Obstetrics and Gynecology: Of birthing, surgery, and nights

Whew, I just finished my OB/Gyn rotation. After those two months of medical exposure, I truly feel like I have only begun the marathon that is MS3/MS4. Both months were challenging in their own ways.

In November, I was introduced to the revered O.R. My inauguration was brief, and much of the mystique and wonder I had built up dissipated within the first week of my month of gynecological surgery. The surgeons and residents I was privileged to work with were focused and skilled, and I have the utmost respect for their craft. Surgery, I found, was demanding in ways I had not anticipated. The focus, diligence, and dynamic coordination required for the routine tasks of surgery was largely new to me in a medical setting. Internal medicine, to contrast, was steeped in speed, intellectual fastidiousness, and static coordination. The O.R. is the here and now; the floor is what was and what will be. The distinction is dramatic, and after experiencing both I can begin to understand the schism between the two disciplines. Moreover, I also can appreciate that while IM is more of a science (to some extent), surgery is an art. The control of every decision in IM guided by evidence cannot readily be replicated in the nuanced motions and subtleties of incisions, cautery, and knots.

“We are all fixing what is broken. It is the task of a lifetime. We’ll leave much unfinished for the next generation.”

Part of me finds dissatisfaction in this. There is an inner desire for certainty in the actions I take. The certainty in art of surgery stems from lifetimes of experience, against which my 25-year old self has comparatively paltry assuredness. And, really it’s a cop out. At its essence, I’m saying there are too many variables in surgery. That’s tantamount to saying there are too many variables in life. There are infinite aspects of in any situation, not simply surgery. I think it’s my engineering background that gives me this aspiration for an ideal action or solution at every turn.  Does medicine simplify many variables into digestible forms that are more interpretable? Blood pressure? Temperature? Possibly. I am not able to determine that. Maybe no one is.

In December, I was exposed to the practice of Obstetrics. In line with the discussion above, the field of OB has similarly a handful of cardinal variables that are critical to its practice – cervical thickness, dilation, contraction frequency, etc. Once mastered, the decision trees are fairly intuitive. Anyways, I was really tested on this rotation. Half of my month of OB was nights, one of the most demanding experiences I have had in medical school thus far. The nights were mixed – some were action packed, some were slow, some haphazard. The adjustment to a nocturnal lifestyle was not smooth, and I found myself craving sleep at times. The best part and the worst part of the rotation was its unabashed spontaneity – at moment’s notice, a C-section case could (and did, many times) step through the door. That readiness required was daunting, and often times, I found myself dreading action towards the end of my shift.

This dread stemmed from a very concrete (and mildly embarrassing) experience I had while on my first week of nights. A patient required a C-section at around 3AM and the team was notified. I had about an hour of sleep at that point, and also had not eaten dinner. I had a vasovagal episode and had to sit down on the floor of the OR in the middle of the case (in the middle of the night), later to be wheeled out against my requests. The ignominy of that event was replayed when the resident reenacted the scene in clinic.

As an aside: one particularly sad part of OB was being part of unsuccessful pregnancies. Intra-uterine fetal demise was unsettling and I cannot begin to fathom the feelings of the patients I saw that underwent such an ordeal.

This rotation was the one I learned the most from during the rotation. My basic science curriculum did not address the nuances of the management of pregnancy; I knew little of pregnancy and its clinical aspects. The hands-on experience I was afforded bridged much of that gap in my knowledge base, and I can say I appreciated it.