Was that my alarm clock making that noise?

May 4, 2008 at 9:49 pm (Clinical rotations)

I started my obstetrics and gynecology rotation this week. Hence, why I have not been able to post anything in quite a while. The hours are a lot like surgery: I get up around 4:00 a.m. so that I can make it to the hospital by five o’clock. I’m usually there for about 12-14 hours. I then come home completely exhausted, study what I can in what little time I have remaining, and then fall asleep into an almost coma-like state. I worked all seven days this week which, after I get through the next week, I will have put in 13 days in a row. I worked more than 80 hours this week. And while that may seem like a lot, given that my residents were always in the hospital before I arrived and after I left, I am certain that they were putting in close to 90-100 hours.

My previous rotation, family medicine, spoiled me with its relaxed work schedule. I would get up around 8:00—8:30 if I didn’t feel like going in—and then would spend a leisurely eight hours in the office before coming home and chilling out for the rest of the day. Since I had had the bulk of the third-year curriculum prior to starting family medicine, outpatient primary care was a breeze to me. I never bothered studying; in fact, I only spent three days doing a half-assed attempt at practice questions so that I can get ready for the shelf exam. But now that I’m on ob/gyn, everything has changed.

When I woke up at 4:00 a.m. on Tuesday morning, I heard the awful sounds of a siren that for a few seconds I was convinced were coming from outside my window. I figured that an ambulance must be running down my street to bring the latest victim of a shooting to the nearby hospital. When I finally realized that the sound was coming from my own alarm clock, I was greatly annoyed at the misfortune I would have over the next six weeks.

Ob/gyn residents are a lot like surgery residents: they have terrible hours which violate federal work-hour rules, they get greatly annoyed at medical students and have a short temper, and they are so stressed from the work that is constantly dumped upon them by the hospital and the attending that I’m surprised one of them has not brought a gun into the workplace yet and started shooting up the nurses station.

We try to break the monotony in this rotation by allowing students to work shifts in the emergency department, catching gynecological cases. I’ve mentioned before that my hospital serves as an urban walk-in clinic for many of the uninsured people of my city. In the past week, I have seen the 6—SIX!—people come to the emergency department solely to get a pregnancy test. They had no other complaints other than wondering whether or not they were carrying a baby. My resident, my new hero, tried to explain to these women that a trip to the emergency department costs almost $1000 for all of the laboratory work and eventual ultrasound that we would perform. These women, with their glazed over looks, just brushed off the notion that they should ever have to pay for health care. Two of them even became annoyed when my resident suggested that they could go to Walgreen’s and purchase a home pregnancy test for $10. One replied, “I just don’t have enough time in the day to go to the drugstore!” To which my resident replied, “Didn’t you just spend three hours and our waiting room? Driving to the drugstore, purchasing a urine pregnancy test, and then driving home certainly takes a lot less time.” But then again, why should any of these women care? Health care is free after all. Having the latest cell phone is more important than having insurance. And hell, while we’re at it, let’s not bother trying to use birth control to prevent another pregnancy anyway.

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8 Comments

  1. SusyCat said,

    Wow, sounds like family medicine is the way to go…makes me think twice about being interested in ob/gyn.

  2. Miami_med said,

    Ah, but it only gets worse. You ain’t seen nothing until you’ve had the pleasure of an urban GYN clinic. Good luck with that *** Thanks God he got that rotation out of the way first***

  3. Anonymous said,

    Half– know that many do appreciate you! And they will later, if they don’t know.Pregnancy makes us weird. Probably many of these women will grow out of whatever mental state they are in. Be wonderful to them– you never know when they will look to you and say, “I want to be like that.” Don’t turn them off of the educated!

    17 years ago I was divorcing my ex husband and I got pregnant by someone else several weeks later. (I did not understand why at the time I was with someone so soon– I was 20 with two children. I knew how I looked and the doctors were looking down their noses at me every time they looked my direction. The guy I was with? I’d tried to leave my abusive ex before– I had to “dirty” myself to get my family, his and him to get the point that I just wasn’t into him!) One night my best friend couldn’t sleep and she called another friend. I’d been bleeding earlier that day but wasn’t worried. I was only eight weeks along and she, the daughter of a medical malpractice lawyer, was not feeling right about this. She called me and our other friend was going to watch my kids and she was taking me to the hospital.

    We got to the hospital around 2 or 3 AM and the nurse, seeing my age, everything about me, two kids, etc. was rolling her eyes at me. She actually asked me if I didn’t have state health care if I’d be there and my gf said, “If she didn’t have me she would not be here.” No cramps, no problems other than a little bleeding– the nurse actually told me that I was probably miscarrying and that it was a good thing! I started to cry– my baby had a name and a personality. I regret that I didn’t slap her for her expression. I wanted to leave but the nurse also told me not to. My friend’s dad called the hospital and told them who he was and to be nice to me or I would leave. (All the medical people laugh! They went silent at me but at least I didn’t get any more eyeball rolls.)

    I waited until a u/s tech came in at 7AM. I had an ectopic pregnancy that was possibly hours from bursting. No signs other than a little bleeding that worried my best friend. She was with me when they saw it and the tech ordered an IV and wanted to get me out of his room. Of course– I wanted to go home and get my kids ready for preschool so my friend could go to work and they were hooking me up to IV’s for an operation an hour later. They said that they’d have not wanted to see what would have happened had I waited an extra day. It was that close.

    They apologized to me for not realizing how serious it was and then started asking my friend how she knew something was wrong– in retrospect, did she think that I had been walking oddly as if to accommodate pain? Did I seem like I was hurting? None of that. It was just her intuition.

    I was on birth control when I conceived that baby– I would later marry a great man who is a super husband and father and we didn’t plan any of our children. (We have more than 5.) I’ve had my tubes tied but I still use condoms and birth control pills and NFP because for whatever reason, my body adjusted to whatever I was using. I’m paranoid about getting pregnant. I’m in school with a huge family and I freelance.

    My doctor with that tubal– he was a huge inspiration to me. I was working on an associates degree and he was like, “What do you want to do? Why stop with a two year? You aren’t one to sit behind a desk polishing a seat with your ass! You’re smart!” I would be single for a few years and we’d discuss sex and valuing my body. He’d deliver four more children for me years later– after I remarried. He came to those baby’s baptisms with his wife.

    Always treat these women with respect and dignity. It may be the only brush with civilized people they have. Treating them badly– that enforces that they are lowlifes. Build them up with the short time you have with them!

  4. Dragonfly said,

    I agree with what anonymous said regarding using the short time you have with people.
    And I start obstetrics next week….hope my body learns to cope – I have been VERY psychologically attached to my pillow this year with some horrible post viral fatigue.

  5. mo said,

    You need to start practicing facial expressions in front of a mirror. Get a friend to pretend to be what you judge negatively and watch how your face changes.
    If you can learn to master that expression you will be a little amazed at how much more compliant your patients will become.
    When you are judging someone they are judging you too and that can create needless stress and aggravation.
    It’s imperative that you minimize any possibilities of stress or confrontation at this time. You just don’t have the available energy for it.
    You need to be able to let things slide emotionally the best you can and the sooner you start to practice this skill the better you will get at it.
    Docs that are relaxed , easy going and can control their reactions to the negative have an easier time getting through residency and they have fewer emotional scars from it. The moment you judge someone you have invested in them emotionally, that means they can now hurt you.
    Skip the judgment , the investment and they can’t.
    It will make you more open to new stuff and that can keep you interested and cheerful and that openness means your patients will give you a break, mostly.

  6. gynecology said,

    Obstetrics and Gynecology, estimated that over half of all pregnant women in 1990 had undergone diagnostic ultrasound, yet research published in the New England Journal of Medicine suggest that 80 percent of all pregnant women are very low risk and do not need ultrasounds.

  7. MG said,

    Four words: Dollar store pregnancy test.

    It’s the same beta-hCG test available for $10-14 at the drug store. Different packaging, same sensitivity.

  8. Griffin said,

    MG – EXACTLY! People who take HCG as a diet aid or fertility drug get all their tests at dollartree and other stores.

    A lot of clinics get theirs in bulk for less than a quarter each — I’ve seen them in the same box!

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