Some stuff about work

On Fridays we have a procedure clinic where women who have had abnormal pap smears come for next level cervical biopsies called colposcopies. This clinic is busy with lots of patients and often lots of residents. It is an anticipated clinic as well as it is considered a straightforward office visit (we aren’t addressing ANYTHING else usually) and the documentation is easy to get done as you go. Unfortunately for me, I’ve had a bad run of luck in colpo clinic - difficult cervixes: to find or to biopsy. I am NOT superstitious about my work flow (I generally don’t believe the notion of a person being a “black cloud” or a “white cloud” and I’m not afraid to say that a service is looking QUIET for fear that the heavens will open on our heads) but I feel like I’ve been cursed in colpo clinic this year. The interns do colpos during 2 of our 4 rotations so we spend half of the year doing colpos on Fridays. After tiring of always having such a hard time, I have been collecting advice from upper levels and troubleshooting my technique with people. Today for the FIRST time, colpo clinic didn’t suck in its entirety. Of course I’ve had a few easy biopsies, but not even enough to count on one hand. Today I took bigger samples, I squeezed instead of pulled, I turned the Tischler (the tool that takes the biopsies) so it was oriented a particular way relative to the lesion I was biopsying. And I finally get it why people like colpo clinic! Part of my issue is that I can’t believe we are taking tic tac sized chunks out of people’s bodies without any anesthesia. Part of my issue was a steady stream of rubbery cervixes. And honestly my technique was faulty. I can do a stat cesarean section but until today, I couldn’t do a colpo with any sense of confidence. Huzzah! Intern year must finally be almost over, I’m finally getting the hang of it!

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My kids are almost done with the school year. We have 2.5 more weeks until they are done! A few days after that they are going to SF to stay with their dad for about 8 weeks. That is longer than our agreement lays out but they wanted to spend a lot of time with him, he could manage it and I didn’t want to refuse any of them the opportunity to be together. I’m pretty upset about the idea of them being gone for 8 weeks, I’m going to miss them so much! And because the human mind is a vast and infinite place, I’m also really looking forward to having the break. I don’t get weekends off, we don’t share parenting time, it’s all Larissa all the time. It is fucking exhausting. I don’t know exactly how I’m going to handle it (though I’ve got the dog walking figured out) but I think 8 weeks is enough time for me to be at loose ends for a little bit and then get into a routine on my own.

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Did I tell you I did a stat c-section recently? A stat is a circumstance where, likely, the baby is not looking great and needs to get born quickly. There are a few things with regard to the prep and the equipment that are different (so we can be ready faster). The surgery is basically the same except you worry less about going through the tissue from skin to uterus carefully and do it quickly then if there are problems, you fix them after the baby is born. And you don’t get to use the nifty tube retractor (it’s called an Alexis retractor and I love it) because it takes too long to set up. We still have time to administer anesthesia, scrub our hands & prep the patient, then we get down to a baby as fast as we can and hand him over to the awaiting NICU team. 11 months ago when I started doing surgery, I could handle about half a cesarean before the adrenaline would fade and I’d wilt. Looks like I’ve learned some things this year after all.

Regarding delivering the baby during a cesarean:

In that stat section, I did everything in the delivery as the primary surgeon except delivering the baby. I probably could have done it but it is a task that takes attention to detail, awareness of passage of time, physical effort and finesse. I started to try but after 10-15 seconds decided to let my upper level do it. There are a lot more things to think about than just sticking your hand in a uterus and lifting a baby out. We make the smallest incision possible (there’s only so much room between the Uterine arteries) and babies can wedge themselves in there in a myriad of different ways and it is pretty important that we flex the head in a way that makes it possible to lift.

On the latest cesarean I did, I explicitly told my upper level I was going to work on delivering the baby until he took it away from me. Having that explicitly stated gave me the freedom not to worry that I was taking too long. I knew he’d take over if it was time. Turns out, I was able to do it. Practice practice practice!