Sunday, January 31, 2010

Getting Sad (and Happy)

This is my last week of my Ob/Gyn rotation. I really can't believe how fast it has gone by. Jake arrives on Thursday so I am very excited about that! We are celebrating Valentine's Day early and we got a room downtown at a swanky historic hotel. We also have dinner reservations at a nice steakhouse, so it should be good. We are planning a trip to Barnes and Noble since it just might be our favorite thing to do.

This last week, I had a bunch more deliveries, a ton of surgeries where I have learned to put in a trocar. That is scary. Way scary. Like palpitations scary. I had three deliveries in one day with Dr. M. By the last one, he wasn't even standing near me during the delivery. It made me feel good that he was trusting me enough. One of the earlier deliveries had a double nuchal cord (cord wrapped around neck twice). No matter what I did, I could not get that cord unwrapped. The nurse kept yelling "the cord is still wrapped the cord is still wrapped." I'm thinking "Lady, do you think I can't see that? My heart is about to come out of my chest I'm freaking out so bad. I do not need you to remind me every .25 seconds." Good grief. Anyways, I got it all unraveled. That was scary though. The baby is totally fine.

I had my evaluation on Friday. It went really really well. Like I was on cloud 9 afterwards. And they helped me start to sort out my big dilemma on residency.

Alright, hopefully I'll have some good stories this week.

Sunday, January 24, 2010

Amazing News

I have received official permission that I can do 4th year rotations out in Colorado starting the week after Thanksgiving. That is under a year away. Excuse me while I jump up and down over and over. I have a lot to do between now and then, so hopefully the time goes by very fast, but I must say that it feels amazing to have an actual date. This means I have to get all my rotations set up and figured out on my own. I have some time though to get it all figured out.

At that point in time: it will be 4.5 years that we've been long distance. I'd say we've earned it.

Tuesday, January 19, 2010

Let's Talk About My Day in the Office

There were no deliveries today so I spent almost the entire day in the office (one surgery). I would like to give just a few highlights from my day.

Positive pregnancy test in a 14 year old.
Positive pregnancy test in a 45 year old.
(yes you read both those numbers correctly.)

A teenage pregnant girl came in for her first ob visit. She's already over halfway done with the pregnancy which means she came in for late care. On the first visit, you get a pelvic exam. Well, I was trying to get the speculum in when she starts to close her legs, lift her butt off the table, and say "I can't do it I can't do it." What does the dr say? "If you can get a penis in there, you can do a speculum exam." Thank GOD I wasn't looking at anyone because my head was between her legs, because let me just say I hate to bite my lip so that I would not laugh.

I had one surgery today with Dr. M. I thought that I would just observe since it was a hysteroscopy and laparoscopy and the surgical assistant does the extra work. Nope, I took her place and did the work. I was so excited!!!! He invited me to do an oophorectomy tomorrow at a different hospital. I'm pretty happy since I haven't seen one yet.

Today, at the OR, the surgery manager came up to me and said "You are going to make a damn good OB." It was totally out of the blue and made my day :)

I have two inductions tomorrow in addition to my surgery so hopefully I will have more stories.

Sunday, January 17, 2010

Soaked with Amniotic Fluid

It's Saturday night around midnight, I'm laying on the couch reading, thinking I'm getting tired and it's time to go to bed soon. And then my phone rings. Lady in labor, plus someone who has been induced. I quick change and head to the hospital. Lady 1 is a primip who is almost complete, but she has this tiny lip on her cervix that won't get over the baby's head. Dr. V pushes it over while we hear a chain of obscenities come from the lady's mouth. All of a sudden, the baby starts moving down really fast and her pushes are good ones. (Yes there's a difference between a good and bad push. You want to push like you have to poop, but many women think they're going to poop so don't really do that. Oh yeah, and there's often pooping involved. Gross.) I get gowned up and sit on the foot of the bed. I get the baby out, hand her over to the nurses, and start working on the placenta. We have to draw blood out of the umbilical cord to send to the lab. Each doctor does it different and how I was taught was to drain it into the tubes. Here, they take a needle and syringe and draw it out from the cord. Well, I'm not very comfortable or skilled at this. LOL. I poked a hole through the vein and the poor lady had a nice splatter of blood all over her. Oops. Anyways, I get the placenta out and go stand up to take it over to the bin. This is when I realize that my ass is soaked. Now since I'm positive I didn't pee my pants, there is only one thing that I could be soaked with-amniotic fluid and blood. Here's the worst part: I can't do a damn thing about it until I'm done. So finally, a half hour or so later I get to change....have to go commando because my underwear is also soaked. Sweet.

Alright, lady 2 is not progressing very well and her blood pressure keeps spiking, so Dr. V tells me I can go try to sleep in the on call room. Well I tried, but it didn't work out very well. Around 6:30 I get up to go see what's going on. Lady 1 has a hematoma which needs to be evacuated in the OR. Ladies and gentlemen, her vulva was the size of a grapefruit. So we get to the OR and the chunks of blood that come thing this kind of stuff doesn't bother me.

We finish up with her and go check on Lady 2. Unfortunately, she is just not progressing well enough so we offer her a c-section. It is now 9 am. I came in at 12:30 with half ass sleeping involved for 2 hours. I'm exhausted. We're ready to start surgery when Dr. V hands me the scalpel. "Ok Jen, time to get that brain moving since you're about to cut into a woman." That's enough to wake up someone. Anyways, I got the baby out but it was difficult because he was kind of big and his shoulders were tough to maneuver. I did a lot of suturing although I was much slower than normal. After surgery, Dr. V offered me the opportunity to go home and sleep. I snatched that up really quick.

So here I am, back on the couch waiting for a phone call because there is one who is about 5 cm and I just know it will be another late night. I took a 4.5 hour nap so hopefully I have enough brain power to deliver a baby and not get soaked.

FYI- when I say ladies, for the most part these women are under 25. Once in awhile, I'll get an older lady.

Any questions?

Saturday, January 16, 2010

I Keep Getting Better

Since I'm in OB right now, and I'm kind of obsessed with it, I am going to have a lot of posts about it. Hopefully the stories won't be too boring. Yesterday was a pretty good day. We started out with a c-section. She was 18 and it was her third baby....I'm not even kidding. Anyways, we're all set up and Dr. V hands me the scalpel. Lub dub lub dub. Yeah that's my heart pounding. I said in a super professional manner "For real?" And she responded with "Just cut in a straight line." Ok...I did. Phew. Alright, she made the rest of the cuts through all the layers. She popped the baby's head out, and told me to do the rest. So I suctioned him, pulled the cord from around his neck, pulled him out, cut the cord, handed him over to the nursery team, and pulled the placenta out. That's a lot more than the previous c-section! Oh yeah, I sutured her up quite a bit too. So exciting! If I get to keep assisting in c-sections, I imagine that I will be a lot better in three weeks when I finish this rotation.

Wiener wacker is back- I did my second circumcision. I did the entire thing with a few hints from Dr. V. The scariest part of all of it...there were three nursing students observing. I was very grateful that I had already done one. I'm not sure I could have handled cutting foreskin with three observers.

And some very exciting news! I have an audition rotation set up for a residency program in Cincinnati for October. My rotation will be in maternal fetal medicine; in other words high risk OB. I got all the paperwork today in the mail confirming everything, so I'm very excited. It's so hard to believe that this year will be spent figuring our residency stuff and that in a 1 year and 5 months I'll be a physician. Damn....

Thursday, January 14, 2010

My First Week in OB

As you have probably gathered, I'm pretty sure I'm going into OB/GYN. So I am very very excited to finally be on my ob rotation. My first week has been fantastic. Tuesday, I had a c-section, and I got to suture up and that night I had a delivery which I did everything up until the baby needed to get out because forceps were needed. he pulled out the baby then I delivered the placenta which I have previously written about. There were two more ladies in labor when I left at 9:30 pm that night. My phone rang at 4:05 am with news that lady 1 was at 9 cm. I busted my butt to get to the hospital but because she was a primip(first baby) she took a really long time. That baby was born until 7:15 am. This lady required an episiotomy. This was the first one I had seen. Holy shit....I really hope that I never need one some day. Her mom, who was holding a leg, saw the whole thing, her eyes got huge, kind of rolled and then she looked at one of the nurses and said "I think one of you needs to come hold her leg." She almost passed out. So because of that, the dr had to deliver this baby too, even though I did all the 3 hours of pushing. Again, I was on placenta duty.

Lady #2 didn't really progress, so she ended up ina c-section last night. I actually was excited because I really like doing surgery and it's more experience for me to practice in the OR. Dr. V let me pull the baby out, which I have not done yet, so that was very exciting for me. I also got more suturing practice. So we get into the PACU, and L&D calls saying our 15 year old girl is complete. Yes I said 15. Her BF was too. She did not get an epidural because the anesthesiologist was in the OR with us. When I walked into the room, the only way I can describe her is that she was thrashing around the bed. Oh was I in for a real treat. We kept changing her position, and with that we had to keep moving the bed around. Anyways, I ended up delivering this baby (by myself!!!) on my knees. I found the entire delivery pretty amusing and was kind of laughing in my head from the things she was saying to just the entire situation. When this girl is my age she will have a 10 year old. Unbelievable.

Today I went back to go say hi to all the new mommies. C-section mom is so excited to see me and asked if I got to do anything new in her surgery. I told her that I was got to pull her baby out and that it was my first time. Her and her mom were just so excited for me. She asked me my name so that she could tell her son that he was the first baby I pulled out. I thought that was sweet. 3 hour pushing lady was happy to see me and is really sweet to me. 15 year old mommy doesn't even know who I am. I told her that I delivered her baby last night and she honestly did not know that. All I can think Teenagers, please close those legs.

Wiener Wacker

That's what my mom has started calling me. I did my first circumcision last week. I kind of knew it was coming so I told Jake the night before that I might be doing one. He narrowed his eyes, looked at me and said "Be careful." LOL....I was careful and didn't cut it off :) I have to admit I was pretty nervous. It's a pretty small place to be cutting. For those who don't know, we do numb with a little lidocaine. We also give them Sweet Ease which is a sugar water that we squirt in their mouth. I love how they smack their lips when we give it to them.

I realized that I write a lot about wieners. Hopefully my readers don't mind.

Update on that Keloid I Cut Out

The pathology report came back and it was squamous cell carcinoma! I'm pretty sure that I would not have been able to do that entire procedure had we known. Anyways, the margins were clear so that means I did a good job!

Monday, January 4, 2010

I Love Cutting!

Today, I went into the clinic to work with Dr. M (one of my fave docs to work with!) since Dr. B was off. She had a procedure schedule to remove a 1 inch keloid from a man's lower abdomen. Basically, she told me I was going to do the whole thing while she assisted. I numbed him up. She showed me what margins she wanted on the incision, and then handed the scalpel to me. I did the entire procedure and it was so exciting! I was actually relatively calm and my hands weren't even shaking (yes I know that's a good thing). I did some of the sutures, but since I'm still a little slower at them, she did a bunch to keep us moving. I'm actually really proud of my handiwork today. I've done cutting, and surgery and all, but today's procedure was all mine. Dr. M complimented me and said that it was excellent. Woohoo!

I'm Too Harsh (apparently)

This week I am working with Dr. B who I worked with previously in Colorado. This week she is on call at the hospital, meaning she sees no patients in the clinic. All the deliveries and admissions for this certain network, she takes care of. She asked me to work with her so that I could get more experience in the hospital. I had to work yesterday. We start at 7:15 and the hospital is an hour away....early mornings suck. Anyways, we had a bunch of admissions and discharges. An elderly man was admitted in the afternoon to the ICU for shortness of breath due to COPD and congestive heart failure. Well, Dr. B wanted me to go do his admission history and physical. I was warned ahead of time that he was grumpy and not very kind to the nurses. I went through a detailed history and physical. He kept telling me that he just wanted to die, blah blah blah. All was well, until the end when the following exchange went down:
Him: I suggest you get trained in something different.
Me: That's not very nice.
Him: Well, do you want me to be nice or honest?
Me: Hmmm, honest.
Him: Well you are too harsh in your approach.
What I'm thinking in my head: Well, I could hold your hand and sing kumbaya. Why on earth did you call 911 if you just want to die?
Yeah, I know...totally out of line, but come on. I don't want to toot my own horn, but I am a really nice person and am sweet to my patients. The nurses happened to walk in right before he said all that to me, so they quickly told Dr. B that I did a great job and stuff. When Dr. B went in and saw him she told him that she didn't appreciate him being rude to me and that I was just doing my job. He told her that I asked too many questions. LOL. I know that I'm not harsh, and it's the first patient who has ever said something rude to me like that, but it still bugs me a bit. Dr. B told me tht he's full of shit because she's worked with me extensively and that I'm one of the nicest people she's worked with. So I got a really nice compliment from a dr, but I had to get a rude comment from a patient in order to get it.

I will probably be seeing him tomorrow. Shall be interesting to say the least.

New Years and a Weekend With My Family

Me and Jake before the sleigh ride.

The Nativity Scene my parents gave us for Christmas. Notice that Joseph is missing. He was crushed, so Mary was a single mom for a bit. We now have a new one who is in much better condition.

On Thursday, my parents flew in. We spent New Year's Eve dinner at Five Guys, but then Jake had to run into work because of a power blip. My dad and him ran down to Boulder, while my mom and I stayed home and had a few jello shots. Jakester and my dad got back a few hours later and we rang in the new year.

On Friday, my sister flew in. I spent the entire day baking an insane chocolate cake for my celebrating my dad's birthday. Everyone had a bad cold except me and Laura, so we all kind of just chilled out.

Saturday was a super fun day! My dad and I ran to Hertz to go get the rental car that we shared. I need a car for the rest of the week since I have to drive so far away for my current rotation. Then we went up to Estes Park for lunch. I found out that my favorite costume jewelry store closed. I'm so sad :( . Then we went on a sleigh ride. It was pretty fun but kind of short. Afterwards, we drove up to Bear Lake to show my family one of our favorite places to go walk around. It was snowing, but was still beautiful!. For dinner, we went to the Melting Pot and as always it was just fricken amazing. Yum Yum.