Ob/Gyn.

Ob/Gyn.

  • How did I feel when I got home?

Ugh.

  • Did I feel excited to look up the illnesses and diseases in the patients I was caring for, or to study for the shelf exam? Was there diversity in the conditions being treated?

No. So many no’s.

  • What were the main feelings I encountered while working with the patients? The medical team?

“Why can’t they just push for a couple hours instead of us pushing more Ptocin to speed things along?”

“Why is the team doing a poll on whether Snape was Harry’s father or not?”

“Oh, look- another low transverse incision.”

“Oh, look- another shelf question about a pregnant woman with bleeding. Still no idea.”

  • How much direct patient contact was there? 

So much. Too much vagina.

  • What were the humdrum aspects in the patient population or workflow that would have to be tolerated for the rest of your life?

Oh dear god where do I begin.

  • Does this specialty address one of the leading causes of death in the world?

Probably.

  • How easily can motivational impact be integrated into a career in this specialty?

Meh.

  • Does this specialty focus on preventing problems or fixing problems?

Both, I guess. But truthfully, Ob/Gyn was like nails on a chalkboard to me. It was the first and only rotation I have disliked during medical school so far- and I’m okay with that. Maybe it’s my lack of personal experience with childbirth, differences in personalities with those who chose to pursue the specialty, or maybe a lack of a lot of exposure to newborns as I was growing up. Or, maybe, my soul spirit was in medicine in a past life and my allergy to Ob/Gyn stems from a deeply-rooted fire that spans through time and space. Whatever the reason may be, I am so blissfully okay with plopping Ob/Gyn onto the pile beside Radiology and Pathology of specialties I can safely cross off my list (and possibly burn later).

IMG_7932

Photographic evidence of my one good day on Ob/Gyn.

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Umbraphile.

Long before we were born,

the universe carved us from the stars.

Life struggles were mapped before us,

like yarn stretched between wooden pegs.

Intersections and constellations and introductions

attractions and revelations and liberations.

Hair flaming in the wind

fingers stretched towards the sky,

the dragon swallowed her sun.

And finally,

she could breathe again.

 

leaves.jpg

Splinter.

You are a biologic carcinogen.

You left splinters under my skin. They don’t hurt most of the time, but when I run my fingers over their grooves they still send electric shocks through my ribcage.

You buried roots in my coronary vessels. I get angina at the thought of you and it drops a weight on my chest and it feels like I can’t breathe.

You spread hematogenously.  I can feel your metastases weighing down my bones and crowding out the marrow cavities. They ache a lot at night.

You left a scar. It’s small, barely noticeable by anyone. Like a plump nodule hiding behind a clavicle, quietly heralding systemic disease.

12

Surgery.

Surgery.

  • How did I feel when I got home?

Utterly exhausted. More sleep deprived than I’ve ever been. The happiest I’ve ever been. Undeniably, completely fulfilled. From Day 1, feeling like surgery has been my purpose all along. My head would be reeling from the insane things I witnessed that day – the trauma patients with ruptured vessels and fractured bones, the massive surgeries with huge slabs of muscle being cut and sewed elsewhere, the surgeons I witnessed trying to grapple with it all.

  • Did I feel excited to look up the illnesses and diseases in the patients I was caring for, or to study for the shelf exam? Was there diversity in the conditions being treated?

Abso-fucking-lutely. Surgery is everything – cutting diseases on the skin, under the skin, under the bones, everything. Once you step out of the OR, it’s back to medicine – whatever you want medicine to be – pediatrics, geriatrics, critical care, cardiology, pulmonology, anything. I love that surgery is all-encompassing. I love that there is an artistic finesse to it – a hundred different ways to perform the same operation. Finding the perfect needle angle to enter the skin, how to more efficiently pass instruments to eliminate unnecessary steps, perfecting the art of fascial planes – I love it all.  Also notably obsessed with stories of what surgery and residency used to be like in the “days of the giants” and digging up original documentation of suturing technique.

  • What were the main feelings I encountered while working with the patients? The medical team?

Honestly, I missed my time with patients. I savored the few minutes in the quiet, dark mornings before rounds. But when I did interact with patients, I felt like my impact was greater than ever before. We were actually helping to solve their problems – we were taking huge strides and fixing things. The surgical team could be cold and intimidating, but overall I was stricken by how extremely competent they are. I was working with the badasses, the ones with grit who stepped into a 5-year grueling residency only to say “bring it on” because they knew it would make them the best. These are my people.

  • How much direct patient contact was there? 

Not enough, at least at this stage in my training. Surgery swallowed my life, and I lived at the hospital. But I have to admit, I missed my free time spent sitting in patient rooms, hearing about their stories. In surgery, time is of the essence, and I usually spent every minute running my ass off or standing like a statue in the OR.

  • What were the humdrum aspects in the patient population or workflow that would have to be tolerated for the rest of your life?

Humdrum? There is not a single thing about surgery that is ‘humdrum’! It is exhilarating. It is fast-paced. It is concise. People and thoughts move at 200 miles per hour, and I loved that. Okay wait, I guess soft tissue infections. Those are humdrum.

  • Does this specialty address one of the leading causes of death in the world?

I guess surgery can help things like heart disease with a bypass, or lung cancer with resection. But ultimately I don’t think those are the true solutions to the problems at hand. I’m still trying to grapple with that.

  • How easily can motivational impact be integrated into a career in this specialty?

There is always a role for motivational impact in post-surgical patients under your care. I think it’s extent depends on the surgical subspecialty. Still trying to grapple with this aspect as well.

  • Does this specialty focus on preventing problems or fixing problems?

Fixing. Instead of standing around, talking about it, passing it off to someone else,

surgery fixes it.

surg

 

 

The White Coats.

I met a man who had so much cancer eroding his mouth that he sneezed and it broke his jaw. So we cut his face in half and scraped it out and scooped out his neck and we chopped one of the bones out of his shin and sewed it into his face to reconstruct the mess we made. But then his heart kept quivering after surgery and it caused a chunk of blood to get thrown to a vessel wrapped around his intestine and it plugged the oxygen supply and caused his gut to die so it rotted inside of him and his belly swelled like a balloon and filled him with sickness. So we wheeled him to the ICU and put him on a ventilator and poured fluids and drugs into his veins to try to fill and squeeze all the vessels in his body to keep his blood pressure up but he was too sick and he just kept sinking farther and farther into his bed and day after day the white coats peeked in and nodded and continued on and finally his wife asked when she should leave his bedside to tend to their livestock and I realized he kept hanging on because he was the toughest man I’ve ever met with callouses on his hands and a life at home and that night I cried in my car and pounded on the steering wheel and asked the moon for answers because I didn’t know if we couldn’t help him or if we just didn’t help him but I don’t know if I’ll ever know the difference.

I met a man with a reputation of fame and success whose life had been crumpled into a hopeless cycle of heroin and bath salts and I remember how my breath stuck in my throat when they removed the dressings and I saw the top of his bare skull shining back at me and later I found out that he had sat in the sun for so long that it had charred the skin on the top of his head black so they had to scrape it all off. And every day I would sneak into his room before the white coats to drip water on the edges of his bandages so he wouldn’t scream when they ripped them off and he would tell me that the drugs made him hear snakes hissing and women screaming being raped and he hated it but he couldn’t stop because being without the drugs was worse and I couldn’t imagine anything being worse so during those quiet morning hours in the darkness I would tell him that things would be different this time and he could have a second chance this time and he could do it this time and I told him to come back and find me to prove me right this time and he told me he would and I wanted to believe that it would be different this time but the truth is I never really did.

I met a woman who was pregnant with needle marks on her arms and powder clumped on the hairs in her nose and her wrists were tied down to the bed and her lips muttered and her eyes stared and followed you but they were blank inside because a puddle of bacteria was chewing into her brain so they wheeled her into the operating room and peeled off a chunk of her skull and dug a hole through her brain until they found the pocket of pus and when they squeezed the white curd out of her brain her body couldn’t handle it because the baby’s heart in her belly stopped beating so the white coats came running and they burst into the room with soapy hands and the nurses ripped the blue tissue paper gowns over them and they sliced her belly open and stretched the edges wide and dug deep inside and when their bloody gloves reappeared they were welcoming a new tiny human to the room and when the operation was over and the day was done I wondered endlessly around the hospital until I finally found the hidden broom closet filled with warm glass incubators and a nurse guided me to the corner and there I saw the one thing that made that day all worth it and I learned over that bundle of new life and whispered this isn’t what the world is always like.

I met a girl who was born with two broken nerves so her vocal cords couldn’t spread apart and she had lived her entire life breathing through a tube in her throat and they had driven for 18 hours to see us and when the white coat told her we might be able to fix it her eyes lit up and I she opened her mouth to speak for the first time and even though it was only a whisper I could hear her excitement when she asked, “Dad, then would I finally be able to swim?”

Surgery.jpg

Do What You Are.

I had a bicycle with ribbed pink plastic handlebars growing up.

I can’t remember much more about that bike, but somehow I can still feel those tiny ridges bending and pressing into my palms. I could probably identify that bike out of hundreds simply from the handlebars alone, down to the most minute of details. Opening this memory causes other memories from Phoenix to innately spill out as well – the plastic taste of the vibrant beads that always jingled on my wrists, the throaty call of the dove that had pulled the sun up each morning, the smell of the gritty orange scrub my dad had used to scrub motor oil from his fingers.

This is what surgery feels like to me.

Silky latex stretching over my knuckles, blue tissue-paper crunching around my waist, the steady rise and fall of a sleeping sternum, sharp clinking of steel surgical instruments, a hypnotizing metronome of a throbbing pulse.

It is a sacred world hidden from society.

A silent language of communication through eyes locking over masks in an intimate huddle of illness.

I have found my purpose.

 

sadjfasdf

 

Admission Note

0012       Trauma admit arriving by air
0013       MVA w/ patient ejected from vehicle. Previously healthy, no PMH
0014       Daughter currently outside trauma bay
0015       ETA 0025
0016
0017       Alert & following commands at scene
0018       Open upper extremity fracture – pulseless
0019       1U of pRBCs and Dopamine en route. BPs running 70s/40s
0020
0021
0022       Pt arrived. Pt is unresponsive. CPR in progress
0023
0024
0025       R arm cyanosis in fingertips, immobilized in splint. Visible midhumeral bone
0026       Distended abdomen w/ bruising along flank. Absent L breath sounds
0027       Needle decompression L chest, return of rush of air
0028       Cardiac rhythm, CPR stopped
0029
0030
0031       No confirmation of airway, anesthesia at head of bed
0032       FAST ultrasound positive for intraabdominal bleeding
0033
0034       Patient being prepped for open laparotomy in trauma bay
0035
0036       Carotid pulse still palpable, faint
0037
0038
0039       No confirmed airway yet
0040       Laparotomy incision made, anesth
0041
0042
0043      Significant bleeding from abdomen
0044      Pulse check — no pulses palpable. CPR started
0045      Mask on and bagging
0046      Hanging 5th U pRBC
0047
0048      Epi 5mg push
0049
0050       Pulse check —  no pulses palpable
0051
0052       Hanging 2U pRBC
0053
0054
0055       Pulse check — no pulses palpable
0056       Rapid infusion running
0057       15 min CPR
0058       Daughter bedside. Restrained
0059       Pupil check — pupils 4 mm, non-reactive bilaterally
0100
0101
0102
0103
0104       Time of death

 

Admission note transcribed by a third-year medical student during trauma activation. Identifying details of this encounter have been modified in order to protect patient privacy.