Such an amazing experience! Started at 10 a.m. and pretty much shadowed the Chief Resident, Dr. A, all day. First patient I visited with her was a pregnant woman who had to be induced because she was at 41 weeks, but was also taking Metformin for PCOS throughout the pregnancy (so I did some Uptodate.com reading on this and found that women with PCOS who take Metformin have higher fertility rates than those who don't, and also lower risk of miscarriage during pregnancy!) -I watched as Dr. A drained the patient's bladder with a catheter, then stuck her gloved hand inside to do a membrane sweep (part of inducing labour, aside from IV oxytocin, etc), as well as gauge how dilated the cervix was (so cool that just by sticking a hand in there, with a little experience, you can tell whether it's 3 cm or 4 cm!). Then, checked in on a few patients with 'false contractions'... the morning was not that hectic overall, though.
However, after watching the residents share a bowl of Nihari with some naan (I had eaten already) for lunch (I really appreciated this commaradery despite the obvious medical hierarchy of things), and getting to know Dr. A a bit better (she got married in her second year of med school and had a baby in her early residency years!), things began to get a bit crazy (in a very good way, mostly!). I watched 2 babies get delivered in quick succession around 3 p.m. -for both the mothers, it was their first pregnancy, so of course they screamed, moaned, etc in all their pain (but nothing quite so dramatic as portrayed on TV and in movies in the West), and both required episiotomies (which I learned about right in the moment... I don't recall ever learning about this in Unit 3, but surely we must have... then again, Unit 3 was a big botch, so I wouldn't be surprised if we didn't!). An episiotomy is an incision made in the perineum posterior to the vulva to make the vaginal opening a bit bigger to facilitate birthing, which is then sutured up again, or 'reconstructed', immediately post-delivery (so it was cool to watch a little mini-surgery, even though no C-sections were involved).
It is absolutely amazing to see that baby's head come out of the womb, though -really one of those moments where you wonder how a whole other person just came out of a person (I know this is so cheesy and cliche, but until you've seen it, you can't pretend to really know anything about it -I thought I could before today, yet actually witnessing it is very special). And contrary to the complicated motions described in Unit 3 (first the head comes out, then the shoulders rotate, blablabla), what happened in both was once the head was out, the rest pretty much slid right out, with all the white goop and blood, etc. Then the nurse takes the little thing (South Asian babies really are smaller than White babies) and does all that rubbing, and warming, and oxygenating, and making sure none of the meconium is aspirated, etc, while the docs wait for the placenta to be expelled and suture up the episiotomy. At this time, I was surprised and grateful that Dr. A treated me like a real med student on a rotation by asking me a couple of questions -good to get a taste of what it will be like to be put on the spot all the time, except relieving that it doesn't mean anything for now.
The first questions was, "Do you know what this procedure is called?" No, I didn't, and that's how I learned what an episiotomy was, and looked it up further on Wikipedia (easier to decipher than Uptodate.com and still pretty accurate I'd say). The second question was "What are the signs of placental separation?" I hesitated, and then came my ingenius response, "The placenta comes out of the vagina?" Yup, that's what I said. Was not trying to be a smartass, but it was all that came to mind and I didn't want to seem like a total idiot (still not sure whether I had prevented this at all with that response though...). But Dr. A and the other resident just laughed good-naturedly and commented, "Oh, that's a smart answer!" (hard to tell whether they were sarcastic, or pleasantly teasing... I'll just assume it was the latter...). And then they told me what the signs were. And then I looked them up online to make sure I'd remember, and as it turns out, the Four Signs of Placental Separation are:
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Apparent lengthening of the visible portion of the umbilical cord.
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Increased bleeding from the vagina.
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Change in shape of the uterus from flat (discoid) to round (globular).
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The placenta being expelled from the vagina.
Anyway, at some point an auditor came and gave a couple of residents heck for some minor issue about one of the patient files (they apparently like to waltz in all importantly and make a big deal out of nothing... clearly, it has to be done, but it's perceived as an annoyance by the department, to be perfectly honest). And as I was told to go home for the day, Dr. A was dealing with a case of a pregnant mother (34 weeks) with an acute abdomen (most likely appendicitis or cholicystitis... which I further verified on Uptodate.com of course), and which is apparently surgically treatable without having to deliver the baby so prematurely, except of course a bit risky since surgery can induce contractions... I guess I'll find out what happened there, tomorrow!
But what a nice change today. I thoroughly enjoyed it (although I don't know if I would enjoy doing this all day, everyday for the rest of my life... I think I'd get bored without variety... this is the trend I notice when reflecting on my shadowing experiences in the NICU and Neurology as well... maybe family medicine? or pediatrics? or a general internist? But right now, I don't feel that specializing is really my scene...) and am looking forward to Day 2 in the Labour Room, tomorrow. At the very least, beats the nightmares of cruelty, rape and torture that I've been having for the last 3 nights, since my visit to Thatta. Someone today told me that I "didn't look fresh"... you try staying up for a couple hours, in the middle of the night, for a few nights in a row and then tell me how fresh you're feeling (this was not supposed to sound so bitter -it was a nice person who said it, I like her, and she means well).
Well, that's it for now!
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