Wednesday was my last day on the floor for OB/GYN and this morning I took the shelf exam. Cancer and antibiotics; cancer and antibiotics everywhere! Man, I hate the shelf exam writers. Not personally - I'm sure they're nice enough people, but I take issue with what they stress on our tests. If you look back on all my TILs for any given clerkship, you'll get a good idea of what isn't on the self exam - namely anything practical or useful day-to-day for the field in question.
Anyways, not much interesting happened during our last shift, but apparently a lot happened the previous night. We almost lost a patient from intra- and postpartum bleeding. The story was exciting, but, for whatever reason, it feels too invasive to tell in this setting. That woman has been through enough and doesn't need her story, anonymous or not, plastered over my small corner of the internet. In any case, the result of the chaos was that by the time we arrived that morning the patient was in the surgical ICU.
A surgical ICU clear across the country is where I got my start in medicine (outside of family issues, of course) by volunteering and then working as a unit clerk. I have been trying to find out, ever since, whether intensive care or some other aspect of medicine is my calling. And by calling, I mean the specialty or subspecialty that I want to try, despite bad grades and long years of training, to be allowed to practice in 5-10 years.
And still to this literal day, I have loved getting any chance to be in an ICU. I love when things have gone horribly, horribly wrong. I love the clarity that comes with needing to prioritize basic functions and then slowly getting to address everything else as the patient gets more stabilized. I am so jealous of the ICU doctors who got to take over our patient when she was in truly dire straits. It's fun and frightening to think that I could still do that as a career.
WednesdayIL: You can use the doppler function of the fetal ultrasound machine to see if there is an umbilical loop in a pocket of amniotic fluid. As I mentioned in a previous post, amniotic fluid pockets are one of the important signs of fetal health. The measurement of these spaces requires being sure they are empty and, as umbilical cord is nearly invisible on ultrasound, having a way to visualize it is very useful. The doppler function color-codes movement as either come towards or going away from the probe. Amniotic fluid doesn't move, but the blood through the umbilical arteries and vein does. So if you see blue and orange in your amniotic pocket, keep looking for another one.
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