Sunday, April 22, 2012

Third Year (Part Dos): The BIG One

So, the intended 4 posts for med school has turned into 5.  However, I realized a single post for 3rd year really wouldn’t do it justice.  This year was so packed that I could probably devote another 4 posts just to this year.  Here is the rest:

Obstetrics and Gynecology:

This field is all about women’s health.  These doctors care for women before, during, and after their childbearing years.  As a result, they become very attuned to the health concerns striking women in each stage of their lives. 

 The Ob/Gyn wears many hats.  This field is one of the few that incorporates a combination of clinical medicine and surgery.  These doctors devote their time to many different practice environments.  They can be in the clinic doing routine examinations, prenatal examinations, fertility counseling, or postnatal checks.  Other times they are in the delivery wing helping to bring new life into the world.    And sometimes they are in the operating room performing repairs, hysterectomies, or other surgeries for women.  It is another field with long hours, and you are faced with the challenge of balancing many different roles.  However, it provides a great deal of variation in your day to keep things exciting!

For third-year students, it is another rotation that requires a large time-commitment.  Just like the docs you work with, you have to divide your time among these numerous practice settings.  Here are some of my favorite OB/Gyn moments!

- Delivering babies!  Mostly I had the opportunity to deliver placentas (the sac that holds the baby during pregnancy, which is delivered after the baby).  But, I did have the opportunity to deliver a couple babies.

- Waiting 12+ hours for the half-hour rush of the delivery

- Seeing first-hand the devastation of ovarian cancer

- Watching the tears of joy from a couple seeing their baby on ultrasound for the first time… and discovering they are having twins!

- Being first-assistant on a hysterectomy, and helping the patient through pre and post-op care

- Discovering the importance of prenatal care.  The blood work your doctor recommends is important! 

- Feeling the depth of a woman’s sadness after a miscarriage 

- Giving a baby to her mom and dad to be held for the first time

- Catching soon-to-be dads before they pass out in the delivery room

- Realizing that when I am someday asked the question, “Do you want an epidural,” it will be a resounding “YES!!”

- Discovering how much of a miracle it is to have a healthy baby

- Becoming an expert at finding baby heart-rates, measuring fundal heights, and estimating cervical dilatation

- Helping a woman prepare to be a mother, whether she is ready to be or not

- Mastering the art of the painless pap-smear

- Experiencing baby fever!  Despite the long hours, seeing all of those moms really makes you want to have a little one of your own.

Pediatrics:

I loved pediatrics.  There is something about being around children all day long that makes work fun and interesting.  This was certainly a field I could have gone into, and definitely was at the top of my list for possible careers.  You have a chance to work in hospital and outpatient settings.  It is rewarding to watch your patients grow up from infancy into adulthood.  You can help to foster a healthy lifestyle that will stay with your patients for a lifetime and see them at critical moments in their young lives.

However, one of the hardest parts about pediatrics is seeing the really sick kids.  There is nothing more devastating to a parent than the death of a child.  There are times I really wondered how doctors can handle being pediatricians and parents.  I know that if I was seeing sick kids all day, I would be in constant fear of my own children becoming ill too.

Here are some of my pediatrics moments:

- Treating children is like caring for aliens.  Their lab values are different, they are affected by an entirely different set of diseases, and you never can quite expect what they are going to say/do next!

- It is amazing what kids will be willing to do in exchange for a colorful sticker

- There is nothing quite like starting your day in the nursery!  Few things in life match being surrounded by a bunch of cuddly, (mostly) sleeping little bundles of newborn joy

- Learning what to expect when I have my own children

- Getting an even stronger feeling of baby fever!

- Seeing the fear in parents’ eyes when they bring in their sick kids, and the relief when they get better

- Never unsuspectingly open a baby diaper.  Otherwise, you are likely to get peed on.

- Get to know your baby poop colors!  They actually mean something

- Get your children vaccinated!  There are few things more certain in medicine than the contribution of vaccines to preventing childhood illnesses. A brief “ouch” is much better than the risk of contracting a life-threatening condition.

Psychiatry

Of course, I had to save my favorite for last.  I am especially partial to psychiatry, as it is the field I will be devoting most of my life to.  Before med school, it really wasn’t a field that I had considered.  I realize that I had a lot of false, preconceived notions about the field.  Prior to starting med school, I didn’t really understand mental illness as a pathological process.  However, just like heart attacks, broken bones, and diabetes, there is a structural and chemical basis to diseases of the mind.  Understanding this helped me to see how medicine plays directly into the treatment of mental disorders.  Diseases of the mind really affect the whole body; they can be physically and emotionally debilitating.  I realize how challenging and rewarding it can be to treat patients with psychiatric illnesses.  It requires not only a strong medical background, but also an understanding of people and effective communication.

While already fairly specialized, psychiatry offers many choices for practice environments and focus.  You can work in an emergency, clinic, or hospital setting.  Practice styles involve short-term care, like through the consult services, or long-term care through inpatient or outpatient services. 

Here are a just few of the memorable take-aways:

- I once was asked, “Are you that princess from England [Kate Middleton]?” Although I bear absolutely no resemblance to her whatsoever, other than we both are women in our 20’s, I couldn’t help but smile. 

- Carrying on a conversation with a person with mania can be a challenge.  It is unbelievable how quickly these patients can talk and the rapidity with which they change topics.
   
- It is incredibly rewarding to be there for a person in his or her greatest moment of need.  A person is never in a more desperate situation than when they are considering or have attempted suicide.  You often are the last line, and what you do next can sometimes be the difference between life and death.

- Seeing a patient with schizophrenia before and after hospitalization.  Medications can really work wonders

- Treatment often takes a lot of time and patience.  Sometimes it can take weeks, months, or years to effectively help your patient.

- Marijuana is not harmless.  It can sometimes make you psychotic

- Trying drugs is a bad choice, especially if there is not a drug test yet for that substance.  That is a great way to end up in CPEP (the psychiatric emergency room)

- Get collateral!  It is the best kind of lie detector test

- You have to truly understand the whole patient.  You have to learn how the body language, speech pattern, word choice, and conversation content all come together.  You have to see a lot of people with the same disease and constantly read about the basis of these processes.  It takes tremendous training and skill to effectively diagnose and treat a patient



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