Disclaimer: For privacy and anonymity, the names and the location will remain unspecified. Please be mindful that I am a layperson, at the beginning of my journey. The terms, procedures and examinations are presented from my point of view.
The shift was 9:30am to 9:30am (24 hours— yes you read correctly). I was shadowing the senior OBGYN at a public hospital in rural Jamaica. The shift started on the Maternity ward and ended on the Maternity ward. However, I did not stay there. It was quite an unforgettable twenty-four hours, an adventure that led me to the Accident & Emergency (the emergency room), the genealogical ward and the operating theater (that also turns into a makeshift ICU when necessary).
The OBGYN I was shadowing started the shift by looking over the dockets (patient charts) on the maternity ward. Making note of those patients who were near delivery and/or were a high-risk pregnancy. Subsequently, the physician called those patients into an office to do an examination and write out a treatment plan. When the first patient came in, it became clear to me that the amenities, we Americans take for granted were not available to these patients. For instance, the patients in this rural public hospital were required to bring a towel (because there were no examination table paper rolls), their own hospital gown and a whole list of other things that a private hospital in Jamaica and/or the hospitals in the states would have readily provided. Nevertheless, despite scarce resources, the patients received applicable care. The physicians were extremely knowledgeable, caring and professional.
During the ward rounds, the senior OBGYN explained the examination steps to me, why certain tests were needed and the recommended treatment plans. For instance, The physician examined the pregnant patient’s tummy to determining the baby’s position: applying slight pressure around the pelvic area to feel for the baby’s head, then each side in search of the baby’s back (a long hard mass); this was necessary for finding the fetal heartbeat. Next the physician attached two transducers one above the fetal heart and the other at the fundus (top of) the uterus to monitor the fetal heart rate and the activity of the uterine muscle. This information was recorded on a cardiotocograph (CTG).
Later in the shift, I followed the physician into the delivery room. There I observed a woman experiencing contractions (screaming for relief—I am stunned at how miraculous the human body is and how resilient women have to be to give birth). The physician determined that the labor needed to be induced. So with a dilator stick/rod the physician broke the membrane; by rupturing the amniotic sac. This I was told will increase the intensity and frequency of contractions by the release of the hormone oxytocin.
The charge nurse (which they call “Sister”) took over and was instructed by the physician to administer oxytocin and methergine, to further induce contraction and to minimize blood loss. I was so happy that I was allowed to stay in the room and observe the delivery. It didn’t take long before the nurse coached her to push. After a few pushes we saw the baby’s head (crowing point of delivery) and then there was this new life “bawling from here to mars” (crying very loudly). There was a part of me that wanted to cry for joy (I would never by the way—I know I must maintain professionalism all the way through) because of this little baby, so new to the world; It was nothing short of amazing. Following, another nurse cleaned the baby with virgin olive oil, weighed, measured and tested for sickle cell.
Shortly after, the baby was given to another nurse, and the mother was instructed to push again so she could deliver the after-birth. Then the nurse made sure that both the placenta, and the membranes were complete. First by checking the umbilical cord (in search of 3 vessels at the cut end: two arteries and a vein). I was told by the nurses that if only one umbilical artery is present, the infant may have congenital abnormalities. Secondly, the umbilical cord is held up, so the membranes can hang down and be examined for completeness. This is to make sure that the entire placenta was expelled.
After an hour or so passed, the senior OBGYN I was shadowing was called into the operating theater. The patient presented with right ruptured tubal pregnancy (ectopic pregnancy) and was hemorrhaging. This was an emergency. We quickly made our way to the operating changing quarters. I was told from the A&E physician intern that in a matter of hours, the patient’s hemoglobin went from 7.7 to 4 g/dL (hemoglobin levels below 11g/dL is determined anemic).
Following we went to the scrub room were the circulating nurse assisted us with putting on the sterile protective equipment and then “scrubbed in." I was instructed that I could witness the surgery from a distance inside of the operating theater (oh boy was I excited). I watched as the senior OBGYN prepared the surgical site for the prevention of infection. Then before you know it the nurse was passing instruments, and the physician was making a midline abdominopelvic incision, and the surgery was underway. There was so much blood, I heard the anesthesiologist call for blood to replace the loss. The senior physician was calm and confident; just amazing. As the physician excised the ruptured fallopian tube, a large cyst was discovered. Another physician called the theater to check the blood loss; I heard the nurse anesthetist say the total loss was three liters. Before starting the shift I was hoping for excitement, and boy did I get it.
Many hours after the cyst was ruptured, excised and sutured it was time to close up. I observed that the closure occurred in layers: first the peritoneum, then the deep fascia, followed by the muscle, then superficial fascia, then subcutaneous tissue ( after the physician used an instrument called a diathermy to produce localized heat which initiates coagulation) and lastly the Skin.
To mince words I will conclude by saying the patient survived. Following the surgery, I was also able to witness another birth, and the A&E patient intake procedures. Overall it was an amazing experience that re-solidified my desire to be a doctor.
I want to say , thank you to those who made this possible. You know who you are. God blessed me tremendously by introducing me to you.
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| That's me to the far left! |
The OBGYN I was shadowing started the shift by looking over the dockets (patient charts) on the maternity ward. Making note of those patients who were near delivery and/or were a high-risk pregnancy. Subsequently, the physician called those patients into an office to do an examination and write out a treatment plan. When the first patient came in, it became clear to me that the amenities, we Americans take for granted were not available to these patients. For instance, the patients in this rural public hospital were required to bring a towel (because there were no examination table paper rolls), their own hospital gown and a whole list of other things that a private hospital in Jamaica and/or the hospitals in the states would have readily provided. Nevertheless, despite scarce resources, the patients received applicable care. The physicians were extremely knowledgeable, caring and professional.
During the ward rounds, the senior OBGYN explained the examination steps to me, why certain tests were needed and the recommended treatment plans. For instance, The physician examined the pregnant patient’s tummy to determining the baby’s position: applying slight pressure around the pelvic area to feel for the baby’s head, then each side in search of the baby’s back (a long hard mass); this was necessary for finding the fetal heartbeat. Next the physician attached two transducers one above the fetal heart and the other at the fundus (top of) the uterus to monitor the fetal heart rate and the activity of the uterine muscle. This information was recorded on a cardiotocograph (CTG).
Later in the shift, I followed the physician into the delivery room. There I observed a woman experiencing contractions (screaming for relief—I am stunned at how miraculous the human body is and how resilient women have to be to give birth). The physician determined that the labor needed to be induced. So with a dilator stick/rod the physician broke the membrane; by rupturing the amniotic sac. This I was told will increase the intensity and frequency of contractions by the release of the hormone oxytocin.
The charge nurse (which they call “Sister”) took over and was instructed by the physician to administer oxytocin and methergine, to further induce contraction and to minimize blood loss. I was so happy that I was allowed to stay in the room and observe the delivery. It didn’t take long before the nurse coached her to push. After a few pushes we saw the baby’s head (crowing point of delivery) and then there was this new life “bawling from here to mars” (crying very loudly). There was a part of me that wanted to cry for joy (I would never by the way—I know I must maintain professionalism all the way through) because of this little baby, so new to the world; It was nothing short of amazing. Following, another nurse cleaned the baby with virgin olive oil, weighed, measured and tested for sickle cell. Shortly after, the baby was given to another nurse, and the mother was instructed to push again so she could deliver the after-birth. Then the nurse made sure that both the placenta, and the membranes were complete. First by checking the umbilical cord (in search of 3 vessels at the cut end: two arteries and a vein). I was told by the nurses that if only one umbilical artery is present, the infant may have congenital abnormalities. Secondly, the umbilical cord is held up, so the membranes can hang down and be examined for completeness. This is to make sure that the entire placenta was expelled.
After an hour or so passed, the senior OBGYN I was shadowing was called into the operating theater. The patient presented with right ruptured tubal pregnancy (ectopic pregnancy) and was hemorrhaging. This was an emergency. We quickly made our way to the operating changing quarters. I was told from the A&E physician intern that in a matter of hours, the patient’s hemoglobin went from 7.7 to 4 g/dL (hemoglobin levels below 11g/dL is determined anemic).
Following we went to the scrub room were the circulating nurse assisted us with putting on the sterile protective equipment and then “scrubbed in." I was instructed that I could witness the surgery from a distance inside of the operating theater (oh boy was I excited). I watched as the senior OBGYN prepared the surgical site for the prevention of infection. Then before you know it the nurse was passing instruments, and the physician was making a midline abdominopelvic incision, and the surgery was underway. There was so much blood, I heard the anesthesiologist call for blood to replace the loss. The senior physician was calm and confident; just amazing. As the physician excised the ruptured fallopian tube, a large cyst was discovered. Another physician called the theater to check the blood loss; I heard the nurse anesthetist say the total loss was three liters. Before starting the shift I was hoping for excitement, and boy did I get it.
Many hours after the cyst was ruptured, excised and sutured it was time to close up. I observed that the closure occurred in layers: first the peritoneum, then the deep fascia, followed by the muscle, then superficial fascia, then subcutaneous tissue ( after the physician used an instrument called a diathermy to produce localized heat which initiates coagulation) and lastly the Skin. To mince words I will conclude by saying the patient survived. Following the surgery, I was also able to witness another birth, and the A&E patient intake procedures. Overall it was an amazing experience that re-solidified my desire to be a doctor.
I want to say , thank you to those who made this possible. You know who you are. God blessed me tremendously by introducing me to you.
