Given the things I learned in Pediatrics, I thought that this week in OB/Gyn I would not get to see a delivery at all. But the hospital's first birth for the month of June happened on the first day I was there. There was a scheduled C-section and the doctor told me to come and watch. I had been hoping to be able to see a birth in this department and I was so privileged to have the opportunity to see it happen. The intern in the department, Vicky, watched with me and explained some things. When we got to the surgery, the doctors had already started cleaning the area to prepare for the incisions. They then started cutting carefully through each layer of tissue separately, peeling them apart as they went through. After they cut through the endometrial layer, Dr. Tsao (my preceptor and head of the department) reached his hand in to find the head. He then took a tool that looks like a toilet plunger and grabbed the head. He moved it around in a circular pattern, which resembled stirring a large pot, and slowly pulled the head out. He wiggled the baby out, cut the umbilical cord, and then gently shook her to make her cry. She cried and the nurses cleaned her up and put a clip on the cord. A newborn baby is bluer than I expected and it took a while for her to turn pink. They woke the mother up to show her the baby while the surgeons were working to start closing everything. Stitching each layer of tissue took just as long as getting the baby out. They started with the endometrial layer and have to make sure that there is no fluid leaking out of the incision. They cauterize where needed to stop bleeding and fluid leaking, and then move to the uterus, peritoneal sac, abdominal muscles, fascia, fat and skin. The skin is stapled shut and the mother is wrapped in bandages and a brace. Seeing this surgery was amazing to say the least, but also a great learning experience. Seeing tissues in their live form is so different from the cadavers. And birth is nothing short of incredible; seeing new life for the first time is indescribable.
Outpatient clinic in OB/Gyn consists of A LOT of PAP smears. Women older than 30 in Taiwan are allowed to get one per year with the National Insurance. There are 4 basic cancer screenings that Taiwanese people do yearly: cervical, breast, colon and oral. Each of these cancers have a better prognosis when caught early. So many women come to get their screening. It is very fast as they usually don't really have to speak to the doctor unless there is a problem. The nurse and intern take care of most of them. They even let me try to do one. It is a really simple procedure but I think I will need to work on it a little more. Between cases, Dr. Tsao presented about acute abdominal pain in urgent care. I learned a lot from his presentation. He went over differential diagnoses for abdominal pain and how to treat it. He told us about the more emergent cases and which you need to rule out first. He also did several ultrasounds and I got to hear a baby's heartbeat and watch its heart beating. He showed me IUD placement and removal as well. In the afternoon, another doctor showed me a CT scan of a woman who has a ovarian cyst that is about 25 cm. It takes up a large portion of her lower abdomen. I imagine that after the surgery she will lose a few pounds. She is scheduled for surgery on Friday, so I'll be able to watch them remove it. She had initially declined surgery, but is now going to go through with it.
The first day in OB/Gyn was wonderful. It was definitely a day that I will not forget and I learned so much in such a short time. We have not studied the reproductive system yet, so this has been a crash course. I will definitely have a good head start in the things that we will study next year. I can't wait for the rest of the week.
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