Ob/Gyn: mid-rotation evaluation and loss

I am half-way through the big, potentially life-altering experiment that is this Obstetrics & Gynecology rotation. Over 14 vaginal deliveries, 8 Cesarian-section assists, a few 24-hour calls, many a pelvic exam, Pap smear, antepartum, post-partum, dilatation & curettage (for both spontaneous and voluntary abortion) and even assisting in a gynecological surgery later, I have officially completed the "Obs" part of this "Ob/Gyn" rotation.

Honestly, I love it. It's medical, it's surgical, there's variety, it's all about women and some of the most beautiful, horrendous and distressing moments of their lives. It's intimate, sacred. Except that once you deliver that baby, you don't really get to follow it. Family doctors can do both, but if there is failure of labour to progress, then they turn their patients over to the obstetrician. If a woman in a poor village in some African or Central Asian country for whatever reason could not push her baby out, and I was the only doctor around, I would not be able to save her life by performing a STAT C-section right there and then. And she might die because of that. But I would also be at a loss to adequately help her 6 other kids with diarrheal and respiratory disease, treat her newborn baby's complications post-premature delivery with growth restriction and appropriately treat her father's angina and her mother's dementia if I'm not a family doctor. Sigh. What to be? What to do? What do I love more? Do I want the breadth or the depth? Do I want to be able to treat anyone's anything? Or do I want to be able to operate and be an expert in one particular field? Tough choices. However, I do think it definitely boils down to these 2 choices for me, so at least I've narrowed it down.

The most touching moment this past month was with the lady with the flowing strawberry-blond hair. A beautiful, rosy-cheeked mother-to-be, full of excitement, joy, anticipation of the little darling soon to be the center of her universe, if it wasn't already. She anxiously lay on the table as one of the sweetest, vibrant obstetricians on the team slid the ultrasound probe over the patient's belly, back and forth, up and down. There was no fetal heart beat. The placenta looked a bit weird. Baby wasn't moving. It's morphology and size told us that it had actually died in utero 2 weeks earlier. The doctor took the patient's hand in hers and shook her head, her eyes glistening as they filled without brimming over. The husband looked down at the floor, his wife up at the ceiling. There were no words. We gave them some time to be alone together, to take stock of their world as it fell apart before them, too quickly to be understood, too painfully to possibly be real. And then they went home to gather some belongings before returning for this strong, beautiful woman to deliver her lifeless angel.

The couple was placed in a room with a blue butterfly on the door so that all the nurses and doctors and hospital staff would know to be especially gentle and sensitive. The occasional screams of labour and the cries of newborns could be heard in neighbouring rooms, as this mother was induced, eventually delivering the fetus, and after requiring additional dilatation and curettage, the placenta, in pieces. I had put my hand on her shoulder as the doctors went through the necessary procedures to evacuate what was left. I had told the couple that even though I was just a medical student, I was here for them, if they needed anything, I was here. "It's just a lot of emotions" they would repeat, and I would nod and hold her hand. Her body relaxed slightly as I held her hand, not letting go, patting her arm, just being. This too is the human experience, and these tragedies accompany every few dozen joyous miracles. But that thin white, shimmering face, and those long curly strawberry-blond locks, those pleading green eyes. Who could forget.