Rotation #3 - OB/GYN and my only weekend with Makenna

It's true that both of the subjects in my title deal with women, but they are not equal with the latter being 100 times more exciting and desirable than the former. :) That is not to say that I entirely and utterly hated my OB/GYN rotation, but more to say that I completely and fully LOVED having Makenna come visit for a weekend! After being apart from her for three months, then having her here, and now having her gone again makes me fully realize just how much i've come to love and appreciate her and can't wait to start our lives together in December! It will be a luxury for us to be in the same state, enjoy meals face to face, and discuss our thoughts in person.

Before I get to the portion of this post about my weekend with Kenna, I first want to write about my experience on the OB/GYN service. It was my first hospital experience and took a little bit of an adjustment after spending my first eight weeks of rotations in low key family medicine clinics. Grant Hospital lies in the heart of downtown Columbus. I knew I was in an interesting place when I noticed on the first day walking into the hospital security guards and policeman at almost every street corner. Another red flag that I wasn't in cute little Iowa anymore was when I went to go down the staircase from the parking garage and a woman stopped me and said "I wouldn't go down those steps at 5 in the morning in downtown if I were you, who knows what hoodlums are in there!" I mostly rode the elevator every morning after that, but out of curiosity did go down the steps once and was disappointed when I found no hoodlums in there. ;) Because of our location, our patient population mirrored almost exactly the surroundings. 95% of the women were low income, African American females. I saw first hand the craziness and sadness of teenage pregnancy, the carnage of drugs, alcohol and tobacco on newborns and mothers, but also the joy of new life entering this ever changing world. It was an extremely rare thing to see a married couple, and not surprising when the father was not involved in the pregnancy at all.
Here are my impressions about OB/GYN:

1. I'm grateful there are others who want to do this specialty, because I don't. There are several reasons. I'll explain as I go along.

2. I got my first taste of being on call and sleeping at the hospital...and while it was painful, it wasn't as bad as I thought. My first on call shift started at 7 am on a Sunday morning and went until 8:30 the following Monday. We were so busy that night that I only got 45 minutes of sleep. We had seven ladies in labor, and they all decided to go at different times during the night, which kept us going till the very end. I caught two babies and delivered another placenta. Talk about blood and guts. I made sure to wear a splash shield everytime. Those who have seen a live birth understand what i'm talking about. :) My other three nights on call weren't nearly so busy. I survived and was surprised at how much energy I had to make it through.

3. I can wake up at 5 am and be functional. I was worried at the onset of the rotation that I'd be so dead tired after waking up early to be to work at six am and then getting off at six pm that I'd have no energy. Well, I was wrong. I actually felt like I had as much or more energy than when I was waking up at 7 for my family medicine rotations. I never thought I'd say this, but sleeping in til 7 am now feels like sleeping IN!

4. OB/GYN malpractice insurance is so costly, the rewards of the lawsuits so ridiculous, the anxiety of making a mistake so great, that it ruins for me the cool experience of the beginning of life. If I chose to practice OB either as an OB/GYN or Family Medicine, the dark cloud of malpractice would loom so close that I'd be more worried about that than enjoying a pretty darn cool experience of helping bring new life...and I know I wouldn't enjoy my job. It's sad, but it is what it is.

5. The Surgeries were cool and I can handle the blood, but I just don't think I'm a surgeon. I nearly passed out on my first day, within the first hour of being in the hospital, after I was hurriedly rushed into the C-section and found myself as the first assist to the section. That basically meant I was standing right next to the operating table with the OB/GYN doc on the opposite side and assisted in EVERYTHING. I nearly fell over as I saw the blood pooling there on mama's belly after the first incision, feeling my knees go weak. But I made a conscious decision right then and there to not let it bother me, and I never had a problem after that. I felt almost in a daze as the scrub tech handed me tool after tool that I vaguely remembered learning about in med school with the doc directing me on what to do with them. As he cut through the abdomen, I had to pull the skin back first with my fingers, then use retractors as we went through the muscle layers and finally the uterus. Once through the uterus, there appeared this bag of water with a head floating around inside. The doc quickly burst the bag, and a mixture of fluid and blood flies all over me. He then tells me to push as hard as I can on the mama's belly to help expel the baby from the womb. So I start pushing, but not knowing how much force to put on there, I just use my arms. He sees my weakness and tells me to "put your body into it Iowa boy!" So I'm pushing with everything I have, and he puts his weight into it as well. Finally the baby pops out, and the doc catches it nicely. Immediately the scrub tech hands me the two clamps and I clumsily put the first open clamp over the cord. I didn't get my hand out of the way fast enough(and I had too big of gloves I found out later) and the doc clamps my glove to the cord as he closes it. I'm quickly handed the scissors and I cut the cord with my other hand. Doc then hands me, no, almost throws me the baby and I'm praying I don't drop the slimy little guy. The nurse tries to take the baby away from me, but my glove is still attached to the clamp and it takes me a few seconds to realize the only way I get my glove out of the clamp is to rip it. So I do, and I then have a ripped bloody glove, and again I'm praying that I don't have an open wound on that finger. I get re-gloved and go back and help the doc sew up the layers of mama's belly. Near the end, I'm handed the staple gun and I do my best to staple the mama shut. And just like that, I participated in my first birth. lol. What an experience. It went fast. Let me assure you it got better in later surgeries after I had time to study and prepare for them. And although surgery is cool, I just don't think its for me.

Enough of OB! If you're still reading this, then you weren't grossed out by my c-section story... so good for you. This is the best part about the post because I get to talk about Makenna! She came into town from October 16th through the 19th. It was our only real time together since July and will be the only time until December 19th...so we tried to make the most of it. I finally had the opportunity to give her the official ring on Friday after picking her up from the airport, which I am posting a computer generated version of it on this post. I went through Belliston's Jewelry in Ogden and was very pleased with there customer service and workmanship and would recommend them to anyone. I even got the ring tax free since I had it shipped outside the state of Utah! The best part about the ring though is that Mak absolutely loves it! We designed it together(well, she did most of it actually, guiding me to what she really wanted) and I picked out the diamond. It was interesting doing almost all of the shopping over the phone, but we're happy with how it turned out. I enjoyed every moment I got to spend with Mak and wish she were still here. She wasn't feeling very well Friday night, so we watched the curious life of Benjamin Button together instead of going out. It was a very strange show with a few good lines about life, and Mak only saw about half of it before drifting off to sleep. I was glad she felt comfortable enough to fall asleep (I was not offended at all) and glad she could get some needed rest for the next day. We spent most of Saturday running around Columbus doing wedding stuff like registering at bed,bath and beyond, apartment hunting, my ring, and tux shopping. On Sunday, we took an amazing drive together to Hocking Hills, a state park, about an hour southeast of here. The fall leaves were gorgeous with so many different shades of red, green and yellow. We took a nice nature hike around old mans cave, which was really no cave but an overhanging wall in a gorge, but it was still pretty cool. We enjoyed listening to possible songs for our wedding video on the way down, and read a book together on the way back.

She put up with my sub par cooking and partially cleaned house, and hopefully she'll want to come back with me to Ohio in December! Thanks for coming love! I can't wait til Dec 22nd!

Health care reform

Its the talk of the country. You would have to be banned to ice caves in Siberia to not have heard about it. I just spent the last few days studying for a health policy exam, had a few conversations with colleagues, and decided it might be time for me to chime in on my feelings about health care reform. Ben Iverson posted a question on his blog about what should be a higher priority for change in the country: education or health care. I ended up writing a novel in his comments and decided to just copy and paste that into my own blog post. Here it is:

Education reform all the way! Don't touch health care. LEAVE government OUT of it. Ok, that is what I'm supposed to say as a physician in training. Actually, I feel there is a great need for health care reform...we need more preventative services covered and creative ways to cover 50 million uninsured Americans. But after going through two years of medical school and spending a few months in the wards, I think we're missing the mark in some areas with the current proposals of health reform. First, where is malpractice reform? Can I tell you how many unnecessary tests are ordered, which raises costs, because of fear of a lawsuit? Here is a prime example that happened not to long ago to me: A young man comes into the family medicine clinic with chest pain localized to a specific spot. He has no risk factors of heart disease(no smoking, diabetes, high cholesterol, high blood pressure,etc) and no family history of heart disease. Heart attacks generally feel like pressure on the chest and a patient won't usually point to a specific spot but pain will be all over. He likely has inflammation of cartilage of his ribs. Do we send him home with a high dose ibuprofen or prednisone prescription to reduce the swelling and tell him he'll be fine? No, that would be too easy. Instead we have to additionally tell him to go to the ER(since we don't have all the fancy equipment at the clinic) when he has the chest pain next, to cover our fannies from a lawsuit in the 0.1% chance he is having heart problems. Anyone think the ER will be cheap for this man or his insurance after they get done with all the testing? Will politicians, most of whom are lawyers, touch malpractice? I don't think so. We'll see.
Second, where is medical education reform? What person in their right mind will want to train for 12- 15 years, plunge into a half a million dollars in debt, and earn 50,000 dollars? Any takers? Let me be clear that I didn't get into medicine for the money. And physicians salaries being reduced to $50,000 may or may not be a reality. But I see my mounting debt and hear all the talk about health reform and it makes me nervous of how long I'll have this lingering debt if reform happens in some areas and not others. Check out this article published by a group of independent physicians for congress that addresses what I think are the critical needs in health care reform.
www.physiciansfoundations.org/usr_doc/Physicians_And_Their_Practices.pdf
I don't like insurance companies at all and their billion dollar profit margins...but I feel like congress is rushing too fast and may put in a system that we all regret in the future because they didn't think it completely through.

Many of the older doctors are saying they will retire early if reform goes through. If that happens, we'll have an even higher physician shortage and it will leave us young docs with so much work to do, will we ever see our families?