Before the jump, two notes:
- This is one of my first blogs about clinical experiences. I believe this post conforms to the blog rules. Please help me obey the law and maintain patient privacy by contacting me if I violate confidentiality.
- This is the first time my horarium included a nighttime rising to help Jesus in a patient. As such, it is the first in a new category of posts: "medical matins," the reason for the title of my blog. As I move through my career (especially those M3 weeks of night shifts) I'll have many more, but today I celebrate the inaugural one! May God bless me through my patients, and bless them through me.
1 AROM: "artifical rupture of membranes." Dr. A induced labor by rupturing the baby's amniotic sac; in short, she broke the patient's water.
2 primagravida: pregnant for the first time!
3 SROM: "spontaneous rupture of membranes." This patient came into the hospital herself, her water having broken earlier that morning.
I woke up while it was still dark to find ice on my car! After much scraping, I drove to the local Catholic hospital, arriving at 7:00am. I found Labor and Delivery (L&D) just as shift was changing, so tired-looking residents were giving report to nurses about what had happened in the previous twelve hours. I stood there in my scrubs and white coat, doing flashcards on my iPhone while I waited for Dr. A.
I enjoy people watching, so I watched the residents. They wore scrubs and fleeces and tired expressions. Their speech flowed easily, full of clinical stuff that I did't understand. A little after 7:00, another medical student entered the nurse's station: an M3. I could tell immediately because the M3's have half a dozen IDs on their badge clips, whereas M1's and M2's only have one (we don't rotate in the hospitals).
She smiled at me and I introduced myself, admitting as quickly as possible that I was an M1. She admitted that this was only her third day on L&D. (Intimacy. We were now bonded, companions in a strange world.) She got to learn how to scrub that morning! What a milestone. She also showed me how to calmly take flack. When it was discovered that the M3 hadn't been taught how to scrub, one nurse said as she walked past us, "I don't mean to be tacky, but you needed to be here fifteen minutes early so we can teach you how. Spread it around to your classmates."
"You have to learn to hold the punches," the M3 commented quietly once the nurse had gone around the corner.
As she learned to scrub, I stood in the section room in a bouffant and shoe covers watching the anesthesiologist insert an epidural (wow and yikes; especially yikes on lousy doctor-patient communication). Finally, Dr. A appeared. As she scrubbed in, she told me that if I felt faint I could back up to the wall and sit down. It wasn't the first time I've been in an operating room, and I've seen an ORLive C-section. But she was emphatic. "This might be the bloodiest—well, one of the bloodiest things you ever see."
I thought it was great.
The second C-section I saw was almost twelve hours later. (I spent a the middle of the day with lunch, errands, Mass and studying.) I observed a different doctor, who worked with a resident as first assist. It was a similar experience: epidural, drape, incise, baby, close layers. The doctor performing the second section was more instructive (he showed me the rectus abdominis, answered my question about which layer he was closing, etc), but I took about the same amount from it. Reaction:
- Cool! (looks fun to do)
- That's a lot of intervention, a lot of scar, and a lot of staples... (doesn't look fun to get)
This was way more amazing than C-sections. In high school, I watched some documentary (Nova?) following a laboring mother through the hours until her baby was born. But in the final minutes I minimized the video player, feeling immodest at watching. (The same way I used to skip through the pictures of cadavers in my high-school anatomy atlas or avoid the reproductive chapter in my grade-school science book. It was inappropriate at that time.)
This day, I watched without embarrassment. I stood respectfully at the back of the room until the nurse suddenly bid me to put on a pair of gloves. Wordlessly, I obeyed. She then had me take her place holding the patient's right leg, helping to apply pressure during the pushes. Some unexpected things happened: once, when neither the nurse nor Dr. A began to count at the beginning of a push (10 seconds per push, four pushes per contraction) I did; and halfway through the delivery of the head, Dr. A advised the patient's husband (positioned at his wife's other leg) to imitate my hold. During the second delivery, I took up the same position and I think I also helped, in my small way. (I was super glad for this, because I feel like extraneous people in a delivery room are a plague, only one rung above MRSA.)
Both of these patients were in McRoberts positions and got episiotomies after turtle sign (these are all terms I discovered later on Wikipedia...). One needed forceps to deliver her baby's head. I was surprised at the amount of traction Dr. A put on the infants to deliver the anterior shoulder (after our brachial plexus lectures, I wanted never to pull anything anywhere). I was also surprised by the freedom the mother permits everyone to take with her body!
These two deliveries were much more moving than the C-sections. First of all, the mother is truly laboring to deliver her child. The urgency, pain, and exhaustion written on her face recruit everyone in the room! As in many other situations, a common need forms an immediate community. This deep, desperate need binds even strangers together very strongly; no doubt, this is why even I felt like a part of the team.
I also experienced the importance of trust in these fragile communities. The first mother was experienced (G2P1), seeing her own doctor (Dr. A), and trusted the staff; the second was a primapara, was seeing Dr. A as the on-call doctor, and came in with a distrust of any kind of intervention. (She wanted no epidural, no pitocin, etc.) Besides this, I think there was very little dialogue between her and the staff. The first mother used Dr. A and the nurses as a body of knowledge at her disposal; this second patient wanted no advice, and the staff responded by whispering behind her back instead of patiently helping. "She's going to be here all night," "She'll end up with more intervention than she would've had otherwise," "I think it's the husband..." The imperfect trust continued through her delivery and I think it was harder for that. Even so, it was a wonderful moment when she looked at her daughter for the first time and smiled.
A few days afterwards, I continued to think about my experience. I thought how puzzling birth is. It's so miraculous, but it's so strange. (A head sticking out of where?) It's animal and spiritual—it's human. It's Catholic. It's beautiful. It's like the marital act or like total surrender: fearful and wonderful.
I had such an awesome time helping these women and watching these procedures. I felt alive, invigorated, and at home. And (as is usual in discerning) I paid attention to people's comments about me. The first patient I helped was surprised to hear this was my first delivery, and told me as she was being wheeled to postpartum later, "You were terrific." (I told her emphatically that she was amazing, which was unequivocally true. I am fortunate: she was so articulate and generous!) A nurse, hearing that I was an M1, said "Oh. You don't have the first-year look." And one doctor asked me to scrub in ("We may need your hands") for the second C-section before learning that I was an M1. (I was half-sad and half-glad about that.)
Summary: the whole day felt sort of like a huge, sacred gift. Thanks be for such a sweet Lord as ours!