You be the Judge

Some would jump at the chance to deliver a baby, others would run away. I find my stand somewhat neutral actually. Don't get me wrong, I will catch one any time or place necessary but It just doesn't do it for me like other aspects of medicine. Hence the reason I will not be working in obstetrics and gynecology in the future. I can be as graphic as anyone wants as far as the details and reason behind my love-hate relationship with OB/Gyn but I will keep it somewhat palatable.

My day Friday morning started at 7 am. We were on call for the group of doctors for labor and delivery as well as seeing our own patients in the clinic. There was a very sweet lady we had in labor with baby #5 all morning. When we finished our morning clinic we went to the hospital and broke her water. My preceptor thought it would be a good idea to hang around since she was nearly completely dilated and looking ready. About 1 pm we suited up and I got to catch my first baby. Pretty routine really. The doc leaned over and whispered in my ear "Don't drop the baby." I have to say it was kind of a duh moment until I got a handful of that greased up water balloon. I was constantly having to re-grip the little slippery pete. Fast forward until 9 pm when I was sitting at home snacking. Phone call from my preceptor announcing "We have four in labor and two are getting close." Boom, off I go to labor and delivery. It was about 2 hours later when I caught the second one of the day. Then my doc just had me assist with the next 2 deliveries since they weren't technically our patients and were first timers. Here comes the good part and my reasoning for this not being my favorite area of medicine. Also not for the squeamish.

Delivering a baby has a unique smell, period. The body part that lies just below the birth canal or vagina is the rectum and anus. Let me paint a picture for you. Before birth, think of an "innie." During and immediately after birth it looks more like an "outtie." Not cool. I also saw an prolapsed hemorrhoid hanging a couple of inches outside the anus. It was my job to deliver and look over the placenta as well to make sure it was intact. The placenta smells awful. Our 3rd delivery of the night, her vagina blew up. Not cool. Took us 30-45 minutes to put it back together.

So, that was my 1st of 7 on call nights. I will enjoy and soak up the next 3 weeks and then kiss OB/Gyn goodbye. Not entirely of course because it makes up a pretty big piece of emergency medicine. Indefinitely I will keep everyone abreast of the excitement to come.

The Things I Must Do to Become a PA

Done with my first week of OB/Gyn. Although it was not exactly as I had hoped, it also wasn't bad either. Especially since my preceptor has Friday's off. That is unless we are on call. Speaking of call, over the next 4 weeks I have six 24 hour on call days in addition to the regular schedule. When I say on call, I mean getting a 2 am wake up to go to the hospital for a patient in active labor. It should be fun and hopefully I will get to deliver lots of babies. This week was a bit awkward to say the least. My preceptor just had me observe for the most part. Therefore, I was that guy that all my patients saw when they looked down between their legs just awkwardly gazing at their most private regions. It is much different when I am actually performing the exam. I dare say that I don't look or feel like a pervert when I get to do it myself. The awkward moment award goes to a few encounters I had on OB day. That is when we see all of our OB patients, which means they typically bring the man along. As I'm sure you can imagine by now, there I am standing at the end of our patients bed trying to look intrigued but not to enthralled. All the while, I am getting eyeballed by the young husband just looking for a flinch in my facial expression. Need I say more.

I'm scrubbing for my first total abdominal hysterectomy with bilateral salpingoopherectomy on Monday. That means we are taking out the uterus, fallopian tubes, ovaries and cervix. That should be fairly interesting.

Next time you are in an awkward situation at the store or over at the in-laws, just remember me. My situation would be hard to top, unless of course you haphazardly exposed your nipple to a church friend.

One Down, Seven To Go

I have officially completed and passed my end of rotation exam for my very first Family Practice rotation. I learned/reinforced a great deal of pertinent knowledge. Including how to perform an excisional biopsy. I was able to excise moles/abnormal skin lesions off of 2 different patients. I, like most other practitioners, enjoy doing the procedures. It is a break from the monotony that goes along with normal medication rechecks. Tomorrow I venture into a realm a bit more mysterious to me, OB/Gyn. My comfort level is minimal in this area because all those years I spent in the emergency room and working with patients, this was an area off limits to a little ol' male scribe. In order for me to become a legitimate practitioner, I must get very comfortable with performing normal and abnormal pelvic exams. That being said, In six weeks from now I am almost certain I will be way more comfortable than I ever thought possible. Not to mention being first-assist for all of the C-sections, hysterectomies, tubal ligations, etc. Of course I will keep my blog updated on the interesting cases and patients of my OB/Gyn rotation. That is all for now. Until next time, Adios.

Welcome to Parenthood

The next paragraph is aimed at the Johnsons'. It is simply a collection of thoughts that popped into my head a few days ago while I was getting ready for clinic and thinking about their current situation. This reflection is based upon my thoughts about becoming a parent.
The days become short, the nights long. You anticipate the next sound or cry she is going to make. Sleep eludes you. You know you love this child, but in a strange kind of way. Like a gift from God intended to push your body and mind to the limits. At times you know not what to do. Blindly you try everything you have heard or read in attempts to soothe that feeble cry. Time. Time is what it takes to learn the lessons of parenthood. Your love for this child will grow exponentially in time to an almost euphoric and tangible feeling. It is easy to set goals for the future. As if your current situation is not perfect enough. The thought of six months down the road she will be able to sit up and eat solids and most importantly sleep through the night. However, it is the long nights, the soothing her when you can't soothe yourself, the moments right now that are building that undescribeable almost supernatural bond you will feel more and more every day. God bless you and your child always.

What has healthcare become?

This musing comes after a relatively benign day at the clinic. However, something interesting happened that made me question the entire healthcare system. That is because, unfortunately, what happened is similar to what goes on in "Doctor's offices" around the nation.

I went to see a patient this morning whom I was informed was "self pay" prior to me going in. That is to say that the patient doesn't have insurance, so he will probably not want any blood work or much done. Or does it? This was a 60 year old truckdriver who had a full page worth of medical issues including chronic pain from an accident. He had never had any routine screenings or even a rudimentary prostate and hernia check. This would be unacceptable for any other post-50 year old man WITH insurance or medicare. So what did I do? I listened to all his ailments and decided it was pertinent to check him for a hernia and to check his prostate since he had never had it done and had symptoms relevant to the exam. For the first time ever, my preceptor comes knocking on the door wandering what is taking so long. I finished up and left the room. The first thing I hear from my Doc is "What took you so long?" "He is self pay, you can't be spending time asking him a bunch of questions and checking his prostate." So after I was a bit blown away, I rebutted with "I was doing him a service since he has never had a full physical or been checked out very well since he is self pay." A bit of a slap in the face to my preceptor since he has been seeing this guy for years. But his only response was, "True."

My lesson is that I shall decide now, as a student to always treat my future patients the same, whether insurance or not.

Stick a fork in me..

I'm a little overdo for an update...but it will have to wait a bit longer. I'm swamped, sleepy and should be doing other things instead of interneting it. The DuToit's are on their way to Missouri for the first time and I'm way behind on studying, sleep, exercising, spending time with Lydia and anything else that may be enjoyable. However, things are about to change. I'm going to try and relax for a few days while our friends are here and I'm thinking the Johnson's will have a new addition before the end of next week. We shall see. But I hope everything with the delivery goes as smooth as that little baby bottom is going to be. Anyhow, I will update later about life at the clinic. Adios.

Dual Roles

I have, as a matter of fact, learned something on my rotation. My preceptor informed me what the term "props" is short for. As in "I gotta give you props for that." In case you didn't know, it means "proper respect." Intriguing. I also have become far too familiar with the male prostate exam. This is a right of passage for all men turning 50 and then yearly thereafter. If most men only knew the poor sensitivity of this exam, they would probably be much less cooperative to "bend over and rest your elbows on the table." Unfortunately, the sensitivity of the exam is highly dependent upon the body habitus(build/shape) of the patient, the length of the clinicians examining tool(finger), and how well the Dr/PA know's what he/she is feeling for. Until we come up with something better, the dreaded finger wave continues.

As a side note, it is amazing how many people struggle with depression and anxiety. I have to keep up with all of the patients I see and their ailments. So far, I have logged 4 times as many depression or anxiety diagnosis than any other! I was given a bit of an open door today to encourage a struggling patient who mentioned that he had been a Christian for 12 years but just doesn't feel happy overall. I'm really not sure about my boundaries as a student and medical professional talking about Christ, but God gave me the opening and I couldn't ignore the opportunity. I told him that even as Christians we still struggle with stressors of this life, maybe even more so because of conviction. But that Christ took on our ultimate sin burden so that we can trust in Him fully to provide for us in every aspect of life. We went on and on and talked for about 45 minutes about his life and struggles. I just pray that something I said could be an encouragement for this man. God has blessed me in my life and I pray that he gives me a great ability to counsel those patients in need.

Studying is always on the back of my mind. Therefore I will close this session so that I can review some medical literature. I do believe I will first check to see if the snow has begun. We are supposed to get 2-4 inches tonight and tomorrow. We shall see.