Future OB/GYN?

Before I started this rotation I thought that by the end of it I would have decided that I didn't want to specialize in OB/GYN. On the contrary, I haven't rule out this specialty. This fact really surprises me.

OB/GYN rotation ended almost two weeks ago. At that time, I jotted down some things I liked and disliked about the rotation.

Relevant medspeak:
obstetrics: branch of medicine that deals with pregnant women during pregnancy, delivery, and the postpartum period. 
gynecology: the branch of medicine that deals with diseases of the female reproductive organs. 

Likes:

• I'd be okay if I only saw female patients for the rest of my career. 
• I like asking people about their gynecologic history. Yup, this includes all the awkward questions we had to practice asking in pre-clinical years. 
• I like gynecologic surgeries. Some common ones I saw were ovarian cystectomy, dilation and curettage, salpingoophorectomy, hysterectomy, different types of tubal ligation, endometrial ablation, diagnostic laparascopy, salpingectomy for ectopic pregnancy. I think it's the coolest thing that I get to see the inside of someone's body. 
• I like doing a speculum exam and finding the cervix. 
• I like palpating uteruses.
• I like checking cervical dilation even though 80% of the time I can't find the internal os of the cervix. 
• OB/GYN residents are nice. But so far I haven't worked with any other residents so I'm not sure how they compare.
• Getting dirty in blood and amniotic fluid. 
• It's the medical application of my longstanding interest in reproductive health and reproductive rights. I've learned a lot more about reproductive medicine, which is someone I always wanted to learn about. I feel like I'm being true to my values and beliefs. I guess I'm still telling people to use birth control, just in a different setting. 

Dislikes:

• Ridiculous work schedule in residency and as an attending. What other physicians or working person would feel fortunate to have to work every fourth weekend and every fourth weeknight? Really, this is considered a cushy schedule for a full time OB/GYN.
• So... I kind of don't like obstetrics. I know this is half of OB/GYN... If I could do a residency that only consisted of gynecology, I would be ready to commit to that now. Unfortunately, it doesn't work like that. I could do a fellowship after an OB/GYN residency in an gynecologic field so that I'd pretty much only see gynecologic cases. But I'm not sure I'll have the energy to do a fellowship by the time I'm through one of the most difficult residencies so I can't make that decision right now. 

The typical patient on L&D

I have finished my clinical duties on OB/GYN rotation. This week we have exams and presentations. So I think this is a perfect time to procrastinate by blogging.

In preclinical years there were rare instances where we saw real patients in hospitals, not hired actors playing the part of patients. One time we were seeing patients on the pediatrics unit. A classmate of mine said something when addressing the parents of an infant that implied the parents were married. But they weren't married and the student felt really awkward.

Now that I've been at this hospital for about two months, the image I have of a typical parent is completely different. The typical obstetric patient at this urban safety-net hospital:
-Teenager or early 20s African American girl.
-The standard age to have a baby is in your late teens or early twenties. I'd say that most of the pregnant patients we see are between 16-22. This means that they're younger than I am. I'm a little bit taken back when I see a date of birth on the chart that's in the mid nineties. I remember the mid nineties! But now I'm not that surprised.
-The baby daddy (terminology is per patient) is minimally involved, if at all. At her delivery are usually her mother, her aunt. A few times I saw the baby daddy cry when the child was born and I was touched by that. But this is pretty rare.
A few days ago I saw a 28 year old patient who was pregnant for the first time. Reflexively I thought that she was old.

Then I saw a pregnant patient in her late thirties so by definition was AMA. Advanced maternal age: 35 years or older at the due date. I thought she was really old. She was starting to have grey hair.

First rotation!

An attending I worked with yesterday asked what specialty I wanted to do. I was honest and said that I wasn't sure. I probably won't decide until the end of my third year, which is as late as possible. He suggested that I write down notes from my rotations so that I can look back on them when making a decision on choosing a specialty.

That is a very good idea, I thought.

Also a couple friends inquired about my blog recently even though it had been on hiatus for months.

So I'm blogging again!

Quick recap:
I'm a third year student now. My first and current rotation is OB/GYN.
Passed USMLE Step 1!
My score was pretty good and I'm pretty happy with it. (Though I really wanted five more points. That's how it always is, isn't.) Good or bad, that uncertainty is over.

A doctor explained Bartholin's gland to a patient this way:
When you are about to eat delicious food, the glands in your cheek produce saliva to lubricate your mouth. Bartholin's glands have a similar function. When you have foreplay, these two gland on each side of the vagina that secrete fluid to lubricate.

I thought that that was a fitting analogy but I think about it every time my mouth waters.