Hard to believe I am back here posting so soon! My tour of OB/Gyn has nearly come and gone. I spent the past 6 weeks at a busy hospital in northern Virginia (NoVA to us Virginians) just outside of Washington DC. They sent a group of us up here because our home campus has a lower volume of obstetrics and I joined in thinking I would like to get good exposure to OB (Family docs, as it turns out, can still practice obstetrics if they choose, especially in the wild West!).
My first three weeks were spent on the busy Labor and Delivery service. A classmate and I alternated between L&D shifts and days watching C-sections. So. many. C-sections. But aside from that, I had a really good time on L&D. I would see new patients in triage; mostly ladies having contractions or leaking fluid who wanted to see if they were in labor. I became quite adept at doing quick sonograms, reading the fetal monitor tracings, and botching my way through a patient history in Spanish. The rest of the time was spent checking on the laboring patients, helping the residents, and most importantly pushing with the patients when it came time. I was surprised at how much I enjoyed coaching the ladies and monitoring their progress. I got to help with several deliveries where the resident would place their hands over mine while delivering the baby, but several times I got pushed out of the way due to complications like the baby's shoulder getting stuck or if they baby wasn't tolerating delivery. Med student gold on L&D is a multip (a lady who has had at least one prior vaginal delivery) since the delivery tends to go quicker and smoother. My opportunity finally came towards the end of my three weeks and I was allowed to deliver a baby all by myself. The resident was behind me the whole time making sure I knew what I was doing (or didn't do anything stupid for that matter), but she let me run the show and everything went perfectly. Such endorphin rushes have never been known!
The next two weeks I was on the urogynecology service, which involves pelvic organ prolapse repairs and pelvic slings for stress urinary incontinence. I was mortified by many of the procedures I saw and won't go into too much detail here. Suffice it to say, I no longer fancy a career involving surgery. I don't know why I was drawn to it early in the year!
There were certainly days on OB when I thought I could see myself enjoying this field as a career. I probably would. But I think the work-life balance would be much harder to attain and I would miss the variety of patients in primary care. If there is a future for me in OB, I guess the door is not completely closed with family medicine. We shall see!
Wednesday, May 30, 2012
Saturday, May 5, 2012
Internal Medicine: Parts 2 and 3
Oh, hi. Remember me? Time has completely slipped away from me these past few months. Case in point, my desktop calendar still reads March.
I spent 2 months on the medicine wards (I believe this term refers back to the olden days when all the patients resided on the same floor, but nowadays our patients are spread throughout several buildings) at MCV and the VA hospital. It was, how shall I say, enlightening. Six days a week, 11-15 hour days, many of those hours spent in a drab team room typing notes and calling consults with less than enthusiastic residents. There was complaining, a few tears, anger and resentment on my part. I did not like myself in this environ. And more importantly, there was no one inspiring me enough to turn my frown around. The attendings were great physicians, don't get me wrong. I learned so much these past few months. But I always love coming to work knowing there will be someone invigorating and excited to teach me something. That rarely happened these past few months.
The patients were never a problem. I got quite close to a few. I helped one gentleman work through end of life decisions. He literally begged for us to let him die as he had developed a colitis that left him sitting in a pool of his own bloody diarrhea for weeks. Another young man I related to all too well, was fighting a brainstem tumor. That kid was mentally and physically tough and easily became one of my favorites. I even got to see him a week out from his discharge and all the progress he had made. Then there were the GI patients, a meek lady with Crohn's disease and a motherly figure with cirrhosis. And the devastatingly sad nursing home patients, many suffering from neglect and malnourishment. What. the. heck. The flirtatious old men at the VA hospital. So, so many of them. They all taught me something.
Towards the middle of the two months, I started to think about an internal medicine residency: nearly 3 years of wards and ICUs and scattered clinics that none of the residents seem to enjoy, even those that claim they are pursuing primary care careers. It got me down. I don't like the hospital much or the confines of the team room or the depressed attitudes. Residency seemed like such a forlorn experience and I lost hope for myself and my happiness over the next few years. But then I started to talk to friends and mentors about it and began to realize I may have been so mentally committed to internal medicine that I was suppressing my inner family physician! And since making that realization I have been so much happier. I admitted to myself that I don't hate pediatrics as much as I have said (I definitely enjoyed my peds rotation). And I love outpatient medicine, that much I knew already. I love that family docs to be get to train in a variety of settings, including a little bit of surgery and ob/gyn. And as my mentor put it, when he goes on a medical mission trip they press the internal medicine and pediatrics folks to see what ages of patients they are willing/capable of seeing, whereas with him they simply show him to his chair. He can see anyone and be of great service in many settings. Since I am pretty sure I want to work in a rural or underserved area, this just makes the most sense to me.
I spent 2 months on the medicine wards (I believe this term refers back to the olden days when all the patients resided on the same floor, but nowadays our patients are spread throughout several buildings) at MCV and the VA hospital. It was, how shall I say, enlightening. Six days a week, 11-15 hour days, many of those hours spent in a drab team room typing notes and calling consults with less than enthusiastic residents. There was complaining, a few tears, anger and resentment on my part. I did not like myself in this environ. And more importantly, there was no one inspiring me enough to turn my frown around. The attendings were great physicians, don't get me wrong. I learned so much these past few months. But I always love coming to work knowing there will be someone invigorating and excited to teach me something. That rarely happened these past few months.
The patients were never a problem. I got quite close to a few. I helped one gentleman work through end of life decisions. He literally begged for us to let him die as he had developed a colitis that left him sitting in a pool of his own bloody diarrhea for weeks. Another young man I related to all too well, was fighting a brainstem tumor. That kid was mentally and physically tough and easily became one of my favorites. I even got to see him a week out from his discharge and all the progress he had made. Then there were the GI patients, a meek lady with Crohn's disease and a motherly figure with cirrhosis. And the devastatingly sad nursing home patients, many suffering from neglect and malnourishment. What. the. heck. The flirtatious old men at the VA hospital. So, so many of them. They all taught me something.
Towards the middle of the two months, I started to think about an internal medicine residency: nearly 3 years of wards and ICUs and scattered clinics that none of the residents seem to enjoy, even those that claim they are pursuing primary care careers. It got me down. I don't like the hospital much or the confines of the team room or the depressed attitudes. Residency seemed like such a forlorn experience and I lost hope for myself and my happiness over the next few years. But then I started to talk to friends and mentors about it and began to realize I may have been so mentally committed to internal medicine that I was suppressing my inner family physician! And since making that realization I have been so much happier. I admitted to myself that I don't hate pediatrics as much as I have said (I definitely enjoyed my peds rotation). And I love outpatient medicine, that much I knew already. I love that family docs to be get to train in a variety of settings, including a little bit of surgery and ob/gyn. And as my mentor put it, when he goes on a medical mission trip they press the internal medicine and pediatrics folks to see what ages of patients they are willing/capable of seeing, whereas with him they simply show him to his chair. He can see anyone and be of great service in many settings. Since I am pretty sure I want to work in a rural or underserved area, this just makes the most sense to me.
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