Cervix

Last week I finished 6 weeks of my first rotation of 3rd year: OBGYN.

It was more challenging yet invigorating and motivating than I imagined.

Let’s start at the weekend before my 1st day. After our orientation July 2, I made my way to Seattle for a surprise birthday party for one of my dear friends. His brilliantly talented girlfriend started his birthday toast with a story about her cat named Cervix.

This is Cervix.

IMG_4306

The story was endearing & heartfelt, but I didn’t realize until the following Monday that it also served as a prologue to my next 6 weeks and my quest to find the cervix. I’ll leave it up to you to refresh yourself on the anatomy, but I didn’t realize how something so easy to identify could be so challenging when baby’s head is smashing down on it. As a mother approaches term, the cervix flattens and softens, but it’s a small piece of anatomy and a small space – how hard would it be to navigate? This assumption was mistake #1. I felt nothing on my first few exams, but as I continued to be confused about what I was or wasn’t feeling, I quickly became frustrated. At one point, I don’t know what was harder – figuring out what I was feeling or trying to hide my confused face to the patient while I was doing the exam. I was unnecessarily hard on myself after several failed attempts, and it was easy to feel inadequate when the doctor, nurse and patient looked at me expectantly after finishing my exam, only for me to look sheepish and give the quick shake of the head no. The turning point started when a nurse dusted off the “vagina in a box” teaching tool.

Vag in a box

Not to mention the several very patient nurses coaching me through each exam – and of course, all the forgiving patients who encouraged me to basically stay the course during an exam until I found it. At about exam 25, I felt it more clearly (and more posteriorly) than I ever had and it’s been a relief for everyone since.

My preceptor was fantastic. On my 2nd day I scrubbed into an urgent c-section and also had a woman present in labor after a full day of seeing patients. Wanting to see the whole process, I stayed at  the hospital that evening to see all the steps leading up to the birth. At 2am, the nurse and I started a trial of pushing with the patient. As I held one of the legs, and the delivery was quickly nearing, the doctor walked in.  Having not yet seen him perform a delivery, I thought I would watch and assist however I could. Instead, he immediately told me to gown up and sit down. I was excitedly terrified – so focused, yet everything was a blur. He guided me through the entire thing and before I knew it, I delivered my first baby and tremulously (!) completed my first laceration repair. And the rotation didn’t slow down for the next 6 weeks. In total, I completed 15 vaginal deliveries and whatever repairs were necessary, and assisted with 10 c-sections with varying degrees of responsibility. It was intense. And I loved it.

It surprised me to have liked the gynecological aspect as much as I did – this specialty is much more than delivering babies. Women’s health is such a fundamental, yet understated, aspect of health & well-being. And it’s extremely vulnerable. I felt such a privilege to be a part of helping women with infertility to incontinence, and everything in between.

Some reflections & lessons learned from OB:

  • It’s easy to feel inadequate. I felt like an idiot ** A lot ** I had to keep reminding myself that not only was this my first in-depth exposure to OBGyn, but it was my first rotation EVER. And I’m a student, not a resident. It’s easy to think that it’s your job to advance your skill level to that of your preceptor and the nurses — especially with a specialty you love.  I was pushing myself hard to make sure it’s wasn’t just a “honeymoon” phase of ditching the classroom for clinicals. Regardless, I had to remind myself (& be reminded) those skills take years to evolve. And while it’s important to develop as many skills and learn as many things as I could, at the end of the day, I was still trying this specialty on to see if it fit me, and more importantly, I still had a shelf exam to pass at the end of the rotation, so I couldn’t get too bogged down in the “doing” of medicine.
  • Not every delivery is a feel good moment, and there is a lot of heartache that comes with this specialty. This hit me the most in the first week when immediately after I delivered a healthy baby girl, we went directly to the operating room to perform a D&C for a woman who had miscarried for the 3rd  time. The quick transition from the “high” after a healthy delivery to being present and comforting to a woman who was scared and sad, and delivering a baby that didn’t make it, was an important learning point that can’t be taught in the classroom. As challenging as it was, I walked away wanting to be there just as much for the woman who delivered the healthy baby as the one who was repeatedly experiencing unexpected loss.
  • The special moments in the Dr/patient relationship. Most c-sections I watched were planned and the women would receive spinal anesthesia after being moved to the operating room. It was here that I witnessed one of the most tender and compassionate moments between the surgeon and patient. Here is this woman, nervously excited for the delivery of her baby, being asked to sit hunched over her full term belly, perfectly still, for an uncomfortable procedure in a room full of surgical equipment and surrounded by gowned and masked people bustling about. The surgeon walks in and holds the woman’s hand as she folds over her belly while the anesthesia is placed. He stands close and almost instinctively, each woman would rest her head on his shoulder and he would quietly coach each of them through what they were feeling and provide encouragement and reassurance. And the whole room was quiet. It’s one of the most impactful displays of human connection that I have ever seen and I hope to provide that level of comfort and reassurance to my patients.

Overall, this was a phenomenal rotation and set the bar high for my clinical years. At the end of my first week, I was already feeling disappointment that I would only be doing this for 6 weeks. By the end of the 6th week, I was surprisingly sad that I wasn’t going to be doing this for the next 3 years. I think this is a good sign. We’ll see where the next rotation leads me.

-stacey

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