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When It All Felt Right

Posted May 13 2012 11:08pm
I'm sitting on my porch, leaning back in the deck chair and draining the last dregs of tea from my mug. The air is thick with the scent of hyacinth, my lungs filling with a floral perfume with every breath. And I'm looking out onto the distant mountains, gleaming bright green in the sunlight of the afternoon. My computer is sitting on my lap and it seems I've been having some trouble finishing posts here; my draft box is piling up with fragmented thoughts and the beginnings of some potential stories. But I think I finally figured out why there's a block in my head, and it's because even though it would make sense to pick up from where I left off and continue my narratives in the order of my clinical rotations, I want to jump ahead and share what's been on my mind for quite some time. And so dear reader, what I want to tell you, what I really want to tell you, is about my ObGyn clerkship. Specifically, one unusually cold Thursday morning when it felt just right.

Now, you might think I'm going to regale with you the first time I caught a baby, and though that was an incredible, momentous experience, that will have to wait for another time. No, this story is about something entirely different. Two words - cervical cerclage.

I wasn't scheduled to work with that attending that day, but I've been waiting since my second year of medical school to work with this particular physician. So, I jumped at every chance I could to follow him. I stayed late when deliveries went long into the night. I came in early to help write notes before he rounded on his patients. And I loved every minute of it. So, when I flipped through his schedule and saw that he had a procedure, a cervical cerclage, scheduled for the next day, I asked if I could observe.

After changing into the forest green scrubs, the new material still rough and scratchy against my skin, I headed into the hall to run the board and figure out where the procedure was scheduled. As per my usual overly anxious self I was early, so I headed into the lounge to read up on what was to be done. A cervical cerclage is a series of sutures placed during pregnancy, around week 12-14, that are used to close the cervix to prevent premature birth. The stitches are then typically removed when the fetus is full term, by week 37. If you think about it, it's such a simple, elegant solution to a serious problem. Help keep the cervix intact and keep the baby protected and healthy in the uterus for as long as possible. After reading up on the different types of cervical cerclage techniques, I made my way into the OR to see if the nurses needed any help.

After introducing myself to the masked faces, I took my place at a safe enough distance from the sterile blue drapes covering the wheeled tables. I watched as people walked in and out, grabbing various plastic boxes and arranging shiny metal equipment in neat rows. There was an order, a logical sense to how things were done to set up for the procedure, and I soaked up the surgical choreography that was happening around me. As I watched the nurse pull out gowns and gloves, she turned to me and asked my size.

"Size 7 gloves please"
"Do you know how to gown up yourself?"
"I have before."
After eying me cautiously she nodded her head to me, the understood nonverbal cue to follow her and said, "Well, I'm going to show you how it's done."

She watched as I opened up the packaging and emptied the tissue packet of gloves onto the table, her eyes never leaving my hands unwrap the sterile gown from its cloth dressing. I stepped out into the hallway to scrub in, the bristly brush soaked in antiseptic soap tracking suds from my fingers to my upper arm and the cool stream of water washing my skin clean. I walked back into the room, little droplets of water collecting at my elbows as I carefully held my sterile hands clear from contamination. The nurse showed me how to properly unfold the blue paper and slip my hands into the free spaces. She demonstrated the exact technique of pulling the gloves onto my hands, the ends snapping over my cloaked arms. I've often made a note to myself how I feel safe and protected in this uniform, and this morning was no different. With my arms tucked against my belly, I watched and listened as the nurse walked me through the different instruments that would be used. She let me help set up the needles, explaining the difference between cutting and non-cutting.

The attending walked in and the atmosphere of the room shifted into full gear. It reminded me of that moment when the conductor knocks against the music stand and the discordant sounds of the orchestra settle into a unified chord. The patient was soon wheeled in and the attending began the prep. I stood off to the side, straining to get a glimpse over the physician's shoulder, but then he ushered me in next to him and instructed me to hold the speculum. He talked me through the entire procedure, explaining that he would utilize the McDonald cerclage, or a pursestring technique for the sutures. I was hunched over, willing my body to accept the uncomfortable position I was in, until the nurse instructed me to stand up straight. The attending looked up at me and firmly stated the words that have echoed in my head ever since.

"If you're going to be a surgeon, you need to have good posture so you don't hurt your knees and back."

The suturing resumed as he and the nurse continued on about statistics of surgeons who ended up needing surgery themselves from poor positioning. But as they talked, all I could think about was the image my attending had painted in my mind - me performing Gynecological surgeries, me delivering babies, me leading a C-section. He said it as if he thought I could do it. It all seemed possible. In that moment, it all seemed so tangible and real. And I wanted it.

I thanked the attending at the end and stayed back to help the nurses transport the patient. I was beaming, both inside and out. My insides were all happiness and light, and everything felt right. Nothing could touch me that day because I was in a truly happy place. And when I need to get back there, which is quite often these days, all I have to do is close my eyes and whisper to myself "cervical cerclage".

I've been interested in women's health for a long time now, I think my aunt had something to do with that . And even though I loved Family Medicine, I knew deep down, even before the actual rotation, that I would love ObGyn too. Well, I pretty much adored it. What surprised me the most was that being on the L&D floor and seeing patients in the Perinatal clinic - it felt strangely familiar. As if it was always supposed to be like that.

So there's the wrench in the plan - do a Family Med residency with a women's health focus, or go straight into ObGyn? I never thought of myself as a surgeon, I'm not even sure if I'll get into a program because it's competitive. It's a tough lifestyle, really tough, and the threat of malpractice is scary. But beyond that, it's ObGyn. It's inspiring and beautiful and challenging and exhilarating. It's being part of an incredible time in a woman's life, and it's being reminded of just how miraculous human development truly is. So, that's why I'm doing a Sub-Intern/Acting Intern rotation in ObGyn next year. I'm a little terrified of having all that responsibility as a fourth year, but I hope that my love for it will squash that fear down. I'm going to fight like heck to do it, and who knows, things just might happen that way they're supposed to.
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