Monday, June 13, 2011

Pre-quarter Of A Century Thoughts II

First thought on Tumblr [here]

I always thought that witnessing my first normal vaginal delivery would have me all overwhelmed with emotion and I'll come back to write pages and pages of emotional rant. But I didn't, nor was I overwhelmed with emotion.

I witnessed a miscarriage first, the abortus in little cup. She didn't even know she was pregnant. Next came a postpartum haemorrhage, and then finally a delivery.

There was a baby coming out of the woman and all I thought of was "Hmm... I see... Interesting...". Next delivery? Same thoughts.

Later on that day I couldn't help but accuse myself of being a detached, emotionless, cold-hearted excuse of a human being. I just saw what could've been a person contained in a little plastic cup, and new life emerge into this wretched place. And went out for ice-cream afterwards. Vanilla, in case you were wondering.

3 comments:

  1. when I get something I wanted so bad I have same reaction as yours...coincidence? or human nature?

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  2. I hated obstetrics. It was soooo obstetric-y.

    The process of delivery--devoid of mythology or the endorphins of being the mother or the father of the deliveree--is a mechanical, messy business. When you are part of the medical team, the medicine of a safe delivery is primary. When you are a learner, learning the medicine of a safe delivery is primary.

    The spontaneous abortus in a cup is a medical solution to nature gone awry--best for all, though a loss that needs to be dealt with psychologically. Most often the mother's next pregnancy is a healthy one to term.

    Postpartum hemorrhage is a medical emergency and to be dealt with as such.

    I was expecting a lot more women's health issues, and all I got was birthin' babies. Oh, and great insight into: obstetrical nurse-physician dynamics; obstetrical nurse vs female medical student psychopathology; and the wiles of British midwives, now obstetrical nurses, trying to maintain their delivery skills--ie don't call the resident to do the delivery, or call once when it is too late, do the delivery yourself, and then bat your eyelashes at the obstetrician and claim you paged the resident repeatedly but s/he didn't come so you had to do the delivery yourself, repeat monthly.

    The latter means that the family practice resident doing an obstetrics rotation misses out on being the primary care giver for a normal delivery--which a few months later s/he will be doing as part of their practice, unless based in a major city. Chahhhming.

    More interesting is being the ER intern and helping a woman through a spontaneous abortion, ie doing the medical part, and while doing that explaining what the obstetrics people have taught you is the most important ie that a spontaneous abortion is a pregnancy that had medical problems and it is for the medical best, and that most likely the next pregnancy will be normal. The woman, still in stirrups, with you still doing your "procedure", looks absolutely terrifed--still. Hmmm, must add, "It's okay, you are not going to bleed to death. The bleeding will stop shortly and you will be fine". Immediate look of relief on the patient's face.

    This is most interesting when the patient is a very young South Asian woman married less than one year, with no family in Canada except the inlaws. She has now failed at her primary task. So, once you have persuaded her she is going to live, you have to remind her again that there are no implications for the next pregnancy and offer to speak to the hub and the inlaws.

    On my 3rd 1st trimester spontaneous abortion in one shift, when the nurse handed me the file, I snapped uncharacteristically, "I've already seen her!". She tried to tell me I hadn't, I insisted I had (despite any chart evidence). Realizing I was bleary-eyed from being hour 13 of a 14 hour shift, the nice ER nurse got the other charts of the ones I had seen, and pointed out that the name on this one was different. I took the chart, and invited the patient into the examining room.

    What rotation are we doing next? :D :P

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  3. Waseem:
    Coincidence. I recently found out that a good friend of mine jumped back in horror at the sight of her 1st vaginal delivery.

    Chiara:
    I was expecting more on Women's Health as well, but turns out it was more about pregnant women and deliveries.
    We're doing Surgery after my summer vacation :D (I think I'm with the group starting Surgery, it's either that or Medicine...)

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