The four of us girls on OB at this downtown hospital showed up, per printed orientation instructions, at 5:30am, and were informed that the doctor we were to meet would not be there till 6:30, and we should sit in a corner till then. We ate breakfast instead, the minute the cafeteria opened, at 6am. No doctors would acknowledge our existence until 7am. So we sat in a corner and felt extremely ignored, and gradually became quite as grumpy as the ob/gyn residents who appeared at 7. It seemed a miraculous transformation when at 8, after rounds, they were laughing and greeting us and talking to us and each other. It really is true: the mornings are bad, and the day gets better, on OB.

Oh: when they did recognize us at 7am, the first comments where why hadn’t we done x,y, and z, the responsibilities of medical students. Maybe because no one would tell us where in the huge maternity ward to find the things. . . grrr. . . I was not grinning by 7:10 am; but being the optimistic character I am, I plan to arrive a few minutes before the required 5am tomorrow, and be very enthusiastic about the scut work.

This morning there was a Csection for a noncompliant diabetic patient, 35+wks, with “nonreassuring” fetal heart tones, and various other indications of fetal distress. (Don’t ask me what they were, I barely gathered from the hail of acronyms that there was something wrong.) So they took her to the OR. The other medical students conveniently had disappeared, so I didn’t have to compete with them, and one of the two residents was busy elsewhere, so it was just the attending, the 2nd-yr resident, and me. It was the resident’s first breech Csection (baby’s buttocks coming out first, rather than the head), so the attending had a detailed discussion with her and me about the procedure, and complications. I was delighted to hear him. He explained that although many people think a breech presentation is an indication for Csection, the difficulties of delivering the baby through an incised uterus are just the same as getting it out through the vagina, so the risk to the baby is at least equally high both ways, plus greater risks for the mother with surgery. So he actually likes to do vaginal breech deliveries whenever possible. (Not in this case because the baby was in distress and the mother hadn’t even started labor yet.) Unfortunately, he’s moving away; so I won’t be able to learn this delivery method from him as a resident.

I got to scrub in, and miraculously did not break sterile field at any point in gowning up (a first for me, not to be sent out of the OR at least once to repeat the scrub). They got the baby out, and he was blue and floppy, with the cord around his neck. At first I thought he was going to be dead, like my other nightmare baby, but he started wiggling as they got the cord off him, and the NICU nurses who whisked him away soon sent back word that he was fine. Then we started sewing up. I was handed the scissors and told to cut, whereupon I promptly forgot how to use scissors, and had to try about three times for every cut of the thread. After the attending left I also got to staple up the incision, which of course led to a very raggedy, uneven line of staples. I felt very guilty about that; but hopefully it should only take two or three more before I can make at least a neat line of staples, if not cut or sew correctly!

The same attending was around all afternoon. (The OB attendings, unlike in medicine, stay around all day, because they have to help with the surgeries and supervise in emergencies.) So he got me in a corner and started interrogating me about causes of neonatal distress, restricted intrauterine growth, and the TORCHES (maternal infections which classically cause fetal defects: toxoplasma, syphilis, rubella, CMV, and herpes), and the fetal heart monitoring strip. I was stumbling away at a great rate, but I got about 50% of the questions right, which was fairly impressive for first day on; and he knew I want to do OB. So I think I was making a good impression. Except that this attending uses the words “Republican” and “idiot/moron/stupid” interchangeably. I’m trying to see how many days I can go before exploding and saying something political; if I can keep quiet for the whole rotation, maybe I can get a letter of recommendation from him. In spite of his radical political views, I like his ideas about forcing as many vaginal deliveries as possible, instead of immediately resorting to Csection; and of course he hates lawyers, like all ob/gyns, so that’s always a safe topic of conversation. I don’t mind using “lawyer” and “garbage” interchangeably. <ducking rotten tomatoes>

But the men on the OB service are slightly weird. They all stand too close to you. Maybe it’s just because they’re all way taller than me; or because they come from “warmer” cultures. They’re also very intense, but the women are that too; it goes with surgery. I think of ob/gyn as a woman’s field, but at least half of the doctors are still male. I find it extremely weird to have men professionally discussing contractions, and the cosmetics of various belly cuts. . .

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