Thursday, August 28, 2014

Obstetrics and Gynecology - A Review


I need a break from studying for my ObGyn NBME Shelf exam (it's tomorrow morning), so I'm going to give a recap of the ObGyn clerkship. You might be surprised by what I have to say (or, if you're an Obstetrician, Gynecologist, or one of my classmates who just completed ObGyn with me, you might not), but to sum it up - it was awesome. Really cool stuff.

I wasn't expecting to like it nearly as much as I did. No, I haven't decided to go into ObGyn. Yes, I'm still pretty undecided on what I want to do with my life (Emergency? IM? Family? ObGyn? Surgery?). Luckily, experiences shall abound in the remainder of my third year of med school.

Okay. So ObGyn was an amazing experience - especially in comparison to M1 and M2. I mean, sitting still and learning in lectures, then sitting still and studying from books/notes/coursepacks is fun and all (I mean it - I actually enjoyed didactic learning!), but nothing really beats getting to be immersed in a real patient care environment. Especially when stuff's happing - and stuff HAPPENS in ObGyn. Most of the time. There were a few lulls (mostly on nights when half the people are trying to sleep thanks to their epidurals), but there was almost always something to talk about, something to see, or at the very least something you had just talked about or seen that you had to then go read more about.

One thing I learned was that vaginal lacerations give me the heeby-jeebies. What's the technical term for that? Oh yeah - The WILLIES. Everyone knows they happen more often than not, especially the first couple of times a woman delivers. It's not necessarily the reality of them - once they happen, they're just something to repair, no problem *dusts off hands as though he's the one doing the repair instead of the resident or attending*. Rather, it's the waiting, when you're not sure how extensive the laceration is going to be. The baby's head is crowning, straining the perineum, the bridge of the nose just barely peeking into the world... It's that moment, right before everything releases. That's the moment that causes the most tension within my chest, and it really takes some getting used to.

Suffice it to say that I really don't blame the mothers when they decline the offer of a mirror.

Keep in mind, I'm not a squeamish guy. My mom had to hold me back so I wouldn't get in the way when they were setting my younger brother's arm after he broke it when we were kids. When I was younger and got shots, they always had to ask me to keep my head back so they could see what they were doing. I was that enthralled. Anyway, I'm not squeamish, but I never thought I would enjoy the operating room as much as I did. For those that don't know, Gynecology is pretty much a surgical subspecialty. They do A LOT of surgery. Hysterectomies, oophorectomies, tubal ligations, exploratory laparoscopies for endometriosis, vaginal vault suspensions, urethral slings, dilatation and curettage, etc.

So yeah. I'm not 100% sold on ObGyn, but General Surgery might be on the table now - I liked the OR that much. Just not so sure right now about the lifestyle. We'll have to see how my surgery rotation goes in January. Wife really doesn't want me to pick ObGyn or Surgery because of the demanding lifestyle. In her words: "Just please don't. If you do, I'll support you. But please don't."

But back to my recap. I delivered 14 babies and participated in 12 Cesarean sections! I also assisted in 18 major and minor surgical procedures. I got to see robots being used in surgery. I practiced my knot tying and learned to close bellybuttons and low transverse abdominal incisions (skin only). I learned a lot from people, experiences, and books. And practice questions. I've done about 450 questions w/explanations (about 150 of which I've done a second time), and I have about 50 more to do tonight before I'm done. Just took a practice exam and passed, so I'm optimistic about tomorrow morning.

So what do I NOT want to forget? Here's a short list:

  1. How it felt to hand the first baby I had ever delivered to his/her parents, and to then see the looks of joy on their faces. How that look was repeated with every set of parents in every delivery.
  2. How hard the residents work! For everyone that thinks med school seems hard, just check back in two years. Then, if I'm anything like the amazing residents that I've been learning from the past two months, you'll see something truly impressive.
  3. The moral considerations I wrestled with surrounding the management of the most complicated cases, and the conclusions that each physician must come to for him/herself.
  4. Wondering in my head about which fathers will cry, get woozy, or do really well - and almost always being wrong.
  5. Seeing the doctors and everyone else work as an amazing, fluid machine when managing an emergency. I have so much respect for everyone in healthcare and what they do together for their patients.
  6. How much I enjoyed everything (minus waiting for vaginal lacerations to happen).
  7. The huge awe I now have for my mom and all the other moms out there, having glimpsed what they go through. And thus, the never-ending respect and gratitude I will one day have for Wife if she gives birth to any of my future gangly-limbed kids. Those will be some mad props.
That is all. Back to the practice questions. Wish me luck tomorrow!

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