OB, Day One

My first day on the Obstetrics & Gynecology clerkship was...fun. Once we got through the scattered and rather unorganized administrative details, they brought in these plastic (insert appropriate hand gestures here) models of the female anatomy, thighs and all, for us to practice the female pelvic exam. Needless to say, while providing us with some experience in going through the motions, it didn't seem very realistic. Whatever latex/rubber/oil-derived polymer they use to simulate human skin simply didn't work - mainly because of its noncompliance. The first step was easy enough, palpating the labia for Bartholin's glands, putting pressure on the urethra to see if there was any discharge. However, inserting the speculum proved difficult. Spreading and holding the labia apart with merely two fingers was nigh impossible - even using brute force with my dominant hand didn't help. There I am, trying to thrust this plastic speculum in between these fake latex thighs, two of my classmates holding the model down on the desk, which is creaking away in harmony with my rhythm. I needed the Jaws of Life to get the instrument inside, and I admit that finally getting the faux cervix in between the two blades looked really really painful.
The final part of the pelvic exam is the bimanual exam, part of which involves the examiner to insert fingers into the vaginal vault to palpate the cervix, while the other hand is placed on the patient's skin, to feel for the body of the uterus.

Instructor: Can you feel the cervix? Okay, now give it a little 'flick.'
Mikey: Define 'flick.'
Instructor: You know, just a...'flick.'
Mikey: Well, 'flick' could be a love tap, or I could really get some leverage and FLICK with enough force to fling a chihuahua off this thing across the room.
Instructor: ....
Mikey: So just a little 'flick'?
Instructor: That would be fine.

So I gave it a little flick. You know, out of all the students, only the guys asked whether any of these maneuvers were uncomfortable. Part of this, I'm sure, is because the female members of the class have undergone this exam enough to know exactly how it feels. Another reason, I'm told, is that men compensate so as to seem more sympathetic than their female counterparts. "Yeah, I just tell the patient to suck it up and deal with it," one of my female classmates tells me. Oooooooookayyyyyyyy. Remind me to not refer any of my patients your way.

*******

I arrived on the delivery ward for my overnight call shift, and got relatively no orientation before they tell me to scrub in on a Cesarean section. Scrubbing in for deliveries is identical to scrubbing in for general surgery, only I get to wear these WICKED AWESOME boot covers:

Pretty freaking hot, eh? I guess some mild splashing is to be expected. The OB operating room is laid out like any other. The experience is not entirely unlike the delivery scene in Monty Python's The Meaning of Life - a machine that goes 'ping', a quick delivery, flashing the baby to the parents, then quickly ditching the baby onto the waiting pediatricians.

After a little slicing, the OB's get to the uterus, which looks like a kickball. A little more dissection, and the membranes bulge through the incision. The baby's head pops out, followed by the rest of its body, and the baby boy starts crying immediately. The OB's clamp the umbilical cord close to the baby and tell me to cut it. They clamp the cord close to the uterus and have me cut there, too. Wheeee! I'm a cord-cutting machine! The OB attending physician grabs my hand and thrusts it into the mother's abdomen, instructing me to start massaging the uterus. Blood gushes out, along with the placenta, a veiny red frisbee thing covered with whitish membranes. If there's anything that comes out of a woman's womb that makes anyone think of Alien or Body Snatchers, it has to be the delivery of the placenta. This jellyfish-like object, which has been coexisting symbiotically with the mother, looks like it was drawn up for the cover of some 5-cent sci-fi/horror B-movie magazine.

The rest of the night isn't nearly as exciting. Waiting....waiting...waiting...for women to go into labor....or not. I'd much rather be busy. Instead, I sit in a comfy chair, trying to study, or trying to fall asleep, counting floating veiny red jellyfish in my head.

Romper Rheum

So...for the last several weeks during the time that I haven't been writing anything on this blog, I've been hanging out with the Rheumatology service. And you know what's really funny about Rheumatology?

Nothing. Nothing that I've seen in the last three-and-a-half weeks. I mean, it's interesting from a medical standpoint, but not much from an entertainment standpoint.

To wit:

I don't think I really appreciated what Rheumatology was before I started this rotation. "Rheumatology" is one of those words that I would hear when I was younger and thought of little old ladies having their "rheumatological" episodes and drinking humors or tonics to treat their puzzling aches and pains. I suppose it's not so simple any more - it's not just little old ladies, and those humors and tonics are now some pretty potent drugs - potentially scary stuff. I find it interesting enough to consider it as a specialty - there's a little of everything in Rheumatology - the need for strong history and physical exam skills, outpatient/inpatient/critical care medicine, and *cough* research *gag* - potentially an ideal field for someone who suspects he has some form of attention deficit disorder. Whenever I get bored of crazy patients in the clinic, I can excuse myself from the room and head down to intensive care and see how the patients with pulmonary hemorrhage are doing.

See? Interesting to me and me only...not so great for the blogging public. Sorry. I warned you.

So, now that the blog-material poor Rheumatology rotation is coming to an end, perhaps we'll see an upswing in Mikey's Blog activity, because...

My next rotation is Obstetrics & Gynecology.

Honestly, I don't know what to expect. All I know is: Monday morning I have OB orientation, and they scheduled me to be on call on the Maternity & Delivery service that evening.

So, potentially...

See! As Mikey's jaw hits the amniotic fluid-soaked floor when he catches his first baby!
Read! About Mikey's mad skillz with the vaginal speculum!
Hear! Mikey's new catchphrase: "Oh my...Why, God, WHY?!?!"