#I honestly can't believe I only have two weeks left of being a Foundation (junior) Doctor

[glorious-blackout]

Junior Doctor Shenanigans - Obstetrics and Gynaecology Edition:

A major part of my job now consists of assisting in C-sections, with one of the most important steps being the application of ‘fundal pressure’ to allow the obstetrician to deliver the baby. This can be surprisingly exhausting, especially when you’re sweating in a surgical gown under bright lights, but it’s also incredibly rewarding when the baby is finally free and lets out their first startled cry. It also means I can claim to have pushed out far more babies than I ever intended to…

On my first Saturday on-call shift, I met a lovely lady on the antenatal ward who had been admitted with mild pre-eclampsia (a condition which causes raised blood pressure in pregnancy and can develop into seizures if left untreated). She was generally well and just needed an antibiotic for a urinary tract infection, so we were able to chat away about the plans for her delivery and her excitement to meet her little boy. Neither of us knew when she was going to be induced, only that it would hopefully be soon. Fast-forward to Sunday, where I met her again on the postnatal ward with her adorable son, both safe and well after a surprise overnight C-section. Not only did she laugh when I reminded her of our earlier conversation, but she also let me have a sneaky cuddle of her baby while I was doing her routine postnatal review 🥰

As if labouring women aren’t suffering enough, they often need grey cannulas (one of the largest and therefore sorest to insert) before they go to Labour Ward on the off-chance that they go on to have a major haemorrhage. Most mums cope perfectly well when we insert them, however I did meet one dad who looked like he was about to faint when I inserted a cannula into his wife’s hand. I can only wonder how he coped with the actual birth…

All babies are cute, but you can always tell which ones are especially cute by how obsessively the surgeons/midwives/anaesthetists/paediatricians fawn over them. Our favourites tend to be babies born with full heads of hair and/or chubby cheeks.

Ovarian cysts are something I barely thought about before this job, but now genuinely terrify me. Thankfully the vast majority of them are benign, though that feels like an inaccurate term when you see a CT image of an ovarian mass so large it stretches to the diaphragm and squashes all the organs around it. On one of my night-shifts, one such cyst resulted in an ovarian torsion (where the ovary twists in on itself, resulting in horrendous pain) and the poor patient had to be taken to theatre for a cystectomy. Not only did the cyst look huge, but it turned out to be a dermoid cyst - something which, when burst open, looks like it contains a disgusting mixture of cottage cheese and human hair. You know something’s gross when even the consultant is gagging.  

Obstetrics is easily my favourite surgical specialty and there’s a lot about working there that I love, but it’s also an organisational nightmare that relies on using junior doctors as its punching bag more often than not. Between constant last-minute rota changes, forcing doctors to cross-cover multiple busy wards, asking someone to cover a night-shift when they’ve already worked six hours that day, and several occasions where nobody was allocated to do the incredibly important on-call shifts, the running of the department feels fundamentally broken and has put several of my colleagues off from ever specialising in Obs and Gyn. 

My ‘favourite’ instance of departmental fuckery was when I was urgently called away to another hospital on the opposite side of the city because they needed someone to assist in Gynaecology Day Surgery. I was somehow picked despite my senior knowing that I didn’t have a car, and thus had to get a bus into the city centre, only to complete the journey in a taxi because my usual connecting bus had been diverted. As well as leaving me a tenner out of pocket, this mad rush meant I arrived barely on time and had to stand in an operating theatre for three hours having not had lunch. What was so important that I needed to be dragged across the city for it? The consultant needed someone to hold a woman’s uterus out of the way during a laparoscopy.

Obstetrics is one of those specialties where even the major emergencies tend to have a happy outcome, which only makes it more devastating when the worst happens. On one of my recent night-shifts, a young woman was brought into the maternity unit having broken her waters at 26 weeks (around 6 months gestation), and to make matters worse she started bleeding heavily during her review. We were able to stabilise her initially, however it was strongly suspected that she had had a placental abruption - a condition where the placenta starts to separate from the uterine wall, resulting in major blood loss for mum and reduced or absent blood flow to baby. If this were the case, the only way to potentially save both of them and ensure mum’s safety would be to deliver her very premature baby. Not long after this was explained to her and her partner, she started bleeding heavily again, so much so that she had to be rushed into theatre for a caesarean section under general anaesthetic as there was no time to perform a spinal. Thankfully she remained stable during the surgery, and her baby girl was born very pale and tiny but alive. We spent the rest of the surgery controlling mum’s blood loss and were thankfully able to close the abdomen without any significant complications. Unfortunately however, while we were working on mum, her daughter had developed a significant bradycardia and low oxygen saturations despite intubation, and wasn’t responding to any of the paediatric team’s resuscitation efforts. After twenty minutes of compressions, adrenaline and blood transfusions, she passed away at only forty minutes of age. I can still remember leaving the theatre in a daze while my seniors and the consultant neonatologist went to break the news to the dad, and despite my best efforts, I ended up crying after the charge midwife asked if I needed a hug. Most of us completed our shift that night in a state of numb exhaustion, only comforted by the knowledge that the mum was okay.

In situations like this, all staff involved should have the option to attend a debrief where our seniors discuss what happened and give us space to express how we feel and cry if we need to. Rather typically, I missed the debrief in this case as barely twenty minutes after leaving the theatre, I had to scrub in and assist with another emergency C-section.    

I feel I should end on a high note, because for all it’s (many) faults, I’ve genuinely enjoyed this job. Having assisted in so many deliveries, you might be forgiven for thinking the significance of each one is now lost on me, but there is truly nothing more lovely than seeing the pure joy on the faces of parents meeting their baby for the first time. Obstetrics is probably the only specialty where happy tears are more common than the alternative, and seeing new mums and dads melt over their newborn child still feels like an enormous privilege 💖