Sep 16, 2011

Like A Surgeon...Cutting For the Very First Time

Ok. I know that is a Weird Al song, parodying Madonna's "Like A Virgin." Nevertheless, this melody is what plays through my head as I learn to be a surgeon.

At first, it was little things. A "gateway" surgeon, if you will. I could sew up fascia, and close skin. Then, I got to come around to the surgeon's side of the table, and do a little more. A skin incision here, a fascial incision there. I'd retreat back to the assistant's side for the important things, like opening the uterus, delivering the baby, sewing the uterus closed

Today I stayed the whole time on the surgeon's side. And suddenly, all these little pieces of things that I had learned to do on their own added up to me being the primary surgeon, me being able to do an entire cesarean section on my own. I could ask for the knife, and retractors, and scissors, and all the things I needed and actually be able to use them. I could smile as my chief resident handed me the suture to close the uterus, instructing me to "sew like the wind" as blood poured out of the gaping incision. I could reach my hand into a person's abdomen, and feel their aorta pulsating under my touch, hold their uterus and feel the baby kick my hands, feel their pointy vertabrae from the inside instead of the outside.

It's kind of like working in the cadaver lab, but this person is alive! It always startles me how warm everything is to my touch, how their is so much movement in vessels, muscles, enclosed much life I can feel resting in my hands. And I think this is part of the draw of be able to do this to another person, to have your hands deep inside them and not only have them live through it, but have a desired outcome from it.

Even routine surgeries are scary for me at this point. I am more focused then I ever have been, with time slipping away from me as if it was only seconds. I leave warm and sweaty, more tired than if I had run a race. It's scary, but exhilirating.

Like a surgeon...cutting for the very first time...

A Few Stories

Once in awhile, the residents get together and just laugh. We have to, with some of these patients. Here are a few stories from this past month's work:

A kind resident goes to evaluate a woman that has presented for multiple times for drug seeking behavior, on the premise of chronic pain. She probably does have pain, at least from being so addicted to narcotics, but we don't want to prescribe anything because it's not good for her, and not good for the baby. As I'm leaving triage, I hear her shouting at my (male) colleague: "Bitch, you don't know my pain!"

I enter the delivery room and greet a woman who is fully dilated and ready to push. I begin to give her my earnest speech about how to push with an epidural, how to pull your legs back and take a deep breath and curl up around the baby. This speech is complete with a demonstration that I think (hope) is helpful and I'm sure makes me look like a giant fool. As I talk, the woman sneezes and delivers her baby.

In clinic, my friend was performing a well-woman exam, and asking about any changes to the patient's breasts. The patient says, "Well, they've gotten bigger..." and asks the doctor to measure her breasts to fit her for a different sized bra! My friend, being a kindhearted woman who used to work in a department store and thus is qualified to do this task, considers it but ultimately decides this is a doctor's office and refers the woman (in all seriousness) to Victoria's Secret. Do you document that referral on the chart?

Meanwhile, on the antepartum ward, another resident is called urgently to evaluate a patient. She has had a cerclage, meaning her cervix has been tied shut in order to help her avoid premature delivery. It is much akin to the string tied at the base of a balloon. It appears that the cerclage has come out, as the nurse reports finding a long black string with a knot in it. The resident comes right away, and the nurse presents him with a paper towel spread between her hands. On the paper towel is a lone long black pubic hair, with a knot tied in it. He explains to the patient, Ma'am, the cerclage is fine. And no, I don't know how that hair had a knot in it.

Over on labor and delivery, I am working with the most anxious patient in the world to push. I'm trying to distract her, to calm her, so we are talking about her horses at home, and shooting animals in the wild, and her latest hunting trip. (Let me say here that I do not have much to add to this conversation, as I am a liberal almost-vegetarian.) Nevertheless, I act interested as she says she'll just die if this baby is a city boy instead of a country boy. She pushes a little more, and I tell her I can see the top of the baby's head, and he has some hair! She asks me if by looking at the top of the baby's head, if I can tell if he is a Republican?

The next delivery I have is normal, and uneventful, and to very nice parents. I hold the baby up and announce the arrival of their baby boy! Both parents start crying; the dad in joy, the mother in horror. What? I glance at their pink carseat, the baby's name written on the board. Oh. Yeah...this wasn't the Liliana they were expecting. The dad is ecastatic, and has already named the baby Jr. whatever his own name was. The mom asks me if I'm sure I got the right baby? I am sympathetic, even though this question is obviously answered as the baby is still attached to her via the umbilical cord. It's not often in this day and age that parents don't know what they are having, and even fewer times that it is not what they expected. On the postpartum visit the next day, she asked me if she could go home. Was she feeling okay? "Yes, and I need to get to BabiesRUs. I have a lot of exchanging to do."

Sep 15, 2011

A Different Life?

I've recently had a little more time for reflections on my life, my chosen path. I'm working nights, and when it's not too busy, I'm able to lay down in between patients. I don't sleep because I am always waiting for my pager to jolt me out of bed, but I can enjoy the quiet. It's getting cool again, and I'm able to run outside, putting one foot in front of the other as my mind untwists whatever is subconsciously present, much like a dream. In these moments of quiet, I wonder about what my life would have been like, had I not gone to medical school. I don't doubt that becoming a doctor was a good choice for me, but was it the only one that was right for me, like I had thought at the time?

Let me be clear. I don't regret becoming a doctor. But, I think about what my life might have been like, as someone else. Or at least as myself, having made different choices. I could be a yoga instructor. I would have been good at that. I could be a professor, with a doctorate in clinical nutrition- my other professional love- or maybe a dietitian, like some of my friends from college had become. I could join my friends on their travel, because I would have time and money too, without worries of massive school debt or a constrictive schedule where I celebrate two days off in a row. I could be a wife and mother, a homemaker, like so many of the women at my gym and who come to see my at the hospital.

I know I am already a wife. But I'm talking about being a different kind of wife. The kind of wife that takes care of chores, the kind of wife ever available for listening, and sex, and companionship. The kind of wife different from what my own husband has. He has the kind that spends every other night away from home and is away even more hours on top of that, who can be distracted, with a limited attention span and patience, who wants to use the bed only for sleeping and expects an equal contribution, if not more, to household chores. The kind that a "dinner out" consists of driving 45 minutes to the hospital and enjoying a cafeteria meal together in between pages.

I think in a different situation, I could have really enjoyed being a mother now. I feel separated from my peers as they have children, as their facebook pages are filled with darling photos and cute anecdotes. I look at my facebook page, and decline putting up another status, because I don't have much to say outside of my life at the hospital. I deliver babies every day, and hand them away to anxious mothers, eager fathers, most younger than I. I am a little jealous, not only for these couples starting their families but for the sole fact that the mother is in bed at 4 am while I am up making rounds.

My dad says that anyone can get pregnant, but it takes a special person to have a baby- meaning me, the obstetrician. He says that I'm special, because these choices that are difficult, and sometimes isolating, that set me apart from other twenty-somethings...they mean that I have worked hard enough to get to have this privilege of being different, of getting to do a really important and special job.

One of the very best things about my new job is the other residents. Aside from childhood friends and a few treasured college/med school friends, I haven't connected well with others as a young adult, I think because my life took such a sharp turn away from the typical twenty-something experience. I'd go to church, to small groups, gym classes, and parties, and find that I really didn't have much to offer to a conversation once the conversation turned away from medicine. Relationships shifted into a more familiar territory- ie doctor/patient- as acquaintances began asking me advice on their pregnancies, but it didn't do much for me feeling like one of the gang. Some didn't understand why I was gone so much, why I wasn't available to volunteer more or be more reliable. And now, I have seven other people that deeply understand my situation. We can never get together all at once, because at least two of us are always working at any given time. We can share these stresses and fears about being subpar spouses, worries about becoming good doctors, laughing at jokes that others wouldn't understand or find funny. They understand that a date is spending time together, regardless of whether it is at a cafe or cafeteria.

The reason I write these somewhat wistful and non-cogent thoughts down is that upon talking with other residents, I've found this to be a fairly common thought process, and not one that I think might be intuitive to someone outside of residency. A chief resident mentioned to me that she loved her job, but felt like she could be completely fulfilled with a different life as well- one as a homemaker and mother. A third-year resident who I adore has a craft closet and could stay home happily baking bread. My heart broke for another resident who came back sobbing back from maternity leave. My best friend from medical school wrote me that she was literally sitting in clinic the other day, looking at the patients piled up, wondering what she had gotten herself into, wondering if maybe she should have considered other options, like cooking school. One of my loved co-interns told me once that she thought what she did was important, and she wanted to be good at it, but at the end of the day, this was a job, and her life and family came first. The census overall is that we love what we do, but we'd love a normal life for once too, and fantasize a little about what our life would look like if we hadn't invested all this money and time, if we had made more typical choices.

Kinda makes me feel better about my half-fantasy of becoming a stay-at-home yoga instructor.