First Week of OB/GYN

So I've got less than 5 weeks left of third year and my last rotation OB/GYN.

I've been told this is the hardest rotation: long hours, lots of work, busy call, etc, etc.

I'll say this much to begin: It's not the worst thing in the world, haha.

OB is really unique in every regards. They deal with women's health, women's anatomy. Nobody else really deals with this aspect of health care. I mean if someone has a baby or they have issues with their baby making anatomy, it's OB/GYN's turf. Let's run through my days on Gynecology Surgery:

Preround at 6am - This puts me at waking up around 420a so I can have oatmeal and such and get to the hospital. I hate waking up early.

Presentations at 7am - Present to residents in conference room. We present on postpartum patients only so there's usually only 3-4 patients. This takes 30minutes or so , usually time to get a drink/coffee/quick breakfast before attending rounds

Attending sit down rounds around 8am - Attendings show up and we sit in a particular formation. Attendings sit in the comfy chairs at the table. The senior residents sit closest to the table. Other residents flank around and the students sit in a corner on the less comfy chairs , huddled together for support. Residents are the only ones that really talk during these rounds and mostly the senior resident.

OB is all about specifics. Presentations consist of mostly Gs, Ps, postive or negative, immune, bottle or breast fed, boy/girl , birth control, circs. I find it really strange not to talk about age or race which is vital in (internal) medicine.

Once this is done, we all flank out to whatever service you're on. There's High Risk OB, regular OB, Gynecology (Surgery), Reproductive Endocrinology, Oncology and Urogynecology. I was on Gynecology so really I just find surgeries I'd like to observe/take part in. So during this relatively short week, I saw two surgeries : I saw a cystectomy/ex-lap that went for 5.5 hours. We had to call in a general surgeon and resident because of extensive adhesions and bowel issues. They basically ran the show, mobilizing bowel to get to the cyst. The bowel has to be resected because of adhesions and whatnot. Ordinarily, such a long procedure would bore the bejeezus out of me but I was able to help as the unofficial circulating nurse, grabbing supplies and making calls while the real circulating nurse was doing stuff. Oh, I also had some precious duties which I'll enumerate:

Alcohol washer - The general surgeon perforated one of his gloves so I had to grab some alcohol and pour it over his hand over the dirty bucket without breaking sterile field.. as I was not scrubbed

Beeper retriever - The GYN surgeon needed me to retrieve her beeper, underneath her gown without breaking her scrub. That was precious.

Glass pusher upper - The surgery resident who I knew pretty well having worked with him on general surgery would occasionally and nicely ask for me to push up his glasses on his face. On one occasion he nodded to me to say "sup" as the surgery went on forever and I mistakenly took that for a cue to nudge his glasses up, that was a little awkward.

Gown untier - When scrubbing out, it's customary to help the attendings/residents get out of their gowns

Beeper caller backer - Occasionally when others are busy, I have to call back pages and say Did you page so and so? And then find out what they wanted and relay that to the attending/resident.

1 hour left and the general surgeon and resident dipped out, the GYN surgeon says: well Dr. Abdullah, go ahead and scrub in, I'm going to need some help. Now, I like scrubbing. Not the idea of suturing or doing surgical things, the actual hand washing. I don't know why this is but something is fun about washing your hands in this giant sink , not being allowed to touch anything. It's almost like hot lava except the lava is everything else besides the air above your waist.

After that, you have to hold your hands above your waist and use your glutes to open doors. There are two main ways to hold your hands above your waist.

There's the t-rex and the methodical evil genius finger positions.

T-rex hands: Hold hands above waist but not together avoiding touching ANYTHING

Evil genius/pensive pose: My variation is slightly different, I don't hold my arms so close to my body and I don't collapse my fingers inward , leaving them up like a tepee but I do have the evil genius look especially behind a mask and sexy scrub cap.

Anyway, I assisted with closure. I suctioned using the Yonker and kept tension on the sutures to close the midline incision. Then I totally placed some kick ass staples.

The next surgery I observed was the next day; it was a robotic hysterectomy. This was kind of neat because there's several monitors that show what's going on. Basically, one doc sits at a terminal and operates the robotic arms and the other assists by directly placing sutures into the trochars or manipulating certain things. Two things stood out about this particular surgery.

A. The robotic hands that are the DaVinci robot. It's like they made a miniature version of Doc Oc's arms and let them run the surgery:

and B. The pulling out of the uterus via the interoitus is like watching that dude rip out the heart in Indiana Jones. Especially when the dialogue went like this:

Second doctor: So I guess we'll have to cut the uterus in half to pull it out.

First doctor: No, I'll just pull it out

[everyone takes a few steps back]

First doctor : grabs the uterine manipulator and tugs , tugs some more and

WHOOSH .. it's out

I also learned that the porn industry borrowed the pelvic muscle trainer from work done by one of our attendings. Apparently, Kegel exercises are not only good for stress incontinence but for sexual performance as well.

Lastly, my first night of call was amazing. Not much happened at night, there was a fourth year student rotating with us and this particular resident doesn't page students. Too bad my other 5 are with the hardest working intern, ever.

5 weeks and counting.