Happenings in OB/GYN

Inside IVF
Two weeks ago I shadowed an OB/GYN who specialized in Reproductive Endocrinology and Infertility (REI). I observed half a dozen discussions about IVF, donor eggs, and donor embryos. And I had a personal tour of the IVF lab. It was surreal and confusing and heartbreaking.

Conception and Death
Last week I was rounding on the gynecology service, and was scheduled to scrub in on a ruptured ectopic pregnancy. The same day, I saw a patient with disseminated ovarian cancer who was being "withdrawn" from aggressive ICU care (heroic measures were stopped and she was allowed to die naturally only a few minutes after I listened to her heart and lungs). The beginning and the end of life, in one day.

Numbers
I have now been to 3 vaginal births and 5 C-sections (one of which was for twins). There was one C-section for prolonged rupture of membranes and severe intrauterine infection. The amniotic fluid gushed a thick purple, like blueberry syrup at IHOP, instead of a healthy clear. The inside of the uterus was mushy and white, instead of the typical mossy red. The baby was a preemie in frank breech, and the NICU team took him and (again, not as usual) didn't bring him back to the Mom before the procedure ended. I hope they do well.

Minefield
I ended up not scrubbing on that ectopic pregnancy case, but it created a small stir for me. When I was told I was scheduled to do it, I thought, "oh great! I am especially interested in ectopic pregnancy and tubal surgery!" This is I want to save early lives and give couples with tubal factor infertility an option besides IVF! Then I realized, "oh dear. What if the surgery planned is a salpingostomy, or salpingotomy?" Quickly, I looked at the patients records and saw that she was planned for salpingectomy. I breathed a sigh of relief.

No such relief for a recent C-section with post-partum tubal ligation. I was scrubbed in on a C-section and then discovered that the patient and her surgeon were planning sterilization. Now normally, it is the medical student's job to stand at the operating table and do menial tasks, such as holding retractors, suctioning, and dabbing the field with lap sponges. Perhaps the best of these menial tasks is cutting suture. For this task, I actually need to ask for an instrument from the scrub tech. "Suture scissors," I say, and hold out a hand. She slaps the plain-jane scissors into my palm, and I proudly cut the ends of the residents' or attendings' thread. A medical student is slacking or inattentive if someone else calls for the suture scissors.

For the tubal ligation, which involves cutting of four sutures, I folded my hands and stood at the table, simply observing and listening. I pretended to be forgetful of asking for the scissors. Once that procedure was done, though, I resumed cutting, retracting, and sponging for the rest of the C-section.

Call
I had my first night call last week. I worked a typical day on gynecology (I got to work at 4:50am for rounds at 6:00), and then had a dinner break from 5:00pm to 5:45pm, at which point I worked until about 7:30 the next morning, with a 45-minute nap somewhere in between. That was exhausting. I am not sure I've stayed up for 24 hours before that. Ever. And I've got to do that again tomorrow. Merp.

Overall, OB/GYN is good.
I like the clinic, I like the surgery, and I love deliveries. I don't like all the people I'm working with, and I don't like knowing so little about what I want to do. It's a little stressful, but overall I'm enjoying it. One thing I'm struggling with is how prayer fits in to a 60-hour work week. During the past week, I've been paging the hospital chaplain and receiving communion from him on days I can (and that means I missed two days!), and I've missed parts of the Liturgy of the Hours several times. Even so, I think I am doing God's will, and I have fewer occasions of sin, and my thoughts stray to Jesus more easily.