As always, with a hint of excitement and ladles of nervousness, we reported to the Department of Obstetrics and Gynaecology just about two months ago. As we were shuffled into the 3 units A, B and C (each withits own unique reputation), Labour room and Casualty, some had Lady Luck on their side while some others knew they had a few more hurdles to cross than the rest.
The Department is one of the busiest at HIMS, notorious for its hectic schedule which reflected upon the interns and staff alike. I was posted in B Unit which initially had the all-male staff of Dr. Rajashekhar Sir (Unit Chief), Dr. Shridhar Sir and Dr. Raghupathi Sir. Later Dr. Nishitha ma'am joined the Unit. On my first OPD day, I learnt the main steps of taking and ANC case including the examination. Now these were things that I could learn well only with time so initially it would take me some time to localize the Fetal Heart Sound (FHS) but slowly, over the weeks, my ears began to get trained to recognize the familiar rhythmic beating, to make an estimate of the gestational age by the abdominal examination and also to assess about the progression of labour based on the PV examination.
A typical duty day involved a quick prerounds of the Post Natal Wards, Immediate and Late Post Operative Wards, Special Ward, ICU and Gynaec Wards after which we had the ANC rounds with the staff and the rounds and follow up of all of the wards as advised by the professors during their rounds. After this we hurried to the ANC OPD to clear the cases and give admission to those in labour. Any emergency case would be taken up for LSCS once all the investigations were in place. By 4PM, there would be rounds by the duty doctor of all the ANC cases admitted during which he/she would decide the course of action: Watch for Progress/ Shift to Labor Room/ Prepare for LSCS or maybe even discharge in case they were not in active labor.
Following this was the tedious process of writing the case sheet (which was later marginally simplified by a book which we had to fill up) looking at any loopholes, any deranged laboratory values or medical / surgical comorbidities. Usually there would be few cases taken up for Emergency LSCS where we were required to assist and close up. The common indications were Meconium Stained Liqour with Foetal Distress, Cephalopelvic Disproportion, Previous LSCS, AntePartum haemorrhage, Pregnancy Induced Hypertension(PIH), Abnormal Lie/Presentation among others. Along with the usual ANC cases, there were several cases of spontaneous/ threatened/ missed abortion or cases who came for MTP or HIV/HbsAg positive which were dealt with in the Septic Labor Room. Cases required strict monitoring of vitals were shifted to the High Dependency Unit (HDU) where PIH, Ecclampsia, Pre eclampsia and GDM cases were monitored by the labor room interns and staff.
One notable incident that occurred when on duty was the case of the 'Tubectomy Meningitis' as I'd like to call it. Two patients who had been operated earlier in the morning, developed restlessness and became disoriented later in the evening even as their vitals remained normal and their laboratory investigations revealed no obvious imbalance. While we monitored the patients all night long in the ICU, the patient attenders were increasingly impatient and we even had to deal with the mob and media attention. They were referred to NIMHANS the following morning where they were said to have 'Bupivacaine Induced Aseptic Meningitis'. Now the patients made a complete recovery but it brought about a lot of changes in the OT and the Post Operative Care of the patient to prevent such instances.
What began with hesitation and reluctance towards this subject gradually changed into respect for this demanding yet equally fulfilling career choice. From the first LSCS assisted to the first baby delivered via normal vaginal delivery, there was a definite surge in my interest and respect towards this department. From bullying irresponsible and intoxicated patient attenders to arrange for blood for their anaemic patient in labour to holding the hand of the sobbing woman who had just had an IUD (intrauterine death) in her first pregnancy, there was something to learn in everyday of OBG.
The Gynaec Ward had its own set of patients who needed to be operated upon for commonly a Fibroid Uterus or a Uterovaginal Prolapse but I also got to see a gigantic mucinous cystadenoma of Ovary in an otherwise frail woman of 70years operated upon successfully. There were plenty of ruptured ectopic that came our way, especially on the C unit duty days but as Dr. R said it, a "quick in, quick out" approach works best to handle these cases. Be it with the interaction with patients or their attenders or sometimes with the professors, nursing staff and even our colleagues, there has been some real high voltage drama we've witnessed/been a part of.
Towards the end of two months, I did feel relieved that it had passed with no major mishap but more importantly, I also felt like I was actually doing something. Perhaps the posting where I definitely had *some* relevance to the Department even though we were mostly treated otherwise. :')
Of course, the completion did not pan out as expected and it definitely was a disappointment but nevertheless, irrespective of the outcome of my derailed completion/erroneous extension I will be thankful for everything I have learnt from the professors and nursing staff during my 2 month stint in the Department of Obstetrics and Gynaecology at SCH, Hassan.
The Department is one of the busiest at HIMS, notorious for its hectic schedule which reflected upon the interns and staff alike. I was posted in B Unit which initially had the all-male staff of Dr. Rajashekhar Sir (Unit Chief), Dr. Shridhar Sir and Dr. Raghupathi Sir. Later Dr. Nishitha ma'am joined the Unit. On my first OPD day, I learnt the main steps of taking and ANC case including the examination. Now these were things that I could learn well only with time so initially it would take me some time to localize the Fetal Heart Sound (FHS) but slowly, over the weeks, my ears began to get trained to recognize the familiar rhythmic beating, to make an estimate of the gestational age by the abdominal examination and also to assess about the progression of labour based on the PV examination.
A typical duty day involved a quick prerounds of the Post Natal Wards, Immediate and Late Post Operative Wards, Special Ward, ICU and Gynaec Wards after which we had the ANC rounds with the staff and the rounds and follow up of all of the wards as advised by the professors during their rounds. After this we hurried to the ANC OPD to clear the cases and give admission to those in labour. Any emergency case would be taken up for LSCS once all the investigations were in place. By 4PM, there would be rounds by the duty doctor of all the ANC cases admitted during which he/she would decide the course of action: Watch for Progress/ Shift to Labor Room/ Prepare for LSCS or maybe even discharge in case they were not in active labor.
Following this was the tedious process of writing the case sheet (which was later marginally simplified by a book which we had to fill up) looking at any loopholes, any deranged laboratory values or medical / surgical comorbidities. Usually there would be few cases taken up for Emergency LSCS where we were required to assist and close up. The common indications were Meconium Stained Liqour with Foetal Distress, Cephalopelvic Disproportion, Previous LSCS, AntePartum haemorrhage, Pregnancy Induced Hypertension(PIH), Abnormal Lie/Presentation among others. Along with the usual ANC cases, there were several cases of spontaneous/ threatened/ missed abortion or cases who came for MTP or HIV/HbsAg positive which were dealt with in the Septic Labor Room. Cases required strict monitoring of vitals were shifted to the High Dependency Unit (HDU) where PIH, Ecclampsia, Pre eclampsia and GDM cases were monitored by the labor room interns and staff.
One notable incident that occurred when on duty was the case of the 'Tubectomy Meningitis' as I'd like to call it. Two patients who had been operated earlier in the morning, developed restlessness and became disoriented later in the evening even as their vitals remained normal and their laboratory investigations revealed no obvious imbalance. While we monitored the patients all night long in the ICU, the patient attenders were increasingly impatient and we even had to deal with the mob and media attention. They were referred to NIMHANS the following morning where they were said to have 'Bupivacaine Induced Aseptic Meningitis'. Now the patients made a complete recovery but it brought about a lot of changes in the OT and the Post Operative Care of the patient to prevent such instances.
What began with hesitation and reluctance towards this subject gradually changed into respect for this demanding yet equally fulfilling career choice. From the first LSCS assisted to the first baby delivered via normal vaginal delivery, there was a definite surge in my interest and respect towards this department. From bullying irresponsible and intoxicated patient attenders to arrange for blood for their anaemic patient in labour to holding the hand of the sobbing woman who had just had an IUD (intrauterine death) in her first pregnancy, there was something to learn in everyday of OBG.
The Gynaec Ward had its own set of patients who needed to be operated upon for commonly a Fibroid Uterus or a Uterovaginal Prolapse but I also got to see a gigantic mucinous cystadenoma of Ovary in an otherwise frail woman of 70years operated upon successfully. There were plenty of ruptured ectopic that came our way, especially on the C unit duty days but as Dr. R said it, a "quick in, quick out" approach works best to handle these cases. Be it with the interaction with patients or their attenders or sometimes with the professors, nursing staff and even our colleagues, there has been some real high voltage drama we've witnessed/been a part of.
Towards the end of two months, I did feel relieved that it had passed with no major mishap but more importantly, I also felt like I was actually doing something. Perhaps the posting where I definitely had *some* relevance to the Department even though we were mostly treated otherwise. :')
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| Labour Room with the Roomie! |
Of course, the completion did not pan out as expected and it definitely was a disappointment but nevertheless, irrespective of the outcome of my derailed completion/erroneous extension I will be thankful for everything I have learnt from the professors and nursing staff during my 2 month stint in the Department of Obstetrics and Gynaecology at SCH, Hassan.
