Omega Beta Gamma Pt. 2

I guess now I can give a more fair assessment of OB/Gyn rotation now that I've done almost a week of OB. OB isn't bad in and of itself. It's actually pretty easy considering most of the patients are generally pretty healthy.

My general day consists of doing morning rounds on post partum patients, going to checkout (worthless for students to be there), and then trying to stay on top of all the new patients coming in through triage and those who are delivering for the next 12 hours until evening board checkout (equally worthless for students to be there). After that I can go home. Lather, Rinse, Repeat x 10. It actually seems a lot like working in an ER with a very focused patient population.

There also is a lot of procedures to do. On gynecology, it was all procedures. On OB, it's less so, but still everyday there is stuff in the OR, deliveries, tubal ligations, etc. It keeps you on your toes and is active medicine. I hate passive management. For example, today was my first delivery. Probably because everyone in Houston delivered today and so we were a little shorthanded. I can't take all the credit though. The resident delivered the head (i.e. yelled "PUSH PUSH PUSH" at the patient until the head was out) and then had me jump in to pull out the rest. I probably would've delivered the head too, but the baby was DOP (direct occiput posterior). That means the baby came out looking up. It sounds good, but it's not because of the diameters involved. So this kid came out looking like a conehead (like most vaginal deliveries), but the cone was on his forehead.

Then, of course, I did the obligate medical student delivery of the placenta. They finally actually taught me what exactly I was doing, so now it makes more sense why you push on mom's belly while you pull it out.

Anyway, so that part hasn't been bad. What's been bad is that a lot of the female residents in this program are mean. They just don't like medical students. I thought that one I had on gyn was bad, but almost all of them on OB this month are that way.

For example, today when I got there at 0500 and began rounding on the patients I worked backwards from the direction the resident usually goes. Once I got to the resident, she got upset and told me "Work the other direction so we aren't just fighting over charts." She just assumed I had ignored what I'd been told the other day and had come late to rounds. I guess she figured out she had wrongfully yelled at me once she got to the other pods and saw notes on all the other patients.

Then after board checkout the residents (all girls on this OB team) just walked out of the room without saying a word to us. So we just went and tried to find stuff to do. I thought we were doing OK, but apparently one of the residents thought we weren't doing the right stuff and yelled at us. Usually the first step in getting people to do what you want is to ask them, not just assume they know and yell after it doesn't happen.

Then we have a bunch of stuff happen all at once with admitted patients. Cool stuff, like a velimentous implantation of the umbilical cord and stat c-sections. The problem was everytime something good happened, they would overhead page the other med student on the team (a girl) to come do them. The other problem was whenever something cool was about to happen suddenly there would be some kind of mind dumbing scut for me to suddenly have to do right then.

So, that's how the day goes almost all day long. I'm seeing all the patients in triage. I'm doing all the stupid paperwork. I'm spending all day trying to chase down the residents. The other (girl) medical student is spending all day doing procedures and scrubbing in cases (that I had been invited to scrub until they found out she wasn't doing anything). And then we get to board checkout at 5 pm. Finally the day was over. While doing checkout on a newly admited patient from triage (guess who the med student was who saw her) a question came up about her history. The attending asked and didn't get an answer, so finally I spoke up and answered the question. And got an evil eye death glare from one of the residents for having spoken during board checkout. Heaven forbid I attempt to make sure the patient gets good quality care instead of protecting the resident's ego. I mean it would be one thing if board checkout was 99% a ginormous gossip session about all the residents and attendings who are not currently present (note the sarcasm). So, once again put in my place for looking out for patient care. Like the time I mentioned chest pain and shortness of breath in a tachycardic women in triage, who had come with a different chief complaint, to the resident who went on to send the patient home at which point the patient called their clinic doctor who then had the patient direct admitted for chest pain. And then suddenly the residents threw a fit over how the patient had never complained of that to anyone and she shouldn't be being admitted.

I guess she didn't read very closely the MS3 note she copied almost verbatim.