WhiteCoat

Repost: Let The Mayhem Begin

I rarely do re-posts, but each time the new round of residents shows up in their brand new lab coats, it makes me think of this story. Today I was grinning on the inside yet again.

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Medical studies prove it. Interns are more error prone during the first month of their first year in training. July 1 is the “changing of the guard,” so doctors and patients alike – be careful out there.

In honor of the graduating students and the residents graduating to their new PGY year, below is my version of a MasterCard commercial for the best story I heard about a new resident on an OB service. First a bit of an explanation.

When a woman is in labor, doctors will periodically do a gyne exam to determine how dilated the cervix has become. When the cervix is only 1 or 2 cm dilated (sometimes called “fingertip” dilated because all you can get in there is a fingertip), delivery usually isn’t imminent. As the cervix dilates, you can begin to feel the baby’s head (unless there is a breech presentation and you feel a foot or the baby’s buttocks). When the patient hits 8 or 9 cm, the patient usually starts feeling a need to push the baby out. Grab your catcher’s mitt, because the baby is coming. A little more information about cervical dilation in pregnancy is here.

Getting back to the story … mind you that this story is hearsay, but it comes from a friend of mine who worked as a secretary on an OB floor, so I consider her a pretty reliable source. I also did an internet search to make sure that I’m not perpetuating some urban legend and I couldn’t find anything. So here goes:

Medical school education: $240,000
Brand new white lab jacket with embroidered name: $37.50
Four pack of Red Bull to keep you up all night during your first call: $9.00
Obstetrical textbook to learn about the stages of labor: $219
Three one-minute cell phone calls to the chief resident to update him on the patient who is pushing but whose cervix remains “fingertip” dilated: $1.20
Spanish-English dictionary to find out why the patient keeps saying something sounding like “debo empujar” (”I have to push”) and keeps calling you “pendejo“: $16.95
Watching the OB nurse double check the patient’s cervix, flip out, and call for a STAT c-section because the patient’s cervix is fully dilated, the newborn is in a breech presentation, and you’ve been sticking your finger in the kid’s anus instead of the mom’s cervix for the past 30 minutes: priceless

9 Responses to “Repost: Let The Mayhem Begin”

  1. dm says:

    Haha, this certainly put a smile on my face :)

  2. Alice says:

    The part of me that wanted to be an ob/gyn is obliged to exclaim, What about just delivering the baby? A breech presentation descended far enough to be that deceiving would be difficult and dangerous to extract by cesarean. Why not call the attending to evaluate for a vaginal delivery first?

  3. Katherine says:

    You make me SOOOO glad that the surgery (bilateral salpingo oophorectomy with sub-total hysterectomy) I just had (10 days ago) was in June… and not July.

    I remember wondering why my doctor bumped me up to June. Maybe it had to do with the intern thing? Or did it have to do with the Edible Arrangement I sent him (thanking him for taking care of me through thick and thin over the past three years)?

    Nonetheless–very happy to be intern free! :-) I’m sure “baby doctors” are fine people, but after my first and last experience in a teaching hospital (GWU in DC), where the intern and the attending misdiagnosed my endometriosis as GERD (!!), I ain’t never going back.

  4. [...] Whitecoat has a story of his learning curve. Leave a Comment [...]

  5. Nurse K says:

    Kid is going to grow up with flashbacks of being trapped and violated. May as well prescribe the klonopin now.

  6. Habib Blacksheep, DO says:

    When my wife gave birth the nurse told us the very same story. In fact, as soon as you mentioned breech and before I’d scrolled down to your priceless conclusion, I had it in mind.

    “She just doesn’t seem to want to dilate, chief! This mom is steady at 2 cm.” Legend or no, this one’s a keeper.

  7. [...] a comment » Ok, so I’m a week behind on this but caught it on WhiteCoat’s Call Room, pretty funny stuff and I don’t know how true it is but with the July 1st turnover all of the [...]

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