96 hours

96 hours between when I got the email today titled "Did I match?" (Yes!) and when I will get the envelope on Friday with the location. 

For now, I'm just extremely happy with all the confirmation today brings: to know that I have a job come July; that I WILL graduate medical school in 8 weeks as otherwise I'll be in breach of NRMP's contract which the med school would never allow; and that I'm going to be an ob/gyn! 

Also, for now, I will be drinking.  That is the advice I have been given (repeatedly) regarding how to get through this week.  I'm taking it to heart.

I should carry Kleenex in my white coat

3 patients cried on my shoulder today.  All for very good reason.  All I could do was listen, hold their hand, look at them in the eye, confirm that it all just sucks and unfortunately no there is no answer for why, and offer Kleenex.  There were a few points where I almost started crying right along with them.  A shitty, rough, complicated day indeed.  A day that requires a long bike ride or a glass of wine - neither of which I had energy for after 14 hours of running around the hospital and knowing that I have to do in again in less than 8 hours.  You know what though?  I love my job.

It weighs heavy on me, maybe too heavy, but I am so glad that at least I can be there to offer a Kleenex. 

This one time, during brain surgery...

Today I had the opportunity to watch a neurosurgeon remove (debulk would be a more appropriate term) a really nasty & invasive brain tumor.  The following conversation occurred during the surgery:

Neurosurgeon (NS): What year are you?
Me: I'm a 4th year, sir.
NS: First, don't call me sir.  Second, what are you going into?
Me: Obstetrics
NS: Really, ob/gyn?  That's too bad.  When I first met you I had thought you very intelligent. 
silence

Then, post surgery:
Me: Thank you for letting me scrub in.
NS: Of course.  It was great having you in the case, and nice meeting you.  I still think you're making a stupid specialty choice though!

And so begins the ob/gyn bashing that I have heard so much about.

On another note - two interesting new stories today about reproductive health.  First a story on the Turn Away Study and the second was ACOG bringing attention to HR 1797, the District of Columbia Pain-Capable Unborn Child Protection Act, which is progressing in the house.  This bill would ban abortions after 20 weeks, leading to more "turn aways" and issues with access.  While it is specific to DC, it could set an ugly precedent. So glad that this is how congress is spending their time, and our tax payer money, instead of doing things like dealing with the ongoing sequestration.  Ugh!

Anxiety about next year

The uncertainty about next year is making me slightly ill.  I was hoping to know by now if I'll be taking a research year or going on to 4th year, but alas, nope.  Having not been offered a fellowship in the first round of selections, I get to keep waiting until all the spots are officially filled up.  Who knows how long this whole process will last...  It is so much worse than sitting by the phone for a date to call!

My peers are fervently filling out VSAS (visiting student application service) applications for audition rotations.  Rumor has it that spots fill up super fast and one must be very strategic about these things.  I haven't opened the email sent from my dean about registering for VSAS.  I have yet to figure out where I'd even want to do an audition rotation!

To make matters worse: my experience speaking at the conference of Friday, seeing where the 4th years matched, and a conversation between ob-headed peers and an OBGYN attending we greatly respect have me wondering if I should go into peds instead.  I LOVE obgyn.  I love everything about it and like what my life could look like.  I can do perinatal care, high risk OB, adolescent health, trans reproductive health, provide abortions, surgery, and the list goes on and on... But a lot of obgyn programs are malignant, conservative, and have seemingly unhappy residents.  I also worry that the all female environment will bring out the competitiveness in me.

I like peds a lot.  I can still do adolescent reproductive health, medical education, trans health, and public health based work.  I can maybe, probably, also provide abortions.  The pediatric community is all so happy, nice, and welcoming.  If I'm going to have my own family, peds will allow for a better balanced life.  Plus, I have many a connection that will help me get into a good peds residency.

Taking a year off would slow down the process a bit, but it will also slow down the process a bit.  Translation: I'll buy myself a little more time before making a decision.  I'll make more noteworthy connections in the obgyn world that should help me for residency.  However, I'll be 30 when I graduate medical school!!!  Yes, yes, I know that age is only a number.  But 30 is a really big number.  It'll also mean that I'll spend the next 2 years nomadicly as I move for the research year and then travel all around for 4th year.

Anyone have a crystal ball?

The ancient art of obstetrics

I've decided that I'm going to need to supplement my obstetrical education to include the usage of forceps, assisting mom to deliver in positions other than supine, vaginal breech deliveries, vaginal delivery of twins, and external version.  I'm sure there are a few other ancient tricks that would be good to learn too but I don't yet know what they are!

I can almost guarantee that I will not adequately learn these techniques in the US and that there very well may come a point in my career where these skills will mean the difference between life and death of a mom or baby.  I imagine that I'm going to have to spend some time abroad to learn these tricks!

Need an answer

Today, for the first time in my 3rd year clerkship (or at least the first time it mattered) I was asked WHY I want to go into ob/gyn.  Normally they just ask what you're thinking about going into...

I fumbled and felt like nothing I said was sufficient.  It almost seemed as if I was sucking up to the 4th year resident who had asked. 

My old answers:
-I'm passionate about women's reproductive health
-I wrote my undergrad thesis on pregnancy & birth through the lens of medical anthropology which is what brought me to med school
-I want to be an abortion provider
-I like surgery, but would prefer having more continuity of care than gen surg offers 
-The more I learn about embryology the more fascinating I find it
-It was between ob/gyn & peds but it turns out that I like surgery
-I think women are being short changed by a lot of current ob/gyns, and I know that I can offer better

And my new answer:
-?????!

Random Stats: OB/GYN version

On my 3 weeks of ob/gyn so far these have been my ratios.  They aren't lining up well with national stats at all...
baby boys to girls: 71.4%
c-sections to vaginal deliveries: 57.1%
episiotomy rate on vaginal deliveries: 66.7%
use of vacuum suction or forceps: 14.3%
inductions at 39 weeks: nearly 100%

I don't know how much this speaks of being in the conservative south or having an older male preceptor?  Or both?

Why I will be a provider

A woman at the end of her first trimester was referred to the MFM clinic for multiple fetal anomalies.  The follow-up ultrasound confirmed the these anomalies and a showed a few others that hadn't been noticed previously.  The fetus is showing a distinct constellation for a significant chromosomal anomaly that is not compatible with life.  Chances are high that she'll have fetal demise prior to delivery, and if not, the baby will not live past a year of age. 

The couple was understandably devistated.  This is not easy news to hear and digest.  This was a wanted baby.  They wanted to know what comes next and wanted to know their options.  The otherwise fabulous doctor skirted discussion of termination.  Even when the woman asked directly about abortion: "who could do it for her? where would she go to have it done?  does it pose any risk to her health?" answers were vague and indirect. 

In the end, she and her partner have a horribly difficult decision to make.  They need more information before they'll even be able to make a decision.  However, if termination is the decision, she should have access to local, safe, and compassionate care.  She ideally should be able to have an abortion preformed by her ob/gyn or the MFM doc she's seeing, the people she already trusts, already has a relationship with, and who already know the whole complex story.  She shouldn't have to travel over an hour away to go to one of the sole providers in the state.  She shouldn't have to comply with mandatory state waiting laws and other such rules.  She shouldn't have to walk through a line of picketers. 

This is only one of the heart-wrenching stories I've been witness to over the last 2 weeks of ob/gyn clerkship.  I'm repetitively seeing the casualties of the war on family planning and reproductive health choices.  I may only be a single person, but I take it upon myself to be a solider fighting in this war. 

Playing catch!

I caught my first baby today!!!  Then, tonight, I caught my second!!   [and I didn't drop them!]

As awkward as it was to be draped in a sterile field moving my hands into new positions, it is absolutely amazing.  I was the first person to lay hands on these two new beautiful beings.  I was allowed to be present at, and to be part of, a hugely piviotal moment in these families' lives. 

AMAZING!!!

OB/GYN day 1

Today marked the beginning of my ob/gyn clerkship.  It involved me sitting in a small classroom for 8 hours that fluctuated between way too hot and way too cold listening to a plethora of lectures of female anatomy, incontinence, prolapse, normal & abnormal labor and the such.  All the while trying not to blow my nose raw or cough up a lung... yay for an end of break cold.  Tomorrow I get to do more of the same.

So far I have learned that an ob/gyn's ego is much smaller than a surgeon's.  Multiple times we were told that "we know that nearly all of you will go into something besides ob" and "the point we want you to remember when you leave ob/gyn behind is..."  This is compared to the surgeons who believed they were G!d's gift to man, and that we, medical students, would be absolutely crazy if we went into a specialty other than surgery.   The feeble humbleness of the faculty today was a bit off putting.  Also off putting was the story one attending told about killing a baby while showing us a picture of a ruptured ectopic pregnancy (no more than 6 or 7 weeks) that caused the woman to hemorrhage.
 
With all of the information they are giving us over these 2 days of standardized orientation, there has been no mention of birth control, family planning, or elective abortions.  And there is no such lecture on the clerkship schedule as of now.  NONE.  This is not because family planning is irrelevant to the life of an ob/gyn... Simply a lovely reminder that I go to medical school in the conservative south.