Week 14: November 30 - December 5 

two-thousand-and-twenty

The Highs: ​

• Procedures This Week: 

  • TRH + BS x2

  • R ovarian cystectomy

  • D&C x2

  • Colposcopy x2

  • LEEP

  • MyoSure polypectomy

  • LSO

  • Bartholin cyst I&D

  • Cholecystectomy (whaaat??) 

• Saw some really great pathology! 
• 2nd 24 hour call day
• Helping Alexander
• I GOT A KINGMAN EM SPOT! 
   

The Lows: 

• Clinic days 

• Realizing that there are some patients who really need help, but no matter how much you try to help them, they still make poor choices. 
   

Overall rating of the week: 8/10

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This week was so much fun! I was in the OR quite a bit, and got to see several procedures. For each patient that required either a D&C or a hysteroscopy, Dr. Hostetler allowed me to start every procedure with a pelvic exam, placing a Foley catheter or straight catheter, and inserting the uterine measuring device. For the D&Cs, she gave me the opportunity to actually do it, which was super awesome!! 

This was my good friend Alexander's first official week of his General Surgery rotation, so I offered to help him out in the OR and show him the ropes! We were supposed to meet at 6:45am on Tuesday morning, but unfortunately, due to traffic, Alexander got there closer to 7:10. Still, that left us about 5 minutes to show him around the OR and teach him where to write his name in the OR, and how to take out his gloves and gown while maintaining sterile technique. We then quickly reviewed how to do a 2-handed knot tie, and with that, he was off with Dr. Vickerman! If we had more time, we would have scrubbed together, but it's okay, I had full confidence that he would figure it out and do well. 

After that, I headed over to Summit View for another clinic day. Man, these are really starting to get to me! I notice that I'm not as excited to spend a full day from 8-4:30 inside of the office. I think that, if I were to become a surgeon, I'd have to do half-day clinics like Dr. Le does. They're just draining!

The bread and butter of OB-GYN is well-woman exams. One thing that I was really looking forward to was understanding what I was feeling on a bimanual exam. So many times, it can just feel like you're touching tissue, but to actually measure how large someone's uterus is, and then know when you're feeling an ovary or a fibroid, takes a LOT of practice! I'm still not the best at it, but I'm grateful for every opportunity to palpate the pelvic organs. It's also insane to think about the fact that I'm given this incredible opportunity to learn medicine, and the privilege to learn on so many people. The patients at this clinic are so kind, and I've been constantly surprised at how many will allow me to repeat uncomfortable exams or do their speculum/Papsmears. Feeling very humbled and honored right now. 

This weekend I had my second 24-hour call day. Dr. Hostetler's call days are notorious for being particularly terrible, so I was bracing myself to be running around a lot and doing my best to help out. Fortunately, or unfortunately, it was a very mellow day, with basically no patients! We came to sign-out at 7am, and all the patients had already delivered the night before and were waiting to move to the mother-infant unit. We rounded on two moms, and then after that, we had nothing to do all day. I brought my overnight bag, which was up in the 5th floor call room, but after I got dismissed, I just stayed in the physician's lounge and studied all day. It was great for me to catch up and do some practice questions, and once I finished, it was close to 6:30pm. It was then that I heard Dr. Vickerman was waiting for a patient with an inflamed gallbladder to come in! I asked him if I could scrub and watch the procedure, and he said, absolutely! Alexander chose Sunday as his call-day, so Dr. Vickerman didn't have a student with him on Saturday. I was able to scrub into the surgery and race against Josh (the awesome PA!) to suture the patient closed. I say race, but really I took my time and made sure to make my sutures look pretty. As we were tearing down the OR room, I got a text from Dr. Hostetler that a patient was in triage! I got excited to finally have something else to do, so I quickly finished up in the OR and made my way back to L&D. 

The patient who came in was someone that I saw with Dr. H earlier in the week - a G12 P8, at 33 weeks, who's had nothing but C-sections in the past. Her current pregnancy was complicated by placenta previa, in which the placenta overlies the cervical os, making it very difficult for her baby to come out, and also placenta accreta, in which part of the placenta was actually growing into the myometrium of the uterus. If this tears during vaginal delivery, it could cause serious post-partum hemorrhage, and mom could be at high risk of death. She was supposed to have a bilateral tubal ligation with her last delivery in February, but for some reason, only one tube was tied off...Dr. S got an earful from Dr. Hostetler about this mishap. Anyway, the plan with this delivery was to do a C-section with a combined complete hysterectomy. This woman physically could not have any more children, lest she want to risk her life. She understood completely, and was happy to consent to the hysterectomy. She also confided in us that she had a restraining order against her husband due to a domestic violence incident, and that she didn't have custody of any of her children. Her three youngest were in foster care, and the rest were grown adults. My heart absolutely went out to his momma, who just didn't know how to care for her children or be a good guardian. However, you could see that she wanted to try, but the system just didn't have enough trust in her to be able to support her family alone. 

Anyway, funny story time. So that patient came in because she felt a gush of water leak from her vagina, making her think she may have broke her amniotic sac. When she came into triage, Dr. Disher performed a speculum exam and saw a pool of clear-looking liquid in the vaginal vault. She performed a fern-test and a Nitrazine blue test, but both were negative. She then did an Amnisure test, to confirm whether or not the fluid was amniotic fluid, but that also came back negative! The fluid didn't smell like urine, so everyone was scratching their heads. Dr. Hostetler finally arrived back to the hospital, and she repeated all the exams herself. Again, all the tests came back negative. So here I am, thinking, Gosh, what could that copious amount of fluid have come from? And then, very shyly, I asked Dr. Hostetler if maybe that fluid could have been from the patient releasing female ejaculate. Except of course, I didn't say it like that, but instead said, "Could she have squirted?" Dr. Hostetler burst out laughing and said, "oh my god, I didn't even think about that but that's amazing!" I was super embarrassed, but hey! You gotta think of everything as a possibility in medicine! We already knew the liquid wasn't semen because we found no sperm on the microscope slide from our fern test. It wasn't urine or amniotic fluid, so that left very few options! I think I both entertained her and impressed her with my train of thought. Haha, it's definitely a story I'm going to remember for a long time. 

We decided to observe the patient in the hospital overnight, and with that, our exciting call-day ended. I slept and woke up at 6:30 and came down to sign out. Once I was dismissed, I grabbed breakfast at the hospital, then came home to shower. I relaxed for about 30 minutes, and then headed back to the hospital to study for the day. Ran into Alexander in the physician's lounge, and we studied for a little bit until he left to go home since nothing was going on in General Surgery that day either. 

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On a final, SUPER happy note, I found out from Amie today (my 3-4th year campus coordinator) that a spot for an Emergency Medicine elective opened up for me in Kingman, Arizona!!! I'll be going there for the month of March to complete my elective. I'm PUMPED!!!! I was starting to lose hope that I'd ever get a spot, but some more good news just keeps coming my way. Woohoo!! 

With that, I conclude my 2nd week of OB-GYN! 

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Week 13: November 22 - 29 

two-thousand-and-twenty

The Highs: 

• Started my OB-GYN rotation with Dr. Hostetler!

• Procedures This Week: 

  • Vaginal deliveries x2

  • Laparoscopic assisted vaginal TAH+BSO

  • Robotic assisted BS

  • 3rd trimester ultrasound 

• Found out I won RVU's Student Doctor of the Year!!!
• Thanksgiving with Hannah 
• Heard the nicest things from some people about me... 
• Got to catch up with Stephanie! 

The Lows: 

• Surgery shelf

• Why am I so tired?! 
   

Overall rating of the week: 9/10

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I embarked on my OB-GYN rotation this week! My first day was a 24-hour call day with Dr. Hostetler, so I had no idea what to expect. I showed up to the L&D deck at 7am on Monday morning and met all the L&D nurses and Dr. Hostetler for the first time. I was surprised to see that Dr. Hostetler was 29 weeks along herself! I learned that she was an RVU alum, and that she actually went to UC Irvine for her undergrad! We were able to connect over California and RVU, and it felt really wonderful to have a female preceptor. She also told me that December was her last full month at NCMC, because she was going to be moving to McKee Medical Center in the middle of January, then going on her maternity leave. That meant that I was likely going to be her last student this school year. What an honor.  

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We had a few COVID+ patients on the floor that day, as well as a patient who was in the first stage of labor. We performed cervix checks on the latter patient after giving her doses of Cytotec to help her cervix ripen. Unfortunately, for the entire day, her cervix remained closed. As for the other patients, I learned that the residents get to see the patients that are not assigned to Dr. Hostetler or her OBGYN group, so most of the COVID patients were theirs. In the middle of the shift, a patient did come through triage already 8cm dilated and crowning. The nurses and residents rushed her into a room and soon discovered that she was Spanish-speaking only. No problem for Dr. Springs (senior resident) though, because he spoke fluent Spanish. However, he kept trying to tell the patient what to do despite her being in severe pain. As he was yelling at her in Spanish, Dr. Hostetler and I went in to help because the patient's doctor wasn't there yet. All of a sudden I was transported back to my COPE Health Scholar days, standing back and watching as a newborn was brought into the world. It's always a surreal experience, one that I don't take for granted, for sure. Once Dr. Spritz arrived (the attending), he told Dr. Springs to calm down and that they needed to regroup and figure out what they were going to tell the patient. Dr. Hostetler took her bow at that point, but told me to stay and watch. I was able to see as the placenta was delivered, but since there were at least 2 nurses, 2 residents, the attending, the patient, and her mom all in the room, I just stood back and watched most of action happen behind the scenes. 

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Later that day, one of the COVID patients finally fully dilated. She had a history of a prior C-section, but she wanted to try to deliver this baby vaginally. The residents were in charge of this patient, and Dr. Ware, their attending, was helping them try to deliver this baby. However, they were having trouble, and I heard they were going to attempt a vacuum delivery. This failed twice though, and now Dr. Hostetler was getting anxious that she might have to do an emergency C-section on a COVID+ patient. We kept trying to call the back-up on-call physician, but that person wasn't picking up their phone. Finally, just when we were going to go scrub, the back-up doc called and said she was on her way. Hallelujah! Good thing, because shortly after that, an OB Emergency was called down to the ED. We ran down to the ED to find out that a patient was coming in who had delivered in the field. As soon as we made it into the trauma bay, a Full Trauma Activation was called overhead, and we were shoved out of the room and moved to a different ED bed to meet our patient. Then, after the FTA, a Cardiac emergency alert was called, and the ED turned into a hectic place! Our patient was a homeless woman who was 29, and had delivered her baby in her outside tent. She then delivered her placenta en route to the ED, and when she came in, her placenta was ON the ambulance gurney. It was crazy!! We made sure she was okay, that baby was okay, and then we transferred her upstairs to L&D to fully examine her. She sustained a first degree laceration, but otherwise, was doing well! She tested negative for all substances, and her alcohol levels were also 0. It was a surprise because when we first interviewed her, she couldn't tell us anything, and was very confused about her medications. Turns out she has a history of schizophrenia and bipolar disorder. Due to her unstable state and complete apathy towards her baby, she was separated from the baby to keep the baby safe. 

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Nothing else happened during the night, but I got to experience my first overnight shift in the 5th floor call room. I had packed my own pillow (thank goodness!) but wasn't prepared for how cold it was going to be! I was also suspicious of the linens on the bed, so I slept on top of the bed in my scrubs and my jacket. I woke up several times during the night because it was so cold, and I kept checking my phone in case I missed a text from Dr. Hostetler, but nothing came in. When 6:30 came, I got up and got ready, then went back to the L&D deck for sign out. Finally, I was dismissed to go home. I came back and crashed. I wanted to be more productive, but I was just so exhausted from the unrestful sleep I got. Next time, I'll bring my own blanket for sure! 

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Wednesday we had surgery in the morning, and then clinic in the afternoon! I was so excited to be back in the OR. Dr. Hostetler was surprised that I seemed to know everyone's names! She said it must be because I'm a DO, that's something that I took pride in. I got to see both a laparoscopic total hysterectomy with bilateral salpingo-oophorectomy and a robotic-assisted bilateral salpingotomy. I got to use the camera and help Dr. Hostetler and Gary (our fantastic first assistant) visualize structures, and also was so glad that I studied up on pelvic anatomy a little bit! I was asked what the infundibulopelvic ligament was and what it contained, and Gary tried to help me out with identifying other structures, but I failed miserably at completing his sentences. He said, "It's not the square ligament, but the ___ ligament!" and me, being so silly, said the CIRCULAR ligament instead of the ROUND ligament. *shaking my head*. I'm an embarrassment, for sure. Haha. But we laughed about it afterwards, and it was all good. 

In the afternoon, I headed over to Summit View Clinic and met the office girls for the first time - Heather is Dr. Hostetler's MA. Then there's also Alondra, Gypsy, Stephanie, Danyelle, and Brenda. They're all so sweet and nice, albeit a little sassy. Haha. They're a great group of ladies to be around!

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We saw several patients that morning and afternoon, and I mostly watched as Dr. Hostetler performed pelvic exams and papsmears for well-woman exams and OB patients. At the end of the day, she let me ultrasound her belly, and I got to see her little man cooking away! She taught me how she systematically performs OB ultrasounds, and then I got to practice on her. Babies are amazing, man! Technology is also fantastic. You can see the fetus's heart on US, and it's so precise, you can even see all four chambers of the heart and the valves moving! Wild. 

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Lastly, I wanted to address winning RVU Student Doctor of the Year. What. An. Accomplishment. Trilce texted me last Friday and told me that I better check my email first thing on Monday morning this week. Even though I was on call all day, I was constantly refreshing my inbox. Around 11:30 in the morning, I got the email from Nadine that I had won! I couldn't believe it! Me, RVU's Student Doctor of the Year. It felt absolutely amazing -- like all the hard work I'd done was being recognized, and all the hardships I'd gone through were worthwhile. It meant the world to know that RVU saw my value, and also deemed me worthy enough to represent our institution in the national competition for COSGP's Student Doctor of the Year. I'll now be competing against all other SDOY's from other medical schools for the title. Dr. Pitcher personally emailed me and said this award is "one of the very highest recognitions given not just by the school but every school.  Absolutely one of the hardest to earn, and you have in solid fashion no doubt.  You have much to be proud of already, I hope this feels like something you know you earned and feel very proud of indeed.  We are all so very proud of you!". Then, later this week, I received an email from Dr. Ross, my mentor: "At the time last Sunday, I didn't know that you had won the scholarship. I later read about it. So congratulations! All your work with SNMA was recognized. Then, I later read that you were chosen as RVU's SD of the Year! That's great and perhaps an even bigger accomplishment. I think you are very deserving. All the best." Follow all that up with a surprise FaceTime call from Trilce, and a heartfelt conversation with Dr. Haider, and I'm over the moon. 

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The support I've received from my faculty and staff at RVU goes to show that with sincerity and hard work, dedication, and the desire to better not just my generation of medical students but the others that follow, comes positive change. My goal is to set higher standards for other students outside of RVU, to make others rise to the level of my institution, because it's the people at RVU, and the great institution that I'm a student of, that's helped support and guide me to where I am. They deserve all the credit for my accomplishments, because without them, I would not be as successful as I am today. Forever, I'm grateful to RVU. I'll be paying that forward, no doubt. 

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This week was also Thanksgiving! Hannah and I prepared hot pot on Thursday. I cooked traditional American Thanksgiving dishes on Friday (green bean casserole, mashed potatoes, Costco stuffing!), and caught up with my lovely Stephanie on Saturday. We met at Ruperts at the Edge in Denver for brunch, and walked around this huge lake/pond with a gorgeous view! It's the first time I've seen her since we both moved away from Parker, and it was SO NICE just to talk to her in person and see her pretty face. We swapped stories of our rotations and dished on the tea going on in our lives. Just you know, things girlfriends do. Haha. Pics of the view below. :) 

 

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Sloan Lake Park, the largest lake in Denver!

 11-28-2020