My first C-section - and yes, I passed out in the OR...

It was the second night on night float, and it was some time around 11pm. I was working with the resident that was scheduled to do any emergent C-sections that night. I was super excited. This was going to be the first one that I would see and help with.

The nurses were great in showing me how to scrub in properly. I had scrubbed in for a laparoscopic procedure the previous night but I was still very shabby. I didn't have time to introduce myself to the anesthesiologist as he was in the middle of taking care of numbing the nervous looking woman.

The chief resident (probably the best resident teacher I have worked with to date) and the 2nd year resident were the ones doing the C-section that night. My role as the medical student was going to be to help with suctioning (estimated blood loss for most C-sections is >500cc), help holding bladder blades (to make sure that the bladder is out of the way when cutting into the uterus) and a few other things. As with most surgeries that I attended, my residents taught me by asking questions about the anatomy, and by showing me structures that were needed to be identified. I was very comfortable in answering "I do not know" to any question that I had no clue about. Never having seen a pelvic surgery before, this was the most frequently used answer. The residents did not even once make me feel as if I were incompetent or stupid. They were extremely supportive.

The room was getting quite hot as time went on. The lights in the operating room get very hot, very quickly. At baseline, I get hot very easily. I grew up in Tanzania, at the equator, but my hometown is 5000ft above sea level, meaning that the weather there never got unbearably hot - and that is my reason/excuse for feeling hot so easily. But I digress.

I was really enjoying this C-section. We had gone through the abdominal layers, and through the uterus. The baby was born. A tiny and very cute looking young girl was brought into this world. I continued to hold down the bladder blade, while trying to soak in the entire experience. 45 minutes or so had passed by at this point. The next thing I knew, the chief resident, who was standing next to me, was tapping my shoulder and telling me to let go of the bladder blade. She was asking me if I was ok. She was telling me to take a seat. And then it hit me.

Did I just pass out in the OR?

Am I THAT med student?

The anesthesiologist was pulling up a chair for me. He told me that I could take off my gown as it would make me feel better. Of course, all I was saying at this point was "I am doing fine, and I am so sorry - I think it just got too hot for me." And I was doing ok at that point. I felt cooler and I felt better. But clearly, it had already happened. At some point, I guess I got too hot and didn't realise what was happening, and had a syncopal episode.

On a scale of 1-10, I was about a 15 in terms of how embarrassed I was.

One of the nurses took me outside as it was much cooler there. Although I felt better at that point, it was the right thing to do. The nurse gave me some apple juice and a little snack. All I could think of while drinking the juice was a) I hope the patient is doing fine and I didn't do any harm and b) Wow, did that just happen?

20 minutes later, I decided to go back into the OR and see what was happening. The residents were just finishing up. All seemed well and that was very calming. They were finishing up the surgery.

I still had no clue as to what had happened. Upon asking my chief resident, this is how the story went: I started leaning onto my chief resident. She told me that some medical students do that to get a better view. But supposedly, she did not expect me to do that, and immediately thought something was going on. The resident across from me tried calling my name but I was not responding. They had then realised that I was about to pass out. They tried to get me to release the bladder blade, but being the dedicated med student I am (cough cough), I wasn't letting go of the blade. That is when I finally recovered and heard my chief resident's voice. The entire episode lasted 45 seconds or so. I continued to apologise as I felt terrible about the incident. The chief resident then went on to tell me her story about when she passed out during her surgery rotation in medical school. The 2nd year resident then shared her story. And then both residents took the time to ensure me that it was not unusual for this to happen.

At about 3am that night, four hours since this incident, I was back in the OR with the same 2 residents helping out on another C-section. They taught me just like before, as if nothing had happened. The asked me questions, just like before. The same anesthesiologist gave me a friendly nod. I saw a full C-section, from beginning to end, with no interruptions this time, and it was awesome.

Gosh, I love medical school!

Ob-Gyn Week 1 - Night Float

We get to spend one week in the Triage area (aka Emergency Room) of the women's hospital during our Ob-Gyn rotation. This happened to be next for me after a great clinic week. We had lecture from 4:30-5:30ish and worked from 6pm-5am ish for the week. We worked with the same team for the entirety of the week (I worked with a different person every day at the clinic). We had a fantastic team that week - the residents and interns were great teachers and my fellow medical student (a 4th year that was sure she was going into Ob-Gyn) gave some very useful advice about rotations in general.

I spent several nights working in the Emergency Room during my first 2 years of medical school. My community mentor was great and I loved the variety of cases I got to see in the ER then. The night float week was no different. I got to see patients with a variety of complaints - some presenting with pre-eclampsia, other with bleeding in their first trimester (and understandingly being very scared by it) and then there were the mothers that were very close to delivering their baby and were feeling as if they were having contractions. It was always sad to inform the mothers that their contractions weren't regular enough and that they would have to come back another time. They were not yet in labor. Yet, the pain that some of these women were in was quite unbearable for them. It is amazing how a husband's or family's support went so far in relieving this pain.

Another great thing about the night float week was that I got to scrub in on emergency C-sections. Before this week, I had never scrubbed into any surgery. I had never seen a C-section done. I had never seen a baby being delivered. And by the end - I had seen 3 C-sections and helped with 2 deliveries. Oh how amazing it is to be a part of bringing new life into this world. The feelings that I went through when were simply amazing. I felt very lucky. As disgusting as the thought of amniotic fluid and blood all over the room is, the joy of hearing that new born baby was simply priceless.

In a nutshell, the week flew by. And I couldn't have asked for a better night float week. My sleep schedule was all messed up by the end but that didn't matter. I had learned a ton and I had developed great rapport with the residents that had taught me that week. Most importantly, I saw C-sections and helped deliver babies!

Ob-Gyn Week 1 - Thoughts on Clinic Week

The patient population at the clinic was very diverse ranging from Caucasian patients to Hispanic patients to Immigrant patients from West Africa and Central America. Patients presented for a variety of reasons some of which are:
- care during their pregnancy weeks (antepartum care)
- general clinic visits for infections, contraception, bleeding
- annual visits
- 6 week postpartum visit

I spent an afternoon at the Colposcopy Clinic. This was an interesting afternoon. Wikipedia says that colposcopy "is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva." This procedure is often done if a pap smear comes back abnormal (There is a long algorithm that is used to determine if a woman needs a colposcopy or not). 3 out of the 4 women who were undergoing the procedure did not want a male medical student in the room - which was a little disappointing but understandable. After reading about the procedure and looking at atlas pictures for most of the afternoon, I was glad I got to see one procedure being done. It was relatively simple and short (and normal which was excellent news for our patient!).

In a nutshell, I loved my clinic week. I enjoyed providing primary care to patients and was very impressed with the preventive health opportunities that were created and acted upon in the clinic. Pregnant women come to hospitals and clinic often for care, and this gives them access to the health care system. It is our responsibility as physicians to take advantage of this - and the staff at the clinic definitely did that!

Ob-Gyn Week 1 - Clinic Week and Physical Exams

We spend one week in the clinic at our hospital during the Ob-Gyn rotation. I was glad I had this week first. It would allow me to ease into my first clinical rotation. During our first 2 years of medical school, we learned how to obtain a full history and perform a full physical exam on our patients in our doctoring course. If anyone disliked this course during the first 2 years, I am sure that they quickly gained a whole lot of appreciation for the doctoring course.

I worked with an intern during my first morning in clinic. I wouldn't have wanted it any other way. Interns are closest to being a medical student, and mine remembered her first day "on the wards" very well! This meant that she did a great job of easing me into this rotation. We went over some of the specific questions to ask when obtaining histories from a pregnant lady. This was good as we had not previously learned this.

We had also learned how to do breast and pelvic exams in doctoring. I am really glad we got a refresher during our first evening as it made me a little bit more comfortable doing them. We are trained using standardized patients. These are people who get paid to act as patients, and we get to practice performing exams on them. A (fantastic) nurse practitioner guided us through the steps and the standardized patient was an excellent teacher too. By coincidence, my standardized patient was the same one I had trained with about 6 months ago, and we both recognized each other and gave each other a courteous shake of the head to acknowledge that we both remembered each other. I didn't expect to have the same patient - at all.

During the clinic week, I got to perform a lot of physical exams, and each and every single time, I was extremely careful to be very professional while doing the exams. This both helped calm my nerves and calm the patient as well. Most patients were ok with having me as the medical student perform the exam under the guidance of the nurse practitioner. A few were uncomfortable and I happily agreed to their request of letting the nurse practitioner perform the exam. As a male medical student, I can see why some females would be uncomfortable in letting me perform a pelvic exam. I am very grateful to those patients that let me perform the exams. They have been a part of some of my most nervous moments in my medical education.