Showing posts with label obstetrics. Show all posts
Showing posts with label obstetrics. Show all posts

Tuesday, June 10, 2014

Skin to Skin

I meant to come home and write all about it. But of course by the time I got home my stomach was aching with hunger and I had a fridge holding wilted cilantro and questionable soy milk. So I had to make a dazed trip to the grocery store where I found myself staring at the nectarines and asking myself, "Do I really eat nectarines?" which then spiraled into an internal dialogue about the ethics of buying fruit that is shipped from a thousand miles away in order for me to have some variety in my snacks. This always happens when I am tired. I start to question everything I eat and try to convince myself that a diet of entirely chocolate and "Mary's Crackers" will suffice.

So now I am just standing there with my basket containing cheese, kale, and tuna and I am nowhere closer to having a normal dinner, showering, and writing up the day's experiences.

I did my first c-section! Let me qualify that statement. I have done all the 'steps' of a c-section in the past - but never all on one person. Usually the surgeon opens up to the uterus and then I go from there, or I open and they close. Or some other combination of events. But this one was mine from beginning to end, the reward for all my hard work, so I was told. I wanted to write it all down, remember every moment, however, many of the details are already starting to blur.

It was hard work rewarded with hard work. This was her third section which meant that the often easily identifiable tissue planes and regions become scarred down to one giant zone of adhesions. Meticulously dissecting the bladder can still result in injuring it or unknowingly cutting too low on the uterine wall. The tissue is also thinner which can be an issue when it comes to closing up, add in the friable bleeders, distorted anatomy, and the clock that is always ticking down on how long the spinal anesthesia is going to last.

My mentor was walking me through it, keeping the pressure on for time while ensuring I was being cautious yet bold. It's a weird combination. When you cut - CUT! Don't saw away taking little swipes! Go deeper...not THAT deep. 

Being new to all of this I still don't appreciate the different forces needed to cut through skin, fat, and muscle. I don't hold the cautery just right, I can't throw a fast stitch in a bleeder. I don't know when to dissect with my finger versus gauze versus a blunt end of a blade versus a blade. It's an entirely different universe suddenly, peeking out between the sterile blue drapes. I'm navigating with a mask that covers my mouth, connected to a plastic shield over my eyes.

Sweat is dotting the inside of my plastic shield and I can feel it running down my sides. The other surgeon is waiting at the dictation desk and his patient, a hernia repair, is waiting in recovery to come in. We are only a little behind schedule but the scrub nurse reminds me that the next surgery should have already started. The baby is out, I can't remember if it was a girl or boy. I can't even remember the mother's name or face. I would have never believed it if someone would have told me that I would forget the gender of the baby of my first skin to skin cesarean. But I don't. I remember green armytage forceps.

I remember being thrilled, scared, and sweaty. I remember having to change my scrubs immediately after, before going out to recovery. They were soaked from my chest down to my knees, as if someone had thrown a bucket of water at me. I remember being happy and surprised that mum and babe had an absolutely unremarkable course in hospital and that they were discharged two days later.

How could I have done that right?

Tuesday, April 16, 2013

Worth It

Things are picking up speed here in the final push to the finish. Suddenly a hundred things are pulling for my attention and I'm remembering the nit-pickiness involved in extricating oneself from one country and moving to another. Annoying things like transferring electrical bills to a different name, showing people the apartment, answering questions about my car to prospective buyers, pawning possessions, cancelling bank accounts and returning internet modems.  Time feels warped in that it seems like an eternity until I am back in Canada, yet there's not enough time to complete all the extracting tasks, study for finals, feed / clothe / wash myself, put petrol in the car from time to time, sleep, and possibly exercise when a window of time and weather presents itself.

Yesterday I was studying with some friends when I realized that we had spent the last 20 minutes discussing which brand of under-eye concealer hides dark circles the best (this may seem like normal conversation to some women but these particular ladies are *not* the make-up discussing types).  This was shortly after we screened each other for depression upon discovering that 'generalized anxiety disorder', 'panic disorder' and 'depression' criteria were starting to hit a little too close to home. We stopped studying psychiatry at that point and moved quickly to cardiology where we all felt slightly safer territory existed.

I woke up a few days ago with a burst blood vessel in my left eye which has definitely hitched up the haggard appearance a couple of notches. I am told that REM sleep can cause blood vessels to burst. Fantastic. This on the heels of 3 straight days of waking up not to an alarm but to the sound of my own teeth, grinding. On the upside I suppose that my face is getting exercise while I am sleeping so...win?

But it's not all cereal for dinner and fitful sleeps.

Today I received a card in the mail from one of my maternity patients. She had been one of those women who labored in such a way that I was in complete awe. I am pretty sure that if (and that is a big IF) I ever have a child I will be the craziest, drug-seeking, wild-eyed, foul-mouthed, sweaty, crying mess. She was this calm, focused, sweet, gracious lady throughout her (analgesic-free!) labor until complications resulted in an emergency c-section. For the duration of our long night together she used hypno-birthing and relaxation techniques to stay calm and work through the contractions. It was an amazing thing to see.

In her card she included the hypno-birthing CD along with a photo of her and her now 5 month old daughter, on holiday in Paris. It was a lovely gesture and a beautiful sentiment. My favorite line from the card being, "I will always have the most amazing memories of my labour...remembering yourself so close in my heart when I think of the wonderful team we had together on that night".

During a week (month? year?) when I have often asked myself if all of this is worth it, I receive this card. What a privileged and beautiful place to occupy in a strangers heart: the place that holds the memory of their child's birth.

Knowing something like that makes up for every single stressful hour. It makes up for being the person who breaks bad news, or the person who has to scavenge for food in the day ward after being in the hospital for 20 hours without a meal break. It really does.

It makes all of this worth it.

Sunday, October 14, 2012

Hark! A Child Cries in the Distance!

I love going into the maternity hospital for work.

Ireland was apparently the first country in the world to have one. Every day I have to dodge new dads in the parking lot trying to juggle car seats and flowers, handbags, suitcases, and "IT'S A BOY!!" helium balloons. Women (mostly waddle) around in various brightly colored bathrobes, either trying to break up the boredom of being admitted, or in the hopes of getting things going in the labor department. Giant bellies, little bumps, nervous nulltips, exasperated over-termers populate the antenatal clinics. It's quite the humming baby factory.

On the labor ward every couple of hours a new admission would walk casually up to the desk with a mix of fear, sometimes excitement, expressions of pain, or lines of fatigue on her face. While being checked in some would have to pause and lean heavily on the nursing station if a contraction took over. Others went shooting by in a wheelchair pushed by an admissions midwife, hair blowing back behind them with the "don't push yet!!!" instruction barked by a senior midwife...a few minutes later we'd hear some hollering followed by the gusty cry of a new arrival to the planet. I could just smile to myself because at that moment only infinite possibilities exist for that baby.

Of course, of course we've seen sad outcomes, unexpected premature deliveries, undiagnosed syndromes and malformations. But even those, which weigh heavily on the staff, give me inspiration from the grace and strength exhibited by the families of those babies.

What a place! What a privilege.

Wednesday, October 3, 2012

Hello, World

No, I haven't drowned in a giant puddle of amniotic fluid.

I am loving life here in OB/GYN but just absolutely wrecked and savaged by work right now. Did nights through the weekend so am currently on my 10th day in a row at the hospital, am working on a Grand Rounds presentation for Friday, applying to CaRMS, writing up assignments...oh and I started collecting data for a new study yesterday.

I have a mouth full of canker sores and an ever-expanding derrière due to stress and lack of exercise.

But I'm good. I'm gooooooood.

Stories to come. Once the dust (er....fluids?) have settled.

In the meantime: birthing babies = awesome. 

Wednesday, September 26, 2012

Well Put....

After examining the tummy of a very pregnant lady we were ushered out into the hall to be pimped by our Registrar. He asked my friend what his findings were and to describe the fetal position.

Friend: Well....When I was feeling her abdomen I couldn't really tell if I was feeling the head at the top or if I was feeling the back and feet. So...at the fundus I palpated either the head or the feet.

[You really can't fault that logic.]

[This was just before I got the fetal lie completely wrong.]

[Figuring out fetal lie, position, and presentation is harder than it looks.]

Tuesday, March 27, 2012

I (Heart) Rural Medicine

In the last 48h have included having the opportunity to:

-catch a baby
-cut a piece of glass out of someone's face (and then stitch them up afterward)
-surgically assist with fusing toes, replacing hips, replacing knees
-perform a D&C
-assist with a hysterectomy
-sew up knife wounds
-assess / treat / discharge about 75 emergency patients
-learn how to insert an IUD

Despite the exceedingly damp climate my hands are cracking from so much handwashing, I'm surviving solely on t.v. dinners and instant soups, clean underwear is becoming a scarce commodity, and I've spent every day (except one) in the hospital since my arrival. And I couldn't be happier.

My days are so full and varied, with such fantastic teaching from the docs here. It's hard to sleep at night, completely wired and excited by each day's events. I feel so fortunate to be here. I'm starting to believe that saying about how "there are teaching hospitals and then there are learning hospitals". Say what you will about rural medicine...but my experience is that people working in remote areas have half the egos and double the desire to teach.

I've been spending a lot of my retractor-holding and trying-to-sleep time thinking about the (soon arriving) residency application process. Today I truly felt like a few things have started to crystallize in my mind about what I want to pursue...

As always it is a work in progress, but I think that will have to be a post for another day.

In the meantime, check out my new O.R clogs while I try to get some well deserved sleep.

Yes, yes I did.

Saturday, March 24, 2012

First Ultrasound!

Bet that got your attention!

Yes, last night I had the opportunity to do my first ultrasound on a pregnant woman. Can I just state for the record that there are many concepts in medicine that fascinate and perplex me, not to mention the endless list of interesting presentations and procedures. But apparently there is one thing that turns me into a giddy, effusive fool: prenatal ultrasound.

I trundled down to the emergency department last night after my flatmate (and ER nurse) called me in to see some good cases. The doc who was working knows me well so he was happy to have me seeing and working up patients. Early on in the shift a pregnant woman presented with some minor bleeding so he wheeled in the ultrasound machine, flicked off the lights and handed me the transducer.

At first all I could see was fuzzy blobs and fluid and then lo! A vertebral column appears in the darkness! And then I saw the heart, its tiny chambers pumping away. I practically jumped up and down, Look! Look at the heart! Hey, there is a femur, wow! The baby is moving his, ah...or her hands! That is amazing!! 

So maybe I should have played it slightly more cool, but I couldn't help myself. It is quite something to look at a nearly flat and unremarkable belly and then suddenly be given a glimpse into a hidden world that houses a kicking, twirling, fist-pumping little being.

I spent the next portion of the evening smiling to myself as I stitched up wounds and listened to heart sounds.

The little beating heart and those dancing legs were a delightful reminder that there are also joys in medicine, even in the emergency department on a Friday night. 

Thank you, little one. I needed that.

A little bigger but you get the idea, image from here.

Tuesday, April 12, 2011

OB or not OB?

We have been up to our eyeballs in pelvic floor muscles lately as our last few cases have been covering pregnancy, babies, ambiguous genitalia, labor and delivery. 

Now normally I am not a fan about learning the differences between the somatic, autonomic, and visceral nerve supply to muscles, but I have to admit, knowing the practical applications for managing labor pain has made this memorization a bit more interesting. I am sure it is because I love procedural skills and can't wait to do my first nerve block, epidural, lumbar puncture, and perineal repair. I started thinking about all the hands on work that OB/GYN's do and then having thoughts that were alien to me until now ..."obstetrics? maybe?"

Truthfully, back in the days when I was an annoyingly-militant-vegan-self-righteous-naive-hippie I seriously considered midwifery (not to say that midwives are those things, I am just elaborating on a phase I went through in my early twenties). I even took my doula training and looked into various programs across the country in midwifery. The only thing that really held me back from pursing this career was the fact that Canada has some ridiculously archaic and paternalistic conservative attitudes regarding who ought to be bringing babies into the world. Depending on what province you live in it can be a seriously uphill battle to create a career for yourself as a midwife--that is, no hospital privileges, being shut out by the medical community, lacking public subsidies, and having to conduct only home births without OB back-up. I just wasn't up for the challenge, I guess. 

Fast forward to medical school where I continued to reject the Western approach to birth, until very recently.

We had an OB/GYN lecture us this week. She was Irish but had spent 10 years specializing in the US in high risk delivery and maternal/fetal medicine. Her lecture was delivered in a soft spoken but direct and powerful way. About half way through she stopped on the slide shown to the left, and said,

"I have always wanted to be a part of this event in people's lives. Even when it is cold, dark, and in the middle of the night I love to get up and head to the hospital knowing that this is what I get to be involved in. When the babies start looking the same and I am not thrilled to be there, I am going to quit. But right now, I feel nothing but privilege for being invited to take part in this pivotal moment in people's lives".

She apologized for how hokey it sounded but I felt that it was quite lovely, to hear someone speak so passionately and honestly about their career choice. I suppose it is what we are all striving for when we choose our future specialty, what are we passionate about? Am I going to love living in the O.R, or intubating patients in a helicopter, or prescribing chemotherapy regimes? It is so hard to know at this stage having only seen as sliver of the health care system. But when you hear someone speak from the heart, and they clearly do love their job, it makes you wonder...could I love constantly being sprayed with amniotic fluid and having only female patients for the rest of my life?

Maybe!

OB/GYN Pros:                                                                     OB/GYN Cons:
-lots of healthy patients                                                          -on call, forever and ever, amen
-plenty of hands-on procedures                                              -bodily fluid exposure extravaganza
-O.R from time to time                                                           -bad outcomes are very bad
-emergency situations*                                                           -only female pts
-many good outcomes                                                             -continuity of care
-continuity of care                                                                   -highly litigious
-many happy/excited patients                                                 -crazy women with 5 page birth plans
-immediate results                                                                  -having patient load
-the whole 'miracle of birth' thing                                          -the training

If nothing else, I am trying to keep my mind open to the possibility of areas that I hadn't considered. I know how most medical students start rocking in the fetal position (pun intended) when you mention their OB/GYN rotation but...who knows? Maybe I will be one of the lucky ones and will actually enjoy labor and delivery!

Or maybe I'll just end up with countless pages of blog fodder.

Either way, win!

*I know that sounds twisted...but I am wired to enjoy emergencies for some reason. I blame my mother for not breast feeding me long enough. (Hi Mom!) 


   

Friday, August 20, 2010

Hip Replacements and Baby Catching

This past week was amazing.

Some of the highlights.

I delivered my first baby! Yes. It turns out if you harass the maternity nurses and docs enough they will call you up to catch one. I had witnessed a few during the summer but it wasn't until the day before my birthday that I got to catch my first one (thanks Doc R!) Baby Jessica was 9 lbs 4 oz, slippery, pink, screaming and born with a head of dark curls.

I was so excited in those last few pushes I had to clasp my hands together in order to keep them from inadvertently just reaching in there and taking the babe out or patting the perineum with anticipation. Doc R and I had gone through the steps verbally ahead of time but I hadn't really thought of what I was meant to do once the slippery, heavy, squirming baby was actually in my arms! I think I was giggling and cheering and almost (sorta) tearing up and then thought-- "er...do I put her down or clamp the cord or...ack!" It was a crazy wonderful blur and flurry of activity, Doc R helped me from there, "yes...just set the baby down now", "oh, right".

Yes she did give me permission to post this photo of her.

That afternoon I got to scrub in for a great toe amputation. It actually amazed me at how simple and slick it is to remove a toe. The thing really didn't give up much of a fight at all, just a couple of swipes with the 'ol scalpel and, thunk! It's in the bin. For some reason I just assumed that everything in the body was really anchored down. Meshed together, tightly woven. I suppose that I've always thought that because in order to have survived the sabre toothed tigers, bears, falls, wars, famine, the body must be a very study structure. But as I am seeing more and more in the operating room, it really isn't.


The next day my colleagues kindly let me spend most of the day shift (which was supposed to be spent working in the  emergency department) scrubbed in on several orthopedic surgeries. Ok, let me just say now, I take back EVERYTHING I ever said about orthopedics.

How I could never do it. 

How I could never stand to watch such brutal surgeries. 

Oh how very off the mark I was. 

Let's just say, tendon harvesting for ACL repairs is a thing of beauty. I was actually operating the arthroscope for that one. Hello that is not an easy task. When you are staring at a large screen tv it is difficult to immediately appreciate that moving the scope 1mm actually turns your field of view to a completely different scene. I could feel the sweat running between my shoulder blades and down the backs of my knees, 

just don't screw up

don't lose what he's trying to look at

don't pull the scope out by accident. 

Yeah, I did all three. Considering the fits of rage that I'd seen come from Dr. S I was expecting him to wrap the scope around my neck and throttle me with it. But to my surprise he only called me a 'useless assistant' a couple of times and commented on how much I was slowing him down once! He also yelled pointed out that holding the scope for the first time was no excuse for not doing a good job. I was in bone-chip, bloody, tendon harvesting heaven so it didn't even bother me. He let me pull the finished graph through the hole to where it was anchored. Pretty amazing actually. 

Other thoughts from the day included, 

Wow! the plantar fascia is REALLY thick and white!

I can't believe that a hammer and chisel were just used to crack open that calcaneus! 

Exposed muscle really is a thing of beauty!

I think I might faint from hunger and sleep deprivation soon!

Hey. I didn't say they were deep thoughts. 

There was also a theme party--70's due to the decor in my living room. It was a combined triple birthday party/retirement from nursing for ABB party. 


Things really took off when both Karaoke and Dance Dance Revolution showed up. 

Yes I am wearing a giant peace sign bindi. Thanks for asking.

There was also a beautiful 15km hike one day, some c-sections, entertaining shifts in the emergency department, dinner on a cruise ship, the move into a new (wicked) house, a meteor shower, and possibly a hang-over somewhere in there as well.




Two shifts left as a nurse. So many memories rising to the surface. Almost exactly 7 years to the day that I graduated.