Sunday, February 17, 2008

The Labours of Pancruleas

I knew I would say this sometime, but I wanted to give it some time. Well, labour room was fun. We got to do a lot of cool stuff that only *cough* doctors get to do. You know, like, “Adrenaline, stat!” and “Damn, here comes the next patient.”

The 12 hour shifts had a funny (ha-ha) way of warping time, so I usually never knew the day of the week or the hour of the day. Or my own name, for that matter. The time left until the end of the of the shift was measured by the state of my feet (not-so bad, uncomfortable, painful, agonising, kill-me-now, I-must-have-died-and-this-is-hell). Oh, and the level of disorientation. I distinctly recall getting an infusion set ready when I was asked to check a patient’s blood pressure.

Did you know that we don’t notice the sex of the baby unless we remember to check? The nurse is the person who notes things like that and tell the patient. It’s an automated process for us- take baby out, hold it upside down, clamp the cord, cut it, hold onto clamp at baby’s end and place baby on tray held out by the nurse, check for perineal lacerations/extension of episiotomy wound, wait for the placenta to be expelled, deliver the placenta with ‘rocking movements’, make sure the placenta is intact, throw away the placenta, place vaginal pack, suture episiotomy wound, remove pack, remove clots, clean the area, extend back to get rid of cramps, throw away gloves, and find a chair so you can finally. Sit. Down. By which time the next patient's uterus thinks it would be a great time to contract in earnest, and you do all this all over again. It was a masochist's heaven.

And now, you can release that breath you didn’t know you were holding, because I shall now proceed to justify the horribly not-so-funny-as-punny title. Things that I did during my labour room posting.

* Catheterised patients whose urine output needed to be measured. And terrifically awesome li’l me did not insert it into the wrong opening (which is a common mistake for all first-timers). I am awesome, no?

* Inserted an intravenous cannula. Foley’s catheters are mere playthings when compared to a cannula, I tell you. You have to find a good vein with a straight course, and make sure it goes into the vein, and not above, under, beside, or through the vein. It took me a lot of tries (yes, you’re allowed to sympathise with the patient, but I poked her while she was having a contraction, so she barely noticed the needle), and I would be really disappointed at each failure. And when I finally did get it right, I kissed everyone in sight. (Read: Skoda, who had threatened to hamstring me if I did not.) The side effect of this is a vampire-like interest in the veins on people's arms. Every time I see a good vein, I get this almost irrepressible urge to establish IV access.

* Assisted the post graduate student in a twin delivery. This was an unusual occurrence; twin deliveries are assisted by PG students themselves. It was awesome. And they were identical twins (or MCDA, as we *cough* doctors refer to it)!

* Sutured episiotomy wounds. It’s done in 3 layers- mucosa, muscle, and skin. Continuous stitches for the mucosa, interrupted simple stitches for the muscle, and mattress stitches for the skin. I got over my suturing phobia, and LEARNING A COOL SURGICAL KNOT might have something to do with it.

* I learnt to TIE A COOL SURGICAL KNOT that makes me look very skilled and experienced. *cough*

* Delivered a first of twin in a breech presentation. I was going to assist the medical officer (MO), but I had gotten ready before she did, and was with the patient when a little butt started coming out. And the other MO (who was not prepared- did not even have gloves on) screamed at me to get it out. This was a horribly complicated case- the patient was only 26 weeks along, but her blood pressure had made friends with satellites and was refusing to come down. One of the babies was already dead, so they decided to terminate the pregnancy by giving her a drug to make her uterus contract. I was very upset at having to deliver a dead baby my first time, and was almost in tears. By then the other MO had worn all the protective gear and she took over. So I didn’t really deliver the child, but I did hold it for a while. Imagine my joy when the baby cried after being born. It was the live twin! The dead one came out a few minutes later. Macerated babies are a horrible sight.

* Delivered a baby. No, it didn’t hurt one bit, why do you ask? The womanpower* shortage during the strike turned out to be a blessing for us interns. I had a baby boy, who weighed 2.99 kilograms, at about 4:15 PM on the 7th of February, 2008. I hope he will turn out to look like the COOL *cough* DOCTOR who brought him into the world. Isn’t he cute? Say he is cute.

* Gave an amnioinfusion. It is a procedure in which fluid is infused into the uterus through a needle inserted through the abdomen and uterine wall. One of the indications for an amnioinfusion is meconium staining of amniotic fluid. The MO on duty inserted the tube into the uterus, and asked me to keep it in place with my hand, and I got to feel the baby’s head while it was still inside the uterus. It felt awesome. This is a dangerous procedure, performed only by experienced doctors. What can I say? The strike strikes again, folks.

* Got a patient’s relatives to consent for a Caesarean section. They decided that it was too risky to induce labour in the patient I gave the amnioinfusion, because it would still take a lot of time, and we could lose the baby any moment. So they sent me to get her relatives to consent for a C-section while they got the patient’s and prepared her for surgery. The patient had been married only a few months, her husband was abroad (somewhere in the Gulf, the capital of Kerala), and her younger brother was the only male available. (We do not generally ask the womenfolk’s consent, because they have a habit of wailing and beating their chests and becoming incomprehensible when the word ‘operation’ is mentioned). He visibly shook when I explained the situation to him, but he pulled himself together and signed the papers for the surgery.

* Scrubbed in as the first assistant for a Caesarean section. The MO told me I could assist her with the C-section for the patient I had just given the amnioinfusion to. I was thrilled, and also: rather worried. I have a history of screwing up at things I eagerly looked forward to. I scrubbed in with some apprehension, and entered the theatre as they were anaesthetising the patient. I need not have worried, because you know what? The MO said that I HAVE A NATURAL INSTINCT FOR SURGERY! Woo hoo! I totally rock! I mopped the area at all the right times so that the surgeon had a clear field, retracted the abdominal wall perfectly, used the suction judiciously, gave proper assistance with the delivery of the baby (he looked as if he was wallowing in shit, which he was) who was immediately whisked off to the neonatologist, held the catgut taut with just the right amount of pressure, and was generally indispensable. Go, me! I learnt that wielding the knife is a completely different experience from merely observing a surgery being performed, and thus I managed to get over my antipathy to surgery. I still hate ObG, though. Some things never change.

* Gave injections. Only qualified doctors are allowed to administer drugs to patients, but I gave quite a few injections during the strike. Intravenous injections are child’s play when given through an in situ intravenous cannula, but if you aren’t careful, an intramuscular injection can even cause paralysis. Nebulisation, on the other hand, is quite easy.

* Stayed up an entire night in the ICU. There was a seriously ill patient in the ICU, and there were too many patients in the ICU for one PG and a nurse (they were the only people on duty in the ICU) to take care of, so they recruited me to look after her. Also, the ventilator would occasionally die, and then I’d have to manually ventilate her until it kicked back in. I didn’t sleep a wink that night, but I found that I loved critical care. It was FREAKIN’ AWESOME! I can honestly say that the patient would have died if I hadn’t been there. It feels wonderful to be able to say that.

So, those were some of the previously impossible things for me that I am now *cough* proficient in. I would see about 30 patients each day, which means that almost a thousand patients were admitted to the labour room in a month. And the most surprising thing is, we did not lose a single patient! How fantastic is that? And given that all of us were in a constant state of disorientation, and quite a few of the procedures are done by students (heavily supervised, but you know… People like me. Scary thought, no?), this is plain awesome. I LOVE BEING A *cough* DOCTOR.

*Most ObG's here are women.

PS: I seem to be coughing a lot. I hope it isn’t cancer. It would be awful for a *cough* doctor to die so young.


nmouse said...

AP, that was incredible. There is little comparison to be made with the training here, but Foleys and cannulae are still the staple nowadays. Are you at SAT?

Thinking aloud said...

your baby is real handsome...looks just like *cough* the doctor who delivered him...

that's a good insight and a good thing too i didn't know this when i delivered my babies else i would be looking very suspiciously at every hand which touched me...:)

Tys on Ice said...

ap, Iam rite now so proud of you...come down to gulf, the capital of kerala, and u can deliver my baby...( somehow tht didnt come out like I intended) but u know wht i mean....:)

but only on one condition : tht u dont tell me afterwards anything about it other than ' you got a baby girl'

Ziah said...

Ap, you rock girl!! This is a much deserved pat on the back for our hard working doctor-in-process!!:) I guess you can walk a lil more on cloud 9... there are a whole dozen lives who can thank you for their being..:)

manuscrypts said...

Note to self: do not read this blog on monday mornings!!!

~nm said...

I had been reading your blog since last week and I actually liked reading your post on babies and deliveries. Probably because despite having gone though a delivery, of my son, I still find the whole process quite amusing.

I was wondering if you have ever been..we...errr..cursed and bad mouthed by a patient? What I actually meant was ...ummm..ok let me say it straight. I actually said a lot of bad words to the assisting doctors when I was delivering and later felt so embarrassed. But somehow I never saw/read you complaining about any of your patients doing this to you.

So either you are a really sweet one to just ignore patients like me pr probably you found other things more worthy to write about than patients yelling at you. :D

Will keep dropping by...

Siri said...

Woh Maii God. Take a bow. And to say that the maximum education has troubled me with is by making me write records, I will have to remember this and also remember to shut up and not crib the next time. Taaallll order that. But yea, you must be one super cool woman to be able to handle all this! Wooh!

As always, well writtaaan!

Tea N. Crumpet said...

I cried with joy reading this and how did you know that as we read your second paragraph that we'd be holding our breath?

I am sad that I am done making babies. I would go to India to have my next one. Of course when I have had interns in, I have supressed my desire to scream and would grunt and say, "OK at this stage I am in transition; get your catcher's mitt on because--" and I'd push. They all thought it was so easy! LOL! I am having a uterectomy in May-- will you come assist on that? ;) Alaska will love you and we won't let you leave!

This post was exciting. Thank you for sharing!

tangled said...

You are one of the reasons people still think doctors deserve respect. :)
Much wonderfulness you have ya.

Prats said...

aaaw....that lil bundle is so cute....and just like the *ahem* doctor.
Whatever guys rock....

ToOothlEss WOndeR! said...

I'm skipping dinner tonight.
I guess I should stop going to the gym and marry a doctor instead.

Ps said...

Oh my god---feeling sick after reading this--*cough--cough*

jayashri said...

you are a good doctor and an amazing story teller. i like reading your blogs. and you have no idea how high the OBG's are placed. Ask a mother. For me OBG and pediatrician are the best thing which happened to humanity. rest all doctors follow.

mathew said...

oops..are all docs like this..isnt surgery supposed to be all serious affair..u made it sound cool..;-P

Madhumita. said...

Words fail me woman. So you're a real live doctor person and everything?? Most intimidating. And look at the nonchalant way you've referred to all your experiences as a medico! Thing is though, I'm slightly worried now as my own D day approaches - not too sure about any medical student cutting me up ... unless its you of course.

Spunky Monkey said...

I have done not one of the things you mentioned. Watched less than three deliveries, let alone conduct any. And all this in a supposedly awesome medical college. Gah.

Shit, I feel terribly unequipped. (People who think that's a pun have a punch coming their away, and not the drinking sort)

But you go girl. Have the fun.

DrWiz said...

I still have to use banana to learn suturing.... My bad :(

Cathy said...

wow - this was a really interesting post! amazing insight - thank you for sharing! i will be back to read more :)

sinusoidally said...

You are getting some really good training. You will make a really good doctor. I am confused about whether you are still in medical school or an intern?

-Poison- said...

lol! all the best with the gud work doc! :)>-

Adorable Pancreas said...

The madhouse with the huge stuatue in front.

@thinking aloud:
See? All this genteics and heredity thing is absolute nonsense. He looks like ME. Hah!

@tys on ice:
Fortunately for you, I do. I was about to send a couple of goondas, and then I remembered your foot-in-mouth disease. I'll be there, tys, and you'll hear what you want to. Only don't blame me if she grows a beard when she grows up. Come to think of it, a couple of girls I know have beards...

You rock too!
Whole dozen lives.... Wow! I did that?

It may not be monday morning stuff, but it sure goes well with your lunch.

WE do the cursing around these parts! The patients only scream until their lungs come out of their nose. The noise gets to you sometimes.
I got HIT by a patient, and I just took it in stride. She was mentally ill, and didn't know what she was doing.
I'm really very sweet, for the record. COVERED in ants, I am.

Recognition. At last. You hear that, people? Super Cool Woman. Me. Muhah- never mind.
I'm going to tear up every one of my records after I graduate. Especially the autopsy one. Gave me nightmares, that one.

@tea n. crumpet:
I have Super Powers that way. :)
Alaska, here I come!
It DOES sound like fun, don't it?

*blush* Dhunkoo.
I am young and idealistic. I might become jaded and cynical later. I hope not, though.


Adorable Pancreas said...

@toothless wonder:
Doctors are dumbells? You are SO dead. Wait a second. Going without dinner is punishment enough.

It's contagious? Damn! I knew I should have covered my mouth.

Awww! Danks. :)
My mom used to worship my paediatrician. I used to fall ill quite often as a child. I used to like Paeds until I started learning it. It's a little too much like SPM for my liking.

Surgery IS a serious affair, but it's a lot of fun too.

I'm sure you'll pul through fine. Just make sure you swear at your husband a lot. ;)
(Sorry, tys. It's the least I can do.)

@spunky monkey:
Only medical colleges in Kerala put their students through this. I'm not complaining, but I can't do it again. In spite being fun.

You use a banana, I used a- forget it.

Ah, praise. Gotta love you.

That meant a lot to me. :)
I'm still in medical school. We were interned in the labour room, as in arrested. In our college, the REAL interns are called house surgeons. Stupid, I call it.

Thanks! :)

love and squalor said...

wow, I was already a lil skeptical about the giving birth being a fantastic experience plug and now you tell me there's so many different ways a woman's body can screw up? I should stay away from this blog.