Archive | September, 2014

The “Crease”….Your Gyn Rotation

30 Sep

Some Things You Learn to Get Used To

If you’ve made through the didactic year and started rotations, chances are this may be a dreaded clinical. Prior to starting clinicals, my program hired people to allow us to practice the GU exam. I have no idea what low spot these people were in to allow 42 pelvic exams in a row, but maybe they were just dedicated to higher education. Luckily, I had some idea of what I was doing on my Gyn rotation….spending a lot of time in “the crease” before I set foot in the door. My most memorable patient was an elderly demented woman brought in from a nursing home. The chief complaint was “She put something in down there”. I was sent into the room with a non-verbal patient to do a pelvic exam. One of the CNA from the home was there to “help”. The speculum was lubed and inserted and….Whaaaaaat? There was not just one thing, there were THINGS. Plural people. I removed bottle caps, tea bags, and an eraser. What kind of nursing home was this? The emitted smell sent me to another world and I felt horrible for this frail old woman. I discarded the objects into the garbage and finished up the exam. After completing this almost impossible task, I got chewed out for not double gloving the previously inserted objects prior to throwing them away. I banked that one for future use! The following are a few heads up that no one ever told me.

1) Many gynecologists are not practicing obstetricians. If you want any experience with pregnancy or deliveries, make sure you find the right clinic.
2) Get your game face on, you will be seeing and hearing about some of the most intimate issues women face. Do not show any signs of surprise or you just lost your patient. As far as they know, you have always known that people get irritation around their recent clitoris piercing.
3) Prior to starting rotation, go over birth control methods. A large portion of the rotation will be about starting/adjusting/discontinuing contraceptives.
4) Dysfunctional Uterine Bleeding….own it.
5) If there are any procedures done at the clinic, get involved! Colposcopies, IUD insertion, Bartholin’s abscess I&D, marsupialization, among others are all really cool things to see, and will cross over to primary care and the ED
6) There will be pro-life/pro-choice discussions…its uncomfortable.
7) Women come to the clinic with very scary situations and diagnosis. Cancer diagnosis and abuse are two examples that pop into my mind. Guide and care for these women carefully.
8) Don’t judge. Its not our place. Gentle discussions about lifestyles are within our scope. Making them feel horrible about themselves because they are in being treated with a second STI from the same partner is not our place.
9) Please…..please, from the bottom of my heart, use lube on that speculum, every time.
10) This may be the job for you if you enjoy seeing many patients a day with similar complaints, but you get to know them at deeper level. There is some variation and higher complexity, but you have to be dedicated to pelvic exams. Many PAs enjoy a high level of autonomy in this field!

FOOTNOTE- I was corrected by a veteran PA who is in the Gyn field. She states that too much lube can actually ruin the wet prep or cytology results. Use in moderation


Slice ‘Em and Dice ‘Em: Your Surgery Rotation

2 Sep


My surgery rotation was at a busy hospital in Philadelphia.  I chose to do a more general surgery rotation to get a wider scope of what happens in the OR.  This included general surgery, colorectal, breast, and ortho.  My favorite was colorectal…not.  I never knew how they had to position a patient for rectal surgery, and let me tell you, it ain’t pretty.  Backside up, retractor in.  If you have never had a surgical experience,  be prepared for the brutality of it.  The patient is anesthetized, the music blasts, and there is no finesse necessary for getting the job done.  Mostly as a student you will be holding instruments.  You will be retracting.  You will be on your feet for 10 hours a day.  I was lucky enough to work under the chief resident who happened to look like Meg Ryan from City of Angels and she actually was pretty decent. Here are some heads up about what to expect.

1) Surgical residents get treated like pond scum….so thats the only way they know how to treat you.

2) There is a TON of pimping going on.  The attendings pimp the resident and the residents pimp you.  You should learn this phrase “I’m not sure but I will look it up and give you the answer later today.”

3) It would be helpful to get a pocket guide for the most common surgical procedures and their indications.  You will be asked about epidemiology, pathophysiology, anatomy, treatment, etc.

4)  Surgery Departments are typically boys’ clubs.  Unless things have drastically changed since I graduated, expect that it will be more difficult to be successful during this rotation if you are a woman.  There is a lot of male camaraderie and strutting going on.  “Oh hello, did you know I’m a surgeon?  Just wanted to remind the whole hospital how awesome I am” Just ignore it.  Show them your book smarts and be prepared.

5)  Go over sterile procedure.  You will scrub in so know how to it before you get there.  Know about the sterile field.  If you break the field you will be the most hated person in the OR for your entire rotation.

6) The surgical techs are gods in the OR.  They know every instrument, how to handle them and how to maintain the sterile field.  They may help you get your gown and gloves on.

7)  Expect to stay late.  Everyday.  There will always be a late, add-on, once-in-a-lifetime case that you would be a complete idiot to miss.

8) Continuing off of #7, sometimes you can’t stay late.  Its okay to say no if you have something REALLY important happening.  An example would be that you are in labor and your water breaking would contaminate the field.  If you truly have to leave on time, just be prepared to get some seriously disappointed looks.  If you can handle it, walk out the door with your head up.

9)  Bring protein bars…at least 3 or 4.  Lunch break is rare.  Breakfast and dinner breaks are even rarer.  Pretty soon, that mass you just helped remove will start to look delicious.  Gross.

10)  This may be the specialty for you if you find out that you like instant gratification.  Someone’s gall bladder turns black, you take it out.   BOOM!  The End. There is less direct patient contact, but you are in close contact with your supervising MD everyday.  In all seriousness, surgeons typically come from the top of their class.  There are many kind hearted and gifted surgeons that you can learn a great deal from.  So be prepared to work long, hard hours this rotation.  Suddenly the textbooks will be replaced by real people and so many pieces of the puzzle will fall into place for you.  I promise, retracting is not nearly as bad as it sounds 🙂

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