May 2006 Archives

By some freak accident of scheduling, combined with a resident illness, there are no residents scheduled on the labor and delivery service today. Which means that it is I, the lone medical student, who will be holding down the fort until 5pm. There is an attending here, of course. But their job is usually to swoop in and deliver the reassuring diagnosis and official plan. It is the underlings who do the paperwork and the collecting of data and the running around. Underling, thy name is Fiona.

The fun starts momentarily when I get to be the first (and only??) assistant on a C-section of an extremely obese lady. "Did you eat today?" My attending said. "Eat. You will be working hard."

I delivered twins last night.

Or everyone says I delivered them. I am more of the opinion that I mostly just got in the way. Nonetheless, I was there, seated on a stool between trembling legs as heads were coming out of small openings and fluids were exploding towards me. I held the first twin as it took its first startled breath, shocked to be exposed to the harsh lights and threatening openness of the world. I tried to hand said baby off quickly to the nurse and get up off the stool as the attending obstetrician chided, "out of the way - out of the way." Ummm, got a tiny baby here, ok? Sheesh. I clamped a cord. I delivered the placenta. I cut the sutures that pieced together the tears. Oh, the cruel injustice of mother nature. Oh, the cursed fate of the daughters of Eve. Stupid old apple.

Babies come out fast once they come. As the first one's head was well on its way, the attending told me to grab the cord clamp. I turned my back to search, only to miss the baby shoot out of her mother. Like a little slippery rocket, literally bursting forth into the world. Its why they call it "catching." Never turn your back on the mom, said my resident. Never.

I am currently on night call on Labor and Delivery. A week of nights. It is the oddest schedule, this 5pm til 8 am work-day, and my body has not quite adjusted to it. I constantly feel like I just woke up from a long, hard afternoon nap, the kind that saps you of all energy and leaves you with a dull foggy headache. And this schedule becomes all-consuming. I don't have time during the day to really do anything but try to sleep a hot sunny sleep and then get back to the hospital. But I see cool things. I see sad things, like pregnant, meth-using, pack-a-day smoking women with AIDS. I learn about delivering babies. I see a lot of fluids. I put my fingers inside a lot of lady parts. (I sometimes have silent, inappropriate inside jokes with myself about using some of the many nicknames for the lady parts in front of patients. Like "I'm going to put my fingers inside your hoo-ha to check the dilation of your cervix." I will never say this.)

Down there. That's funny too. I think I might be delirious.

You know you're in medical school when on a lovely spring saturday afternoon you think to yourself that you can't believe you have already been at the hospital for 6 hours. And then you think, only 18 more hours to go.

Someone remind me of what that commercial was: it aired during the superbowl a couple years ago, and consisted of people aggressively rampaging through an office, repeating weird phrases and being destructive. And this woman kept saying "BABIES!!" with a frantic wide-eyed glare. Was this a commercial for Skittles? Someone help.

BABIES!!

My resident let me finish sewing up the incision after a perineal carcinoma resection. (peri-anal. you got it).

He said "Ok, future emergency room doc, sew like the wind." For that is, as of now, my chosen future.

And I, seated between the woman's stirruped legs, gloved hands slowly pushing a needle through sliced unmentionables said, " it will probably be more like a gentle breeze."

My attending surgeon told me to call my Mom.

We were in the process of finishing up a gynecologic surgery (and by "we" I mean the attending and the resident - I was mostly just standing there) when we came across the appendix. That graceful, slender, unnecessary appendage, protruding like a dainty pink finger from the cecum. Vermiform appendix. From the latin vermis, or worm.

I am currently doing a mini-rotation in Gynecologic Oncolgy (Gyn Onc), which deals with the treatment of cancer of the lady parts. Ovarian cancer, cervical cancer, endometrial cancer, as well as numerous vaginal and vulvar cancers and pre-cancerous lesions whose removal makes me cringe with sharp pangs of sympathy. While the subject matter is a wee bit gloomy, this rotation is exciting to me because it is 100% surgery. The best way of getting rid of these tumors is to cut them out, and this provides the medical student with an intimate tour of gynecologic anatomy. The uterus is cool. It really is.

But the uterus is close to other things. The bladder. The bowel. Important vessels. Things you don't want to cut open accidentally. So working with the uterus in surgery means man-handling these other parts, pushing them out of the way, carefully, holding them back. And this is the perfect job for a student. "Put your hand down here, Fiona." "Retract this for me." And then your hands are in. Nestled in soft warm bowel, feeling the strong pulse of the external iliac. "Suction in the hole please." You get good with suction as a student.

But I digress. The appendix. The phone call to Mother. We came across the appendix. And it is often customary, when one stumbles upon this little organ, to take it out. Appendicitis is relatively common, and can be quite dangerous, as well as very expensive. You are already in there, the theory goes, so why not just get rid of the risk? Especially since the act of being in there can leave behind scar tissue that can pre-dispose to appendicieal trouble.

So the surgeon turns to me and says, "Do you want to do an appendectomy?" Ummm... yes please. He guided me through, step by step, where to clamp, when to cut, what to tie off. "Clamp closer to the base." "Don't pull up so hard on the mesentary." "Nice tie." And then I was holding the appendix in my hand, passing it off to the scrub nurse and saying, "specimen."

Then he told me to go home that night and call my mom and tell her that I did an appendectomy today. So I did.