Nine Down, Just One More To Go

Yes, it’s done! The exams are over! Now I have a week off.

Hmm, I forgot to plan something for next week. I guess I’ll have to sit around, twiddle my thumbs, maybe read a book, have coffee with friends, do some bike riding, and generally do nothing.

Yeah, that sounds like a plan.

I want It Over Already!

The rotation is coming to an end. Exams for this rotation are going to be in the next two days. I am at a point where the more I try to study, the more my knowledge seems to get all mixed up. All I am getting now is diminishing returns for my efforts. So, I am finished with studying. I’m going to put on a movie. Come on, exams, do your worst!

Ethical Minefield

I visited an in vitro fertilization (IVF) clinic today as part of our OB/GYN rotation. I am aware of the debate around assisted fertility – Should people who are infertile for whatever reason be able to use technology to achieve pregnancy? Should the government allocate any resource for assisted fertility? Isn’t infertility natural selection in play – that people who are infertile are not meant to pass their genes to the next generation? Are we interfering with evolution by providing the means for those people to achieve pregnancy? – but with the IVF clinic visit, I came to realize a whole broadened range of ethical issues beyond the rationale behind the use of IVF.

Okay, this is an IVF clinic, the people working here and the patients probably all have looked past the ethical issues of using IVF. But IVF comes with a slew of new ethical issues. Each IVF cycle produces a number of embryos; the guideline allows only one to be implanted, so the rest of them are frozen for five years. After that, the couple needs to make a decision on what to do with them – keep them frozen for another five years or let them thaw (and die). What if a couple splits during that time? Does each parent have custody of half of the embryos? What if the father gives custody of all of the embryos to the mother? Will he still be liable for child support if the mother then decides to have a child using one of the embryos? Just when the law and guidelines are interpreted to provide a solution to a scenario, more what-ifs can come up, each one pushes the ethical and legal boundaries and contributes to the minefield that can potentially blow up in the faces of doctors and patients.

One of the doctors told us that, after working in the IVF for a while, he came to realize that everyone needs to come to terms with each ethical dilemma that may arise with every decision. On the issue of when life starts, he has come to the conclusion that life does not always start at conception. Like with natural conceptions where chromosomal abnormalities are the most common cause of first-trimester miscarriage, a good percentage of the eggs fertilized via IVF technology contain chromosomal abnormalities and thus not viable for implantation. Not all eggs and sperms are created equal and, due to de novo mutations, not all embryos are created equal. To someone who believes absolutely that life begins at conception, the number of embryos destroyed for that reason alone would make the place seem on par with abortion clinics, not to mention the thawing of all the frozen embryos. Clearly, one would have to become a moral relativist to be able to work in this field.

Brisbane Bound

Four weeks came and went in Hervey Bay. It has been busy but also very productive. I caught all four babies. The consultants and PHOs have been refreshingly nice to us and the teaching was excellent. So, I am leaving Hervey Bay feeling that the subject of obstetrics and gynecology is much more under control than four weeks ago. I don’t think I can expect clinicians in Brisbane to give me as much attention in the next four weeks.

Good bye, Hervey Bay. You have been good to me.

Oh, Baby Baby

A major requirement for this rotation is that each student has to catch four babies. My experience with catching babies runs as deep as the one time when I helped out the midwife at a birth at the beginning of last year on my rural rotation. Unlike a lot of things in my medical training so far, like taking history and doing physical examination where we practiced over and over until we were blue in the face, we are stuck straight into it when it comes to delivering babies.

But I learned. The midwives were there to coach me on delivering the babies while coaching the mothers on breathing and pushing techniques. I realized that a major part of delivering babies, from the perspective of the midwife, med student, or doctor, is like cheer-leading, sans pom poms. When the contractions during the first stage become too painful for the mother, I offer her nitrous oxide and instruct her to breathe through each contraction. When the mother is exhausted and thinks she can’t push anymore, I follow the midwife and encourage her to push – with a calm voice. As one of the midwives put it, catching the baby in itself is the easy part. A lot of the work goes into what you do for the patient before and after the birth – anything from getting drinking water for the patient to wiping her bottom after a series of hard pushing, from helping the patient get into positions that might be a bit more comfortable to getting her warm blankets, it’s all part of the job. Of course, the medical side of things like taking her obs, documenting the progress of labor, and pain management has to be attended to constantly.

At the end of the day, seeing a healthy baby cooing in the arms of the exhausted but relieved new mother would bring a smile to anyone’s face, even if it’s two in the morning.

A Different Demographic

On my way to the hospital in the morning, I walk past the hospital sign. As per Queensland Health regulations, smoking is forbidden past the sign. So naturally that’s where clusters of smokers congregate, with a haze of smoke wafting around them or being blown into people’s faces as they walk by. One of the people leaning on the wooden stump is a young thin woman with a bulging abdomen, obviously pregnant. And yet, she’s puffing away without a care in the world.

I normally try not to be judgmental about people’s behaviors, even when there is a direct connection between their past or current behaviors and their subsequent illnesses. As long as they know the risks and are willing to take their chances, I am of the opinion that we, as health care professionals, are not there to save people from themselves. But when a woman becomes pregnant, it’s an entirely different story. All that individual freedom to choose what to do to their own body argument goes straight out the window, because it’s not about her body anymore. I am sure she has been educated about the dangers of smoking while pregnant. By knowingly allowing these toxic substances to circulate around her body, cross the placenta, and mix with the fetal circulation, what she is doing really amounts to child abuse.

~~~~~~~~~~

At antenatal clinics in the last few days, I saw quite a few pregnant women in their late teens coming in for check-ups. Some were on their first pregnancy, but some of them were on number two or three. I was told that it’s quite normal for young women to start having babies while in their teens in this area. The youth of these young expectant mothers were only rivaled by the young mothers I saw in rural Zambia. Such is life in rural Australia. While women in metropolitan areas focus on their careers and put off child rearing for later and later, women in rural areas run on a different clock, with a completely different set of priorities. I am not saying there’s anything wrong with having children so young, but to someone who grew up and live in the career-focused paradigm, seeing people who are content to start families as the first priority in their lives at such a young age is something that will take time to get used to.

Like they say, different strokes for different folks.

Back to Hervey Bay

It’s the beginning of the second-to-last rotation: obstetrics and gynecology. I will be spending the first four weeks of the eight-week rotation back in my old haunt Hervey Bay.

The med school is putting me and another fourth year up in a house in a new subdivision just behind the hospital. Driving down the new road behind the hospital, I can’t help but notice that the neighborhood in front of me could have been airlifted straight out of Anywhere, USA, and plopped down in the middle of Australia. The same denuded landscape that had been clear cut to make way for cookie cutter houses, the same manicured lawns with feeble saplings propped up by supporting frames, the same deserted streets in which the only indication of human inhabitation are the cars parked in the driveway. The elegantly designed Queenslanders that are built and oriented to suit the warm and humid Queensland climate have given way to the cheaply and massed produced prefab homes. Another unique regional feature has died a quiet death by the forces of McDonaldization of the Western world.

This sterile neighborhood will be my home for the next four weeks.

In the morning, I walk over to Hervey Bay Hospital that had grown so familiar to me last year. Walking down the central corridor like I had countless times before, I keep running into junior and senior doctors who had taught me last year. To my surprise, they all recognize me and stop to chat. Sure, there were only ten of us here last year, so they didn’t have to deal with a thousand med students coming through day in day out. But stopping to chat with a lowly medical student? That’s way beyond what I’d expect big shot doctors would do. And yet, there I am, shooting the breeze with the head of surgery, being asked about my elective in Zambia by the consultant in medicine, listening to another surgeon recounting his OB/GYN rotation during medical school.

It’s nice to be back in Hervey Bay.