Tuesday, March 25, 2008

Call Of The Sirens (Part V)

The next installment of one person's faded reminiscences of medical training from the mid '80s to the mid '90s.

When last we left our heroine, there she was, having gotten all of the easier rotations out of her way, which, while not stress free, by any means, did enable her to go home to dinner and her own bed at night. She was able to see something of her friends of a weekend and even get a little exercise. Nothing helps sanity like a night's sleep in your own bed and having a beer with your friends on a Saturday night.

At this point in time, there were two specialties that I was seriously considering: Internal Medicine and Obstetrics/Gynecology. The internal medicine seemed a good match with my personality--it's for the plodders, the fiddlers, those with a fair amount of patience and attention to detail, who don't mind spending their days finding just the right cocktail of potentially lethal drugs to treat senile Aunt Mary's end stage congestive heart failure, complicated by brittle diabetes, labile hypertension, not to mention Aunt Mary's propensity to take a swing at anyone coming near her who somehow resembles Myrtle, her hated neighbor of 40 years ago. It's for someone who gets a gleam in their eye when being presented with a patient having 21 problems on their medical problem list, 22 drugs on their medication list, 14 drugs on their allergy list, symptoms of "I'm weak and dizzy all over" and a desire to talk about The War; yet who won't forget to make sure tetanus, influenza, and pneumonia vaccine status is always up to date. Oh, yeah! Bring it!

Ob/Gyn appealed to a slightly different part of me; the part that loved using scalpel and suture, the part that had a pull toward women's health issues, not to mention that whole miracle of birth stuff (sniff!).

With such heady decisions in mind, at the age of 24, I faced the next 18 weeks--a month and a half on ob/gyn, followed by 3 months of internal medicine, all in the depths of winter. Nothing like seeing your potential future at its bleakest.

You know, I figured that of all the areas of medicine, ob/gyn was likely to be the most joyous. I was so very wrong.

Ob/gyn was a bleak, living hell, peopled with exhausted, angry, bitter beings, whose only joy in life was spreading their bile and vitriol as far and wide as they could. At least that's what it was like on the University Hospital's obstetrics unit. There were, I believe, 6 of us students, one of whom was my good friend, Adam, who became my twisted rope of mental sanity. Without Adam, the bitter and cynical (emaciated and ever-pale, living on only coffee and the occasional stale cookie) soul that he was, and therefore only minimally affected by all the toxic atmosphere, I'd have shut myself into a cupboard to hide with the emesis basins and die. Adam, who cajoled me down the stairs, smelling of placenta and urine, after yet another sleepless night spent watching the scratchy patterns on the fetal monitor strips, checking cervices for dilatation. ("Um, 5 cm?" "NO! Idiot! 6 cm! Can't you feel the difference? And she's +1, not 0! Worthless scum!") Another night, following a day and being followed by yet another day, of getting literally pushed out of the way with a 1-2 combination of hip bump and elbow swing, deftly executed by one of the interns, who dashed in at the end to catch the baby, and cut and sew up the episiotomy. I did get a few deliveries myself over the weeks, but it wasn't the experience I'd wished for. Adam, who, no matter how angry my rantings, always topped my woeful grousings and made me smile ruefully, as we tromped off in the early morning hours, cups of bad coffee in hand, to check all the new moms on the MFBU (mother-fuckin'-baby unit), to make sure their C-section incisions were healing well, and cajole them to get up and walk around, dammit (the more you walk, the faster you fart, the faster you fart, the faster you poop, the faster you poop, the sooner you get the hell off our service and out of the hospital).

For a couple of weeks during the day, we were also farmed out to the inpatient gynecologic service, which was mostly ghastly bizarro tumors. The 'best' was the one the size of a beach ball in this very lovely woman. Fortunately, she had a good outcome, if a prolonged hospital course. The worst was the one with a horrific vulvar cancer that required not only the removal of her genitalia (external and internal) but half her pelvis and one of her legs. You don't forget that. No, you don't. She was youngish, in her 40s, I believe. We also spent time in the gyn clinic, doing lots and lots of pelvic exams, or at least the female students did. Poor Adam and the other guys seemed to spend a lot of time standing outside closed exam room doors. The women would let the guys in for the history taking part but were less than thrilled with them being there for the exam, which was understandable. The WWII vets in the urology clinic were a different matter. I only had one request that a male examine him. You can't beat a WWII vet for toughness. (Or maybe they were just being pervy.)

In speaking to my colleagues who drew their ob/gyn rotations at the private hospital across town, I heard that their experiences were completely different, with cheerful residents happy to teach and nurses happy to help and guide. None of us of the MFBU brigade believed such blatant bullshit.

Ob/gyn was pure, toxic evil.

So. That left me with only internal medicine on my now very short list, which, of course, put me into a state of extreme-freak. Nothing like knowing that you not only need to love it, but that you need to impress the socks off the attendings so you can get strong letters of reference for your applications for residency programs in a year. Don't want to end up as a house officer in the unheard of and uncared about residency program at St Mary's Hospital of the Long Forgotten in Blackhole, North Dakota, no-siree-bob. This is not to disparage North Dakota. I personally find North Dakota rather pretty, but it does have the reputation of being near the ends of the American earth, which is a bit odd as it's in the center of the continent. The vagaries of geography and extreme cold.

I think we'll take a break, here, as we next travel to the wonderful world of internal medicine, which in the true spirit of an internist, will be discussed in excruciating detail. (Bonus factoid: Why are internists called 'fleas'? Because they're the last thing off a dead body.)

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Blogger CarpeDM said...

But, but Grey's Anatomy & what's her name's spin-off has led me to believe that delivering babies is a wonderful and happy experience, after, of course, wrestling with trauma for 45 minutes. And look at how pretty they all are. I am very disappointed.

I have often wondered the same thing about North Dakota myself. How exactly does it be the ends of the earth when it is in the middle of the continent? All I know is I'd rather not go there if I can avoid it.

11:36 AM  
Blogger Dumdad said...

Crikey, it sounds like Dante's Inferno but worse. I'm glad I never had any desire to become a doctor other than having pretty nurses attend to my every need (sexist, chauvinist cochon, they all cry, and quite rightly too!)

1:37 PM  
Blogger Mother of Invention said...

I'm sure you'll show us in vivid detail how "gutsy" you are in Part VI!!!
Not sure what I'd choose if I were in your position. Maybe ortho so you can get people up and as mobile as they can be after injuries and weasr and tear. Maybe that's just because I'm dealing with really painful knees right now and I'd love someone to take that all away so I can be active again. I'm swimming but mostly doing exercises and arms only. My husband has been doing ultra-sound since Dec. and no real change. Only mild arthritic change shown in x-rays so may be mostly tendons and muscle. Very frustrating for me and my husband as most of his patients would be much better by now!!! Darned diabetics and their weird neuropathies etc.!!!

2:24 PM  
Blogger PixelPi said...

Can't wait for part VI. It's so reassuring that I now know that my yearning to be a librarian or something like it kept me away from nursing school, much less trying medical school.

And it's obvious I watch too many Discovery Health programs where babies are delivered by smiling doctors and nurses. Can't wait to hear about fleas.

4:50 PM  
Blogger Rozanne said...

I am loving these medical school installments! I mean, I've always heard that being a med student is hell, but details like "smelling of urine and placenta" and the walk, fart, poop, go home protocol really bring home the reality of it.

I have to say I'm glad I've never been in an Oby/Gyn ward in any capacity.

8:33 PM  
Blogger Diana said...

Dana- Oh, we shall deal with the completely unreal fantasy that is GA in a bit. I actually have gotten sucked into it, via Netflix, but it is so very wrong in so many aspects. Actually, for me, "Scrubs" hits the feel closest, at least the first couple of seasons.

Dumdad- I'll wish you every pretty (but male--I'm evil) nurse in the hospital to your case, should you ever need to be in hospital.

Ruth- Funny you should say 'ortho'. Back in high school when this whole doctah seed was planted, I'd thought to go into sports medicine, which is heavily ortho. But then I found ortho so very, how should I say it?...dull. Sucks about your knees. Have you seen a good PT? They can do amazing things. Double damn neuropathy. Such things should be shot at dawn.

PixelPi- Until the age of 14, I was going to be a librarian. All those lovely books. I suspect that being in a pretty-pretty hospital with adequate staffing goes a long way toward to banishing the vitrol that I experienced.

Rozanne- I've often wondered what the patients percieved. They were treated with much more respect than the staff and residents treated each other, but it can't but have rubbed off on them a bit. Functioning as the county hospital, it did a lot of indigent care and a lot of the very high risk care. Not too much of the bread-and-butter 'happy middle class, uneventful pregnancies'. The teens were the closest we got. Such a whiny bunch they were, the birthing 15 year olds. (Yes. NO KIDDING. They were children, themselves. I realize that they'd whine. It just got old when you were so very tired and depressed, yourself.)

8:24 AM  
Blogger Jocelyn said...

As ever, these posts leave me gasping, "Holy Jeevus, did I do right not to ever, ever consider medicine."

I will, btw, NEVER forget the moment I was forced (er, "cajoled") into putting my feet on the ground post C-section. That standing up was the worst. And I was in no hurry to get off hospital service. I was nowhere near ready to go home.

12:57 AM  
Blogger Amy said...

Ah, and some things never change. There were many things that ultimately kept me out of medical school but I kind of think the commitment for the rest of your life you better love this or you will want to chew on tin foil bit really kind of did me in.

OB/GYN is up next for me. If I don't die on the 11th floor in Geriatrics first.

12:10 PM  
Blogger listie said...

I can't wait to read the next installment.

11:07 AM  
Blogger Teresa said...

That POOR woman! A tumor the size of a beach ball? She lost not only her 'Whoopee organs' but a LEG too? That is more bizarre than I could ever imagine! I hope she had people who loved her to help her through all of that hell.

2:22 AM  

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