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Clinic. - Nobody wears a white coat any more...
...a tribute to becoming a doctor.
ayradyss
ayradyss
Clinic.
Two patients : 1:30 and 2:45. Awaiting anxiously to report my patient show rate today. We have grave doubts about the second one; her history suggests a no-show, but we shall see, O Best Beloved.

I did not get my sleep; I was paged back out and got to put my hands beside the obstetrician's during the vaginal delivery of full-term twins. This, O Best Beloved, is a sentinel event. This was not the careful catch of tiny two-pound wisps of babies, not done in the operating room. This was a delivery, and I got to help. The OB doctor who'd spent the day and most of the night with me, following his patients, telling me about a vacation spot I simply must see in Costa Rica, moved out of the way once the second baby was delivered and handed me the double-clamped umbilical cords. "Slow and easy." He is a waiter, a doctor who wants the placenta to separate on its own. So I held my hands on the cords, kept a gentle tension - just enough to know if the cord lengthens - and let him do the fundal massage.
"Twist it gently," he said; my face is easy to read - when the cord lengthens and the placenta begins to emerge, I am wide-eyed, startled, and a little panicky - "twist it gently and don't let it flop." He means that I am to catch the placenta as it slides out, twist it to lessen the tearing of the amniotic sac, and make a controlled and tidy delivery - without dropping it - into the waiting bucket. I learned with the last patient, and it went well. This time, a double placenta came suddenly, quickly, and I dropped the cords and tried to catch it, twisting a bit but mostly just slowing the descent. There was an audible "plop" as it landed in the bucket. I looked over at the obstetrician. That was a flop, wasn't it? Beneath his mask, the corners of his eyes crinkled: a smile. "That was a flop. But there wasn't anything you could do about it."
Twins did well, are doing well. Success.

And then deliveries and Cervidil placements and histories and triage. Once in a while now I am seeing a patient for the second - or, in one case, the third - time in triage. I am surprised that I remember them now. Sometimes not the names, but the faces and the families. I slept from four to six, was awakened by the pager beeping. Apparently a patient was bleeding heavily and trying to pass out over in postpartum; the OB had given orders but asked for me to go see her.
Panic.
I don't know what exactly to do; I've never seen a postpartum hemorrhage patient. So I fell back on the default behavior: check the chart, look at the patient, do the best physical exam I can. And then report back as to what I saw. It seemed to satisfy, but served to drill in even further how little I know.

I have so much to learn, O Best Beloved. So very much to learn.

now feeling:: thoughtful introspective

2 whispers echo . o O ( ... ) O o . whisper a word
Comments
From: (Anonymous) Date: July 13th, 2005 08:01 pm (UTC) (etched in stone)

From your mom

I love reading your journal entries - your writing is so descriptive and vivid! We ALL learn how little we know when in new situations and it sounds like you are doing exactly what you need to do. I'm glad you have good, kind doctors to work with. How exciting to actually "be" a doctor. You are getting the experience you need to have!
From: broken_onewon1 Date: July 14th, 2005 12:31 am (UTC) (etched in stone)
Sounds like your doing fine to me. Sure you have a lot to learn atleast according to you, but your learning it aren't you? :) Hope this finds you well.
2 whispers echo . o O ( ... ) O o . whisper a word