Sunday, March 27, 2011

Labor and Delivery Nights

The last week of my OBGyn rotation, I worked three nights in Labor and Delivery. I had been dreading it and finding an ascetic pleasure in it, admiring and pitying myself for having to stay up all night.

During days on L&D, I was largely ignored. I felt too tired to assert myself into the unit and compete with the off-service interns and residents, most of them mothers, who seemed very stressed out and talked to each other exclusively about their children. On nights, I was fortunate to work with three men, an intern, an R2, and an R4, who seemed to like their work. The men also had children, but they had stay-at-home partners, who cared for their children. I’ve never liked it when people refer to women doctors or scientists as “bitchy”, stating they are worse than men, because they are trying to be aggressive like men. It was a small sample size, but I think women still have more stress placed on them. They would probably be more mellow if they had a stay-at-home wife or partner caring for their children.

My first night in L&D was long—I helped deliver a woman’s first child, and it took forever. But by the third night, I was loving L&D. The three residents included me. By my last evening, I felt emotionally and physically drained, and became mawkish, wanting to hug the residents goodbye. I wanted to express how deeply I appreciated my time with them, the opportunity to be pimped and learn from them, to help with births, to see and worry about a pregnant mother who smoked meth for motivation to clean her house, to write patient notes, to try to communicate with native Spanish speakers, and to be awake all night in the hospital when most people are asleep. I did not hug them. I thanked them for teaching me. Then I cried all the way to my car after I left. I find as I approach the end of my required rotations, it’s a struggle to both get going to the hospital, and to leave the unit to go home.

Saturday, March 19, 2011

OB Triage and Superstition

A woman at 33 weeks gestation came into the OB triage after it was noted that her amniotic fluid was low. She was told she may need to be induced, and that she would be staying in the hospital. 33 weeks is four weeks shy of 37 weeks, when the baby is full term, and the baby's lungs may not be fully developed at that time.

“I usually wear a green ring, that is dear to me” she lamented, “But this morning I changed rings. I can’t help but think that caused this to happen. I know it’s silly. I’m superstitious. If my husband heard me say this, he would say, ‘Don’t be dumb.’”

I knew exactly what she meant. Superstitions provide comfort to us, giving us a sense of control and reason. An arbitrary cause of a bad event means it could have been prevented. The realization that random luck plays such a prominent role in our lives is quite distressing, while pinpointing a cause can sometimes be satisfying. And we all have people in our lives who dismiss this whole occurrence by saying, “Don’t be dumb.” They mean well too, it takes blame off us, by not making us responsible through superstition.

Thursday, March 17, 2011

On Reactions to autism: “I’m sorry” vs. “Cool”

I told one of the pediatricians I worked with that my nephew has autism.

“Oh, I’m sorry,” she said, with a frowny-face. Her response annoyed me, as he is very healthy.

I cocked my head and looked at her, then said, “Oh, well, it can be hard.” I made sense of it by considering her to understand how challenging autism can be and simultaneously thinking, “We don’t need your fucking pity bitch.”

I met a 20 year old patient at a clinic, who said she was going into education for kids with special needs. “People with developmental disabilities are the new, unspoken for minority,” she explained.

“That’s great,” I told her, “I’m quite familiar with that, because my nephew has autism.”

“Autism, cool.” She smiled.

I smiled too. Is it cool that my nephew has autism? In general, no, but my nephew is a mighty cool seven year old. “Kinda immature response,” I thought. Life would be easier for my family, and likely for him too, if autism was less a part of who he is. But my smile was genuine. I thought about all the things I love about my nephew, his odd nuzzling, his repeated exuberant exclamations in line at Costco, (“No, not the lady!” when we hand something he picked out to the cashier, or "No, don't do it!" if we do something he disagrees with), his predilection for gas stations and chain restaurants. “Cool” made me feel good, and I understood it as celebrating him rather than pitying his difference. I preferred that reaction by far, to “I’m sorry".

Sunday, March 13, 2011

Thoughts on urogynecology

Urogynecology is like urology, but for women.

For the purposes of urogynecology, you are your vagina, your prolapsed uterus. In all fields of surgery, you are draped and covered, with only the relevant part of you left bare, clean and sterilized. I am all for humanistic medicine, the idea of treating the whole person, but in surgery, I find it comforting rather than objectifying, that the person is removed from the procedure, while their organs and pathology are front and center.