The first sentence of a certain unnamed ob/gyn review book is "Pregnancy is the state of having products of conception implanted normally or abnormally in the uterus or occasionally elsewhere."
I invite readers to submit their own first sentence of an ob/gyn review book. First prize is a massage at Spa Brownie.
Mine:
Pregnancy is a total trip.
Tuesday, October 28, 2008
Wednesday, October 8, 2008
Two ways to make an Ob patient cry
1. Tell her the sex of her baby. Today was the first time I had seen that moment, and I teared up, too. Labia are remarkably distinct in a 20-week fetus! The couple was there with their daughter and had expressed wanting a boy, for variety, but when they heard they were going to have another daughter, they still got so happy. She went from an amorphous "it" to their little girl. I have always liked the wait-and-see, surprise route, but this was clearly very special, too, a moment when she became more real to them.
2. Tell her that her low-ish levels of amniotic fluid could mean a) her bag is broken and she'll have to be hospitalized until she delivers, b) her placenta is pooping out, or c) she's not even listening anymore. I don't know, it was this crazy example of how we freak people out over probably nothing and why I understand a minimalist prenatal approach without lots of technology and tests. OK, so this woman has a little oligo, but suddenly we're discussing what she would do if she underwent fetal non-stress testing and discovered huge dips in heart rate, and oh no, we're hypothetically discovering this when the baby is 25 weeks, which is technically viable but they baby could have lifelong health problems. Seriously, this doctor was conjuring images of her being ambulanced to UCSF from Eureka and even said at once point, "Now I know you don't want your baby to die..." (That sounds worse out of context than it actually was, but still!) I was like, how did we get here? With these tests that tell you your risk of Down's syndrome is now 1 in 690 instead of 1 in 200. What does that even mean? Even though this patient wasn't even being evaluated for Down's risk, she somehow still had to assert, "I would keep this baby even if it had Down's!" I don't know, it was a very confusing visit for me. We feel like we have to prepare patients for the worst, but what ever happened to crossing bridges upon getting to them?
2. Tell her that her low-ish levels of amniotic fluid could mean a) her bag is broken and she'll have to be hospitalized until she delivers, b) her placenta is pooping out, or c) she's not even listening anymore. I don't know, it was this crazy example of how we freak people out over probably nothing and why I understand a minimalist prenatal approach without lots of technology and tests. OK, so this woman has a little oligo, but suddenly we're discussing what she would do if she underwent fetal non-stress testing and discovered huge dips in heart rate, and oh no, we're hypothetically discovering this when the baby is 25 weeks, which is technically viable but they baby could have lifelong health problems. Seriously, this doctor was conjuring images of her being ambulanced to UCSF from Eureka and even said at once point, "Now I know you don't want your baby to die..." (That sounds worse out of context than it actually was, but still!) I was like, how did we get here? With these tests that tell you your risk of Down's syndrome is now 1 in 690 instead of 1 in 200. What does that even mean? Even though this patient wasn't even being evaluated for Down's risk, she somehow still had to assert, "I would keep this baby even if it had Down's!" I don't know, it was a very confusing visit for me. We feel like we have to prepare patients for the worst, but what ever happened to crossing bridges upon getting to them?
Saturday, October 4, 2008
To be known
Sometimes I feel like the worst part of third year, worse than the long hours and being "beaten with the idiot stick," as Chunk puts it, is feeling awkward and intrusive and out of place nearly all the time. People not knowing what you are doing there and what they are supposed to do with you. Which was why I particularly loved my OHNS (that's the new way to say ENT) surgical team on Thursday. They were just like, "Hey! Great! Check it out! Here's what we're doing!" Same with a neurosurgeon on Monday. (Yes, I saw cerebellum.) Every day I appreciate how amazingly nice someone is to me.
But then there was a day when I saw two people who really know the real me and care about me on a deeper level, and it felt so good to see them that it made me sad to think about the superficial level I survive on normally when I'm here. I saw Dr. Jeff from the Health & Healing Clinic, and he looked at me like my doctor dad and made me laugh spontaneously and genuinely. Then as I was getting on the elevator with my medicine preceptor, my stream of trying-to-sound-like-I-belong BS was abruptly interrupted upon seeing Holly, my body/mindworker, of all people! It was so surprising, and she is so intense, I was kinda speechless and dumbfounded. Having her see me in this context, having her presence pierce this place, really threw me. And made me want to have some more sessions with her!
Anyway, this is all to say that our coworkers can be the nicest people and most generous teachers in the world -- and we can be grateful for them! -- but they will never substitute for our true support system. I think if I ever saw Scott or Mom or Chunk within these walls, it would have the same effect: a direct comparison, collision, invasion. Confronting the difference between how I feel around them and how I feel around everyone else here.
Then there are med school pals, the bridge. The name of this blog has been modified to placate one of them, that's how important she is.
But then there was a day when I saw two people who really know the real me and care about me on a deeper level, and it felt so good to see them that it made me sad to think about the superficial level I survive on normally when I'm here. I saw Dr. Jeff from the Health & Healing Clinic, and he looked at me like my doctor dad and made me laugh spontaneously and genuinely. Then as I was getting on the elevator with my medicine preceptor, my stream of trying-to-sound-like-I-belong BS was abruptly interrupted upon seeing Holly, my body/mindworker, of all people! It was so surprising, and she is so intense, I was kinda speechless and dumbfounded. Having her see me in this context, having her presence pierce this place, really threw me. And made me want to have some more sessions with her!
Anyway, this is all to say that our coworkers can be the nicest people and most generous teachers in the world -- and we can be grateful for them! -- but they will never substitute for our true support system. I think if I ever saw Scott or Mom or Chunk within these walls, it would have the same effect: a direct comparison, collision, invasion. Confronting the difference between how I feel around them and how I feel around everyone else here.
Then there are med school pals, the bridge. The name of this blog has been modified to placate one of them, that's how important she is.
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