week 40: obgyn @ highland general hospital

I’m not sure if I’m being sentimental about my third year starting to wind down or I’m just missing being on L&D – but I was a little saddened this morning at the thought of not delivering another baby again for what might be a long while.

OB/GYN at Highland was exactly what I was hoping it would be and it was more. I had heard coming in that the highs are high and the lows are low - and it sure lived up to that promise.

There were a number of lows… I had to excuse myself from the OR during a really cool open surgery because I was so nauseous from my period that I couldn’t stand straight. The next morning, I almost passed out during a vaginal surgery from feeling overheated (a first for me, I'm usually freezing in the OR) – and then proceeded to complete a 24 hour call that day. For the first half of the rotation, I switched services and attendings every half day, which involved adjusting to a whole new set of energy and expectations each time. Some attendings could be intense with their questions, others were less invested in my learning until I could prove I was a good student. It was easy to feel disconnected when I didn’t have a team to ground me or patients that I could follow for more than one day. No one walked me through how the archaic EMR worked for my first week (I almost cried asking a nurse about overnight events the first time I tried to pre-round, my lil nerves were so frayed). During the second half of the block, the entire hospital transitioned to Epic and I didn’t get credentials for the first few days. I got to see each new attending use Epic for the first time during my last two weeks – computer tasks that they used to be able to complete in a few minutes now took a full hour, the help of tech support personnel, and a lot of swearing. I would leave SF at 5-something every morning and get to Highland before the sun was out, most days I didn’t leave until it was dark all over again. There were times my role felt unclear, times my presence was unexpected (I’d drop into clinic and announce that I was assigned to work with a person who had no idea I was coming). And of course, our patients could have the most complicated social circumstances or speak a language we couldn't get an interpreter on the phone for.

But y'all these lows - they showed me how tough I could be, and they made the little victories feel so sweet. On a long phone call during my commute back into the city, my friend Ansur reminded me that pressure makes diamonds. And there were a lot of moments on this rotation that no one was around to see this, but y'all in my heart, I feel like I started to shine.

Every day was a new adventure. I delivered more babies than I could have hoped to, saw more deliveries than I could count. I got to close on C-sections, and I first assisted on more surgeries in three weeks of gynecology than my entire surgery clerkship. I saw abortion care at multiple stages and realized that this is work I could really do down the road. I got to see unstable patients in the emergency department who needed stat surgery as well as urgent women’s health needs in the clinic setting. I felt babies kick and found fetal heartbeats and located cervixes on speculum exams and learned how to spot a placenta on ultrasound. My suturing and knot tying are cleaner than ever before. I felt like I moved patient care forward more than any rotation I’ve been on so far. Taking a strong stance on my plan or checking in on my patients multiple times during the day actually made patient care better in concrete, tangible ways. I counseled patients on birth control (always start by asking if they plan to have more kids and what their family is like and when they would have their next kid and if not for a lil while, how can we help them out, rather than straight out asking what birth control they plan on using, as if the baby they just delivered is so unpleasant that we'd go to great lengths to avoid a repeat). I had patients try to learn my name (which has been rare for me). 

Women and their families really let me into their lives, didn’t make a fuss when I had to wake them up at 6:30 so I could present their case at 7 AM signout, encouraged me to press on their bellies, and welcomed me into their births. I’m not sure if it’s the nature of OB/GYN, where we work with sensitive conditions that can carry enormous social, interpersonal, political layers, or if it was just my first time working at a site with so few residents that I was really on the frontlines, but I felt so connected to my patients and it often seemed like the feeling was mutual. The nurses and MAs really looked out for me too, whether it was asking a patient in clinic if I could join the visit or quietly tucking my hair into my bouffant in the OR or if it was grabbing me for an impending delivery, I’m so grateful they took me under their wings. The midwives were fantastic – they were supportive, soothing, grounded, as they lifted up our fierce patients in this transformative experience we call childbirth. The intern I was paired up with on L&D encouraged me to take the lead on deliveries and surgeries (and treated me to lots of good cafeteria food - thanks Octavio!). And I did end up loving the attendings I had. Some of them were a little intimidating at first, but once they saw that I was earnest, they invested a lot into teaching me and providing me specific, concrete feedback. These attendings were so gentle, thoughtful, and protective of their patients, and seeing them in action taught me more about how I want to treat my patients too. They held their patients' hands during anesthesia, had tough conversations in fluent Spanish, reminded people of their choices and their agency, and showed enormous grace and warmth to women who don't always receive it.

Towards the end of the rotation, I wanted to show my attendings that I had learned so much and really grown. But between their Epic frustrations and their other responsibilities on the floor, I’m not sure if anyone noticed me trying to shine. My last day, our intern was away for didactics so I was on my own, and I saw every patient that came into triage, completed their initial workups and notes (most of them with the use of an interpreter phone), followed up on their tasks during the day, and made plans that I presented to the midwife mostly and once to my attending. All the while, I remembered to address the symptoms our patients came in for rather than just focusing on the concerning fetal heart tracing or labs that were unexpected surprises, and staying patient-centered was something I was proud of. I was working quietly in the background, doing the not-so-glamorous tasks that *someone* needed to do, no fanfare or recognition for stepping up - when it occurred to me that I was playing the role of an intern. So even if the evaluations end up coming back lukewarm, I’m leaving from this rotation with new knowledge and skills that make me feel like I can really manage our patients.  So much so that I could see myself being an effective OB/GYN intern… And isn’t that what medical training is all about?

Highland was kind like the wild west for an MS3, but it sure is a special place. I can’t articulate how lucky I feel to have been here these last six weeks. There were moments on this rotation that I was assailed with this feeling that I was TRULY living the dream. The magic and wonder never wore off for me; I knew I’d like OB/GYN but I didn’t expect to love it like this. I’m still sorting through my feelings and honestly, I don’t want to think too hard about my specialty until third year is over. But if I don’t love anything else all that much… I’d be so happy to become an obstetrician/gynecologist. Stay tuned!

xoxo

Juhi