A Tale of Two Days

It was the best of times, it was the worst of times. We'll start with the bad so that we can finish with the good. The day finished with a lecture on abortion delivered by a prolific abortionist(who, ironically, is associated with the "Family Planning Center"). The lecture, billed by the course director as being focused on the medical aspects of abortion, sadly failed to live up to that description. Instead, it was an hour long cheerleading session about the benefits of abortion and how low the risks are compared to delivering a baby with occasional tidbits of actual knowledge thrown in. The words "studies have shown" were thrown around a lot, but with no actual citations to back them up. Having reviewed the literature myself in the past, I think his claims were greatly exaggerated; when I have a little time, I'll go back through and find some of the articles I've read in the past. He also dismissed the pro-life movement as being "anti-choice" and our ethics, arguments, and evidence as "just rhetoric." Just for kicks, he also threw in an incredibly inappropriate description of the abortion process that is not suitable for print; if for some reason you really want to know, ask me by some other means.

Anyway, after the lecture ended, I introduced myself to him as one of the pro-life students he had spoken about. I said that I respected his opinion though I disagreed with him, and I asked him to please have a little respect for my beliefs and those of like-minded people. His response? "Sure, I respect your beliefs, but that doesn't change the fact that you're anti-choice." I told him that I respectfully disagreed, and that I didn't think that name-calling by either side was conducive to a productive dialogue. He replied "I won't argue with you. You can't call me anti-life, I'm very pro-life. I believe that people should be able to live however they want. You're anti-choice. You don't think a woman should be able to choose how she wants to live." I again told him that I respectfully disagreed and that I could produce evidence to support my beliefs ("It's just rhetoric," he snorted), but that I wasn't looking for an argument, merely for a little respect. "Psh," he said, "fine. I respect your opinion." And he walked out of the room. So yeah, first serious challenge of the rotation there. Dunno how this will play out long term, but if I never have to work with this individual again, it'll be too soon.

Anyway, the good...today I actually got to deliver a baby. Not to watch one delivered, not to have the intern's hands doing all the work over top of mine, but to really, truly be the one to work the baby out of the womb and into the world. Before too long, everything in the preceding paragraphs will be forgotten. This I will NEVER forget. It was a C-section delivery, and the PA had just incised the uterus so that we could bring the baby out when the attending said to me "Hey Seth, do you want to deliver this baby?" I don't remember what words found their way out of my mouth at that point, but the upshot (clearly) was "heck yes!" "Ok, here's what you need to do..." I had learned all the techniques, but many of them deserted me in the face of this actual delivery...and the fact that it's a lot less scary to push really hard on a mannequin than to exert serious pressure on a baby. And I do mean SERIOUS pressure. It takes a lot to get the shoulders out. I didn't do it perfectly, but I got the little guy out in one piece and in perfect health, and that's what counts, right? Hopefully I'll have a chance to do that once or twice more before this part of the rotation ends, but regardless, I think (and hope!) that this delivery will forever remain etched in my memory.

Anyway, that was the day. I'm sorry to have to spoil the delivery of such a beautiful, awesome creature with a story of a sad, confused, insecure individual, but I promised I'd chronicle the challenges associated with the rotation, and unfortunately, that's going to be one of them. Still, though, disheartening though that encounter was, it'll drift away with the morning breeze and leave the memory of a beautiful newborn baby boy screaming his lungs out while resting in my hands. Still can't get over the sheer awesomeness of that. Anyway, until next time, all...peace and God bless!

Long day = short post

Mostly a good day today. On post-partum rounds this morning got caught briefly in the awkward situation of being in the room while the intern was counseling a patient about contraceptive use. For better or worse, it was short enough that I didn't have time to leave the room. Otherwise, the day was highlighted by two vaginal deliveries (aptly described by one of my classmates as "so gross but SO AWESOME!") and an uncomplicated C-section resulting in three healthy children and three ecstatic families. The residents were also in full teaching mode today for some reason that I'm not going to question, so it was a productive day both in terms of skills and knowledge. No other real issues, blessedly. That will, unfortunately, likely change tomorrow when an attending with whom I've unfortunately crossed paths before delivers a lecture on abortion. Suffice it to say that if it's at all similar to the one he delivered 6 or 7 months ago, I'll have plenty to say about it in this space tomorrow.

Anyhow, I guess so far this hasn't been bad. I hope and pray that lasts, and that the good news delivered by another classmate (maybe we'll get a pro-life Ob-Gyn option after all!) comes to full fruition before next year. That's all from me for tonight; hope everyone's doing well. Peace and God bless!

Pure wonder

Early start this morning...got onto the floor a little before 5:30 to meet the intern. I got to hang out in the nursery while we were waiting, so no complaints there. Shortly thereafter we began helping out with postpartum rounds. Once more the issue of contraception came up, as one of the expected questions for the new mother is "what kind of birth control do you want to use?" It's kind of sad, really...you're talking to this woman, often holding her child, and you're supposed to ask how she wants to make sure that she won't be holding another one anytime soon. Anyway, once again the intern (different intern this time) rather surprised me with the pleasantness of her reaction to my statement that I could not and would not counsel about contraception. Of course, the patient I saw had had a tubal ligation after her delivery, rendering the question rather pointless...

The next thing for the day was grand rounds, which was a pretty decent account of the history of obstetric anesthesia. The presenter's occasional references to religion caused a bit of eyebrow raising on my part (I may have been reading too much into it, but it seemed like she set up a sharp contrast between the logical, humanistic view and the "religious" view which was exactly the opposite), but it wasn't a focus of the presentation. From there it was back to the clinical floors.

At one point when all three of the MS-3s were together in the central team area, one of my classmates asked me about what I had said on rounds about contraception, wondering if I could clarify a little about my moral stance and the reasons for it. In the end, it turned into a pretty decent discussion among the three of us; I'd like to think I did something to clarify my understanding of (and the Church's teaching about) abortion, contraception and sterilization. As a quick aside, if anyone has questions about any of those things, I'll be more than happy to speak with you about them.

After that came the true highlight of the day. I had signed up to participate in a 10:30 C section, but when I got to the OR at 10:17, I was just in time to see a real live miracle. One moment there was nothing but a hole in a woman's abdomen; not ten seconds later the surgeon was holding a baby girl. She was pretty blue (which I'm told is fairly common), but otherwise looked great. I couldn't see mom, but the look on dad's face told a story more eloquent than any ever written. It took a couple of minutes for the pediatrician to assess the infant (she was a breech baby, relatively cyanotic as previously mentioned, and needed a bit of a workup, which I was blessed to be able to help with), but when he was finally able to bring the child to her father...it'll have to suffice to say that no words exist that could do justice to the beauty of the moment. Everyone should have the opportunity to witness that at least once...it was an instant of truly pure wonder.

The rest of the day was pretty smooth, although nothing nearly so exciting as the delivery happened. I met a few more expectant mothers and nervous families, went to a lecture, and did the standard clinical-ish things. So far, two days in, things have been ok; I'll be hoping and praying that that continues.

That's all I've got for now...back with more updates tomorrow. Till then, peace and God bless!

...Well, I guess that wasn't so bad...

Actually, today could have been a lot worse. The day started off with an orientation by the course director and course coordinator, which was fairly routine. During one of the breaks, the course director asked me to hang around and chat for a minute. He told me that my beliefs would be respected completely during the rotation, but warned that there might be a few "hiccups" along the way. These, he told me, he wants to know about so that he can take appropriate action to prevent recurrences in the future. That was promising, if slightly ominous. After lunch, we began the clinical part of the rotation. I'm starting with labor and delivery (L&D), so two classmates and I reported to the central control area in the L&D suite. There we met our residents, who began to orient us to our surroundings. They seemed genuinely interested in teaching and began doing so immediately. One of the things that came up was post-partum rounds in the morning. The PGY-2 we're working with had compiled a one-page summary of key questions to ask, facts to include and abbreviations to know for progress notes. One of the questions specified that the patient was to be asked what kind of birth control she would be interested in going forward. A few moments later, I had an opportunity to go see a patient with the intern. On the way over, I took a deep breath and explained that I wouldn't be able to recommend or counsel patients about birth control. I frankly expected her to be annoyed, but she just nodded and basically said "Ok, just remind me that you haven't discussed that with the patients." She kept teaching, too, and didn't seem to treat me any differently. She even let me use the ultrasound (highlight of the day, definitely!). She and the PGY-2 also taught us how to read the fetal monitors, which promises to be a useful skill for the rest of the week. All in all, I was pretty happy with the residents and had a fairly good clinical experience today. The day finished with a lecture on peripartum care and the delivery process which was OK but pretty scattershot; the lecturer often went off on tangents before completing full thoughts. Oh well, given that the rest of the day mercifully went pretty well, I can deal with a disorganized lecture.

Anyway, that was day #1 on Ob-Gyn. All in all, I have to say it was a pretty decent day. If all my residents and attendings are like the ones I met today, maybe this won't be such a nightmare after all. We'll see how it goes...day #2 starts at 5:30 tomorrow morning. Back with more tomorrow evening; till then, peace and God bless!

A true "defining moment"

Actually, it's a "defining month," but that's just semantics. So here's what's going to happen...each day for the next month (while I'm on Ob-Gyn), I will be chronicling my adventures (and my misadventures) in this space. I will attempt to be as fair and objective as possible, but I will warn you now: I WILL make editorial comments on both the good and the bad. Also, in case you haven't gathered from the title of the blog (and from my bio), I am a practicing Roman Catholic and I have strong objections to abortion, contraception, and sterilization. Part of the objective in my taking time to do this each day is to give a firsthand account of how these issues arise in daily practice at Magee and to what degree a pro-life student will be affected by them.

All I can say now is that I'm terrified. I don't quite know what to expect...I've heard so many different stories from so many different people, and I have no idea what my experience will be like. I guess I'm hoping for the best, expecting the worst, and praying for the strength to stand strong and not falter. Orientation starts at 8 tomorrow...prayers would be tremendously appreciated, both then and throughout the rotation.

One last thing: I've decided I'm going to make a conscious effort to be as positive as I can, so as a theme song of sorts I've decided on one of my favorite hymns (sorry, this was the best version I could find on YouTube). Peace and God bless!



"And whether our tomorrows / Be filled with good or ill, / We'll triumph through our sorrows / And rise to bless Thee still!"

Things I've Learned...

I guess the best-laid plans end up in about the same place as all those good intentions... Anyway, I'm done with my first clinical rotation (surgery / anesthesia) and a week into my second (infectious disease up at the VA). Some things I've learned from my patients and colleagues during that time (edited to ensure HIPAA compliance):

-It's a terrific idea to play with a loaded firearm. Because it's not like the .357 hollowpoint will blow a sizeable hole in your leg that will require the EMS paramedic and I to take turns holding pressure on the wound for nearly an hour in the trauma bay. You're just lucky that the bullet and all the shards missed the femoral artery.

-It's been said before, but it bears repeating. There is one action that will inevitably land you in serious trouble. So whatever you do, avoid minding your own business. Whether you're standing on a corner or you're hanging out in some park, a bunch of dudes will seek you out and beat you and your buddy to a pulp. When you are telling me your story, I will be hard-pressed not to laugh out loud because, according to you, you were SOCMOB (if you don't recognize the acronym, go to the "Things I Learn from My Patients" link on my blog and read a few entries) when this all went down. The sad part? You're probably telling me the truth.

-If you're an kindly, mild-mannered older gentleman with diabetes and you whack your head on some sharp edge, by all means ignore the laceration and the egg-sized lump on your head and try to tough it out. No reason to trouble the doctors and nurses with something so minor, right? A week later, you'll end up coming in because the wound isn't healing and is purulent and you have a substantial hematoma besides. Bonus: you'll end up with sepsis and round out an evening by coding and being brought to the ICU (first of my patients to code on me...sure he won't be the last).

-As an FYI: if you're going to call an ID consult for a patient to make sure you know what course of meds he/she needs to go home on, you might want to do that BEFORE discontinuing the patient's antibiotics. And if by some chance they do get cancelled / lapse, it's probably not a good idea to wait for a week(!) before checking with ID to see if the meds should have been stopped.

There are more (both ironic and genuinely useful), but that's all I have time for tonight. Till next time, peace and God bless!

Starting MS-3 year!

Wow. Baptism by fire seems to be the rule as a third-year medical student. I've been on my surgery rotation for one week now. Generally, a day now consists of getting up at 4 so I can get ready and walk to Children's by 5:30, review charts and calculate I&Os till about 6:15, rounds with the chief resident or the fellow until a little after 7, then meeting with all of the on-service residents, fellows, and attendings to go over the flow for the day before heading off to the OR a little after 8. Of course, some days the flow is a little different -- there may be pathology conferences or morbidity and mortality (M&M) meetings to attend, or grand rounds, or some other variation. In any case, once everything else is done, the vast majority of the rest of the day is spent in the OR. Most days I spend 8 or 9 hours in there, and I consider it all time well spent. I usually end up leaving between 6 and 7 PM, picking up a new set of scrubs for the next day, and heading back home to eat, sleep, and get ready to do it all over again. The days are long, but the surgeons are beyond terrific (and I'll be honest, I never expected to make that comment about surgeons) and it's been a wonderful experience so far. Funnily enough, the best part of the whole thing (at least to this point) didn't even happen at CHP. After I finished at Children's on Friday (about 11:30 AM), I headed over to Presby for 3 hours worth of lecture. Note to whoever is in charge of the lecture sessions: turning the light off during a lecture filled with sleep-deprived medical students is probably not a good idea. For most of my classmates, once lecture was done for the afternoon, they had to go back to work for a couple of hours before the day ended. Not me. Instead, I faced one of the many rites of passage of the third year medical student and a true "defining moment": my first overnight call.

Next time: notes on my call night. Till then, peace and God bless!