Why I Chose Ob/Gyn – Obstetrics Portion

Photo Cred: gnelyseo on Flickr Creative Commons
Photo Cred: gnelyseo on Flickr Creative Commons

 

Day 1 of Medical School:

I’m showered, made-up, and well-slept. As a newly wed in a new city embarking on an exciting journey, I possess a palpable eagerness akin to the first day of Kindergarten. Although I am somewhat intimidated and terrified, my mind is focused and eager to get going with this adventure to becoming a doctor.

I confidently write my specialties of choice on the welcome questionnaire.

  • Pediatrics or
  • Emergency Medicine

 

Fast Forward 4 Years to Match Day:

I’m nervous, lactating, and definitely not well-slept. As a new mom to twins in a familiar room holding an envelope encasing my future, I can’t help but feel nauseated. I open it to find relief in the contents and then see a large screen flash my “MS1 chosen specialties” alongside my ERAS picture and actual Match results revealing a totally different future than I envisioned in chapter 1.

Match Day 2013
Match Day 2013

It’s then I realize that only a very small minority of our class actually applied and matched into the specialty they came to medical school expecting to train for.

 

So, how’d I end up here?

Perhaps the most stressful decision we make as medical students is what specialty we will go into. I had distinct plans to avoid any surgical specialty, specifically including Ob/Gyn, mostly out of fear that surgical specialties were not compatible with having a family. I also had an underlying belief/worry that I did not possess the required moral fortitude or tactile skills to operate and lead in high-stress environments.

In fact, even after rotating through these specialties and realizing I enjoyed being in the OR, I still spent the next several months in a mental debate with myself creating reasons I should choose a non-surgical specialty I liked instead of this surgical one I loved. At the end of it all I simply could not justify choosing something I was less apt in and enjoyed less based purely on what turned out to be misguided fears…especially after all the time, money, and effort I had put in to simply being able to make that choice.

Ob/Gyn had several drawing factors for me, some of them I’ve written about in the past. One of those, what I call the “Happiness Factor” was particularly appealing. Despite crazier hours and more intense training than some of the “lifestyle” and “cognitive” specialities, I was happier on my Ob/Gyn rotation than any other. Additionally, I felt like the Obstetrics aspect was uniquely happy. Where else in a hospital are people EXCITED to get admitted?

That being said…

While Obstetrics actually is 90% YAY-BABY-DAY(!), one must not forget that there remains a less-discussed, ever-present 10% which is purely heart-wrenching. This field is usually good, but when it’s not good…it’s downright terrible.

  • Delivering babies you know will never cry…holding your breath for the most deafening silence you’ll ever know.
  • Cradling babies born living, but far too early for modern medicine to help.
  • Telling a mom there is no heartbeat.
  • Taking care of parents who know their baby will be born with life-threatening, limiting, or lethal anomalies.
  • Hugging grieving parents after an unexpected newborn death.

These are all things I’ve done, most of them more than once. These are tragic circumstances which come with the territory. At one point in my life I thought this was made okay by the fact that they are bookended by lots of “He’s soooo cute” squeals to a lovely soundtrack of crying newborns. I’ve come to realize, this 10% is actually a sacred part of my job. Knowing I have the opportunity to guide these families through scary, uncharted waters and give them the tools to find a glimmer of happiness in the unthinkable is what makes this worth it. These women and their families deserve attentive, compassionate, focused care on their darkest day.

Taking care of women through their pregnancy, happy or sad, is not just a job, it’s a privilege. I am welcomed into the most exciting, scary, heartbreaking, wonderful, confusing and intimate of times. The physical, emotional, and social aspects of pregnancy, labor, & delivery make the obstetric part of my job continually exciting.

Maybe the new just hasn’t worn off yet, but even after hundreds, if not thousands, of birth days it still feels like a privilege every time I set foot in a delivery room.

Imposter Syndrome

I wrote this my first year out of medical school and at the time shared it on a site I was writing for. I’m re-sharing all these years later, because it’s still very applicable (both to me and others) – particularly since many of you are at the beginning of your med school or residency journey.

Doctor Amelia
Imposter – My daughter as a lady bug, doctor, Doc McStuffins, kid.

IMPOSTER SYNDROME

Occasionally I find myself in the OR standing over a patient (on a step stool, thanks to my losing battle with a vertical challenge), scalpel in hand, with a “holy-geez-someone-call-a-doctor” feeling. It’s that surreal feeling you get as you transition into a new role, just intensified I think now that my new role involves…I don’t know…cutting people open and pulling out their babies or looking at someone’s insides with a laparoscopic camera?

Honestly, each day is a weird transition of sorts. I get up every morning and do normal things – shower, nurse a couple of babies, lock the front door with a piece of toast hanging out of my mouth and a coffee cup balancing in the crook of my arm, and I transition. The transition is usually seamless – get to the hospital, round, deliver babies, scrub for surgeries, or see patients in clinic, lather, rinse repeat. But every once in while when there’s a moment to step back and survey a situation I will suddenly notice this flood of weird feelings, like I’m a kid playing dress-up and at any minute I’ll have to come back to the real world.

It happens the first time you do a full physical in medical school, or as you sit counseling a family during a tragic diagnosis or bad outcome, maybe when you hand off a tiny, slippery, screaming human to it’s exhausted mother – this overwhelming feeling of “I should NOT be allowed to do this” delicately balanced with “how did I actually become capable of doing this?”

Everyone in medicine feels it at some point and I don’t know that it’s easily explained to those outside the medical field. The only non-medical thing I can personally relate it to is the feeling of overwhelming responsibility paired with shear terror you get as you cradle your first born (or first bornS, if you’re in the multiples club with me) in a quiet house and realize the hospital failed to send you home with a nurse or monitor or instruction manual of any sort. You know, when your brain is wavering between “I got this.” and “Nope, totally don’t got this” but hasn’t quite established where “comfortable” is just yet.  It’s this air of not belonging, almost of doing something you shouldn’t be doing, even though you’re doing exactly what you should be doing.

It’s weird. It is so weird.

I’ve heard it called Imposter Syndrome somewhere, I’m honestly not sure if that’s an actual title of something or if I pulled it out of thin air, but it seems appropriate. I assume the frequency of this feeling will continue to fade as we settle into these new roles, but I wonder if it ever completely disappears? After years of practicing medicine do you ever still get that feeling or does it become so routine that you lose sight of the uniqueness of it all? Either way, I can only assume that with a country full of interns braving their PGY-1 year that I’m not alone in the Imposter Syndrome struggle.

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I’ve had a few distinct times I felt this – my first cadaver lab as a med student, probably my entire first year as a doctor, my first midnight and only-Ob-in-the-hospital delivery as a new attending, my first solo surgery. It’s important to note that these things never feel unsafe – it’s not so much a feeling of unqualified as it is a sense of finally realizing this dream you’ve had so long. I can only describe it as a sense that you are finally granted both permission and skill to do these amazing things.

Ob/Gyn Residency – An Update (At the End)

IMG_6626Well hey there, can’t believe anyone is still making it over this way. Residency is kind of time-consuming, who’da thunk it?

I started this post 1.5 years ago and never finished. Awesome.

Considering we’re coming up on the half-way point end of my residency experience, I figured now would be a good time for an update. Last I checked in was a year ago basically forever ago and I was learning to do LEEPs on summer sausages and perineal laceration repairs on cow tongue. Since then I’ve graduated on to being allowed to work with actual patients who are much easier to talk to and far more enjoyable to be around.

Current Going Ons

So, what am I doing these days? Well, this month I’m on Elective. As a chief electives are really awesome, because I basically get to do whatever I want. For me at this point that means I am doing book-keeping things (getting my Texas medical license, which is about 2,000 steps, updating my certifications for BLS and ACLS, etc.) and stalking all the clinic books to see more vulvar pathology and infertility things. I’m also helping out in L&D some, taking q4 traditional call (from home, because my program is awesome to the chiefs), and operating a bit with the group I’ll be joining next year.

Obstetrics

In the past 3.5 years I have delivered more babies than I can count. Some of them stand out as memorable, others fade into a pool of joyous but not unusual. I’ve delivered extraordinarily tiny babies who were very premature, very sick babies, stillborn babies, babies who died soon after delivery, babies who belong to my personal patients and friends and co-workers, babies who made their way via stat c-sections, “birthday babies” (in what other field is it AWESOME to work on your birthday?), surprise babies, twins, and everything in between. Most of the birthdays have been incredibly happy, many heart-wrenchingly sad, a handful were awkward, many were scary, some were downright strange, but most were just lovely experiences that didn’t leave long-lasting impressions due to pure volume. Despite the variety, I can confidently say every single delivery has been absolutely an honor for me. I am still truly in awe every time I attend a delivery that I get to this as my job. It’s unreal.

Gynecology

A mix of clinic patients, procedures, and surgeries – I’ve come to enjoy this sector of my field so much more than I anticipated. It turns out that surgery as a doctor is about a billion times more enjoyable than surgery as a medical student. I’ve done countless “minor procedures” like D&Cs, LEEPs, hysteroscopies, tubal ligations, and diagnostic laparoscopies. In my second year I got more experience with open and laparoscopic abdominal procedures – myomectomies, giant ovarian cystectomies, salpingectomies, ruptured ectopic pregnancies, bleeding ovarian cysts, etc. Open myomectomies are a “second year case” but still one of my favorite surgeries, I have no idea why – I just find them very fun. Third year I operated with the oncologists a lot. The past two years I’ve done more hysterectomies than I ever anticipated. I’ve gotten to do a good amount of Urogyn (pelvic organ prolapse and incontinence) surgeries. I have seen a huge range of very interesting cancer cases and I absolutely loved my Oncology rotations. I loved them so much that I very strongly considered a fellowship in Onc (which was absolutely never on my radar until last year). More on that non-decision later. Outside of Oncology I’ve operated on a handful of very sick patients, but for the most part non-oncology patients tend to be relatively young and healthy. This was actually one of the reasons I was drawn to this field in the first place.

Life

Oh, life. The twins are 4 years old now and absolutely the coolest kids I’ve ever met. We added a new addition to the family in June, he’s a cute little ball of chubbiness and is learning to crawl and pull-up now. We unexpectedly and tragically lost two of our sweet dogs earlier this year. As most of you know they were an integral part of our family dynamic and we will always have a void where they belong. I’ve accepted a job in College Station starting in August – so if you’re in need of an Ob/Gyn in the Texas A&M area, come see me! 🙂 We never planned on going back, but a great opportunity presented itself and we are absolutely ecstatic to make it back to Aggieland!