Melons and Foufs

As a women in her mid thirties, I am now of an age where having children is starting to look unlikely. I have been married for ten years and have been completely settled and happy during that time but have just never had any urge to have a baby.

I sometimes think I must be wired up differently to other women because I have never been broody and have never once thought that I would like to have a baby.
I don't know why but do wander if it's because I saw too much at a young age!

I have always been fascinated with pregnant women (I do see the irony here) and took the first offer I had as a student nurse in 1993, to see a live birth. It was horrible. The women was in pure, unfettered agony and the husband was crying and shouting at the midwives. The midwife kept examining her to see how dilated she was, and every time she did, the women screamed to leave her the hell alone. When she dilated to 10cms, she needed an episiotomy (I had to sit down, the sound of crunching will never leave me) and then she couldn't push properly so they had to get this suction machine and pull the baby out. I thought it was all over but then the lady started haemorrhaging and the husband passed out, falling on top of me.

Fast forward fifteen years and I find myself as a final year medical student in a
birthing centre. I can see that things have changed. The medical room of the nineties has been replaced by a birthing room, which is a big lounge-like room with a bed, sofa and rocking chair in. There were no medical instruments to be seen (They were all tucked away in a friendly looking pine cabinet)

The midwives firmly told me that I was not here to "Deliver" a baby because in this environment, the women delivers her own baby. Midwives are scary people who don't like doctors very much (They hate medicalising birth) but are the kind of people that you definitely want around!

The next big difference I saw was that there are no longer repeated checks on how dilated the women is (They check every four hours, rather than hourly like I have seen) The midwives let the women's body tell her when it is time to start pushing, unlike the old days when the midwife would tell the women to start pushing because she was dilated to 10 cms. The emphasis is on non-intervention, i.e allowing things to happen naturally without medical interference.

Thinking about it, the birth in the 1990's and the one I saw last week were similar in that they were both first time young mums, having normal deliveries. The latest birth looked far less stressful because of the nicer environment but the one thing that doesn't seem to get any better is the bloody pain. These women are in AGONY!

We are living in the 2000's.... why are women still in so much pain when they give birth?

Fannies, Foufs and Va J Js

....These are just some of the names that my patients have today used to describe their vaginas.

The dilemma I have is that, according to the bloody hours and hours we have spent on communication skills over the years (My medical school prides itself on turning out docs that can speak to patients), we are supposed to use words that the patients use to discuss their condition.

In some situations this is fine, for example :

Patient : Hello, I have a pain in my belly and have been throwing up for days.
Me: OK Mr Jones please can you tell me more about this pain in your belly....


It's a bit different in gynae:

Patient: "I have a lump in my fouf"
Me: "Ok then, when did you notice this pain in your fouf?"


Surely not!!!

Seriously though, I am enjoying obs and gynae. That may be a simple statement to you, but after years of hell, it is so strange to now be able to say that I am enjoying the course. I think I have also mentioned in previous posts that I am waiting for the stage when I am no longer shocked about having to do intimate examinations. I have spent my first two weeks in gynae like a rabbit in the headlights as I take a history from a lady, knowing that I then going to be examining her.

To tell you the bad bits (And it doesn't get much worse) during my first examination the speculum broke in half in situ. Both me and the patient were mortified. The consultant reassured me that this sometimes happens with the plastic speculums but I think she was trying to make me feel better. I managed to view the cervix - have never seen one before!

To get further examining experience, we have had to speak to ladies who are about to have gynae surgery to ask them if it is OK if we examine them once they are under anaesthetic. I am amazed at them all allowing us to do this - they have been brilliant with us. I also think it is really good for patients to know that students don't have carte blanche to examine them without their consent - if they don't consent then we don't go anywhere near them and this is reassuring, I think.

Gynae surgery has been an eye opener. I saw a lady having her fibroid removed through her cervix and couldn't believe how big it was - makes you realise how these women have difficulties getting pregnant. The fibroids I saw took uo most of the uterus so no room for a baby!

Ah well, back to the land of foufs

Still waiting for it all to click into place......

After the thrill of finally passing some exams first time, I have moved on to my Senior Rotation in Obs and Gynae. Can't believe I am a final year student.

If any doctors are reading this, I would love your thoughts on something. Before starting out in Medicine, I assumed that in the final year, I would know loads of stuff and be able to manage reasonably well on a ward. Now I am here, I don't feel like I know enough. I know a bit about a lot of stuff, but am in no way the competent student that I thought I would be in my final year. I know I am not the brightest of students, but I look at the cleverer ones around me and see that they also look a little lost.

If there are any doctors reading - when does it all click into place? And do you have any advice for the final year?

xx

Stunned

Results were out today......I passed! Can't tell you how relieved I am and stunned as the OSCE really did go very badly.

I have wrote in an older post about the year 2 exams that I failed and the stigma attached to this because not many people fail exams at med school. Passing has given my self esteem a much needed boost.

Bring on senior rotation and my last year at medical school!

OSCE HELL

My fourth years exams are finished.

The OSCEs were a living hell - can't believe at my age that I get so stressed that I forget basic, basic stuff. I was so angry at myself after it.

There were six stations. The first was was split into six smaller stations and asked about investigations such as what you tests you would do for a patient with suspected TB, what some blood tests results meant and a microbiology sample which then asked what antibiotics should be used.

The second two stations were patient managements ones and were awful. We had 10 mins to go through a patients notes, GP referral letter and then write a management plan. There was loads of info to get through and in the panic I hardly wrote anything down. We were then herded into a fake ward where the patients that we had just been looking at were lying. We had to explain what we thought was wrong and that bit was kind of OK. I made one hell of a mess of both of the management plans and just can't see how I have passed it. I just hardly wrote anything and screwed up pretty badly.

The next two stations were with real patients. This was OK - I had to take a history from two patients (With Schizophrenia and SVT) and then examine them, reach a diagnosis and discuss possible management with the consultants. The last station was a practical skills one and I had to take some blood off a plastic arm.

The rumour is that we can fail one of the six and still pass, but I am sure I have failed both management stations and probably (I am ashamed to say) the blood station. I have been taking blood as a nurse for ten years and managed to forget to take a sharps bin to the patients side. The patient reminded me when I had put the needle in and so this is unsafe practice. Not looking good.

You might think I am being silly but I did make a big mess of things. What is really bugging me is that the stuff that I got wrong is such basic stuff. It is stuff that I could have easily done as a nurse, without ever having done a day of medicine. Part of me is saying that this is what medicine will be like in the real world, but part of me thinks that it will easier when I have another year of clinical experience under my belt and am seeing these things as a doctor, day in and day out.

We then had a written paper which was also fair and I don't think I did too badly with it.

Results are out in a few weeks and I have to pass both the OSCE and written paper to pass. The resit is in June.

I started my new block today - seven weeks of obs and gynae. Can't wait!