Surgical Assistant: Nicole, MS-3

Farley and I had to give our case presentations to one of the directors of our OB/GYN core rotation today. I think it went really well. Dr. Hardcore had us give the presentations to him and he questioned us so thoroughly that we were extra prepared for today. I really knew my patient's case well, which made answering questions about her much easier because I was confident that I knew her well. Farley did such a great job that the doctor wanted a copy of his presentation. Overall, we were successful and did a great job this morning.

Dr. Hardcore told us to go home and rest (we were out late last night and had to make changes to our presentation so we were up past 2:00 and had to be up at 6:00 to get to the office to do our presentations by 7:30). Anyway, we had to be back for our lecture at 4:30. It was Dr. Hardcore's turn to lecture us. He decided to let his 4th year medical student who was doing a sub-internship in OB/GYN do a presentation on thrombosis and pregnancy. She did a great job and it was her last day as a medical student. She doesn't officially gain the title of Doctor of Medicine until her evaluation is submitted and I am sure it won't feel real until she walks across the stage at Madison Square Garden in June and has her doctorate in her hands, but she is done with medical school! After the lecture we returned for a surgery and the 4th year scrubbed in and got to close up the entire surgical site herself. She did a great job.

I was the next due to scrub in and we had a c-section to do. The surgical assistant wasn't there at the start of the surgery (there is only one working at night and perhaps he was in with another surgeon). Dr. Hardcore said, we will just start without him. I was the surgical assistant. Surgical assistants go to school and get specific training in helping with surgeries; however, in Miami, many of the surgical assistants are often physicians from other countries who have not taken the US boards and done a residency in the US. I think all of the surgical assistants at the hospital I am working at are Cuban or other Caribbean or Latin American physicians. Anyway, I had to do all of the pulling that bothered me to watch in my first week of the rotation (I had to use my whole body weight to help open up). When they open the uterus, they are very careful. After he made the initial cut, he told me to push down until I opened up the uterus. I was not strong enough to do it. Also, I could feel the baby and was petrified of hurting him. So, Dr. Hardcore had to open the uterus. Then there was a little beautiful BOY right there. I started helping him out and the cord was wrapped around his neck. It was crazy because as quickly as I said, "the cord is around his neck", I had removed it! Victory!! Then as he was being delivered, I saw that there were not one but two full knots in the cord. But this little boy was doing great after the delivery.

Next, Dr. Hardcore said, "put your hand in her uterus and get the uterus out." Apparently it is a very common that medical students are too gentle and he is always telling us to do our job so I had to do my job and get this placenta out. I think in our defense, we are always afraid that we are going to hurt someone and we don't know exactly how much pressure to use because we don't have experience. I guess we are getting experience now. Next, I got to sew up the uterus. I didn't tie the knots because my gloves were slippery because they were covered in blood. Then I got to help him perform the tubal ligation. I even got to cut (well really cauterize) one of the tubes after he tied it off and had everything prepared. I also got to suture the fascia, and the subcutaneous stitches of the skin. Midway through the surgery the surgical assistant came in and Dr. Hardcore said that I was doing a good enough job that the surgical assistant could skip this surgery. I know that I do not have impressive surgical skills yet (I am only a 3rd year student), but it was a honor for him to say that I was doing a good enough job to assist him alone.

It was amazing.

I love it! I didn't think I'd like the surgery aspect of OB/GYN, but it was fun. I can see my sutures getting better and better. I am growing so much as a professional. I don't think that I am going to fall in love with surgery and decide to be a general surgeon, but anything is possible. Like I have discussed before, I have been interested in OB/GYN for a long time, but I really thought I'd go into pediatric oncology. I am shocked at how much I love OB/GYN. I am still not convinced that I will want to do an OB/GYN residency rather than a pediatrics residency, but I am so happy that I am enjoying this rotation. I feel like I have more options now.

Hey Mama, Let's Meet Your Baby!

We arrived at the hospital at about 10:00 am on Friday morning. We were suppose to be going into a laparoscopic surgery for a patient with pelvic pain and who wanted to know if her tubal ligation could be reversed. Well, we didn't get to the main OR at 10:00 because there were some ladies in labor. All of the ladies we delivered were nulliparity (no children) and very young. You really never know how a labor is going to go. Some women have an extremely hard time, despite having several children, and others surprise you and excel. It was Farley's turn first. His patient was 19 and she got an epidural late in the labor. She pushed that little boy like old pro. Every time she pushed you could see the baby move. We try to be in the room ready to go before Dr. Hardcore gets in there. Farley was ready to go and we were waiting for the doctor. The patient was ready to push that baby out and when she felt the next contraction she started pushing. The doctor walked in right as the head came out. Farley was ready to go and he got to deliver this little guy with the doctor's instructions. I was shocked at how well she pushed. Most first time Mom's I have seen don't "learn" how to push as quickly and efficiently as this gal did. I think she only pushed three or four times and this baby was out!

Right at the end of the delivery, Dr. Hardcore asked whose turn it was next: it was mine. He said come on, you are going to break a lady's water. I have never broken the water before. It wasn't that hard to do, but I thought that I didn't get the sac because I didn't see or feel the water. Some ladies have a huge gush and some have very little. Dr. Hardcore check and I did in fact break the membranes. My gal was still in high school and she came to the hospital when she was 10cm dilated. After breaking her water, it was only 20-30 minutes before we got to meet her little girl. Her Mom looked scared. I don't blame her. Her daughter was so young and her life was changing dramatically. Since she was already dilated to 10cm, she could not have an epidural. She was in a lot of pain, but she handled herself with a shocking about of calmness and grace. When I broke her water, she was probably at zero station (baby's head is at the level of the ischial spine). She was pushing with the nurses to get the baby down to + 5 station (or +3 depending on which scale the practitioner uses). At +5, the head is visible, which is also known as crowning. My patient was starting to get a little tired, so Dr. Hardcore told her to try to relax and to not push during the next few contractions. So she tried to rest and I coached her about how she needs to push: put you hands on your thighs near your knees and pull them toward your chest, put her chin down into your chest, take a deep breath then hold your breath and push like you are trying to have a bowel movement for ten seconds. She listened so closely and she was so intense. When she was tired, I was afraid she might give up, but then I asked if she was having a boy or a girl. She said a girl. Then I replied, "I can see your little girl's head. Don't you want to meet her? She is almost here. You can do it. Hey Mama, let's meet your Baby!" There was a fire in her eyes and she said, "I want to push now!" From there on out, she moved that baby like a champ! Dr. Hardcore came back in and there was a beautiful baby girl in no time. My patient was concerned that she was going to tear during the delivery and unfortunately she did. With Dr. Hardcore's help, I got to help suture her up. I have never injected a patient with lidocaine before so not only did I get to practice suturing, I learned how to do this.

Next there was a c-section. She was a TOLAC (Trial Of Labor After Cesarean); however, her records from the previous cesarean had not been sent so she was no longer a candidate for a VBAC (Vaginal Delivery After Cesarean). The cesarean went well and despite having to have a cesarean rather than the vaginal delivery, the parents were beaming with pride over their beautiful baby girl. Following the first c-section, there was another planned c-section. She was a larger woman (400Lbs) and the anesthesia wasn't working well enough so she had to go under general anesthesia. Whenever Farley scrubs in for surgery something happens, the woman has trouble getting anesthetized or Dr. Hardcore stops for a vaginal delivery, and he ends up scrubbing in and standing in the OR for 40 minutes. Anyway, she wanted a tubal ligation, so after her baby boy was born, they completed the tubal ligatation.

After leaving the L&D OR, we headed to the main OR for the first patient of the day. When we got there, another surgeon was throwing a temper tantum that would rival any angry 2-year old. Even though Dr. Hardcore had the rights to the OR, despite being hours late--you cannot stop a delivery once the baby is crowning nor could the VBAC turned c-section wait--he let Dr. Temper Tantrum take the OR.

Shortly there after a Code Blue was called. It was in a part of the hospital that Dr. Hardcore's gynecological patients go. Dr. Hardcore was talking to a couple of CRNAs at the time the code was called. Out of nowhere, they were on the move and so were we. In the elevators, Dr. Hardcore said that the code was one of the CRNAs, who had a stroke our first week in the hospital. Every CRNA who wasn't in surgery, at least 3-5 doctors, and a handful of nurses were running the code. After an hour, they finally called his time of death. It was an extremely hard day for the hospital staff (and obviously, his loving family who we tried to comfort during the code).

After the code, we headed to the office for a few hours. I didn't get to go see a patient (there were two patients and SIX medical students...there are two other medical students who are suppose to be with Dr. Hardcore on the weekends during this rotation, but they had not showed up until today). Nonetheless, I had a great time in the office because there was a four month old baby who needed holding while her Mom had a procedure. I was happy to oblige. Oh, and this little baby was really pretty, with her curly hair in cute pig tails.

After being at the office, we rushed back to labor and delivery for another delivery. This mother was also young and nulliparious. The father of the baby had been killed a few months ago, so this was a very bittersweet day: the baby was a boy who was taking on his Daddy's name. The hallways were so packed with people waiting for this boy's arrival they threatened to call security, which resulted in the people spreading out further along the highway. This mom had a really hard time pushing out this baby and I thought that she was going to end up with a c-section because the baby's heart tracing started showing that he was stressed. Dr. Hardcore came in and used the vacuum on the baby and Mom was able to push him out. When we left Labor and Delivery, a woman at the end of the hallway yelled, "There is Dr. Hardcore!" The hallway burst into cheers and we all got high-fives. There were so many people in this hallway, that I felt like a college football or basketball player (like a ZAG!) running though the tunnel of screaming fans and getting bilateral high fives. It was an amazing feeling, even though I didn't do anything but cheer as Mom pushed the baby out. I thought it was awesome that so many people came to support this Mom and the paternal grandparents on such a bittersweet day.

Next, we headed back to the main OR to finally do the surgery on the pelvic pain patient. This was a laparoscopic surgery, which I have not seen yet. Dr. Hardcore was looking to see why she had pelvic pain and determine if the tubal ligation could be reversed. She had really good sized fibroids (benign leiomyomas) of the uterus which caused her pain. Unfortunately, she didn't have enough of her tube left to try and reverse the ligation. There are different ways to do the ligation and she had her tubes cauterized. This means that they tie off about 3cm of the tube then then cauterize both sides of this 3cm specimen. After they cauterize the tube, they put sutures in the new ends. In reality, this causes more of the tube to die. They need about 5cm of good tube plus good fembriae to reverse the tubal ligation (no one has gotten pregnant without at least 5cm after having her tubal ligation reversed). In case you don't know, the fembriae are the finger-like projections on the ends of the uterine tubes (Fallopian tubes) that encourage the egg released from the ovary to enter the uterine tube rather than to float away into the peritoneal cavity. At any rate, Dr. Hardcore really couldn't do anything for her because (1) he cannot do a myomectomy to remove the uterine fibroids without a consent to do so, which includes the fact that it could reduce her ability to carry a pregnancy and (2) he could not reverse the tubal ligation and he will have to refer her to a reproductive endocrinologist if she wants to try in vitro fertilization.

After that, Dr. Hardcore was suppose to have a D&C for a missed abortion (there was an intrauterine pregnancy, but the baby died and was not expelled from the uterus). However, the patient's significant other sneaked her in McDonalds so she couldn't have the surgery.

Then, we got to go home. It was just a typical day for Dr. Hardcore.

"You saved a life tonight"

We went into the clinic at 9:30 am on Thursday and left at 1:30 am on Friday. We saw patients, we went to lecture and we came back to help deliver a baby. Then Doctor Hardcore said, "it is time to work." There was an ectopic pregnancy and she needed emergency surgery. It was my turn to scrub in. Obviously, I've never seen an ectopic pregnancy and this ectopic pregnancy, like most, was in the fallopian tubes. I don't know how this looked compared to other ectopic pregnancies, but right when they opened her up, I could see immediately where the ectopic was located. It had not burst and the doctor was easily able to remove it. She also had a pretty good sized cyst on her ovary, so the doctor burst the cyst. It was an exciting night because we were able to remove the ectopic before it burst, which could have killed the patient. I got to suture the fascia layer and the fat layer! It might not sound that exciting, but it is so awesome that Dr. Hardcore not only teaches us but he lets us help. I was a little surprised because it was so late and I know he was tired. I wouldn't have been surprised nor would I have blamed him if he would have just done the suturing himself so he could get home and get to bed sooner. Of all of the preceptors in this rotation, I think Farley and I probably got the best one. He maybe very hard to in contact with and we are working more hours than any of our peers, but we are allowed to do more hands on work than anyone else I've talked to. I have always had OB/GYN on my short list of possible residencies and after working with Dr. Hardcore, I know that I would be happy in OB/GYN. However, I did go to medical school fully intending to do pediatric hematology/oncology so I am not willing to say that I have made a decision to go into OB/GYN yet. It is nice to know that there are multiple things specialties that I would be excited to spend the rest of my life practicing.

When we were in the parking lot, Dr. Hardcore said to me, "Go home, call your Mom and tell her you saved a life tonight." I don't think I saved a life and they really didn't need my help to save this woman's life, but I did help. It was a great feeling!

"Now, you are an Obstetrician"

We were not sure what time to arrive at the hospital, so we decided to arrive about 9:30 and round on Mother Baby. We finished about 11:30 and headed over to Labor and Delivery. None of Dr. Hardcore's patients were anywhere near delivering, so we decided to head downstairs to get coffee. The PA student and I really wanted to go off the hospital campus for lunch so about 12:00, we headed to Pollo Tropical, which is a chain of restaurants that serves Caribbean influenced chicken, rice, beans, veggies and deserts. It was yummy! We got a call saying that Dr. Hardcore was in route and we needed to hurry. We got back to the hospital in about 20 minutes and we beat him back. After Dr. Hardcore arrived, we rounded on his patients in Labor and Delivery and he had to break a few membranes (aka broke the patent's water). Then we headed over to the office for a few hours. I saw some obstetrics patients and I saw some gynecology patients. I think we were seeing patients until 8:00 or 8:30. We hung out at the office until about 10:00 before heading back to Labor and Delivery.

After arriving at labor and delivery, we check on the patients with Dr. Hardcore. Then about 10:30, we thought that a patient was ready to delivery. All of the students were in the room because we wanted to be ready for when Dr. Hardcore arrived. The Mom was dilated to 10, 100% effaced, but still at a 0 or -1 station. The nurses were trying to get her to push the little boy down station -3, but she just didn't have it in her. They gave her another 30 minutes and thankfully, she was ready to push. The epidural didn't seem to relieve her pain enough and she was having a hard time with the delivery. I don't think she wanted to push, but she did it. Farley was helping to delivery this baby and this Mom was a bit of a challenge. Unfortunately, she had a tear and Dr. Hardcore and Farley had to suture her up. She did NOT want to be sutured, despite having an epidural and local anesthesia to alleviate the pain. She kept pushing Farley and the 4th year medical student had to grab her hands to keep her from hitting him while he was suturing her. Dr. Hardcore even had to stop and talk to her. She did not want to be sutured, which I do not understand at all. I understand she had some pain, but she was given two types of anesthesia. But then again, she couldn't see how her vagina looked and maybe she didn't the consequences if she didn't have her vagina repaired properly the first time. That is just not a lingering problem you want to have.

At 11:30 after the delivery, Dr. Hardcore let us into the doctor lounge and told us to get comfortable. That should have been a sign. We waited until about 1:30 when the action started again. I got to help deliver another baby. This was a special baby, as she was conceived via in vitro fertilization. It was also one of Dr. Hardcore's favorite patent's so I didn't get to actually deliver the baby but I did delivery the placenta and massaged the uterus after the delivery. After the delivery, Dr. Hardcore had to run to the next room and deliver another baby. Dr. Hardcore returned and we needed to stitch the patient because she had a small rip. I helped him stitch and honestly, it was more nerve wreaking than stitching in the OR.

After those deliveries, we were playing the waiting again. There was one patient who was dilated to 8 and was 80% effaced. We thought the delivery would happen relatively quickly: We were wrong. At 3:00 am, I decided that I was cold so I headed back to the doctor's lounge and watched the Cosby Show under a blanket. At 4:00, I headed back out to see what was going on, which was nothing. At 4:30, I decided to try to sleep. I had a hard time falling asleep, but I think I slept for about 40-60 minutes. At 6:00, Farley came and woke me and the PA student up: the Mom we were waiting for was having a c-section. As the preparations started, we debated who would assist. It was the PA student's turn, but she didn't want to. That made it my turn. We talked her into assisting and I think she was glad we did. The surgery didn't start until after 7:00. The PA student did a good job stitching and was excited that she did stay all night for this surgery. At the end of the surgery, Dr. Hardcore looked over to Farley, the 4th year medical student and I and said, "Now, you are Obstetricians."

We left the hospital about 8:30 am. It was a long day and I really didn't expect it, but it was a good day. Thankfully, Dr. Hardcore told us to take Tuesday off and not to report until Wednesday afternoon. I slept most of the day and I am ready to sleep again. I was probably should have gone to bed an hour or two ago, but I didn't want to wake up at 3:00am and not be able to get back to sleep.

Weekend Haze

On Thursday and Friday of last week, we left the hospital late and I didn't get to bed until 2:00am. I slept until 2:00pm on Saturday! Geeze! I knew I was tired, but gosh golly. I went to 5:00pm Mass and I relaxed a bit. Unfortunately, I was wide awake until 2:00am again. I hate having my sleep schedule changed, but that is part of medical training.

On Sunday, I slept in again. I studied, went to the grocery store, worked out and made beef stew for the week. It was another relaxing day--other than working out !

Friday

When we left the hospital last night, Dr. Hardcore told us, "Don't call me at 8:00, don't call me at 9:00, maybe call me at 10:00" so Farley and I decided to go to the hospital to go to the hospital at 10:00 and round on the patients. We rounded then we ran over to Labor and Delivery. It was my turn to deliver the baby. As usual, it was a baby girl. I just don't help deliver a baby unless it is a baby girl! Anyway, this mom did a great job pushing. I had just put my hand at the base of the baby's neck/top of the shoulders then in one push the baby was out. She almost flew! It was another healthy, happy, baby girl!

Since Dr. Hardcore had a very late night Thursday night (he admitted a few patient's after he sent us home at 12:30), he headed to his office to take a nap. We went to lunch at the cafeteria and we sat in a courtyard gardens. In addition to Farley and I, there is a fourth year medical student doing her sub-internship and a P.A. student in this rotation. Luckily, we all get along really well and have a great time. It has made our down time so much more enjoyable. So after lunch, we headed to the labor and delivery unit to wait for some action. We offered to place IVs, draw blood and put in foley catheters, but they didn't need any help so we sat in the wheel chairs in the corner and tried to stay out of the way.

All of the sudden, there was extreme tension in the air. A Mom arrived in antepartum who didn't appear to have a fetal heart rate. Luckily, upon placing the internal fetal monitor, the baby did have a heart rate, but it was extremely slow. They needed to do an emergency c-section and the on-call doctor was in route, but not arriving fast enough (I presume it was due to stupid Miami traffic). Anyway, Dr. Hardcore was close by and he rushed into the OR. The nurse manager asked us not to go into the OR so we waited outside by the doors watching patiently. It looked like an episode of ER. Dr. Hardcore came out of the OR smiling and laughing then asked why we didn't come in and informed us that he is the only person who can kick us out of the OR. Anyway, Mom and Baby were okay. The baby came out screaming, but some of his labs were a little off so they were going to monitor him. Thankfully, it all ended well.

Next, we headed into another room for another vaginal delivery. It was a healthy baby boy. Then right after that it was time for another vaginal delivery, which was another baby boy. Then it was time for another c-section. This time it was Farley's turn.

This mom had a previous c-section so there was no emergency in this delivery. Farley asked Dr. Hardcore if he could stitch. Farley did a great job suturing. So great in fact that Dr. Hardcore was talking about how impressed he was with Farley's command of the suturing equipment.

Then, I got to type a note for the doctor because he needed it fast and he can't type before we were dismissed for the week. We wanted to come in this weekend, but the doctor is suppose to have a couple of other medical students who are suppose to be with him over the weekends and they haven't come in yet.

Thursday

The end of last week was crazy. Thursday, we started out at Dr. Hardcore's second office at 9:25. This office is about 15-20 minutes away from the main office and the hospital where he practices most of the time. We saw a few patients with the doctor. I got to see a couple that had a baby the first day of my rotation. The little girl is so beautiful that I think she will be the next Ms. Venezuela.

After seeing the patients, we went to Boston Market to grab a bite to eat then we rushed to the hospital. There was a c-section planned, but it got started a few hours late. It was my turn to scrub in and I decided I was going to ask to help out this time. After opening the patient and getting the little girl out, I asked Doctor Hardcore if I could suture. He let me suture the fascia layer. For those of you who don't know, the fascia layer is one of the most important layers. It is the connective tissue that keep the abdomen from herniating out. I thought I would do a stitch or two, but I did the entire layer. After getting the patient back to the recovery room, Farley and I had to rush to our lecture on breasts. We were a little late and apologized to the professor, who didn't care because he thinks the world of Dr. Hardcore. After class, we headed back to Dr. Hardcore's office, which is at the hospital. As usual, it was a full house so we helped out as much as we could. We left his office at about 10:30 because a patient needed a c-section. It was the other medical student's turn to scrub in, so Farley and I observed. We stayed and helped get her to recovery. By the time we finished at the hospital and were sent home, it was 12:30.

Jogging

I have never been a jogger/runner in my life; in fact, I really dislike jogging. Farley loves to go running and has been trying to get me to go running with him for years now. I finally gave in a couple weeks ago. It agitates my exercise induced asthma, which in turn, agitates me. Nonetheless, Farley and I have gone jogging three or four times per week and running three to three and a half miles each time. It is rather funny because my sprint is his normal running pace. He is being a really good sport and going slow so that I can keep up/breathe. He is also very encouraging--I would have given up without his support. I am getting a bit faster, but my asthma is still bothering me. It is such a strange feeling because my body wants to keep going, but I cannot get the air out when I am breathing (Asthma is considered a reversible obstructive breathing disease. It you work out so that you are breathing hard, then try to catch your breath breathing out of a straw, you would get the idea of what I feel like. Luckily, asthma is reversible unlike patients with COPD, which is not reversible.). Living on South Beach and just being a half block from the Miami Beach boardwalk is the only reason I agreed to try jogging. We don't have much time to just go sit out on the beach, so this way I get to work out and enjoy living on one of the most famous beaches in the world.

This is the view to the East, while we are jogging.

This is the boardwalk that I am jogging on. I guess I can't complain too much!

Suture Kit

Dr. Hardcore sent us home with expired sutures and suture kits so we could practice suturing. I asked him if we should get pig's feet, as they are often used to practice stitching, but he said there is no need because the difficult part about stitching is using the needle holders and hemostats. He suggested we stitch up anything we have around the house, such as old towels. Here are a few pictures:

Above: Here is the equipment which we are suppose to practice with. Obviously, we need a lot of practice---look at all of that stuff!

Below: If you ever see a medical student coming toward you with a needle that looks like this, run. I would!

I am glad that Farley and I took the opportunity to learn how to suture on the island during the suture clinics. On the island, it was a fun study break and now it is really helping. I cannot remember everything I learned about stitching in my first and second years of medical school; however, it isn't completely foreign to me. I am picking it up much faster now. Before I know it, I will get to help close up a surgical patient!

A Jam Packed Week

We worked for about 60 hours in five days this week and it wasn't that bad. In fact, it was really fun. There were many deliveries, cesarean-sections, and surgeries so the hours flew by. I was planning on posting about the days, because they were so awesome individually, but I haven't had a chance to sit down and compile my thoughts on the week until right now. At this point, the days all melt together. Here are some of the highlights:

• On Monday, I got to assist in delivering my first baby. It was one of the most incredible experiences of my life. It was a beautiful baby girl. Happy Birthday Beautiful!
• On Thursday, I did the history and physical on a patient who was being admitted for the delivery of her first child. I spent a lot of time with her and got to know her just a little bit. On Friday morning, the nurse said that she was delivering and so I ran into the room to watch the delivery. The doctor let me assist again! Another beautiful baby girl!!
• Friday morning, I got to scrub in and assist in my first surgery. The patient was having a hysterectomy because she had a uterus full of benign leiomyomas (uterine fibroids), which can cause increased bleeding and a ton of pain. I have felt benign leiomyomas during pelvic exams and seen in the cadavers during anatomy. The leiomyomas themselves basically feel the same in all three situations; however the uterus feels different in a cadaver than it did freshly removed from this patient. Obviously, the cadavers are processed and they are very similar but a little tougher/harder. There are some medical schools who are no longer using cadavers to teach anatomy. I cannot imagine how they learn the anatomy (it is all so twisty and it is in 3D). In ways, watching the surgery was like being back in the anatomy lab because I have seen the insides before. There are little things like the thickness of the vessels (even just feeling the vessel) tells you if it is an artery or a vein. I think there are somethings that are best learned by touching and doing rather than reading. Anatomy is one of those things, despite how much I hated the anatomy lab.
• Also on Friday, I got to scrub in and assist in my first cesarean section. Happy Birthday Baby Girl!
• Had a patient with premature rupture of the membranes (PROM). PROM is one of those things that is all over my OB/GYN text book so it was interesting to see a case. I know that sounds horrible, but this mom is close to term so they are just having her hold off delivery for a few more days. Both Mom and baby look good. I have had a chance to see a patient with PROM, which makes remembering the syndrome and remembering how to treat it much easier. For the rest of my life, I will remember this woman's face and her name. These patients make such an impact on medical students. I wonder if they know how much they mean to us.
• Saw a cerclage removed. A cerclage is a super stitch that is placed in a pregnant woman who has cervical incompetence. I had read about cerclages and wondered how a regular old stitch would hold together a cervix. I was wrong: a cerclage is no regular stitch. It is a super stitch. Watching a stitch being removed may not sound exciting, but I am glad I got to see it.
• I saw not one but two patients with polycystic ovary syndrome! This is another syndrome that we hear a lot about in school, not just in the third year OB/GYN and endocrinology text books but in the second year pathology. I even had a question about polycystic ovary syndrome on my boards last November.
• I saw a diabetic and hypertensive pregnant lady. These are major problems in the United States and again it was a great learning experience to see how the doctors managed this lady's problems. Last night I was reading in my OB/GYN book about pregnant ladies with diabetes and hypertension and it was so helpful to have seen a patient with those problems. It just makes things make more sense.

I have always had OB/GYN on my radar, but I've never known if I could handle the surgery. I just don't think I am cut out for surgery. I was a little grossed out by the first few surgeries that I saw. Just observing the room and watching the surgeons, who have to be rather aggressive to perform surgery, is a strange feeling. It is sort of like watching a surgery on t.v. I kept thinking about the surgery from the patient's prospective--Thank God for Anesthesiology! Anyway, once I was actually at the table, my perspective on the surgery completely changed. It was amazing! During the surgery, I was trying to figure out what and why the doctors were doing what they were doing (In medical school, one doesn't learn how to perform surgery step by step like a surgical resident. In medical school, we learn to stitch and staple, proper technique for scrubbing into surgery and similar things). When I say I assisted, I really mean that I held retractors, gave tension to the thread when the doctor was stitching and suctioned blood out of the field. All in all, I was surprised how much I liked the surgeries.

On the other hand, I knew that I would love delivering babies. I have got to say that it is one of the most exciting things I have ever done in my life. Once the little heads are out, it takes a little bit for the shoulders to come out, then the babies quickly arrive, like a ketchup packet being stepped on. I have cut the umbilical cord in both deliveries that I assisted and I am here to tell you that the umbilical cord feels a little rubbery. For those of you who do not know, the deliveries are not that bloody until after the baby is born. The uterus has lots of blood in it as does the placenta so during the delivery of the placenta things start to get bloody.

I am still very interested in hematology and oncology, but this OB/GYN rotation is making OB/GYN seem like a very viable option for me. I am still not 100% sure I want to do surgeries nor am I sure about the crazy hours that OB/GYNs work, but I love this rotation.

Is Farley on T.V?

It isn't just me. I have heard this from several people. Farley looks so much like the guy in the Old Spice Commercials. I couldn't put the video directly into my blog, so here is a link. When the Farley look alike in the commercial says, "look at your man, now back to me, now back at your man, now back to me. Sadly, he isn't me." I am shocked because when I looked at my man then to the guy in the Old Spice commercial, I was beginning to wonder if my man was in the commercial. In fact, I think Farley may have been filming for this ad campaign while I was having surgery last January! The resemblance is almost uncannily, see for yourself below. Now, I was going to post a picture of Farley from the beach for a proper comparison; however, I thought that would be objectifying him. Besides, Farley would make the actor look bad because Farley is in such good shape!

If I only had a picture of Farley making the same face, it would be even better!

Easter Dinner

We were on call again today, so I was unsure if I could get my turkey baked. I slept in late and when I work up, I decided to bake the bird and hope that we didn't get a phone call. I've never made a turkey by myself before, so I called my Mom a few times to clarify what I needed to do. I had made the stuffing the night before so all I had to do this morning was to wash the turkey, get rid of the gizzards and such, stuff the turkey and put it in the turkey bag to bake it. Unfortunately, I couldn't find a turkey bag in Miami, so I bought the next size down (which was for up to 8 pounds) and just put two of them on my turkey, which was slightly less than 13 pounds. Because I used a bag, it only had to bake for 2.5-3 hours (which was great since we were waiting for a call). I also made sweet potatoes (or yams, I am not sure which I grabbed at the store), mashed potatoes, zucchini and carrots, and brownies for desert. Luckily, everything turned out wonderful and we didn't get called in while we were cooking or eating! Here are a few pictures of the dinner:

Saturday

We are suppose to go into the hospital today, but we just don't know when. Dr. Hardcore thought it would be an afternoon thing, but as we already know, the Moms and Babies have a big say in what time things happen. I slept in until about 10:30 then tried to get some stuff around the house done. I wanted to go take a walk or perhaps jog on the boardwalk, but I am a little afraid to venture too far from the house. I also didn't want to be all sweaty in case he calls and I've got to get to the hospital quickly. Thus, I haven't done much at all today. I started my stuffing for my turkey and I did a little laundry. It is almost 4:30, so I suspect that we will be getting a call soon, but you never really know. It has been really nice to lounge around today, but I also feel like I can't get too into something (such as going to the beach or working out) because I don't want to be caught in the middle of something when we get the call.

Five New Lives

Yesterday was my first day on call.  I knew that the first time would be exciting and that in reality it isn't all it is cracked up to be.  Dr. Hardcore didn't think any of his patients would deliver until the afternoon, so he told us not to worry about reporting early in the morning unless he called.  At 5:45, I heard a familiar sound and jumped to grab my cell.  He had a lady about ready to deliver and we had to rush to the hospital.  I was so excited!  I ran to go wake up Farley so we could change and hit the road.  We were walking to the car by 5:50 and at the hospital by 6:10, which was just in time to miss the delivery.  But, that was okay because he had two other women who would soon be ready to deliver.  We waited while he finished some paperwork then when he was giving us a lecture on fetal heart beats and contractions I got really, really hot.  I was about ready to ask if I could go sit down and the next thing I remember is Dr. Hardcore and Farley kneeling down next to me with the entire nursing staff surrounding me.  Yes, I faint.  That will teach me to get up and moving so quickly without eating anything.  I was lucky enough to faint at the shift change so all of the day and night nurses were there.  It was so embarrassing.  Nothing was even going on at the time.  No disgusting ER/Grey's Anatomy type scenes.  We were just standing around talking about fetal heart beats.  Apparently I moved my hand in a weird way and Farley stepped over (we were standing next to one another) and he grabbed me so I didn't even hit the floor, I was placed there.  Then I was given a wheel chair, orange juice, a donut and coffee.   

After that humbling experience, it was time to deliver a baby!  The first Mom was so quiet and calm (she had an epidural).  She pushed that baby out like she was doing something as mundane as washing dishes.  It was unbelievable.  She had a lovely little boy.  Then we went to the Mother Baby unit and rounded on some patients.  Then the second call came. This Mom also had an epidural, but she wasn't calm at all.  She was screaming so loudly and thrashing in the bed.  The doctor had to clam her down and get her to push rather than twist and turn.  Once he was able to do that, Mom number two pushed out a little girl.

Somewhere in the midst of the rounding and baby delivering, we saw an anesthesiologist who was coming to give a woman an epidural.  The nurses and Dr. Hardcore started asking him questions as to if he was feeling alright, but he claimed that he just had the flu.  He was shaky and Dr. Hardcore ask him to please call one of his partners to come in because he looked so ill, which he promised to do.

After delivering baby number two, Dr. Hardcore let us go home for a few hours.  As we were all walking to the parking lot, Dr. Hardcore informed us that the anesthesiologist had a stroke!  It was a really good thing that he was int he hospital at the time because he could get treatment quickly, but I will be keeping him in my thoughts and prayers.  I hope that he is doing better today.

We left the hospital at about 11:30 and went to Target to grab a few things before heading home (namely, trail mix for the car and powerbars/luna bars for early morning call).   After getting home, I had lunch and took a nap.  I work up in time to take a shower before getting the next call at 3:47 pm.  Farley and I quickly changed and were out the door again.  Unfortunately, we hit rush hour and, probably because it was Friday, everyone and their dog (literally) was trying to get on or off Miami Beach.  It took us 40 minutes to drive to the hospital (we can usually do it in 15-20 minutes and obviously even quicker than that at 5:45).  After getting to the hospital, we had to park (a long ways away because we are the lowest in the hierarchy of the hospital).  We then rushed to the labor and delivery unit only to find the P.A. student.  Dr. Hardcore wasn't there yet.  Another medical student met up with us.  He is rather famous at my medical school because after taking his Step 1 boards, he was diagnosed with T-cell Acute Lymphoblastic Leukemia and was Philadelphia Chromosome positive.  For those of you who don't know, this is a horrible, horrible diagnosis, especially since he was in his mid-20s at the time (in someone younger than 10 years old, it would be better, but still a really bad diagnosis).  Anyway, he had immigrated from Cuba several years ago, but he hadn't been here long enough to qualify for medicaid and our school's insurance had lifetime caps (but no more, Thank you Mr. President and Congress!!).  Anyway, this guy needed a bone marrow transplant to live and was on some crazy expensive drugs because he was Philadelphia Chromosome positive.  I am happy to report that he had his bone marrow transplant two years ago and if you hadn't known that he had been sick, you never would have guessed it.  He has been out of school for two and a half years fighting his cancer.  He is a little nervous because he tried to keep studying while he was treated for cancer but really could not.  I think he will do great in this rotation because he is focused and kind.  He is a super nice guy and I am sure that he will teach us a lot about medicine because he has experiences as a patient that I do not.

Anyway, while we were waiting for Dr. Hardcore and discussing our colleague's story, another OB/GYN asked if we wanted to watch a c-section.  So, the PA student and I went to watch.  It looks to aggressive and  painful.  No wonder if takes at least six weeks to recover....it looked horrible!  After the beautiful baby boy was out, they just lifted the uterus up and stitched it up.  It was so strange to see the uterus out of the body and then they put it back in.  They finished stitching her up and the pediatrician took a look at the baby.  Both Mom and the baby were doing well.

Shortly there after, Dr. Hardcore arrived.  We headed into deliver another baby.  This was the only mother whose significant other was at the hospital at the time of delivery.  I think it was the most exciting delivery of the day because this baby was so obviously wanted.  Mom, Dad and maternal grandma were so excited her for birth.  This little girl was absolutely stunning.

After her delivery, we all headed back to the OR for another C-section.  This time Dr. Hardcore was doing it.  Dr. Hardcore uses a different technique where he has these rubber circles that are attached by what I think is plastic in between them.  basically, you get a tall cylinder without the ends and that is inserted into the surgical site.  It helped open up the area and then he just lifted the baby up through the cylinder.  He then sutures the uterus in the body rather than lifting it out of the body.  Apparently there are advantages and disadvantages to both methods of performing c-sections, but this way sure looked nicer on the mom.  I am sure, in actuality, that they are both as painful post-operative, but it looked nicer.  Dr. Hardcore let one of us step up to the table and we all decided that that should be our cancer survivor since he wants to be and OB/GYN and he is only with Dr. Hardcore on the weekends (he is with a doctor who only does gynecology and so he is with Dr.  Hardcore on the weekends to do the obstetrics).  The cancer survivor looked so happy to be helping with the c-section and then after the c-section, he assisted in the tubal ligation.

So, it was about 8:30 pm and we were sent home for the day.  In summary, I saw five new babies born, three vaginal deliveries, two c-sections, one tubal ligation, there was one anesthesiologist who had a stroke, one cancer surviving medical student, and I was the one medical student to faint.  All in ten glorious hours of hospital work.  This is going to be an exciting six weeks.