Day 4 - Meeting Dr Jan

So today was the first day of our rotation. We set out to find Joy Hospice and our attending , Dr Jan.
http://www.mbalehospice.org.uk/
Read through the website, it's pretty amazing stuff.
So of course we got lost en route. We tried to cut through the regional hospital as opposed to turning right at the little clock / turnaround .

* will include day 4/5 stuff *

Joy Hospice is a special kind of place . It's a mixture of a mini hospital with ten "ward beds " and outpatient clinic . The kinds of patients I've seen in clinic this far :

Ward

Infant with diarrhea illness treated with ORS and zinc 

Older lady with spondylosis and uncontrolled htn 

Young gentleman with wasting / fatigue found to have AIDS, cd4 count in 100s. He's been having some hypotension . He's also complaining of nausea and weakness  . My theory was that he could have an element of adrenal insufficiency but without a Chemistry / cosyntropin/ cortisol level, it's hard to prove . My c.o. Was amenable to trying steroids though :) labs cost money to patients in clinic   . HIV testing is free when available but we have to pick the best test for the money so this far he's only had a cd4 count .

2 different ladies wi asthma exacerbations. One lady came in with hypoxia and severe distress , was given steroids and only two salmuterol treatments which ....blows my mind. Needless to say I requested at least q4 treatments , with Ashley and Courtney in agreement .

Outpatient 

Young girl with fever / abdominal pain = typhoid and uti ( cipro for both)

Older gentleman with tendon pain and early satiety = hpylori positive / pud and partially torn tendon ( a good find on me and Ashley's behalf with a bunched up tendon and obvious deformities when patient lay prone comparing the two tendons 

Young girl with follow up , she had previously presented with significant weight loss / night sweats / nocturnal fevers  / anorexia and had been treated several times for "malaria " without improvement . The person at joy hospice took a thorough history and realized there was a sister with newly dx tb and patients afb came back +++ = newly dx tb. On follow up , two weeks into treatment she looked happy and alert . She thanked the clinical officer for saving her life :) 

So that was clinic so far . I feel very fortunate to be helping and learning . People are referred to joy hospice in times of desperation when other doctors can't help them.  I feel very fortunate to help in my little way and learn from the Ugandan people and our fellow healthcare workers.

I will blog about our clinic staff and dr jan later, since there is so much to share. 

Uganda Trip!

Days 1-3

Day 1
Left Lake Grove at noon. We quickly found out our driver was a conspiracy theorists . His theories included jet fuel as a coverup to distribute an agent orange kind of agent to the atmosphere , that politicians are trying to revert us to feudalism with a ruling class and peasant class ,etc. Good Times.

Flying
Flying and traveling was ...lengthy
Brussels was 6-7 hours / layover then "chilled on runway for an hour " / Brussels --> Rwanda  7hours / layover ( people get off , bug sprays gets sprayed , potties get used approx 1h) then land in Entebbe around 10ish. We stayed at Entebbe Backpackers (http://www.entebbebackpackers.com/) which was a nice little place . Cheap / mosquito nets/ your own shower

We slept over from midnight to 530a then started our journey once again, to our final destination of Mbale , Uganda . We drove in a van half-awake / jet lagged until about noon. Stopped in Jinja (popular tourist stop , site of rafting ) for breakfast @ http://www.enjoyflavours.com/  . Here I learned some rules for traveling abroad from Ashley :

Rules for traveling abroad
1. Eat what the locals eat , which is usually veggie unless you're in a touristy area . Street meats are usually out all day and likely to give you the diarrhea ,etc.
2. Don't order ice , usually . Unless you know the water us treated / filtered (that makes the ice ) .
3. The children will call you Mzungu (http://en.wikipedia.org/wiki/Mzungu) which means white person / with the undertone of meaning someone with wealth / foreigner .
...more to come ...

We finally arrived at our new home around  noon  on Sunday , Palm Sunday .  Since we travelled so early , we got to appreciate Ugandans dressed in their Sunday best carrying palms as they made their way to church. ( kinda looked like below ( from google images ))

Casa del Turista
http://www.tripadvisor.co.uk/Hotel_Review-g668276-d4367873-Reviews-Casa_Del_Turista-Mbale_Eastern_Region.html#

We were greeted by the owner and wonderful host at casa , Baker . Casa is  nice little dorm kinda of setup. Our rooms have beds/nets/ standing showers/ western toilets . We can actually see mount Elgon from the rooftop at casa. Baker is a wonderful host and helped us build a dinner menu and let us know about all the outreach casa takes part in from supporting two high schools to recycling straws to make purses which can be resold.  

You should specialize.

It's been 2.5 years since I've written a blog post!

In that time period, I've completed half of my  internal medicine and pediatrics residency.

I've met a wonderful young lady, who I've been with for almost 19 months.

I've been stuck in a blizzard and 30 inches of snow.

I've had my tire slashed by some disgruntled employee at my apartment complex.

I've gotten a bike, which I'm slowly breaking in. I need to ride more.

But the reason I'm writing this.
After two years I've made a decision on what I want to do with my life.

I started off Congenital Cardio (after spending a month in Orlando @ Arnold Palmer), then considered Nephrology strongly. My goal was to do boards in Adult Nephro and see both kids/adults.  Now, finally, I'll do my alma mater proud and go into primary care.

Med School Alma Mater

Despite the warnings of :

1. You should specialize
2. You'll never make enough money.
3. Primary care is underpaid, under-appreciated.

I've come to realize something.

According to Webster:  Primary means
a : of first rank, importance, or value : principal primary
 purpose>

b : basic, fundamental primary
 need>
They are potentially the most important doctor you see.
Having done ICU, Cardiac Units, 1 month in ER, I've learned just how important a good primary care doctor is.
They can be your cardiologist, nephrologist, endocrinologist, pulmonologist, gastroenterologist, psychiatrist. 
They can be your nutritionist, your advocate, your ally, your friend. 

I've had the pleasure of working with some amazing attendings in my continuity clinic , both in pediatrics and medicine. I've also worked with private attendings as well.  It's enjoyable to see the same patients, to help fix their diseases. I enjoy my conversations with my patients. I enjoy seeing them lose weight and get their diabetes under control. I enjoy seeing them overcome diseases and diagnoses and prognoses. I am humbled every day in clinic. I am challenged.  

The good internist/primary care doc is a Renaissance Man/Woman. They will know enough about every organ system to start a good workup and often complete and treat those diseases. I can schedule a colonoscopy, follow up the results and keep surveillance on my patients. I can titrate their statins to optimize their LDL goals. 

The most important thing about this realization is that I can see myself doing this for many years. In 20, 30 , 40 years, experience will only add to me knowledge and skill as a generalist. 

Perhaps, my mind will change in the next two years, though unlikely. 

Catching Up

So , I haven't blogged in.. a long time. Apparently, since August when I discussed the Mosque Debate that was going on at the time in New York.

I'll go ahead and summarize what's been happening in my life, of course with as many pictures as possible and extra length for things that take up extra brain space for me.

Infectious Disease (September)
Originally I was attempting to get an away rotation/elective in Infectious Diseases in New York but vaccines, yes vaccines got in the way. That's right, Jenny McCarthy was right, vaccines not only cause Autism but ruin lives in general. NO, that's totally wrong. Jenny McCarthy has her attention misplaced much to the detriment of Autistic and Unimmunized children in America, I'll expand on that later..

Back to my vaccines. I never got chicken pox as a child. Blame my nurse mother or my introverted, outcasted schoolage version of Robert, Robert -2.0.


Therefore I had to get a varicella titer. Turns out my titer was 0. Zero. Nil. No more anti-varicella antibodies in me. So I needed a booster, which I got a bit too late. It'd take weeks to months to change my titers and I gave up. Plus I found out my insurance wouldn't cover labs, later I found out said insurance wouldn't cover me, being 25 and somehow stuck in a noncoverage gap.

Oh Frustration.

Immune status, FAIL.

So instead of spending time in my favorite city, I teamed up with our ID Doc @ my home hospital. This was fun because I was able to function at several levels. Initially I backed up the intern on ID and we split patients. Then our intern switched to another doc and I became a sort of resident intern working with a visiting student. The ID team is like the super internal medicine team. We're consulted when the main teams , be it ortho, surgery, internal med can't figure out what drug to use or what's causing the fever, etc. Ask a couple questions, draw on some people's legs. ( I love outlining cellulitis legs because you get to draw on people) , and then round with the attending in the afternoon or night.

I had lots of fun on ID. I liked thinking at a different level and doing a careful review of the patient as a whole to try and pinpoint the reason why we were consulted. At one point , I considered this as a career option, but not so much anymore.

Pediatric Cardiology (October- 4 weeks and December (@ home) - 2 weeks)

This rotation probably was the hardest I will work all of 4th year. This was my favoritest rotation.

First, I started off kinda rough. I didn't really have a schedule to begin with, so I kinda floated around for the first week. At first, it seemed intimidating being the only student in a congenital heart clinic. My attendings were as follows (all Peds cardio):

Maternal/Fetal Echo Mainly
Electrophysiology/Syncope/Chest Pain
Interventional
Echos/ Regular
Peds Cardiac Intensivists


Second, I'm used to guessing my way to an answer or making assumptions and whittling my way to an answer and my attending wasn't having any of that. So I realized I'd have to quickly learn my way around murmurs, a good physical exam, EKGs, etc. And I did. By week 3, I could skim an EKG, diagnose a murmur and even guess a diagnosis, work up chest pain/syncope and counsel like nobody's business.

The attendings eventually were won over by me. I find that if I prepare with reading and come in with a smile, I can win most anyone ever. I loved my peds cardio patients loads. A sampling of the things I saw:

Kabuki Syndrome: In essence it's a congenital condition that can involve cardiac conditions, hearing defects, mental retardation, growth retardation, etc. The syndrome is named as the children take on the appearance of a "kabuki" doll. My little guy was super cool, playful (interestingly, 50% are described as unusually playful). We played with toys as the cardiologist counseled the parents.


HLHS: B-T (Or Sano) , Norwood, Atrial Septostomy followed by Glenn followed by Fontan. This is one of the more amazing patients to follow on peds cardio. The Hypoplastic left heart kids and friends (friends being the various kids who have shunts for reasons like atresias, etc) In short, with the use of gortex, some fancy stitching , connect the aorta to the right/single ventricle. You shunt blood into the pulmonary arteries , patch it here and there as the kiddo grows, hopefully you outpace the inevitable cirrhosis.




The Tet Kids. Patch this, band that, call it a day and wait it out. I do have a story that warms my heart a wee bit. Please indulge me. So I was working with the E-P doc and NP doing stress tests. A cute little blonde teenage girl with ToF comes in for a stress test to determine the nature of her dyspnea and sats. So there goes the stress test, it finishes and the girl sits down.

A few minutes in , she starts crying. We ask her what happened? She says " I want to go to college." We realize that for whatever reason, she thought she was going to get bad news, that she wouldn't live to college years.

The EP Doc in a very classic Dr. N way (Dr. N has these phrases he uses to relate to adolescents and he uses them consistently and somewhat awkwardly) goes, well the only thing that'd keep you from college would be your SATs and grades...

Then he follows up with his old adage. As far as your heart goes, it's fine.. but I can't say a boy won't break it.....

Syncope/ Chest Pain

So I know what you're thinking. First, what does Gatorade have to do with Syncope. Second, what kind of innuendo is gatorade aiming for here. Young female athlete perspiring selectively in her "thorax" area.

Vasovagal syncope, the body's inability to restore homestasis in the setting of orthostatic changes and stress. (At least that's my definition) For my teenagers, basically your tank ain't full and your pumper aint pumping appropriately so your brain says woah and your body says get low.. and ya faint or feel faint rather. So to fix this, you keep your tank full with some gatorade, before , during and after sports and in hot weather , even without sports. With further dysfunction such as the autonomic dysfunction of Pott's syndrome, you might throw in some mineralocorticoids such as Florinef (fludricortisone) and vasoconstrictors to clamp the vessels a little.

And lastly, a review on Marfan's. Many of us have read up on the Marfanoid appearance. The pectus chest, the long limbs, the lens dislocation, the MVP, the joint laxity, hyperextension, scoliosis, elastic vessel changes.


So we saw a young man who looks Marfenoid but the genetic tests were all negative but we were keeping an eye on him for his aortic root dilatation.

Cool kid, basically got to d/c his beta blocker and say: Sports, have it chap!



























And lastly, lastly. Autism and Vaccines

I could rant about this for hours and hours. But here's my line. Vaccines do not cause autism. There is the possibility that they might trigger an underlying disorder but that's like blaming someone who steps on a remote mine for the explosion, sure they set it off, but they didn't put it there.

I read a really great book about the whole "link" and the publicity and Jenny McCarthy's campaign.

Take home message: We will see a resurgence of diseases such as Measles, Mumps, Rubella, Rotavirus, Influenza, etc.


Sure, there have been circumstances where Rotavirus vaccines had been pulled off the market for an increased rate of intussusception and then there's the Guillain-Barré syndrome warnings.

From the CDC:

What happened in 1976 with GBS and the swine flu vaccine?

Scientists first reported a suspected link between GBS and vaccinations in 1976, during a national campaign to vaccinate people against a swine flu virus. The investigation found that vaccine recipients had a higher risk for GBS than those who were not vaccinated (about 1 additional case occurred per 100,000 people vaccinated). Given this association, and the fact that the swine flu disease was limited, the vaccination program was stopped.
Since then, numerous studies have been done to evaluate if other flu vaccines were associated with GBS. In most studies, no association was found, but two studies suggested that approximately 1 additional person out of 1 million vaccinated people may be at risk for GBS associated with the seasonal influenza vaccine.

Well that's that. You've been updated. To follow: Med-Peds, the journey... where I talk about Med-Peds and the interview trail and why I chose this path for residency.

Finding a Place to Pray, The Mosque Debate

Summer of 2008, "The Last Summer of Medical School"

I did what I always did when I have a few days off and want to go have fun somewhere, I go to my second home, New York. While I can't call myself a tried and true New Yorker, I'd say being born in Brooklyn and living there for 5 years allows me some claim. I've probably visited there most every year after.

So I spent a week there between my first and second years of medical school. I did the things that touristy people do, I went to the museums, ate the gyros, etc , etc. Then comes Friday. You see while I'm certainly not the most committed Muslim, praying 5 times a day, etc. but I will always make a sincere attempt to make it to Friday (congregational/Jummah) prayers. If I'm not in Georgia, I usually google the nearest location and head that way around 100/130p. I was in the Financial District, having spent the morning at South Street Seaport at a Whaling Museum and Restaurant with Andrew and Helen. The nearest location was off Warren Street , a few blocks away from where the World Trade Center was.

Now, I've got a horrible sense of direction but I found the Masjid (place of prayer) readily enough. You see, the main "masjid" was the basement of a store that extended out into the street and across the street. There was two services, so one I saw one service come to completion. Men in their business attire, colors as varied as the rainbows, catching a service in the middle of their work day. As they filed out, a new group replaced them, joined by me. I attended, enjoyed a relatively short sermon and went about my day, just like the rest the attendees.

And therein lies the beauty of New York. It's a place where you can grab breakfast at the Dunkin Donuts run by an Indian Family, grab a gyro from the Arab vendor, eat dinner in Little Italy and go get some sketch electronics in Little China. I've been to a college Model UN conference hosted at the Marriot on 6th Avenue. I've debated with an Ethiopian Guy on the loving nature of Christ in New York City. I've walked through Central Park after a day at the museums. I've been to Columbus circle to go hear some Jazz with my cousin and aunt. New York is the greatest city I've ever been to. It's dynamic, it's accommodating, it's always moving, always awake.

Given that, I've felt ambiguous about this Cultural Center being proposed to be built near Ground Zero. In one sense, it's inflammatory in the sense that there is a strong emotional component to how we feel about 9-11 and the victims and their families. So the suggestion is that they move the Mosque to somewhere more P.C., less inflammatory, safer.

But that's not the New York I know. It's a place where things do stand in contrast to one another and things work because people are smart. They would want a place where their fellow citizens could pray and Interfaith Dialogues could take place. If Muslims like myself have failed in distancing themselves from the attacks of 9-11, it's not because we haven't spoken out against it or distanced ourselves. It's because we don't do a good enough job in taking part in the community we exist in, as Americans.

-Robert Karim Abdullah

Weeks 2 and 3, Halfway in/out of the forest

Week 2: High Risk OB / Maternal-Fetal Medicine

So I was told by slim shady (one my goodest friends in medical school) that I would rather enjoy High Risk OB as it involves treating moms with babies that are risk for things like macrosomia, Trisomies, etc. As such, I made sure I'd get a full week on this service.

She was totally on spot. Maternal-Fetal Medicine totally works for the pediatrician in me. Basically, using ultrasounds and other diagnostics, the high risk doc evaluates moms to be and counsels them on his findings. This doc that I worked with was awesome. He'd have the ultrasound techs do the ultrasounds, then he'd review the findings in his office. He'd correlate with any kind of other tests/screens that he might have. Then he'd go and talk to the patient. This is where I would tag along.

One of the more interesting cases was a finding of ventriculomegaly. Basically, the baby's ventricles were a touch bigger than expected. We ran through all the possibilities with mom and dad. While certainly not exhaustive, we split it into infectious, congenital (genetic), structural. We ruled out congenital as it is unlikely that a trisomy or genetic illness would have ventriculomegaly as the sole finding. You'd expect skeletal abnormalities or other defects. The US Techs were super helpful in explaining what they would look for to rule out Down's syndrome, etc. This sums up some of the findings that they look for:

I suppose this takes the whole nastiness of OB (GYN Exams, Diseases, Etc. ) and introduces a more cerebral aspect of it. Here, you use technology to help diagnose a developing baby. This particular day at the office as full of "your baby is normal, everything is okay."

Other than that, I spent my afternoons helping out on the floor. We also had two days at the County Health Department. It's really a student/resident run clinic and we get to do a good bit. Let me highlight my classic of classic moments at the Health Department:

At the conference table where we sign out to the residents, basically suggesting our treatment plan, etc.

Resident : So did you do a wet prep

Me: Yeah

Resident: and the results?

Me: Oh, the nurse hasn't told me them yet

Resident: What?

Me: Yeah, she took it.. isn't she gonna review it?

Resident: You're supposed to look at the slide

Me:......

Me:... yeah...

Resident: Go check if she still has it, if you did the prep, she ought not to have thrown it away

Me: Okay

Me (to nurse) : Hey, do you still have the slide I did

Nurse: uhhh, you didn't seem to want it.. so I threw it away

-FAIL-

Week 3: OB FLOOR

Floor is basically the heart of OB. Everything happens on one half the third floor. You basically enter via the card access door and your day begins and ends behind this door. There are four areas of activity :

3 South/ 3 Main - Postpartum peepz. This is where the moms go after they deliver. These are the patients that we round on at 6am. Most of the time.. it's a rapid fire question asking consisting of breast/bottle, circumcision?, nauseavomitingdiarrhea (I do sometimes say this as one word), birth control, pain, walking any?, tolerating food? any questions

3N - Other stable OB patients

L and D - laboring patients, patients that need close nursing. These ones are rearing up to pop em out. This is also where the OB OR Rooms are. C-sections, D and Cs and that kind of stuff goes down here. All the L and D rooms are built for delivery. There's a bed for baby, scrub gear to suit up, and the bottom of the bed comes out for maximum baby delivering optimization.

OB Assessment - As Mikey T. would say. OB Assessment is more like OB Ass. This is where preggos (I know this is a horrible word to use for mothers to be but it sounds funny and adds some edginess to my blog) who have any sort of complaint or are past a certain week time period go. So if they have a cough/fever/ SOB.. they get turfed here. As such, we have to evaluate them which means : H and P, Ultrasound (more than likely), Cervical Exam , Labs of some variety, waiting until we can safely send them home.

Call Night #2 - So this was my most tiring and exciting call night of 3rd year. I think I stayed up all night once on surgery but I can't remember.

So call began around 5p, now I'm the floor student so really call is no different than being on the floor so I basically signed up to be on the floor from 6a Monday to whenever they let me go after 8a Tuesday. Really, the fun didn't start till 730p. I had gotten my dinner of subway and was praying for a super quiet night but then I went upstairs and Mikey was there. Now Mikey is a bastardization of my resident's real name .. but we'll use it for blog anonymity purposes. Mikey tells me there's people in OB Assessment. We got stuck in OB assessment and floor stuff from 730p-1230a . We admitted a lady that was gonna deliver soon. At this point the following transpired over two hours

1230a

Mikey: So, that's pretty much it. There's labor notes that need to be written q2h on this laboring lady

Me:...

Mikey: But I'll take care of em

Me: [thank God]

Mikey: What's the number to your call room

Me: I'll text you when I find out, when do you think she'll deliver?

Mikey: I'd guess 5a/6a

Me: That's good, can get a fair number of hours (a fair number of hours on call = 4-5 hrs sleep, anything above that means someone was extra nice to you)

Mikey: call you if anything happens

Me: see ya [4-5 hrs sleep.. awesome.. ]

zzzzzzz

zzzzzzz

zzzzzzz

2: something am

[phone rings in call room, I wake up super confused and thrown off.. I reach for phone]

Me: Hello?

Mikey: She's laboring and ready

Me:.... okay

So then proceeds the craziest 1.5 hrs of my life. We get upstairs, Mikey confirms that I want to deliver this one. She's multigravida so it should go all right. I put my booties on, put on a face shield, ask for size 8 triflex, and it's go time. They didn't get the epidural in so she's in pain. She starts to contract. I have my hands in position, V to protect the bajingo with my right hand and other hand ready to protect baby's head. Baby starts to crown. Baby's head is delivered, reposition hands , right hand on top, left hand on bottom. Time to deliver the anterior shoulder... AND

holy crap, the baby has stalled... stuck.. beneath the pubic symphasis

residents take over

mcrobert's position is assumed : mom's legs are pushed back

pubic pressure is applied

baby is turning blueish

everyone is anxious at this point

in what seemed like an enternity, a decision is made to do an episiotomy, basically cutting the bajingo (at first I thought this was to give the baby some room, but later it was explained that this is really to give the person delivering more hand space to manipulate the baby so they can deliver; if you think about it, the pelvic anatomy dictates how the delivery goes, only anatomical manipulation will change the outcome, so a surgical cut doesn't do that)

baby is delivered

baby cries

I get a little teary eyed beneath my face mask , realizing that cry means that baby is alive

Mikey T: okay, let's get the cord blood and deliver the placenta

Me:....

I then proceed to get the cord blood and deliver the placenta which is really a bloody mess

----and finish --- , 1st deliver OVER

around 400a, after dictating, etc

Nurse: so did you see that roach

Me: what??

Nurse: it was on one of your gloves.. .. actually your glove, you started the delivery right

Me: yeah

Nurse : there was this roach.. that came from somewhere

Me: gross

Mikey T: yeah.. maybe I did see a roach

Me: [rolls eyes]

So that remained the running joke/urban legend the rest of the week .. that in the midst of this chaos.. a roach came from "somewhere" and ran across my glove and disappeared like a fart in the wind. So after that , Mikey T tells me to peace out and get some rest. I couldn't sleep of course and I probably netted around 2-2.5 hrs of sleep that night.

The baby turned out to have Erb-Duchenne's palsy (injury to C5, C6 nerve roots) from the shoulder dystocia. We definitely took the baby to the nursery to check her moro reflex and she had the classic waiter's tip. Per my OB attending, 90% resolve on their own with rehab.

So that was really the highlight to my week. Otherwise I'd been able to do a good bit besides take Histories and do physicals. I assisted on

I've done abdominal ultrasounds, vaginal ultrasounds, removed a cerclage, congratulated a bunch of new moms with my "your baby is beautiful". Thank God, I haven't seen a non-beautiful baby yet.

Lastly, here's some tidbits/definitions:

Cave of nastiness - One of my fellow students/friends made an reference to the cave of wonders in Aladdin. I told her that we're dealing with the cave of nastiness.

Wanting to palpate the fundus - I feel a strange desire to check every female's fundus after being on the floor.... Weird, I know.

Blending into the background, not getting introduced - Two things are tantamount to being a medical school. One is blending into the background and not being noticed. The other is walking in to a room with an attending and not getting introduced resulting in a very awkward encounter where you realize that they realize.. that they have no idea why you're there and who you are.

Over the top, getting in nice with people - Being nice to the point of demeaning yourself works.. and it works well. As long as you believe in yourself.. you can pull this off with good results. Nurses love my comments like "I'm no expert like them.. or these wonderful nurses... "

Bovie - I finally got to use the bovie electrocautery tool. It was the greatest surgical moment of my life when my resident hands me it and says.. cauterize that over there... AWESOMENESS It's almost like a miniature light saber for surgeons...

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.