Welcome to Vaginaland

4 02 2012

My first week of Obstetrics/gynecology is over.  The first week of a new rotation is always hard, and at my school, where we rotate through several different hospitals and offices, the first week is always a struggle just to get oriented to a new place, a new system, a totally new set of expectations, a new group of nurses and techs that mostly see you as a nuisance, and a new culture among the residents and attendings.  Add in a completely new knowledge base and you’ve got OB/GYN. 

There are so many things that are different about this one that I can safely say that my experiences in Medicine, Family, and Psych have helped me very little.  Really the best way to get a grasp on the scope of everything is to recount my first couple of days.

At orientation the first day was when we received our location assignments and schedules.  The rotation is broken into a month of obstetrics and a month on gynecology, though we do a fair amount of both during both blocks.  So 8am orientation that day I learned that I would be taking night call that evening and had orientation during the day, followed by a full day of workshops and clinic the next day.  Thankfully orientation ended a little early and I was able to go back to my apartment to grab my toothbrush and an hour and a half of sleep but after that it was go-go-go from the start of night call at 5pm Monday through 5pm Tuesday, and by the time I’d fallen asleep on Tuesday at 6pm I had been awake for 36 hours (34.5 if you subtract the quality nap the previous day).  There is a 28-hr rule—not allowed to spend more than 28 consecutive hours at the hospital—but since orientation on Monday and my pelvic/breast exam workshop on Tuesday were not “direct patient care,” it didn’t count.  Yeah.

It was a massive shock and the worst part was I had no idea what was going on.  Obstetrics (or, as they call it, maternal-fetal medicine), has an even bigger list of abbreviations than any other specialty I’ve seen.  I didn’t even know what a cerclage was, or what SVD stood for, or what it meant to have a 3rd degree vaginal tear, and I made the mistake of asking my resident instead of looking it up on my own. She just looked at me like I didn’t know my head from my elbow.  I saw my first vaginal delivery that night, and it was disgusting.  Between not having slept or eaten, I almost couldn’t handle watching the doc stitch up the tears afterward. 

Not showing it was a little difficult, but I didn’t want the mother to feel bad.  Not like it’s her fault.  Although I mentioned my reaction later and one of the workshop instructors pulled me aside and I was reprimanded for describing childbirth as gruesome because she was offended that I would call a woman disgusting.  Ugh.  All this from a woman who had never given birth vaginally.

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A word about the culture of obstetrics—there is a personality type.  There’s one for every specialty, really, but this is the first time that the residents have worn the stereotype like a second skin.  What I have found so far is this: all of the male residents are super chill and very personable.  Almost all of the female residents I’ve met are kind of bitchy.  More than a dozen times so far, when I’ve been tagging along with one of the female residents, they have back-talked a nurse or tech or attending or another resident or patient to me just because I was the only one there to listen.  Friends, I was in a sorority in college and I saw this behavior in my sisters maybe twice a year, and a few of those situations were legitimately scandalous. 

Don’t get me wrong, a few of them are helpful, too.  One of the ones doing some of the petty complaining was actually really straightforward and honest about her expectations of us, and spent a good amount of time actually teaching us what we should be doing.  I understand that a lot the residents behave the way they do toward us because med students are a handful, especially when they are new, and on top of that they are all overworked, sleep-deprived, and under tremendous pressure.  But that’s still no excuse to be a jerk. 

Overall, the hours are terrible.  I have to be at the hospital at 4:15 am and usually don’t leave until at least 5 pm.  Being on night call means spending at least 28 hours awake (the residents here will let you sleep, but won’t wake you if something interesting happens).  The upside is that, as long as we aren’t on call, we get weekends off.

This rotation will be challenging for me, and with everything I’ve seen so far there will be lots of interesting things to write about.  But for now, it’s study time 🙂

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