This is lining up to be a nice quiet weekend. Yesterday was a bonus day off, when my supervisors signed me off from the ObGyn block on Thursday, and since they had no clinical activity on the Friday, i decided to have a study day, and i did a bit of the pre-work for a tutorial on Monday, and did the laundry and tidied the flat.
Today is a freezing morning, and we are promised some -5 ish frosts over the weekend which will be fun, so some time today i need to top up on screen wash and de-icer to make sure I can get through the weekend in the car. Today should have a leisurely feel - some shopping, gym, about it until late afternoon, when there is rugby to be won - we can't afford to lose the first match, because with Scotland playing Wales tomorrow, an english victory today would only spur the Welsh on, knowing that they was one team less in the contest for the Grand Slam.
Showing posts with label Gynaecology. Show all posts
Showing posts with label Gynaecology. Show all posts
Saturday, February 7, 2009
Saturday, January 17, 2009
Traveling, traveling, traveling far.....
The hospital where I am doing my Obs/Gyn is about 25 miles away from home. And has 3 main roads into the town. All 3 currently have roadworks, meaning that it can take 30 minutes, or 45 minutes to get to the hospital in the morning. The antenatal clinics are about another 10-15 miles beyond the hospital, which makes getting there lots of fun as well. There is a bus, but it takes 1hour plus a 25 minute walk. May as well just resign myself to a 320 mile weekly commute!
Straightforward cases and ethics!
I'm finding Obs/Gyn a strange block - Obstetrics seems to be a mix of sonography, surgery, medicine, and being a referral service for Midwives. A lot of the consultant work involves initial assessment by sonographer / midwife and then just a quick consultation by SpR / Consultant. This makes trying to talk to people for long enough to get a case study quite difficult.
One day I spent time on the Maternity suite / labour wards, initially shadowing my consultant, but later the Spr & Fy2 who seemed to be doing most of the work. There was less of the competition and agro between Midwives and Medical staff than i had been lead to believe existed, and also less resentment to my presence as a Medical student.
Two cases filled a large part of our day - a young woman who had a C Section and also had HELLP which meant her blood wasn't clotting correctly. She developed a haematoma under the would and was taken back to theatre to have it removed. As they undid the staples, there was a strange sound, and a plume of blood sprayed towards me as I jumped backwards to escape the pool of red arterial blood on the floor. The clot was removed, and the bleeding vessels were sealed. It was an interesting case, because she was at that moment receiving lost of blood products and transfusions, and the situation had fairly rapidly escalated from a post op patient who was a bit sick, to a surgical emergency. Interesting to see, but not very mentally taxing.
The second case left me thinking for a long time about ethics and my opinions. Itw as a patient who had gotten pregnant despite a contraceptive implant, and then decided to have a medical termination. The implant secrete progesterone (which IIRC both 'prevents' implantation to stop a pregnancy, but once one has started, maintains the placenta). The Medical termination pills cause blocking of progesterone receptors, causing the placenta to die and the uterine contents to be delivered following further medicine administration a couple of days later.
In this case the patient had passed the foetus into the vagina, and the placenta was coming out. My consultant used a speculum to open the vagina and said, "Look in there. see the hand and face...." I was quite unprepared for that to be what I saw. Medical termination sounds very sanitised and clean. The actuality is less nice, and quite traumatic on the mother.
This has contributed to a growing ethical dilemma for me over the issues of terminations and abortions, which I may explore in a future post once I get time to read more on the subject.
One day I spent time on the Maternity suite / labour wards, initially shadowing my consultant, but later the Spr & Fy2 who seemed to be doing most of the work. There was less of the competition and agro between Midwives and Medical staff than i had been lead to believe existed, and also less resentment to my presence as a Medical student.
Two cases filled a large part of our day - a young woman who had a C Section and also had HELLP which meant her blood wasn't clotting correctly. She developed a haematoma under the would and was taken back to theatre to have it removed. As they undid the staples, there was a strange sound, and a plume of blood sprayed towards me as I jumped backwards to escape the pool of red arterial blood on the floor. The clot was removed, and the bleeding vessels were sealed. It was an interesting case, because she was at that moment receiving lost of blood products and transfusions, and the situation had fairly rapidly escalated from a post op patient who was a bit sick, to a surgical emergency. Interesting to see, but not very mentally taxing.
The second case left me thinking for a long time about ethics and my opinions. Itw as a patient who had gotten pregnant despite a contraceptive implant, and then decided to have a medical termination. The implant secrete progesterone (which IIRC both 'prevents' implantation to stop a pregnancy, but once one has started, maintains the placenta). The Medical termination pills cause blocking of progesterone receptors, causing the placenta to die and the uterine contents to be delivered following further medicine administration a couple of days later.
In this case the patient had passed the foetus into the vagina, and the placenta was coming out. My consultant used a speculum to open the vagina and said, "Look in there. see the hand and face...." I was quite unprepared for that to be what I saw. Medical termination sounds very sanitised and clean. The actuality is less nice, and quite traumatic on the mother.
This has contributed to a growing ethical dilemma for me over the issues of terminations and abortions, which I may explore in a future post once I get time to read more on the subject.
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