I've now been fingerprinted by the Federal government so I should probably rethink all my big bank robbery plans. Working at the VA hospital for my anesthesia rotation has definitely been a change of scenery. Out with the young pregnant ladies and in with the rough old veterans. But it's been good so far. And the hours have been heavenly.
One of my friends really wants to be an anesthesiologist. I can see the appeal but I don't really think it's for me. A lot of hurry up and wait...a lot of repeating the same exact thing over and over. I know anesthesiologists have to be ready for anything if something goes wrong, and it can all go horribly wrong, but mainly there's a lot of monitoring ("you've wired me for sound" as one patient put it), mixing and pushing drugs, and airway protecting. I did get to watch a carotid endarterectomy from a distance and today I saw a guy with a very large umbilical hernia. The anesthesiologist is important...but in many ways they play second fiddle to the surgeon.
It seems only fair that since I mentioned Michael Jackson's death in my very first post, I should follow up on the fact that it's now been ruled a homicide. What drugs were in his system? Propofol, diazepam, lorazepam, midazolam, lidocaine and ephedrine. I saw every single one of those administered today to prepare someone for surgery. In a controlled environment...when we were going to breath for them. It's like his doctor broke into the OR and sifted through the anesthesiologist's drawers of drugs. Scary. Once you're knocked out you do want a trained professional watching over you. Or else...
Friday, August 28, 2009
Wednesday, August 26, 2009
A Miscarriage of Justice
Every year around 300,000 women worldwide die from cervical cancer. In the U.S. it's closer to 3,000 and that number should soon decrease due to the new Gardasil vaccine. What makes the difference? Pap smears...one the most effective screening tests for cancer. If you catch it early, which is totally possible with annual pap smears, then a straight forward colposcopy and possibly a LEEP can basically take care of the problem. However, once cervical cancer spreads things become much more complex. In much of the developing world annual pap smears simply aren't possible (food and water may be a higher priority) and so many cases are caught when they are much more advanced and the options are limited. Although Gardasil is great and could soon almost eradicate HPV in the U.S. (as long as we start vaccinating boys too) it will never have that much of an impact on our cervical cancer numbers because they are already low due to all the pap smears (maybe too many pap smears...apparently with the liquid prep that is more accurate and now most frequently used you only need to be screened every other year meaning that at the clinic where I was working and most everywhere else women are actually being over tested, not that there's any downside...just a little more cramping...but it could be seen as an unnecessary waste of resources). Where Gardasil could have a major impact is if it was available to women around the world at a reasonable price. Now that would really be something.
I've just finished up my OB/GYN rotation, survived (hopefully) the NBME test and the OSCE and sat through another meeting on ethics, one of our competencies for this rotation. The core ethical principles are all important...Beneficence, Nonmaleficience (hopefully most doctors aren't setting out to do harm) and Autonomy (I think this is a much bigger deal in the U.S. then elsewhere). Those are all well and good and you constantly deal with them on a case to case basis, but the one I think really deserves more attention is Justice. Treating individuals according to what is fair, due, or owed to them. And this is where the whole conversation explodes. I would argue that everyone in this country is entitled...yes, ENTITLED...to a certain basic level of health care. It sure seems self evident to me...but obviously there's a very vocal group who disagree. On a related note, rest in peace Ted Kennedy, I wish you could have stuck around to finish the fight. But health care reform is a topic for another day, what I really want to talk about is Women's Rights.
So yesterday I had my annual gynecologic exam which seemed a fitting way to end the rotation. Doctors in general might be better informed if they had to go through all the things they do to their patients (not that they should undergo needless operations, but being a patient gives you a whole new perspective). For convenience I went to the clinic where many of the patients we had seen at Methodist get their care...it's open to people without health insurance and serves a different population than the private clinic where I worked the past two weeks. You can definitely tell the difference. I mean, it was totally adequate, I got my pap smear and my birth control prescription which was all I needed anyway, but that was really it. No comprehensive physical exam or extended chat about how life's going. Which is fine, I didn't want that anyway. But it would have been nice to get a proper blood pressure reading (if only my BP was 100/61, but I guarantee it isn't, not by a long shot). And no pelvic exam? No breast exam? I don't mind that it was a midwife and not a doctor, but I started to mind the wait. Still I was receiving care and that's a vast improvement over much of the world.
On my half hour drive to the clinic I've been listening to "A Thousand Splendid Suns" by Khaled Hosseini and it really got to me...in a driving down the highway with tears streaming down my face kind of way. Not that I thought things were rosy in Afghanistan (we'll see what happens with the recent undecided election), but seriously. Women have no where to turn for help if they are stuck in an abusive relationship. Hell, they can't even walk outside alone. Unfathomable. In one of the most wrenching scenes the main character has to have a C-Section without anesthesia because there's none in the women's hospital where she's forced to go. That's just crazy. CRAZY. I saw 11 C-Sections in my month on OB/GYN and trust me, when someone yanks your uterus out of your body and sews it back together you don't want to feel it.
The New York Times recently ran and article, "The Women's Crusade", which touched on many of these issues and some of the ways change might be possible. Maternal morbidity and mortality around the world, especially in Africa, is out of control. No one should have a one in ten chance of dying during child birth in their life time. That has serious ramifications for the economic prosperity of a country...and it's just ridiculous. Of course, many of these countries have horrible things going on beyond the disgusting treatment of women...but implementing programs for proper health care for women and children seems like a sensible place to start. Last summer when I was working with Mayan Medical Aid in Santa Cruz La Laguna, a Mayan village in Guatemala, we were all about prenatal care and women's health. It gives you the best chance to start out little children on the right foot and hopefully bring about transformation of a community. Give mothers protein and proper baby brain myelination will follow. Provide education for children with well myelinated neurons and you can change the world!
I've just finished up my OB/GYN rotation, survived (hopefully) the NBME test and the OSCE and sat through another meeting on ethics, one of our competencies for this rotation. The core ethical principles are all important...Beneficence, Nonmaleficience (hopefully most doctors aren't setting out to do harm) and Autonomy (I think this is a much bigger deal in the U.S. then elsewhere). Those are all well and good and you constantly deal with them on a case to case basis, but the one I think really deserves more attention is Justice. Treating individuals according to what is fair, due, or owed to them. And this is where the whole conversation explodes. I would argue that everyone in this country is entitled...yes, ENTITLED...to a certain basic level of health care. It sure seems self evident to me...but obviously there's a very vocal group who disagree. On a related note, rest in peace Ted Kennedy, I wish you could have stuck around to finish the fight. But health care reform is a topic for another day, what I really want to talk about is Women's Rights.
So yesterday I had my annual gynecologic exam which seemed a fitting way to end the rotation. Doctors in general might be better informed if they had to go through all the things they do to their patients (not that they should undergo needless operations, but being a patient gives you a whole new perspective). For convenience I went to the clinic where many of the patients we had seen at Methodist get their care...it's open to people without health insurance and serves a different population than the private clinic where I worked the past two weeks. You can definitely tell the difference. I mean, it was totally adequate, I got my pap smear and my birth control prescription which was all I needed anyway, but that was really it. No comprehensive physical exam or extended chat about how life's going. Which is fine, I didn't want that anyway. But it would have been nice to get a proper blood pressure reading (if only my BP was 100/61, but I guarantee it isn't, not by a long shot). And no pelvic exam? No breast exam? I don't mind that it was a midwife and not a doctor, but I started to mind the wait. Still I was receiving care and that's a vast improvement over much of the world.
On my half hour drive to the clinic I've been listening to "A Thousand Splendid Suns" by Khaled Hosseini and it really got to me...in a driving down the highway with tears streaming down my face kind of way. Not that I thought things were rosy in Afghanistan (we'll see what happens with the recent undecided election), but seriously. Women have no where to turn for help if they are stuck in an abusive relationship. Hell, they can't even walk outside alone. Unfathomable. In one of the most wrenching scenes the main character has to have a C-Section without anesthesia because there's none in the women's hospital where she's forced to go. That's just crazy. CRAZY. I saw 11 C-Sections in my month on OB/GYN and trust me, when someone yanks your uterus out of your body and sews it back together you don't want to feel it.
The New York Times recently ran and article, "The Women's Crusade", which touched on many of these issues and some of the ways change might be possible. Maternal morbidity and mortality around the world, especially in Africa, is out of control. No one should have a one in ten chance of dying during child birth in their life time. That has serious ramifications for the economic prosperity of a country...and it's just ridiculous. Of course, many of these countries have horrible things going on beyond the disgusting treatment of women...but implementing programs for proper health care for women and children seems like a sensible place to start. Last summer when I was working with Mayan Medical Aid in Santa Cruz La Laguna, a Mayan village in Guatemala, we were all about prenatal care and women's health. It gives you the best chance to start out little children on the right foot and hopefully bring about transformation of a community. Give mothers protein and proper baby brain myelination will follow. Provide education for children with well myelinated neurons and you can change the world!
Wednesday, August 19, 2009
Beta Alpha Beta Iota Epsilon Sigma
OB/GYN really is kind of like a sorority. First of all there's only one male resident left in the entire residency program and only one male attending at Methodist. Secondly, we spend portions of the day sitting around in the resident room watch Good Morning America and Oprah, reading People and US Weekly, knitting, shopping for handbags online, and talking about relationships. That's all well and good...it just feels weird when it's a big part of your work day! Still, I'm enjoying all the girl power! And I think that for the most part it's a really good thing that women are taking over the field...there are just some things it's better to talk to about with someone who can directly relate.
It's the same with the doctor I've been shadowing for the past week and a half. A large part of the day is spent counseling people on diminished libido or heavy menstrual periods. Dr. Lee is focused and descriptive but also reassuring and understanding. I just don't think male doctors can make the same connection with their patients. Not to say that some women wouldn't prefer a male doctor in this situation...but for the most part the girls club seems to work well. It kind of makes me feel bad for all the guys in my class who have to go through this rotation.
Working at this new hospital has definitely been a different experience. The building itself is only 5 years old so everything is sparkly and super nice. It's also outside of the resident education system so it's just me and Dr. Lee which is both a good and bad thing. I've learned a lot just from shadowing her and watching how she interacts with patients, but most of what I've done has been observation since these are her private patients and I don't think she's quite sure what to do with me. We see patients in clinic all day most days...though starting at 7 or 8...not 4:30! At least a third of the patients are routine OB visits leading up to delivery so lots of listening to heart tones (something I actually get to do!) and measuring bellies. There's also the annual exams (yay pap smears!) and random visits for STDs, colposcopy, etc. We do surgery on Tuesdays and Fridays...though I'm not convinced surgical options are really the best for treating chronic pelvic pain. I really like the continuity of care, but I don't think I want to be talking about periods all day, every day for the rest of my life!
It's the same with the doctor I've been shadowing for the past week and a half. A large part of the day is spent counseling people on diminished libido or heavy menstrual periods. Dr. Lee is focused and descriptive but also reassuring and understanding. I just don't think male doctors can make the same connection with their patients. Not to say that some women wouldn't prefer a male doctor in this situation...but for the most part the girls club seems to work well. It kind of makes me feel bad for all the guys in my class who have to go through this rotation.
Working at this new hospital has definitely been a different experience. The building itself is only 5 years old so everything is sparkly and super nice. It's also outside of the resident education system so it's just me and Dr. Lee which is both a good and bad thing. I've learned a lot just from shadowing her and watching how she interacts with patients, but most of what I've done has been observation since these are her private patients and I don't think she's quite sure what to do with me. We see patients in clinic all day most days...though starting at 7 or 8...not 4:30! At least a third of the patients are routine OB visits leading up to delivery so lots of listening to heart tones (something I actually get to do!) and measuring bellies. There's also the annual exams (yay pap smears!) and random visits for STDs, colposcopy, etc. We do surgery on Tuesdays and Fridays...though I'm not convinced surgical options are really the best for treating chronic pelvic pain. I really like the continuity of care, but I don't think I want to be talking about periods all day, every day for the rest of my life!
Monday, August 10, 2009
My Birth Day!
That's a quarter of a century! Makes a girl think...
Wish I had delivered a baby today, how awesome would that be?!?
Wish I had delivered a baby today, how awesome would that be?!?
Sunday, August 9, 2009
26
So I just survived my last OB/GYN call and it was a doosie. Not quite Jack Bauer, end of the world stuff, but 5 C-Sections, 4 of them emergent, and lots of running around. No missing nuclear warheads, government conspiracies or biological warfare, but lots of fetal heart decelerations, arrested labor (not as entertaining as Arrested Development), and pre-eclampsia. But it was fun in a weird, med school kind of way.
A break down of my long day:
6:30 am: Rounding on postpartum patients, are they breast or bottle feeding? do they want contraception? how's their incision? nausea/vomiting? vaginal bleeding? ambulating? eating? flatus? fun stuff
7:45 am: Breakfast! My amazing resident buys me some fresh fruit from the cafeteria (not from the horrendously expensive Au Bon Pain which has taken over the hospital)
8:00 am: Changeover with the people from the night before. Gotta love running the list.
8:30 am: Cervical check on a HIV+ lady. She hasn't told her family her HIV status. Fortunately she has a low viral load. I'll cross my fingers for the baby.
8:45 am: Update records for some of the patients.
9:00 am: C-Section #1...this one was planned...it was the lady's 5th section! Crazy. Wisely, this time around she's also getting a bilateral tubal ligation...I get to cut the fallopian tube. Yay!
11:00 am: Watch the swearing in of Sonya Sotomayor...all goes smoothly, no jumbled lines. Try to study Case Files.
12:00 pm: Lunch! I eat the lunch I packed the day before and never ate since I went out to Clarian West to see the uterine septum removal. That day I ended up eating a chocolate pop-tart for lunch. Not the best.
12:15 pm: Check the Amniotic Fluid Index on a lady at term who may or may not have ruptured. It still looks good...she goes home...no baby today.
12:30 pm: Recheck the lady with HIV. Slowly progressing. I secretly hope she'll deliver vaginally and not tear. There's so much blood and blades and scissors flying around during a C-Section it'd make me a little paranoid to participate in that surgery. I trust universal precautions...but still...
1:30 pm: The lady in Room 5 isn't progressing...we're going to do a C-Section but then the nurse suggests we give her an epidural and see if things change. So we wait.
2:00 pm: Back in the break room watching Runaway Bride. I prefer Pretty Woman.
2:15 pm: Write a bunch of B9 discharge papers. Hopefully some women can go home soon.
3:00 pm: WatchSex and the City ! It's the one where Miranda moves and is afraid she'll die and the cat will eat her face, Carrie gets back together with Big and they go bowling, Charlotte dates the widowed guy, and Samantha becomes a social outcast only to be saved by Leonardo DiCaprio ex machina. Why do I so clearly remember all the episodes? Why can't medical knowledge stick so well? At this point I do the smartest thing I did all day and eat some of the pesto pasta I brought for dinner. Even though it's early I'm hungry and you never know what's going to happen...
3:30 pm: Go to check on the lady in Room 5 and discover that the baby in Room 9 is crashing and needs a C-Section first. I get to retract, sponge, sew up fat and staple. It's a boy! Hurray! Get reports that the baby in Room 3 is crashing. Great.
5:00 pm: Room 3 gets a C-Section...the little boy is all tangled in his umbilical cord but does fine.
6:00 pm: Now it's Room 5's turn for a C-Section. Haven't I done this before? She's quite large and has about 6 inches of fat over her uterus. Challenging surgery. Get reports that a 430 pound lady just came into triage and the baby does not look good.
7:30 pm: Call Monkey via Skype on my phone! So glad he'll be back in a week and I'll be done with this craziness.
7:40pm: The staff physician is ordering Jimmy Johns and gets a #5 Vito for me. Awesome. Write Op Note from the last surgery.
8:00 pm: The super size lady is brought back to the OR but the spinal anesthesia is taking a while because, well, her spine sure as hell can't be palpated or visualized and she can't bend forward at all. Also can't monitor the baby properly through all the extra tissue. Yet another reason not to get fat. But seriously...this lady is almost 4 times as big as I am!
8:30 pm: Spinal still not in...go eat Jimmy Johns. Everything looks better after eating.
9:00 pm: Back to OR. Help position patient which requires about 8 people, table extenders, tape, and lots of rolling and pushing. Definitely the largest person I've seen in an operation...of course I've been working on little babies in the past rotation which are challenging in their own way. Scary moment when we take out the baby and there's lots of meconium in the amniotic fluid and she's totally blue and not moving. Hand her over to peds and she eventually gets apgars of 3/8/8. So glad the baby survived!
10:30 pm: Out of surgery. The lady with HIV delivered while I was in one of the C-Sections. Yay!
11:00 pm: Amazingly the resident sends me to bed. Fabulous!
5:00 am: Wake up for morning rounds. See our three antepartum patients. Pre-eclampsia, IUGR, and an MVA with a pelvic fracture...very not cool during pregnancy.
6:30 am: Meet my friend who's just starting her rotation here and has to be on call and see all the postpartum patients we delivered yesterday. Plus her resident isn't there. Help her see patients, it's nice to check in on all the ladies we delivered yesterday not that I'm not delirious.
8:00 am: Change over
8:30 am: Stumble out into the sun and humidity. Good bye Methodist!
A break down of my long day:
6:30 am: Rounding on postpartum patients, are they breast or bottle feeding? do they want contraception? how's their incision? nausea/vomiting? vaginal bleeding? ambulating? eating? flatus? fun stuff
7:45 am: Breakfast! My amazing resident buys me some fresh fruit from the cafeteria (not from the horrendously expensive Au Bon Pain which has taken over the hospital)
8:00 am: Changeover with the people from the night before. Gotta love running the list.
8:30 am: Cervical check on a HIV+ lady. She hasn't told her family her HIV status. Fortunately she has a low viral load. I'll cross my fingers for the baby.
8:45 am: Update records for some of the patients.
9:00 am: C-Section #1...this one was planned...it was the lady's 5th section! Crazy. Wisely, this time around she's also getting a bilateral tubal ligation...I get to cut the fallopian tube. Yay!
11:00 am: Watch the swearing in of Sonya Sotomayor...all goes smoothly, no jumbled lines. Try to study Case Files.
12:00 pm: Lunch! I eat the lunch I packed the day before and never ate since I went out to Clarian West to see the uterine septum removal. That day I ended up eating a chocolate pop-tart for lunch. Not the best.
12:15 pm: Check the Amniotic Fluid Index on a lady at term who may or may not have ruptured. It still looks good...she goes home...no baby today.
12:30 pm: Recheck the lady with HIV. Slowly progressing. I secretly hope she'll deliver vaginally and not tear. There's so much blood and blades and scissors flying around during a C-Section it'd make me a little paranoid to participate in that surgery. I trust universal precautions...but still...
1:30 pm: The lady in Room 5 isn't progressing...we're going to do a C-Section but then the nurse suggests we give her an epidural and see if things change. So we wait.
2:00 pm: Back in the break room watching Runaway Bride. I prefer Pretty Woman.
2:15 pm: Write a bunch of B9 discharge papers. Hopefully some women can go home soon.
3:00 pm: Watch
3:30 pm: Go to check on the lady in Room 5 and discover that the baby in Room 9 is crashing and needs a C-Section first. I get to retract, sponge, sew up fat and staple. It's a boy! Hurray! Get reports that the baby in Room 3 is crashing. Great.
5:00 pm: Room 3 gets a C-Section...the little boy is all tangled in his umbilical cord but does fine.
6:00 pm: Now it's Room 5's turn for a C-Section. Haven't I done this before? She's quite large and has about 6 inches of fat over her uterus. Challenging surgery. Get reports that a 430 pound lady just came into triage and the baby does not look good.
7:30 pm: Call Monkey via Skype on my phone! So glad he'll be back in a week and I'll be done with this craziness.
7:40pm: The staff physician is ordering Jimmy Johns and gets a #5 Vito for me. Awesome. Write Op Note from the last surgery.
8:00 pm: The super size lady is brought back to the OR but the spinal anesthesia is taking a while because, well, her spine sure as hell can't be palpated or visualized and she can't bend forward at all. Also can't monitor the baby properly through all the extra tissue. Yet another reason not to get fat. But seriously...this lady is almost 4 times as big as I am!
8:30 pm: Spinal still not in...go eat Jimmy Johns. Everything looks better after eating.
9:00 pm: Back to OR. Help position patient which requires about 8 people, table extenders, tape, and lots of rolling and pushing. Definitely the largest person I've seen in an operation...of course I've been working on little babies in the past rotation which are challenging in their own way. Scary moment when we take out the baby and there's lots of meconium in the amniotic fluid and she's totally blue and not moving. Hand her over to peds and she eventually gets apgars of 3/8/8. So glad the baby survived!
10:30 pm: Out of surgery. The lady with HIV delivered while I was in one of the C-Sections. Yay!
11:00 pm: Amazingly the resident sends me to bed. Fabulous!
5:00 am: Wake up for morning rounds. See our three antepartum patients. Pre-eclampsia, IUGR, and an MVA with a pelvic fracture...very not cool during pregnancy.
6:30 am: Meet my friend who's just starting her rotation here and has to be on call and see all the postpartum patients we delivered yesterday. Plus her resident isn't there. Help her see patients, it's nice to check in on all the ladies we delivered yesterday not that I'm not delirious.
8:00 am: Change over
8:30 am: Stumble out into the sun and humidity. Good bye Methodist!
Saturday, August 1, 2009
Babies!!!!!
I got to deliver three babies in the past three days! Amazing! There was always another pair or hands right behind me, but for the most part I got to do everything. And it was really slimy. I've realized I think I'd rather be the doctor in the room who comes in and cares for the baby than the doctor or midwife who has to sew up everything and wait to deliver the placenta. I've also realized that I think my dreams of an all natural childbirth were not completely realistic...if I'm going to be pushing anything through my vagina that could tear it apart, I think I'll have an epidural, thank you. Trust me, those women still feel it.
The birth's themselves are so incredible. One minute there's no baby, and then, ta da! there it is!!! The mothers and families are so happy and relieved...it really is a fun thing to be a part of. It's amazing that these women let a med student be there at all. Not that there's that much I could mess up and there's someone always close at hand. But still. It makes you feel privileged. Of course, the doctors really aren't in the room for most of it. The nurses are great and close at hand...but the doctors and even midwives stay away until the very last minutes when the woman is about to burst.
C-sections are crazy too. The woman is totally awake, she just can't feel anything as we reach in and dig out the baby. What a lot of blood! Way way more than anything I saw in peds surg. And the surgeries themselves are quick and dirty...or not dirty really...they just lack a little finesse. No more 3mm tails on suture like in surgery...here it was all a cm or more and the incisions on the uterus can get a little wacky. But they get the job done. Plus I got to sew more in one day of OB than I did in four weeks of surgery. Go figure. Still the most incredible thing to me is how fast the uterus contracts after surgery. I guess you can feel it after a vaginal birth...but when you see the thing involute right in front of your eyes it's quite something.
There's also been some sad things in OB...still born babies, scary pre-eclampsia, lots of premature preterm rupture of membranes. Sigh. I just have to remind myself that we see all the crazy cases and that 90-95% of pregnancies have no problems and are solely handled by the midwives. Due to our population base we've also seen a lot of young mother's...I'd say at least half if not more are younger than I am, and many are repeat pregnancies all ready. Scary. I'll wait 4+ years for that, there's just no way right now. But hopefully I've reached a turning point in my work hours. All my dreams were shattered and this past week was just as bad as peds surg...still had to be there 5am-6pm and in general we were even more busy during the day. Sadly I'm all done with OB for now (except for my two overnight calls coming up soon) and it's on to GYN. Not terribly excited, but I bet I'll see some neat surgeries. And hopefully I'll get some much needed sleep!
The birth's themselves are so incredible. One minute there's no baby, and then, ta da! there it is!!! The mothers and families are so happy and relieved...it really is a fun thing to be a part of. It's amazing that these women let a med student be there at all. Not that there's that much I could mess up and there's someone always close at hand. But still. It makes you feel privileged. Of course, the doctors really aren't in the room for most of it. The nurses are great and close at hand...but the doctors and even midwives stay away until the very last minutes when the woman is about to burst.
C-sections are crazy too. The woman is totally awake, she just can't feel anything as we reach in and dig out the baby. What a lot of blood! Way way more than anything I saw in peds surg. And the surgeries themselves are quick and dirty...or not dirty really...they just lack a little finesse. No more 3mm tails on suture like in surgery...here it was all a cm or more and the incisions on the uterus can get a little wacky. But they get the job done. Plus I got to sew more in one day of OB than I did in four weeks of surgery. Go figure. Still the most incredible thing to me is how fast the uterus contracts after surgery. I guess you can feel it after a vaginal birth...but when you see the thing involute right in front of your eyes it's quite something.
There's also been some sad things in OB...still born babies, scary pre-eclampsia, lots of premature preterm rupture of membranes. Sigh. I just have to remind myself that we see all the crazy cases and that 90-95% of pregnancies have no problems and are solely handled by the midwives. Due to our population base we've also seen a lot of young mother's...I'd say at least half if not more are younger than I am, and many are repeat pregnancies all ready. Scary. I'll wait 4+ years for that, there's just no way right now. But hopefully I've reached a turning point in my work hours. All my dreams were shattered and this past week was just as bad as peds surg...still had to be there 5am-6pm and in general we were even more busy during the day. Sadly I'm all done with OB for now (except for my two overnight calls coming up soon) and it's on to GYN. Not terribly excited, but I bet I'll see some neat surgeries. And hopefully I'll get some much needed sleep!
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