What I Learned on my OB/GYN Rotation

OB/GYN happened a few months back, but I haven’t blogged about it yet. Area medical student discovers blogging difficult to schedule during third year. Story on page 12. Ahem. Anyway, here are some more lessons learned:
saying-vaginas-could-save-your-life

  1. The human body is freakin’ amazing, and female bodies are amazing in specific ways. I mean, the human ovary, man. This is an organ that ruptures and heals itself once a month for like thirty years. The first time I saw an ovarian cyst removed, I was confused about why we were closing up when the de-cysted ovary still looked like a frittata, but the attending told me, “In a month or two it will have completely remodeled and repaired itself, like you never know we were here.” That’s pretty wild.
  2. I am not a future surgeon. Yeah I could have told you that before, but I am so strongly interested in reproductive health (this is the one rotation during which I actually looked forward to studying for the stupid SHELF exam) that part of me thought maybe, just maybe. I liked my residents, I loved the patient population, I was interested in the diseases, but I just don’t love the OR. I really like to talk to my patients, which is less fulfilling when they’re unconscious. And I can’t get used to the practice of avoiding contamination by resting my hands on an anesthetized patient as though they were a table.
  3. Here is a list of surgery-adjacent activities that are acutely physically painful: Standing for hours, sitting for hours, holding retractors in the same position for hours, keeping ones hands sterile for hours by folding them over ones thorax as though preparing to break into a chorus of How do you Solve a Problem Like Maria?, being the first person awake in your whole neighborhood (mediated by emotional pain). Have I mentioned I’m about to start my surgery rotation?Miranda
  4. Ovarian cancer really sucks. I’ve made a pest of my self on every rotation since OB/GYN trying to get my superiors to test for ovarian cancer in patients who are in the hospital for, say, psychiatric disorders. As you probably know, the biggest challenge is getting a diagnosis early, because the symptoms are not very specific and are often ignored. If you haven’t yet, tell your gal pals, your girlfriends, your wives, your sisters, and your moms over 40(ish), not to ignore digestive, urinary, or abdominal symptoms. Meanwhile I’ll try to work on their doctors (not the OB/GYNs, though, they’re on it).
  5. Spanish skills are in short supply around here (see the photo below, taken in the surgeon’s lounge, of the cup of soup that had been reserved for a chief resident). Because of cost, interpreters were sometimes only requested on the L&D floor when there were at least three Spanish-speaking patients. The thought of going through labor surrounded by people who can’t understand you gives me chills. As far as my education went, having enough Spanish to hang got me a lot of opportunities to work with patients. But I also found out the hard way while rounding on a patient the morning after her c-section that I didn’t know how to say “pass gas”–I racked my brains unsuccessfully for a Spanish translation of “fart,” and finally wound up acting it out. I figure there’s about a 30% chance the patient in question just wanted to see what I would do. IMG_0421
  6. Among OB/GYNs, gender was a weaker predictor of awesomeness than I expected. The only clinician I observed exhibiting true indifference to patients’ comfort was female. There were certainly some male OB/GYNs who truly believed themselves to be the victims of discrimination, and that was, ahem, frustrating. As one of my female colleagues put it–and in order to honor her original wording while preserving this blog’s PG rating I will be making use of the French word for seal–“Oh, they’re at a disadvantage in one field? Boo Phoque3-ing hoo.”  On the other hand, one of my awesomest male colleagues really clicked with this rotation, and I’m psyched about it, because of things like this: When one of the attendings found out he was considering OB, she encouraged him to talk to some of the male doctors about their experience. “Why would I need to do that?” he answered. “I already talked to the female doctors.” Basically a doctor with humility trumps a doctor whose genitals and/or gender identity matches your own.
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Six Times Psychiatry was Accurately Represented in TV or Film

This post was brought to you by my psych rotation. I won’t be telling you anything, really, about my experiences on the psych unit, because these are some of the most vulnerable patients in all of medicine and it doesn’t feel appropriate. Media representations of psychiatry, on the other hand, I will talk about all day. It’s been on my mind ever since the morning I got to sit in on some ECT sessions. ECT, if you’re not familiar, is Electroconvulsive Therapy, colloquially called shock treatments, and if you are familiar it’s probably because you’ve had some. Otherwise chances are you’ve been exposed to some wildly inaccurate conceptions of this medical procedure.

I haven’t experienced ECT as a patient, and wouldn’t presume to speak for those who have. As a rule, however, modern ECT is not represented in media from the patient’s perspective, and for good reason: that would be hard to film, and boring, because patients go through this procedure under anesthesia. In fact it’s kind of boring to watch IRL, in the best possible sense. ECT is performed with the patient 1) asleep and 2) medically prevented from having muscle spasms associated with some types of naturally occurring seizure. The patient points their foot, and makes a face (caused by involuntary muscle contractions, not pain, see above asleepness), and that’s the whole show. Well I guess the machine also makes an inoffensive beep to make sure everyone knows the shock is being administered. But there’s just…not much to see. Do these important details come through in the way ECT is represented in, say, Homeland?

HomelandECT

Haha, not likely! No, Homeland wants you to know that mental health treatment not only ruins careers, it looks and sounds like a living nightmare. At least that’s how it seems by the end of Season 1; I stopped watching after that because of this scene. Also because of the more than slightly exploitative approach to its protagonist (as this blogger put it, “It says a lot that for the most part the obsequious wannabe terrorist was a more sympathetic character than the mentally ill woman he was conning”), because of its casual islamophobia, and because it is a major pet peeve of mine when supposedly hardened, CIA-employed characters say nonsarcastic lines like, “My god. You’re in love with him!”

Look ECT isn’t magic, though TBH it can feel that way when a really sick patient who isn’t responding to medications or therapies starts to get better after having this treatment. This isn’t going to be a summary of the evidence base surrounding its use, though please feel free to post one on your own blog. I raise this issue because I think it typifies the representations of psychiatry and mental health care in popular culture. In contrast to the way medical doctor characters are so often written as relatable heroes (Grey’s Anatomy, E.R.), or at worst as lovable scamps even when their behavior is sociopathic (Scrubs, House), our baseline cultural understanding of psychiatry is pretty different. I object to the double standard. There are deep historical reasons for the mistrust between the public and psychiatrists, but yo, there are deep historical reasons to distrust anyone remotely connected to medicine (paging Dr. J. Marion Sims). I don’t believe the double standard is fair or accurate. The stigma attached to mental illness is bad enough–do we have to stigmatize the treatment of those illnesses too?

And so, by way of counteracting the trope of the sadistic power-mad and also just vanilla-mad shrink, I have assembled a collection of representations that I believe give a more realistic picture of psychiatrists. They’re not hero-healers, they’re just folks, and sometimes they help their patients live with incurable and potentially life-ruining diseases. This is list is by no means comprehensive–hello, I’m in medical school, I don’t have time to watch good TV, much less shows I hate like The Sopranos–but let me know if you’d like to do an updated content analysis some day. Here is a link to an out-of-date scholarly analysis if that’s your bag.

Below the jump the entire post is spoilers. Continue reading