for a living.) Plus, you’ll probably make lots more money. (i.e. Okay, you probably won’t be sued into vagrancy.)”

Whatever.

It occurred to me recently that a lot of this negativity probably, actually stems from the fact that most people who don’t do OB/GYN, just don’t like it. As my current attending puts it, “You either like OB/GYN, or you don’t.” (Or, as one of the nurses in their office put it “They just hate OB/GYN.”)

And when I think about it, I can recall countless non-OB/GYN physicians grimacing painfully as I excitedly regaled them with tales of deliveries, sections, hysterectomies, pessaries, and pap smears before they (pointedly) changed the subject. I particularly remember one internal med doctor I worked with as a nurse who was so excited to be taking another job where they wouldn’t “have to be doing any of those pap smears anymore!” [pap smears, YUCK, written all over their face and inflection]

OB/GYN = Ewwwwwwwwwww......

Frankly, if some doctors don’t like OB/GYN stuff (fine, that’s cool), instead of condemning me for liking it, I think they should be congratulating me. I mean, they have no desire whatsoever to deal with “crazy pregnant ladies” or “all those ER patients with vaginal discharge [shudder].” Well, I can’t wait to “deal” with them. Heck, that’s all I want to deal with. So make both our days, send them all to me, and instead of thinking I’m nuts for wanting (and totally loving) this work, think I’m doing you a big favor, and throw me a frickin’ party.

I’m just saying.

OB/GYN = Party Time! That's more like it.

Which (sort of) brings me to Reason #456.

I read this article yesterday on NPR’s health blog about doctors talking to (or not talking to) patients about their sex lives. From experience, I have found that many physicians are not necessarily comfortable talking to patients about sexuality. For example in first year, before OB/GYN was even a twinkle in my eye, I watched a generalist complete a yearly physical on a young female college student. They did all the exams – heart, lungs, abdomen, pap, pelvic, wrote a script for birth control, and sent the patient on their way. They did not ask one question about sexual partners, sexual practices, STD testing, nothing. I was very surprised and a little dismayed. Last year I heard about a patient who had expressly been sent to an OB/GYN with persistant UTI’s for further investigation of sexual practices and a workup for STD’s. Later the patient presented with yet another UTI, and per the OB/GYN’s note, none of these things had been done. I completely understood the generalist’s frustration as they read the note and asked me “You’re going into OB/GYN, shouldn’t they address that stuff??”

Yes, yes they should.

Sexuality and associated health concerns are a fact of life, and an important part of a patient’s overall well-being that cannot be ignored. I am sure that patients have a hard time talking about such issues, and probably more often than not, the (sensitive, non-judgmental, well-educated, trustworthy) doctor is going to be the one who has to start the conversation so that any concerns can be properly addressed. We need to be better about this, and I for one, am very happy to be going into a field where I will be a (sensitive, non-judgmental, well-educated, trustworthy) resource doing my best to help patients with these important issues.

And, on a lighter note, Reason #457. (Or, a stolen, precious OB/GYN moment that was the highlight of my non-OB/GYN week.)

A few days ago I walked out of a patient room and one of the nurses beckoned me to the lobby where, to my absolute delight, I found one of the patients I’d delivered months ago waiting to say Hi with their baby. The patient had been a delight to work with, I’d spent all day on L&D with them and their family, and when the baby came I had been just as ferklempt as grandmabear.

The baby was spectacular, all decked out in their best baby duds, snoozing and drooling like a little angel. As I exclaimed and made a general fuss over them, the proud mamabear said she had heard I was in this particular clinic and they just wanted to stop by and show me the baby. And then they handed me a thank you card, and I got ferklempt all over again.

And that is my kind of Pediatrics. I love kids. I do not like having to poke, prod, or otherwise torture children in the name of medicine. And with OB/GYN I get the fun part of Peds, aka the exclaiming and general fuss-making, without all the Bad Guy stuff. (P. S. Pediatrics people you are my Absolute Heros for being willing and able to do the Bad Guy stuff. Seriously.)

Highlight Of My Week. Sniff.

Really, does it get any better?

QOD

“So, do you actually, like, deliver the babies or whatever?”

“Well yeah. Sometimes.”

“But….why????”

“Uh, because it’s awesome. Why not?!”

“Because….you’re pulling out this…..this….six to eight pound…..Ball of Liability that no other doctors want to touch!”

~ Exchange between myself (assuming you can guess my part) and another (health professions, but non-med student) student earlier this week. (Also, the best “Why the F would you want to do OB/GYN?” quote to date. “Ball of Liability,” just slays me.)

It’s been kind of a rough week. First of all, I’ve been studying my butt off to keep up with my current rotation. By 2 am Wednesday (yesterday? was that really only yesterday?) I was struggling to make myself get through another 68-page NCCN guideline by rounds at 0700, wondering how in the h*ll I’d managed all the (unrelenting, almost 24/7) studying the first two years of med school. And I still have no idea. (Seriously, how????)

And then, of course, it is Match Week. At this point, I am acutely stressed/borderline freaking out about it, and frankly, this is how I would prefer to spend it:

Hiding. And pretending like nothing is happening.

Versus, apparently, Everyone Else In The World:

Everyone Else In The World. Ready to PAR-TAY.

My less-than-enthused attitude about the general party vibe/actual Match Party was unfortunately noted by the Powers That Be which led to:

Major Butt Chewing In The Middle Of Rounds + Gross Sleep Deprivation + Already Moderate Steady State Of Stress → Uncontrollable Tears of Mortification/Anger (aka The Worst) + Ignominious Dismissal From Said Rounds = Current Acute Stress Level With Increasing Chance Of Five-Alarm Freak Out

Now I understand, and am completely cool with Everyone Else In The World chomping at the bit to tear one off the instant they tear open that envelope. More power to ya. I, however, am more consumed with all the implications of The Match, and see that missive as more of a (n almost literal?) Pandora’s Box, rather than an invite to the Kegger Of The Century.

I have no idea where I’ve matched. It could be any of the programs I ranked. Part of me is excited to start the next phase of my career, mostly because I will finally just be doing (hopefully) all OB/GYN, all the time. But right now, the larger part knows that no matter where I match, it means I will be leaving the place I’ve lived for the past decade-plus, and with it, the people I love, behind. I will be going somewhere urban, which will be a huge change from the sleepy little (I’m talking little, like pop. 306. On a good day.) communities and way of life I’ve grown accustomed to, where instead of knowing everyone, I won’t know a single soul. And in the meantime, I will have a Massive Move and a Million Little Pieces of Detail to contend with. Including remembering how to lock my doors again, and learning How Not To Get Mugged.

I wish I was different, but this is how it is, and this is what I am going to see when I open that envelope. I don’t know how I’m going to make myself do it (honestly, preferably after a suitably large dose of Dutch Courage), but I sure as h*ll don’t want to do it in front of a bunch of people I haven’t exactly been BFF’s with the last two years.

As a last resort, I made an appointment with my shrink and asked them what they thought I should do. They advised me to hit up one of my attendings for some benzodiazepines.

I am not even kidding.

........Um.....no (???). And P.S. That is why I pay you $150/hr. So, I *don't* have to resort to such measures.

Right.

Instead, I decided to go to my Happy Place, aka L&D. (Reason #476 Why I Know I Have Chosen The Right Specialty – When Life gets me down, I go to Work to cheer up.) As often as possible, every time I had a chance this week. I got in on several deliveries and even got to catch and suture once. (Hence the QOD.) It was so wonderful. Brief islands of blissful engagement to the exclusion of all else, where I focused solely on the patients and the work, and basked in the eventual joys of multiple birthdays.

Sigh.

I’m going to a Gyn surgery first thing in the morning. One last sweet reprieve before I will be forced to face The Match Music. I still have no idea how I am going to get through it. Just that (somehow) I will, and I that am going to be wearing my sweaty, pastel, Just For The OB/GYN’s scrubs when I do.

(Not-So-Youthful) Enthusiasm

Today, is just, a great day.

It is a beautiful, uncharacteristically snow-free, somewhat Spring-y March day outside, I’ve officially got one less week before I’m done, I get to spend (another!) entire weekend off with one of my most dearly beloved best of buds, plus, I learned SO much this week!

SO much.

My excitement about all this learning of Useful Stuff (with all due sincerity) cannot be overstated.

Other Student on Rotation: “Um, yeah, I’ve never seen someone get this excited about RPhWorld. I applaud your, uh, enthusiasm.”

Me [madly, gleefully clicking links]: “Are you kidding me? This is so….I mean it’s just….so…..awesome!”

~ One of many, new-found knowledge Moments Of Joy courtesy of this week.

Sure, I have been tired out, adjusting to spending so much time just reading and studying after months of purely clinical experiences, but it has been so worth it. I have been tearing through ACOG Practice Bulletins and Cecil Textbook of Medicine and learning ridiculous amounts of clinically useful information.

For instance, did you know:

* That Primary Hyperparathyroidism is the most common cause of hypercalcemia and Glucocorticoids are an extremely effective treatment for hypercalcemia but only in conditions where hypervitaminosis D is the underlying cause?? Or that hypercalcemia can lead to depositions of calcium in soft tissues (including the cornea!) especially when there is concurrent hyperphosphatemia??

* Or that albuterol (in higher than usual doses) is a treatment for hyperkalemia? And calcium gluconate used to treat hyperkalemia is actually used to counteract effects of high levels of potassium on the myocardium??

* That standard of care is to discontinue antenatal chronic B/P medications within two days of finding out a patient is pregnant, then you should offer an alternative medication (usually methyldopa), then you need to discontinue methyldopa within two days of birth and resume the antenatal medication?? Unless its an ARB, ACE Inhibitor, diuretic, or amlodipine, which are all contraindicated with breastfeeding??

* That 70-85% of pregnant women have nausea and vomiting, and 35% of those women have clinically significant nausea and vomiting (leading to significant psychosocial morbidity), and one study found hyperemesis gravidarum is undertreated and has lead patients to terminate pregnancies??* That Vitamin B6 and doxylamine (Unisom) are first line treatments for nausea and vomiting in pregnancy, and that preconception supplementation with a multivitamin can potentially help patients avoid or diminish nausea and vomiting in pregnancy?? Not to mention, that if not treated with Vitamin B1 (Thiamine), pregnant women who have had significant nausea and vomiting for > 3 weeks are at risk for Wernicke’s encephalopathy with lasting neurological sequelae?? (I mean, what??)

* Don’t even get me started on everything I just learned about OB analgesia and anesthesia. Seriously.

Pretty much my life for the last week. So frigging awesome. Really.

Ah, unless you are watching me study. Which, apparently, is so frigging boring.

Oh! And, in addition to the usual clinical resource suspects (i.e. UptoDate), I have been discovering and plundering new, amazing, and (very importantly!) reliable provider and patient** resources. Such as:

RPhWorld.com – Ridiculous amounts of pharmacologic knowledge. And calculators. I had no idea so many helpful med/clinical calculators existed in the world (For the Maths impaired individual, this has to be on par with finding oil in your backyard. RPhWorld where have you been all of my medical life?) AND it is FREE. No. Joke.

ACOG.org – Chock-full of everything you ever wanted to know about OB/GYN and more. For providers and patients. (Note: Plus, as a student you can apply for membership for FREE. Pssst – ACOG membership looks really good on a CV if you are going into OB/GYN!)

Epocrates Online – This is a standard resource for clinicians, particularly in the form of smart phone apps, but I also discovered providers and patients can register online (again, for FREE) to access not only tons of information about medications, but also about common disease conditions. (Note for students: If you click on a disease and see the resources listed below, you can often click on a citation for a full text article – Bonus!)

Medscape – Another standard resource, but note it is also for providers and patients. Plus it is another (reliable) source of the latest news in medicine, full-text articles, and again, you can use it for FREE if you register.

This is just a taste of the clinically relevant bounty I’ve encountered this week. I could keep going (like, indefinitely), but it’s time to pack for a weekend of extreme fun (in which I continue suppression of all obsession related to The Impending Match. With loads of BFF QT. Yay!).

Such, a great day. I daresay if L&D picks up next week and I actually get in on a delivery or section in the midst of another week’s learn-a-thon, life, will be all Mary Poppins and sh*t.***

*According to ACOG and an NEJM article.

**Personally, I have been encountering quite a few patients lately who are getting medical information from TV commercials (“I’m not taking [Insert Medication Here]!! Have you heard all the side effects of that [Insert Medication Here] on the commercial??! Hell, my [Insert Body Part here, usually, Pecker] could fall off!!” Usually, I have seen the commercials, and can’t say I blame them.), Woman’s Weekly, or Dr. Google. I am all about providing patients with quality educational materials, and I think it is totally awesome when patients take the initiative to research medical conditions and treatments, so I love having actually accurate, and reliable, sources to refer them to.

***Practically Perfect In Every Way

Excerpts from the Third World, Part II……

I’ve been back almost exactly a month now. I’ve taken Step 2 CK (in 6 hours flat thank you very much, I wanted to be done NOW) and finally submitted my residency application this week. I’ve finished all the work I’d left waiting at home, the initial rush of activity has died down and now, frankly, I am bored. I just finished my first week of my internal medicine sub-i, and while my attending is pretty much the nicest guy ever (I chose to follow him for a reason) and I really enjoy the solely hospital-based work, business is sloooooooooowwww. After the constant, almost 24/7, fast-paced, challenge of work in Haiti, all of my rotations at home since have been, well, boring, by comparison.

As I sit, all day, waiting in vain for an admit, something, anything to do, checking my phone every two seconds for interview offers, I think of Haiti.

Week one……

Morning conference is in the hospital’s library every morning at 07, the medical staff gathers and led by the chief of medicine, the going’s on in the different departments are reviewed (the number of cholera cases still, thankfully, trending down) and then there is a short educational presentation……

The hospital's main courtyard.

After conference we go to the med/surg ward to round. We’ve had a couple post c-section patients to check on. We ask about pain, activity, diet, flatus, admire the babies (okay, that’s just me), check incisions and write notes and orders. Then we head to Maternite (labor and delivery) to check on patients there. The nurses handle most of the vaginal deliveries, so the MD’s role is mainly to check in and write orders……

After Maternite we go to clinic. The OB/GYN clinic consists of a block of 4 small rooms in the hospital, just down from L&D. The rooms are, for lack of a better term, grungy. There are 2 offices and 2 exam rooms all connected, divided by makeshift curtains. In the exam rooms there are a couple of exam tables, an old ultrasound machine, and in one corner a pile of ‘sterile’ packages that I ransacked this morning to find a cache of speculums and something, anything (*besides* a 20 ga hypodermic needle, ACK) to break a patient’s waters with. We have sink for handwashing with a faucet that refuses to completely shut off, and now after sweet talking the nurse, a nice new bottle of Spanish (?) antimicrobial soap to go with it……

The central corridor. From the hospital blog. Patients wait for hours, sometimes days, in the corridor to be seen in the differnent clinics. At night hundreds of people camp out in the halls, sleeping on the floors and benches.

We work with a nurse and an interpreter. Our interpreter, I have decided, is pretty much a used car salesman in interpreter’s clothing. I have no idea how he ended up with us and I suspect he requested it for some (probably borderline nerfarious) reason. He immediately hit on me on day 1 as soon as my attending wasn’t around, and though I flatly shut him down, he started today off with a bold request that I give him my clinical reference book and, while I’m at it, take him back to the US with me when I go. Then he called me “a mean old lady” when I firmly told him no, stop asking me stuff like that or I will ignore you. Luckily he had other things to occupy his time including trading in (what I can only assume was) black market perfume and diapers between patients and hitting up patients for their digits or chatting on his cell phone while I’m in the middle of history taking. Our translator, the con artist.

When he is not busy with other matters, our interpreter does push us to see as many patients as possible. So far we have been seeing 40-50 per day. We are so busy I’ve been quickly thrown into seeing patients with simple issues on my own, consulting my attending when necessary, writing notes, orders and scripts. It’s been overwhelming and a little scary, but in the way that the most amazing learning experiences are overwhelming and a little scary. I am learning at warp speed here. Honestly, it grates against my previous training to some extent. I am concerned that we give patients the best quality of care possible, but we just don’t have the resources, time, lab, microscopes, etc to be as thourough as I’ve been taught I should be. Part of me hopes also that I’m not inadvertently learning some bad habits, but here we are doing the best we can with what we have. Everyone is….

The observation ward, sort of the equivalent of an ER. From the hospital's blog. It is always full, often to overflowing.

There has been a good variety of patients so far. Mostly gynecologic complaints and high risk OB’s because less serious issues like routine prenatal care are dealt with in outreach clinics. We see alot of people with heavy or irregular periods, patients who have had miscarriages, and for some reason A LOT of patients for pelvic masses. We have 5 surgeries scheduled so far to remove huge fibroids (the last one we scheduled today looked like she was 9 months pregnant, in fact we all thought she was pregnant until she told us she was there for her surgery for fibroids). We have a couple c-sections in the works as well. The surgical suites have just been remodeled and are actually very nice. I am really excited about our first cases tomorrow. A day in surgery anywhere is a good day…..

A couple highlights in clinic so far were getting to tell someone for the first time that they are pregnant (a happy surprise for both of us, and a good reminder that the number one cause of amenorrhea in a woman of childbearing age is pregnancy, way to go genius), getting to tell a patient (and actually being able to tell on ultrasound!!!! getting LOTS of ultrasound practice) the sex of their baby, and an extremely fastidious elderly patient with a pessary, ripping ripping our interpreter a new one (Afterwards he demanded that I fire her. No way pal.Too. Funny.)…..

Haiti does not have much to offer as far as local goods, but they do have a long tradition of unique, characteristic and very beatiful art. Mostly paintings and metalwork. This is an example hanging in the hospital's main corridor.

The hardest part has been the language barrier. Communicating with patients is my specialty, hands down my best, most useful skill for proivding the best quality care and expressing compassion for, and connecting with patients. I was really at a loss yesterday without it. Today was a little bit better, I can say a few phrases in creole or french now (today I learned how to ask – does it hurt when you pee – an extremely useful phrase in a gyn clinic, pretty proud of that one) and tonight I actually sort of ended up translating for my attending when we went to check L&D one last time after supper. That felt so good and I hope, hope, hope that it keeps getting better. It felt so great to actually understand and be able to communicate, even a little, with patients and staff today. To see them smile at the connection. The best.

Children playing outside the hospital. From the Hospital's blog.