O.K. When I was deciding on my specialty in medical school, there were several criteria that I wanted to meet. One had to do with working in or out of the hospital (I wanted in). The next had to do with how much clinic I would have to do (little to none). And, the final criteria had to do with gyn exams. Hate them, hate doing them, some things in life I don't really want to see on anyone.
So when the time came to decide, surgery was a great fit. I would be working in a hospital, I would have very little clinic, and, for the most part, very rarely would I ever have to do a gym exam. And, so it's been for the last 4 years. I did my last gyn exam as a 4th year medical student in May of 2003. Until yesterday.....
My home for the next month.
On my very first shift, with my very first patient. I saw the tag on the board, "Abdominal Pain." No problem. I was a surgery resident, and we are well versed in Abdominal pain. As an Emergency Medicine resident, I walked in the room and met my patient who described a severe pain in her upper abdomen. No problem. "Oh yeah, Doc, by the way, the pain actually started in my lower abdomen, well pelvis actually, and now that I think about it, I had unprotected sex about the same time the pain started and could I be pregnant or have an STD?" Major problem.
Suddenly, I felt like a medical student again. I went to my chief resident to present the patient, and I had to admit it had been 4 years since I had done a gyn exam. He was like, "No problem. Grab the cart, grab some swabs, do a wet mount and I'll show you where the microscope is." Um, "wet mount?" I think I heard something about that during my OB/Gyn rotation in medical school, 3rd year... So, I was walked through the procedure by my chief; who, by the way, also had to help me with the microscope because I hadn't used one of those since 2nd year histology class. Needless to say, it was not a very pleasant beginning.
Luckily, it was the only gyn exam of the day. During the course of the next 9 hours I saw a total of 6 patients. It doesn't sound like much considering some family practice doctors see 4 - 6 patients an hour. But, you have to realize that in the Emergency Department a doctor may manage 4 - 5 patients an hour, and they all don't leave within fifteen minutes.
For example, my first patient had to have a pregnancy test and an ultrasound (the culture swabs I obtained won't be ready for 2 days.) So, she took about 2 hours from start to finish. After my exam, I saw my next patient while I waited for patient #1's lab results and ultrasound results to come through. Pt #2 was very sick and needed constant re-evaluation. He ended up needing a chest x-ray, CT scan, multiple labs, a cardiac echo and would need admission to the ICU. I saw him at the beginning of my second hour, it took 4 hours to get all of the labs and imaging studies done, and when I left 7 hours later, he was just being seen by the admitting service in the ICU. While I was waiting on his work-up studies, I saw 4 more patients: a musculoskeletal chest pain, a drug allergy reaction, a patient with fluid in one lung most likely from lung cancer, and a 20 something who woke up blind in one eye. A nice mixed bag of patients. Like I used to say in med school, "The ED is like a box of chocolates, you never know what you're going to get and some are just plain nuts."
So, this was my first day. I know I will get better. I know eventually I'll stop feeling like a medical student and start feeling like a doctor again. I know soon I will be able to manage more than a patient or two an hour. And, those gyn exams... I'll just have to take them one day at a time.