Saturday, October 1, 2011

Fair's Fair

"Fair" is an important part of "fair warning". Yelling "Fore!" as your Titleist 3 ricochets off an unsuspecting golfer's head doesn't qualify. That would seem to be too late to aid anyone and, while the "warning" portion still applies, you lose the implied utility of providing not only helpful information but also a chance to make use of it. You are giving the warned party time to react, and that's important. Imagine what Abe Lincoln could have done with fair warning. Probably retained a good bit of his brain matter, would be my guess. And so it was that on my first overnight call on Labor and Delivery, the nurse midwife pulled me into one of the labor rooms the moment I set foot on the floor. Knowing my past predilection for wooziness in such situations and this being the first time I would view childbirth, I gave the midwife fair warning as I donned sterile attire. "You told us during orientation that usually one student in every OB/Gyn rotation group faints during a delivery. I'm Aron." I also told her it was more a possibility than a certainty, but that's less fun. We covered proper protocol should such a thing happen and off we went as the patient was fully dilated and starting to push. This week on Flash Gordon: Can our intrepid hero overcome the threat of vasovagal response and stay on his feet during the live birth of a human child? Yup. Shoot I blew the suspense so I guess I wasn't made to write old timey radio drama after all. Objectively, the proces of childbirth is disgusting and I'm fairly certain I don't need to explain in detail the reasons why. Yeah, I've heard the fluffy arguments about how The Miracle of Life trumps the rest of that stuff, like the smell. There is a distinct smell that goes along with childbirth that isn't so much offensive as it is the smell of someone caramelizing the top of a creme brulee but utilizing a pile of old car tires instead of a ramekin. It turns out, though, that there is actually something slightly magical about the whole process though and it does indeed trump the various offenses. So the midwife delivered the baby, I delivered the placenta (gross!), and no one got hurt or wound up face down unconscious in birth materials. I can't say I was looking forward to OB/Gyn. In fact, of all the rotations lined up for the year, OB/Gyn was the only one I approached with apprehension. Six weeks later and it turns out I rather enjoyed the rotation, enough that I'd almost consider OB/Gyn as a career choice. The chance to do both clinical work and surgery is enticing and women's health is a neat field. Consider one particular case I participated in on an overnight call. Retained placental tissue caused bleeding in a mother As the 71-year-old attending continued working to remove the offending tissue, he recognized the need for more serious action and ordered blood and blood products as well as paging the surgical team in. By the time the operating room was assembled and the patient prepped, an hour and a half had passed with the patient missing well over a liter of blood. The attending decided that it was too late to do anything but an emergency hysterectomy and since he's old school, he did so without electric cautery, opting instead to ligate everything with suture material. By 2:45am, surgery was over. Because the attending ordered blood early, the patient got necessary transfusions in a timely manner during surgery. What was a perilous situation for the patient resolved successfully due to the calm anticipation and diligence of the attending after midnight. Cool stuff, OB.

1 comment:

  1. glad you're enjoying it man. keep on it!