A Woman's Journey - An OB/GYN Rotation

​I believe this means I will continue my mission of sharing my experience in every rotation this year. Let us venture into a female-dominated rotation: Obstetrics and Gynecology. This rotation is quite different from Pediatrics; instead of focusing on the child, we focus on the mother, the woman. The one who brings light and life wherever she goes, whether she bears a child or doesn’t. 

​If handling children wasn’t scary enough, asking personal questions from women related to their menstrual history, contraceptive history and whatever else happens there felt even more stressful since you are asking the patient herself the questions and if she has family members around, it can be uncomfortable for her to describe her symptoms and even more so when she doesn’t understand the question and her family members have to explain it to her (but guess who feels more uncomfortable? The person who's article you're reading!). On the other hand, the parents told us every detail they knew in Pediatrics because they didn’t feel that the questions were inappropriate. However, later on as I developed confidence in myself, that I actually knew what I was doing, the experience improved.

​I remember in the first few weeks, patients in the labor room would answer a few questions before telling us to leave as they were tired and in pain, and we students would look at each other, worrying about whether the reason we couldn’t take a full history was legitimate or not to our preceptor, and that’s from a perspective of a female student. Male students often are unable to take a proper history of patients because patients are often uncomfortable describing their symptoms to them, refuse to be examined by them and are not allowed to observe vaginal deliveries in the delivery room. It’s a disadvantage but a reality and understandable; I’d prefer to be examined by a woman than a man because it’s just more comfortable and safer that way. 

​However, these are just the few hurdles that I’ve had to face. Apart from that and burden of studying so much in this rotation (and forgetting it the next day :/), this rotation has been very interesting, fun and most important; interactive. In Pediatrics, I had a great time talking to patients’ families and interacting with patients but then their story would end after I checked out their labs. In OB/GYN, you could follow the patient’s progress, or at least the faculty encouraged you or made sure you followed their progress so that you could get the whole picture of what the patient went through. Often during morning reports, our professor would know the patient and tell us that their surgery or delivery is planned at so and so time so students who are assigned to the labor room should observe or even scrub in. After their delivery or operation, those who were on call are sent to those patients to take their history and update their preceptors about the patient’s status. Hence, it seemed more holistic to be so involved in a patient’s time in the hospital.

The OR:

​On my second call day, we were sent to the OR for a C-section, the first that I’d seen. I was already trying to process seeing a woman’s abdomen cut open, the uterus and amniotic sac exposed, followed by the clear amniotic fluid and finally a gray-white, swollen and crying baby come out, when Dr. Huma asked me why I didn’t scrub in. I was confused at the time but later felt honored that they would trust a 4th year student to help assist in their procedures. 

​Afterwards on a Saturday, when call timings last from 9am to 9pm, I observed a myomectomy (removing a fibroid from the uterus), as well a total abdominal hysterectomy with bilateral salpingo-oophorectomy (removing the uterus, fallopian tubes and ovaries) where I assisted in inserting a urinary catheter. Dr. Gulshan was very kind as to put a stool behind the surgeons so that I could get a good view of the operation, while also asking me a series of questions about each step which I would be blank after listening to them, such as what ligament was being cut, what structure the surgeon was holding, etc. Afterwards, we even got to hold the uterus, a tough organ which was bicornuate (heart-shaped) and fibroids were palpable, with thin squishy fallopian tubes and ovaries connected to it. 

​I was able to scrub in during a Dilation and Curettage procedure for removing an incomplete miscarriage and a breech C-section delivery. Even though my job was as simple as holding a retractor for proper visualization of the cervix and to hold the uterus while Dr. Huma stitched the incision back together (feeling my heart drop when I felt that the uterus could slip out of my hands every time she pulled hard on the suture), I felt more involved and interested in the procedure as it felt like this was my patient who I was responsible for.

The Labor Room

​I was finally able to see vaginal deliveries on a Sunday call day, that too being two deliveries side by side. The first happened smoothly and it was fascinating to understand what crowning looked like. The second delivery was more critical as the patient was in tremendous pain and was unable to keep her legs on the stirrup so I was told to put on my gloves and help. The CTG monitor showed that her baby’s heart rate was dropping so we had to convince the mother to push and push otherwise a C-section would be required, which she did not want. Shouting “PUSH!” from afar as compared to shouting it while trying to stabilize her leg was a whole different experience because at that point, it felt like she was delivering the staff’s and my baby and we had to get it out safely and quickly before a C-section would be needed. 

​Eventually the baby had to be delivered by vacuum pump and an episiotomy was given. To be honest, the delivery didn’t creep me out as much as the episiotomy did because of all the blood that came pouring out and how it was later stitched back together, but when the baby finally came out, we all cheered!! Afterwards, I’d recall the NRP (Neonatal Resuscitation Protocol) I learnt in Pediatrics while watching the Pediatrician check the status of the baby; Alhamdulillah NRP wasn’t required. What also creeped me out more was getting the consent form for epidural analgesia signed by an actively laboring patient. It is distressing to see the pain women have to go through to bring life into this world, but it is tremendous how much strength Allah gave them, which is hard to understand until you’re with them in the delivery room, and even that experience is incomplete.

The OPD

​As hectic as they were, I enjoyed my calls because there was work to do. I was usually assigned to Dr. Huma in the OPD and was always on my feet from 4-7:30pm, taking one history after another, checking out ultrasounds, writing prescriptions, observing how the patients were counseled, being fed tons of grapes and plums by Dr. Huma and bugging the nurses for more histories (who Masha Allah were also on their feet, working hard). It’s interesting how many possible diagnoses can form from common symptoms such as heavy menstrual bleeding and irregular cycles. After my second last call ended, Dr. Huma let me accompany her to see her post-op patient and I was impressed how happy patients would be to see her and talk to her and how warm and empathetic she was. After that, we prayed Maghrib together in the 3rd floor Masjid before parting ways. It wasn’t much but I felt honored to accompany her that day.

Nurpur

​Shifa Rotary Clinic is a free primary health facility located in Nurpur Shahan, a small village in the outskirts of Islamabad. Most of the patients we see there are unable to afford even the most basic medicines, which this clinic provides. Some students during their clerkship are assigned here to take histories and write prescriptions. There is a big contrast between patients there as compared to SIH, with patients coming with pelvic inflammatory disease of variable colored discharges, urinary tract infections, anemia due to lack of adequate diet, late antenatal bookings, etc. as compared to those with relatively milder symptoms, and I became more aware of the struggles they face in getting proper care.

The Faculty

​Lastly, what I admire most about this rotation is the faculty. Everyone was pro-active, making sure we studied hard for each topic and understood it within the class. Each member added their own element of teaching and knowledge to the sessions. While we prepared for the topics each day, they also taught them based on Ten teachers, guidelines and their clinical knowledge but if you didn’t study for the topic or left the call early or made any shortcuts, they could easily catch you red-handed. Personally, they felt like mothers; teaching and helping you every step of the way, cracking jokes and having fun but punishing you with extra calls, correcting you every time you made a mistake and guiding you as to how to improve, whether it was during class or formative OSCEs. This faculty was so invested in our learning and success that if I underperformed, I was more worried about disappointing them rather than myself. 

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​That was my OB/GYN rotation experience in a big nutshell. How was yours? Let me know in the comments below. 

Nahin Sani

MBBS Class of 2023