This week has been really busy and stressful so far! Actually, Monday wasn't so bad, but I did see two deliveries that day, so that was cool! But we also had a ton of patients in the clinic, so it was a lot of running back and forth, and I was there for about nine hours of continuous work. Our clinic patients weren't anything very exciting, lots of annuals and prenatal visits as usual, so at least that was nice. The two deliveries were uneventful; both went really quickly and had no complications.
Yesterday, I got to the clinic and saw, much to my surprise (and, as I later found out, everyone else's), another student there! She is a nurse practitioner student who is almost done with her rotations, and she also previously was a nurse for many, many years. At first, I was a little annoyed that she was there, even though she was really nice, because she has way more experience than me and was stealing my thunder at "my" rotation! I quickly realized that I was just re-experiencing the older-sibling syndrome, however, and got over myself pretty quickly after that. It was actually nice to hear about some of her experiences from her previous job and her previous rotations, and we also traded names of helpful textbooks and pocket guides like true students do! Unfortunately, I think she rubbed my preceptor and his partner the wrong way a little bit, because they seemed annoyed by her presence (and the fact that she wouldn't stop talking during surgery! That's a big no-no for a student!!). Apparently, her program hadn't told them she was coming on that particular day, and they thought she wouldn't be there until after I was gone. Having two students in an already small office can get crowded, so I understand their frustration. We also had a surgery yesterday afternoon, which was strange for a Tuesday, and that was uneventful as well - a supracervical laparoscopic hysterectomy. As usual, I got to scrub in and hold things here and there, and close one of the incisions at the end.
Today was insane! We started out with a C-section, and that was really cool because I've been seeing the patient every week when she's come in for her regular visits, so I knew her and had seen her in the office four times already. It was really cool to see even a small fraction of the full-circle process! The C-section went well, and I got to scrub in and was placed in charge of sucking up all the blood (very glamorous). After that, we had a vaginal hysterectomy, and the NP student scrubbed in on that one (and had to hold the bladder retractor for 20 minutes, so I consider myself lucky for that!) while I watched. The next one was another supracervical laparoscopic hysterectomy with left salpingo-oophorectomy, and while the surgery itself was a pretty routine procedure, the patient made it difficult. She was morbidly obese and had severe diabetes, and her blood glucose was through the roof on her pre-op labs, which is never good. Also, because she weighed so much, anesthesia was very difficult, especially because the surgeons need the patient in Trendelenburg (head tilted down), which compresses the lungs even more, to get the bowels out of the way during the surgery. It was very complicated, and the two doctors were very stressed during the entire procedure. After that was all over (and I sutured two of the four incisions that were made), I was paged to OB for a delivery!
Originally, my preceptor had planned to let me do the delivery on my own while he watched. That's one of my goals for this rotation that has yet to be accomplished. So, I was really looking forward to it, even though I knew that this particular patient had a worrisome history with all of her prior pregnancies and this one, so I wondered why my preceptor thought I should be the one doing it. Anyway, I checked her and thought she was fully dilated because I could feel the head, and she started pushing. After a few minutes, though, the OB nurses weren't seeing the fetal heart tracing anymore, and that's when the panic started. Of course, not seeing evidence of the baby's heartbeat is scary. So, they put two monitors on the baby's scalp through the vagina, and then they were able to see the heart rate again. But then, they started seeing decelerations of the baby's heart rate, which is not good either. At that point, my preceptor was worried enough that he decided we had to do a C-section, stat. So everyone springs to action, calling the OR and trying to get everything set up. Meanwhile, the patient is screaming and moaning in pain, and she's even having pain between contractions, which is not normal. Luckily the husband kept calm, but he was very pale! And then, once everyone was there and ready to wheel her away to the OR, she said she needed to push right then! My preceptor checked her and said that she was actually ready for a vaginal delivery, and she could do it right then. So only about five minutes later, the baby was out! But the trouble didn't end there ... the placenta didn't come out fast enough because it was attached really securely to the uterine wall, and the cord wasn't attached to the placenta very well either, so pulling the cord to get the placenta out was out of the question. My preceptor ended up having to go in vaginally and manually detach the placenta and pull it out in two big, bloody pieces. It was a very stressful, very bloody delivery, but luckily both mom and baby came out okay.
And, after doing all the cleaning up and paperwork, my preceptor got us both ice cream. He said he needed it after such a long and crazy day!
Thankfully, we have tomorrow off. And another delivery should happen on Friday, so hopefully I will get to run the delivery myself! :)
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