Thursday, April 7, 2011

Obs and Gobs for Real

In Febuary my sister Dr Tabubil started as an intern at one of Brisbane's big city hospitals.  Her first rotation is in Obs and Gobs - Obstetrics and Gynecology to those of us without that delicate Australian turn of phrase. 
            It's been rather full-on, and even after four years of Med School, O'nG has required something of a mental adjustment.  The first day or two, she came home at night tired - but exultant.
            "I assisted on two births - and I stitched up an episotomy tear!  By myself!  And it stayed closed!  I am greatI am a doctor!" 
            Soon she was coming come home pale and exhausted - and silent, and when pressed, would mutter hair raising fragments of thought like:
            "the blood the blood/nobody/ should lose that much blood/ and still have a uterus - nine liters/ if they'd had a drip pan we could have recycled/ it was coming back out as fast as we piped it in."
            "he told me to rip her open! We/ were doing a C-section and the registrar made a cut and put his hands into her belly/ he made me put my hands in there and PULL/ 'TEAR, Doctor Tabubil!' / I didn't have enough leverage and he shouted 'RIP IT!  TEAR it! PULL it!  HARDER!'  I wasn't strong enough/ he put his hands underneath mine and he-PULLED and RIPPED and TORE."
            She splits her days between the birth suite, the OR and the ward, where she's learning to be an instant authority - the thumb of god - over a corps of nurses who need signatures Now! to dispense  medications she she'd never worked with for conditions she's only read about.  She's become familiar with the symptoms of preeclampsia and placenta previa and HELLP syndrome, which really frightened her.  She's learned how to work with expectant mothers who talk around  the issues that frighten them, and to steel herself to read  the charts of the patients who come in as "anonymous" - and to pray to a higher level of god than herself that the baby will grow up to survive the environment that the mother is hiding from.  She's seen her first baby die - and her first expectant mother die.  She's seen residents weeping over stillborn babies, and nurses squaring up to threaten the men who've bribed or broken into Centerlink computers to find out where their pregnant women are giving birth. 
            And there are the babies.  She's learned to do a full physical exam with one hand, because the other is cuddling a baby.  She does more ward rounds than she needs to, because the babies need cuddling.  The mothers love her because she adores their babies, and she loves them right back, because they let her come in and cuddle a dozen times a day. 
            And at some point along the way, her joy in the babies spilled over into her increasing fascination with the surgeries and two weeks ago she found herself vociferously refusing to swap a surgical slot for a ward shift because "I only get one day in the OR this week and I'm not swapping it for anything!   I love doing C-sections  - opening up a mum and bringing out a healthy bub!  It's real doctoring! "
            But she's not having one of her own - nuh huh. Nothing doing. She's seen too much too fast. She waxes enthusiastic over adoption. And surrogacy. 
            "Both are viable options.  I'm willing to explore both when I get around to it. But I'm sure you'll be fine." (she said with spectacular condescension.)  "You haven't seen the real front lines like I have.  Ignorance is totally bliss."

And last night I had a phone call from her:
            "You and Mr Tabubil and Miles and Sarah are driving up to Uluru for Easter right?  Uh huh. There isn't much out there between you and Uluru, is there?"
            "Not much."
            "And HOW pregnant is Sarah going to be when you do this?"
            "Seven and a half months."
            There was a big sigh down the phone line. "That's what I was worrying about.  Do I need to give you a few tutorials just in case?"
            "How to deliver a baby while Miles drives hell for leather toward somewhere with a cell phone signal?"
            "Yup.  I'll start with the short version.  We'll work up from there."

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