My sixth rotation was OBGYN at Queens Hospital Center. I was very excited going into the rotation as this specialty was most interesting to me during didactic year. Being able to learn about OBGYN in summer semester and then put those lessons into practice and experience both sides of obstetrics and gynecology was pretty amazing. My favorite aspect of this rotation was that because my placement was inpatient, I was able to spend time on the labor and delivery floor, with the gynecology team and in clinic, which was more of the outpatient aspect of OBGYN. This gave me experience in all areas and a breadth of knowledge.
I really enjoyed my time on the labor and delivery floor. The first delivery I witnessed was a 32 y/o F G4P2012 at 38w6d gestation. The patient was fully dilated and effaced and had just begun pushing. After a few minutes, the baby’s head emerged but the shoulders seemed to be stuck and the chief resident called out “call PEDs, shoulder dystocia!” After around 40 seconds of pressure on the mother’s pubic symphysis and gentle traction on the baby’s head, they were able to pull the baby out. This was an interesting experience for several reasons. First, it was the first normal spontaneous vaginal delivery I had ever seen which was quite incredible. Next, it was a case of mild shoulder dystocia and so it was interesting to see the maneuvers done and in which priority, unique to this case, in which they were performed. Lastly, the second-year resident was gowned up to deliver her but when it became complicated, the chief resident stepped in and took over. It’s always a good reminder that no matter where you are in your journey of becoming a provider, it’s not only okay but necessary to call for help when you’re in need in order to best and most safely care for patients.
One patient I encountered was truly memorable – unfortunately, not for a happy reason. This patient was 62 years old from Trinidad and presented to the hospital a few weeks prior with stage 4 cervical cancer. She had developed a fistula which prevented her from receiving further chemotherapy treatment. She was also experiencing severe pain which was not being controlled properly, despite the amount of opioids she was taking. I was present when the attending broke the news to her that there was no longer any curative treatment they could provide her with, rather only palliative care. Her husband was with her and they both cried and pleaded for a different update, a possible breakthrough. It was heartbreaking to witness. I came back to her the next morning on rounds and when the rest of the gynecology team left to go to the next patient, I stayed with her, sat on her bed and held her hand. We spoke for a few minutes and I tried to give her as much hope as possible, which she appreciated tremendously.
My time in clinic was a nice change as I was able to see more routine obstetrician and gynecologic visits. One 55 year old female presented complaining of vaginal spotting intermittently for the past month. Due to her menopausal status, an endometrial biopsy was performed. I was able to assist the PA in performing the biopsy and was present for the counseling and education she provided to the patient.
Lastly, the time spent in the OR and procedures was something I found very interesting in OBGYN. Two surgeries/procedures I scrubbed in for was a cesarean section and a dilation & evacuation. Both were noteworthy. The c-section was the second for a patient who had a previous c-section. Compared to the first c-section I saw for a nulliparous patient, this patient had a lot of adhesions and so the technique and skills required differed. The dilation & evacuation was for a 49 y/o patient with primary infertility at 18w gestation. She had conceived this pregnancy from IVF with a donor egg. I definitely experienced and learned a lot on this rotation. The aspect of new life coming into this world juxtaposed with loss, both of potential life and women with malignancies, was overwhelming and showed me two very different sides of a complex and amazing specialty.
