OB and ID

I really need to try to write these earlier...when it gets to this time of night, I have little energy and only marginally more motivation to write about the events of the day.  I was in clinic again today, and once again it was pretty standard.  I saw several patients, both OB and Gyn, wrote notes, and ended up accidentally walking off with one of the office Dopplers.  Oops.  Topics for today included leiomyomas (uterine fibroids), causes of urinary incontinence, and effects of pregnancy on the pulmonary and cardiovascular systems.  Also got a decent look at hormone replacement therapy in PBL thanks to a couple of trials from a few years back.  Anyway, not much exciting today, but also nothing in the way of moral dilemmas or controversies.

On a health-related but Ob-Gyn unrelated note, I very briefly saw an article on MSN about a new plasmid that's popping up in Asia that confers broad-spectrum antibiotic resistance on (generally) Gram negative organisms.  Apparently these bugs are resistant to any and all beta-lactams (carbapenems included), fluoroquinolones, aminoglycosides, and basically everything except colistin (which hasn't been widely used in the US for years).  Anyone know anything more about this?

Anyway, that's all for tonight.  In the OR with Dr. Jaja tomorrow; we'll see how that goes.  Till then, peace and God bless!

Another day at the office

Pretty run-of-the-mill day today.  Worked for a few hours, did a few histories and pelvic exams, and called it a day.  Not much in the way of learning points or interesting cases, just some very nice, very...well, patient patients who allowed me to sharpen one of the more awkward skills required of a medical professional.  The only small issue was that one patient wanted information and counseling regarding her IUD (IntraUterine Device, a contraceptive gadget implanted in the uterus for any non-medical types); Dr. Jaja basically told me not to worry about that, that he'd take care of it.  I really have to say (as I've noted before) that this is a very good alternative for anyone like me with issues of conscience surrounding some of the mainstay topics of Ob-Gyn until we get a truly pro-life alternative in place.

Anyway, that's really it from me for tonight.  Hopefully I'll have more to say tomorrow...second day in Wexford.  Hopefully I won't get lost this time!  Peace and God bless!

Sorrow and joy

This will come as no shock to anyone who's done an inpatient rotation, but rounding isn't very much fun. Especially when you're covering three teams and it lasts for four hours. UGH. Worst of all, the last patient we saw was on her first post-op day after a C-section to deliver a baby that had suddenly and unexpectedly died at nearly 40 weeks gestation. Dad told us that an ultrasound last week had showed that everything was normal. At this point, no one is really sure what happened. I wonder what they'll tell their other kids...I'm sure they said they would come home from the hospital with a new brother / sister. How do you go about explaining to children that their new little brother / little sister died? What a horribly, terribly sad situation...prayers for that family would be greatly appreciated.

On a happier note, to sort of balance out the sadness of death, I got to catch another baby, a 9 pound boy. Little fella was kind of slippery, but I managed not to drop him (dictum #1 on Ob-Gyn: "don't drop the baby." In case you're wondering, it's also #2 and #3). It's really hard to stop smiling after an experience like that. He was perfectly healthy and mom was in good shape; dad had a rather dazed grin on his face after the little fellow finally decided to pop on out. He got a rousing chorus of "Happy Birthday," but apparently our little buddy didn't care for the rendition -- he cried from start to finish and quieted down almost as soon as the song was over. *Sigh* everyone's a critic...

Anyway, that's all for now. I have tomorrow off, which means I most likely will not be posting, but I'll be back again on Monday. Till then, peace and God bless!

30 second post

It's late, I'm tired, and I'm working tomorrow morning, so this is going to be short. Today cured me of any smidgen of desire I might ever have had to a) practice anything related to Ob-Gyn, or b) to work as a primary care / outpatient physician. I got to do a fair amount (bimanual exams, speculum exams, Dopplers for fetal heart tone) but the work in an outpatient Ob-Gyn clinic is mind-numbingly boring. Seeing one patient after another for six or seven hours is draining after a while, particularly when four or five in a row are simply well checkups. Ugh. Oh well, working with Dr. Jaja is still very much a positive thing, as his humor and willingness to teach and get me involved help at least make the day productive. At this point, I'd suggest anyone in my position at least consider volunteering for the experience with Dr. Jaja rather than doing the resident clinic -- better variety, more continuity, a good degree of involvement, and respect for strongly held beliefs. Of course, if the rotation at Mercy comes through...

Anyway, that's pretty much it for me...back tomorrow with a weekly wrap-up. Till then, peace and God bless!

The good and the bad

On the surface of things, today was a pretty good day. I saw several patients with Dr. Jaja, did a couple of pelvic exams, and best of all I got to catch a baby more or less on my own (although I felt really bad for the family medicine resident who had probably spent more time with the new mom than I had). It was a good day for learning. The less promising part of the day was more subtle and centered on seemingly innocuous questions of language. Part of what I'm required to do each day for Dr. Jaja is to write a very brief (half-page or so) summary of a single patient to be discussed the following day. My writeup yesterday was about a woman who was worried because she'd had an episode of bleeding after being pregnant for several weeks. She verbalized this by saying "I'm nervous about my baby." Thus, in my writeup, I described her probable diagnosis as "threatened vs. complete miscarriage" and referred to her unborn child several times as a baby. Why is this significant? While I was discussing the write-up with Dr. Jaja, he mentioned in passing that the more correct terminology was "spontaneous abortion" instead of "miscarriage" and "fetus" instead of "baby." He brought these up just by way of explanation, and not with any ulterior motive, but it was emblematic to me of the culture in the country in general and at Magee in particular. Its net effect is to make the word "abortion" less loaded by linking it with something that unfortunately occurs naturally and to minimize the humanity of the unborn child. It is thus no surprise that the pro-abortion establishment has inculcated the use of this language in medical parlance, especially in the world of OB-GYN.

Anyway, that's all I have time for tonight...back tomorrow with reports on my first outpatient experience in Wexford. Till then, peace and God bless!

First day of clinic

Ok, so I know I promised details, but it's already 10:30 and I'm exhausted. So here's the abbreviated version. The schedule for today said that I was supposed to start at noon. I had a hard time believing that, but I found nothing to the contrary. Still, I couldn't countenance waiting till noon to get to the hospital, so I got there around 10:15 and found Dr. Jaja's office, then went down to the library hoping for a miracle. God came through. The library had purchased -- and JUST received -- several new copies of the Hacker and Moore textbook that's the recommended reading for the clerkship. So I spent the time until noon reading and then went up to meet Dr. Jaja. The afternoon was pretty good. After Dr. Jaja laid out his expectations and the learning objectives, and after I explained what as a Catholic I was and was not willing to participate in (he not only didn't have a problem but was supportive of my following my conscience), we dove into the rather extensive patient list headfirst.

Today I was largely just shadowing. This was due in no small part to the fact that I have virtually no experience with obstetric / gynecologic histories and physicals. I know most of the theory, but my comfort level is low and my skills are still poor. One of the major goals of this part of the clerkship is to remedy those weaknesses, and it seems as if Dr. Jaja has a plan for how that can be accomplished. Today I watched (and semi-participated in) several obstetric antepartum visits (learned how to perform the Leopold maneuvers among other things) and a couple of gynecologic exams (learned proper use of the speculum and how to perform a Pap smear). Tomorrow I'll be back in L&D, where I have at least a little bit better background (one whole week's worth!), and I think that'll be fun.

The rest of the afternoon was ok. The ethics session was intellectually stimulating (sort of) but not especially helpful, and PBL was decent (relatively poor cases on prenatal counseling followed by better ones on STDs). Otherwise not much to tell.

Anyway, that's all for tonight...back tomorrow with a report on L&D. Till then, peace and God bless!

Back to work

Ok, didn't post over the weekend. But it was back to work today, so back to blogging. For better or worse, not a lot to write about today. The woman I was following looked like she was on the verge of delivering all day...and finally started pushing just as I left for PBL. And there weren't enough C sections to go around. So I ended up doing a lot of reading today...hopefully that'll help me not embarrass myself tomorrow when I start doing clinic work with Dr. Jaja. We'll see how that goes, but having met and worked with him briefly last week, I think this might turn out ok. I'll be as detailed as possible in my description of how the days run to give anyone who might be interested in signing up for this alternative a feel for what happens on any given day.

I guess the one thing that did happen today was a PBL that spent a great deal of time discussing contraception and sterilization. It really sort of made me think...the way the facilitator approached the topic (and the way that medicine and, indeed, society in general approach the topic) was from a mindset of contraception being a fundamental right. The underlying corollary to this, of course, is that sex is also a fundamental right. Furthermore, there is an even deeper and more insidious understanding that we as human beings should be able to do whatever we want without consequences or responsibility. And by these flawed understandings, we have taken an act that stood at the pinnacle of human relationship as a total, reciprocal self-giving and turned it into a cheap tool of quick pleasure, a Saturday night "hook-up." It has been said by many theologians that sexual intercourse, the act of conjugal love, is the nearest we can come in this life to approximating the love of the Trinity. But by removing the consequences and the need for commitment, by removing the responsibility and gravity that once attended sex, the act itself has become meaningless and emotionless, having no particular value over and above any other means of showing affection or obtaining pleasure. The message today is that sex is fun, babies are inconvenient, and that the individual's enjoyment is the most important thing. Hakuna matata, right?

...but didn't Simba eventually realize he was wrong for leaving his responsibilities behind? Maybe, someday, we will too. Anyway, that's my sermonizing for the day. Back tomorrow with new and exciting stuff! Till then, peace and God bless!