Sunday, October 12, 2008

Catchin babies

So I finished my peds/family practice rotation at the community health center last week. I was pretty sad to leave because I really like the clinic, the staff, and my preceptor. I got A LOT of spanish practice, which was really good. We saw a lot of interesting patients, and I got to do a few procedures (IUDs, nail removals, sutures, etc). I am always amazed at the crazy things that people diagnose themselves with, that make absolutely no sense. It's not just the Hispanic culture either. For example, one lady was convinced she had liver problems; when I finally got her to explain why she thought this, it was because she woke up with a bad taste in her mouth. People also have no idea where their organs are; 'kidney' pain is anywhere from the scapulae to the sacrum---and it's never actually kidney pain, it's muscle pain. Lots of people think they have thyroid problems if they have a sore throat (!?) Always amusing, but it helps to think about these things in order to explain and reassure patients. It's always fun when people end up being pregnant and have 'no idea how that happened', and that explains all their symptoms. One of the most fun things is diagnosing new diabetics. I had 2 patients who had lost about 100 pounds each in a few months, only to check their blood sugar and it's in the 400s and their A1C is >14. I got to feel fairly comfortable with managing diabetes, so that's fun.
So, now I've started OBGYN. The clinic I'm at has one doc, an NP who works 1 day/wk, and a PA who works 3 days/week. They are all REALLY REALLY nice, and VERY excited to teach, without grilling me all day long. He really wants to make me a pro so he's given me 2 OBGYN textbooks that he wants me to read about 200 pages from by next week! That would be fine and I want to learn but this week is also when another one of my research papers is due, I have to take thecompetency test for peds since I finished that rotation, plus this week we have our return visit at school and will be doing a bunch of testing I need to study for also!
The whole aspect of being in a specialty instead of straight primary care is pretty fun because we don't send the complicated things away, they get sent to us! So I'm in clinic 4 days/week and then he usually does surgery on wednesdays, so I'll get to be in on that (which is WAY more exciting than just doing prenatal checks all day in the clinic). The PA is kind of a pro at hormone replacement therapy, so the doc sends all those patients to her, and he does all the OB pts. He also does a few different procedures in the clinic, as well as all his own Ultrasounds, which is pretty fun to see the parents find out the gender or their baby. This week, in addition to all the pre-natals and postpartums, we've done a lot of irregular bleeding, ovarian cysts, endometriosis, as well as bladder issues, and then of course plenty of annual exams (I am the pap pro), patients who want to not get pregnant and patients who want to get pregnant, a few miscarriages. But the best thing this week by far was friday.
The clinic is about a block from the hospital in American Fork, so friday morning he had a girl who was being induced. We went over and broke her water (he did that, I didn't touch her...ew). She was pushing all day and nothing happened, so the hospital finally called him when we were on our last patient in clinic, so as soon as we finished we went back over to check her. He determined that the baby was malpositioned, facing anterior instead of posterior, and that the mom's pelvis was a shape not conducive to birthing. He tried to rotate the baby with his hand a few times, but that didn't work, so he talked to her about her options (meanwhile I'm secretly hoping for a c-section because that would be more fun for me, but I did feel bad for her; she looked MISERABLE). She really didn't want to have to do a C, so he told her he'd try rotating the baby with forceps. We went to the OR in case he would end up needing to open her up ( but I didn't scrub in). He stuck those suckers up in there, got the baby turned, and pulled and PULLED and that kid did not want to come out. Meanwhile, of course the mom is still awake and the dad is there watching. So Dr Nelson decided he'd been trying long enough and he'd have to do a C section. The OR staff was on top of it; I was impressed how smoothly it all went. He called in another doc to assist, got her all prepped, and started to cut. But, apparently the epidural still wasn't working totally effectively (the anesthesiologist had come up the first time he'd tried rotating the baby to give her more anesthesia), so finally he decided it was time and they ended up kicking the dad out and putting the mom under general anesthesia. After that it went so fast! It was pretty cool to see how well the 2 drs worked together, and how well the scrub nurse did. They cut that baby out of there, handed her over to the respiratory therapist and ped nurses, reached in and pulled out the placenta, and that was that; they closed her up. It went really quick (I thought--he told me he was taking his time). The baby was pretty big, and started crying right away, just like in the movies.
So even though I didn't get home til 830, it was a cool experience. I've never seen an actual childbirth so I thought this is probably the only time I will so I was a little excited, but then to actually do surgery was a lot more fun. Hopefully we'll do a few more before I'm done there. It definitely did not make me have a pressing desire to ever have a child! I thought puppy deliveries were messy...
It pretty much turned to winter this week :( I ran a 5k yesterday with a friend, and was really regretting it when I was leaving my house and saw it was SNOWING. The run was a little up Provo canyon and it was pretty much A BLIZZARD. And, I got up a little late and couln't find any running pants, so I was in shorts and a sweatshirt, and borrowed mi amiga's gloves. The snow slowed down a little while we ran, but the cold was definitely motivating because that's the fastest 5K I've ever run. Next weekend we're going to Moab for a 1/2 marathon, so I hope it's a little warmer!

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