"Baby, baby!!": OB/GYN rotation in Fairbanks, Alaska

Last January, I submitted my preferences for all 3rd year clinical rotations. Recognizing the unique opportunity to see and spend an extended period of time in different parts of the beautiful northwest (on the medical school's dollar), I specified that I would love the opportunity to do one rotation in Alaska, and one in rural Wyoming or Montana.  Contrary to the usual rotation requests, I did not specify the time of year, which specialty I wanted to do in each location, or specific cities.  So, when I received my schedule in April and had been assigned to FAIRBANKS, Alaska (the northern most site) for OB/GYN in late summer (the best time of year) - to say I was thrilled would be an understatement!

I arrived in Fairbanks to an incredibly generous setup: TWO offices (one private one in the hospital, and one shared one in the clinic), my own O.R. locker, a very nice car to drive, and a beautiful condo all to myself situated directly on an incredible wildlife conservatory!  I took the first day there to unpack, and identify a new church "home away from home", and within 48 hours of arriving already had a dinner invite!

Hey!  It's the small things!  :)

The conservatory which served as the grounds for my nightly jog.

Once at the clinic, I was immediately put to work training in OB visits in the clinic, labor and delivery in the hospital, and gynecological exams and surgical fixes for all ages and relevant health concerns.

Sample Day:
        6:30 - Rounding at the hospital on patients who had delivered, were in labor, or had had surgery in the days previous.
        7:00 - C-Section at the hospital!!
        8:00 - At the clinic, reading through the charts of patients I would see that day
        8:30 - Start seeing clinic patients!  Prenatal care, gynecological concerns, "annual exams", etc.
        3:00 - Done seeing patients in clinic, catch up on charting, eat lunch/dinner
        4:00 - Back to the hospital!  PUSHHHHHH!!!  Laboring any patient in the hospital in labor.
        7:30 - To bed!  .....maybe......yeah right.......
        (11 pm) - Ring, ring, ring!  "Hi, Analiesse?  We have a G3P2 at 9cm, about to start pushing.  Please hurry!
        (2 a.m.) - Ring, ring, ring!  "Hi, Analiesse?  There is a woman with a miscarriage in the E.R., who needs a D&C.  How soon can you be here?"
        (5:30 a.m.)  - Beep, beep, beep!  (Alarm clock.)  You have GOT to be kidding me!!  :-)

My Responsibilities/Abilities:
One of the most common questions I receive is with regards to how much I am able to actually do.  "I mean, YOU don't actually do the surgeries, yourself....RIGHT??!"  Umm, no.  Well, kinda.  But, no.  You can breathe.  ;-)

•  Clinic visits: I typically saw a patient and did their entire history (asked all the usual questions..."how long has it been going on for?"  "what have you tried to make it better?"  "are you bleeding/cramping/swelling/vomiting/crying/screaming, etc.") and did the physical exam (listen to the heart, see what parts I am supposed to see....all except for the breasts and vagina)....then I would come out of the patient room and give report to my supervising physician, he would ask me a million questions, and I would give a treatment plan....and then we would go back in together, and I dis the remainder of the exam with the physician watching and directing as necessary.
•  Patient in labor:  The extent of my involvement with laboring patients varied significantly, depending on how long I had been on the rotation, which physician I was working with, and the comfort of the patient.  By the end of the rotation, I would typically labor the patient all the way through on my own ("PUUUUUSH!!!  Almost there!  Okay, deep breath.  PUUUUUUSH!!!"), and call the physician in right as the infant started to crown (top of the baby's head is visible to everyone in the room).  I was able to "catch" (deliver with out assistance; the doctor supervising from over my shoulder) on multiple occasions, but really, this aspect varied the most.  And please remember, the patient and child were never in additional danger by my presence; the physician was always within running distance, should I have needed the backup.  :)  In fact, in many cases, the patient received BETTER care because they have one more set of hands and eyes, and often a more *present* person (I usually had fewer cases to concern myself with, than the physicians, so would spend more time with each patient).
•  Gynecological surgery: It was expected that I would prepare for surgery extensively the night before: know the anatomy I would see like the back of my hand, understand possible complications, and why the procedure was being performed.  Then, depending on the surgery and my level of experience on the type of case, I would act as either the 1st or 2nd assist to the surgeon.  Assisting typically involved retracting (holding things in place), suctioning, and some basic suturing.  
• Now, I LOVE surgery, don't get me wrong.  But honestly?  This was my least favorite aspect of this rotation...because of the extent of "pimping".  "Pimping" is when you are verbally tested over anything and everything, at the drop of a hat.  Of course, in the O.R., when one is scrubbed (sterile) and hands are in a patient, there is no quick Google search to be had.  It's either in your brain, or it isn't!  And there is always a room full of people (anesthesiologist, scrub nurse, circulating nurse, surgeon, assistant surgeon, and whoever else) to hear you hit or miss.  I would quite frequently freeze up, even if I knew the material well, and it did not take long for me to dread walking into the O.R. for what became hours of an oral exam.  (It really wasn't that bad.  But it's a mind game!)

Biggest Mistakes:
    (Kind of) Comical:  I was doing a pelvic exam on a woman who had had a total hysterectomy, and was concerned about her risk for cancer.  Not feeling a uterus (since it's obviously been removed) or anything suggestive of a cancerous mass, and caught up in the process of the exam, I stated (well meaningly!), "Well, there's not much here!!"  The woman jumped.  "WHAT DO YOU MEAN, 'there's not much here' ?!?!?!?!"   .......oops.....I mean....(sigh)......

   Serious: So, I write on this so as to acknowledge that, yeah....this is hard stuff....and to my fellow medical students:  it's not just you!  (Gulp.)  I was assisting on a mastectomy, and in closing the patient at the end of the surgery, I was suturing from one side of the wound, and the surgeon was suturing from the other side - with the intention to meet in the middle.  And, well.....somehow my suture needle found its way into (gulp...) the hand (gulp...) of the surgeon.  (GULP!)  Needle stick!  This means HIV and Hepatitis testing for the surgeon for a while to come.  NOT GOOD.  Not good at all.  And I can now hang my head in massive shame....  and someone, please remind me to remove this post come time to apply for residency.  ;-)

 Best Memories: 
   1. One of my best friends, Kelci, flew up to visit me!  We had an incredible time watching chic flicks, soaking in hot springs, dancing under northern lights at 2 a.m., whitewater rafting, ATVing, singing karaoke, hiking, and just generally sharing our hearts with one another.  Along the way, we also met a couple other fabulous individuals, and the adventures had together as a group stand among my all time favorite memories.

2. My father also flew up to visit while I was there.  Together, we adventured around Mt. Denali/McKinley and talked careers, Faith, and "boys" (he loves receiving updates and instilling his Daddy wisdom).

Poorly attempted "Selfie".

3. I integrated rather quickly into a phenomenal "church family", and was adopted by a family within that church while there.  I love that family dearly, and hold memory of the time spent together close to my heart.

"Sushi Party" at the Ekblad's!  We rocked that sushi!!

What God Taught Me:  Choose the Brighter Lens

Lens 1:  These rotations are by NO MEANS "easy"!  I was constantly messing up, walking on egg shells, and working insanely tortuous hours.  These are all things through which any medical student could really use the arms of family, the support of friends, or the ears of co-med students as we reassure one another: "it's not just you; and while that's bad....you'll never guess how I screwed up!!"  But in Fairbanks, as the only medical student for over 1,000 miles, and objectively evaluated by nearly every individual I encountered....through the shake downs and scoldings, I often found myself asking, "Am I really just that terrible a student??"

Add on top of that, while gone, I missed my brother's 21st birthday, my sister's 27th birthday, and my two nephews' (who are the WORLD to me) 8th and 2nd birthdays.  Additionally, my grandfather (whom I love dearly, and lived with my first year of medical school) was diagnosed with terminal cancer mere days before I boarded the plane!!

"Inadequacy" and "loneliness" were certainly fitting descriptors.

-----Now, completely erase that image from your head-----

Lens 2:  The medical school is essentially paying me (as in, my loans are no greater than the medical students staying in Seattle, and my flight, car, and condo were covered) to live up an extraordinary adventure!  I got to spend six weeks in one of the most beautiful corners of the world, was warmly embraced by the community, made incredible new friends, and got to actually *do* the medicine I have been dreaming of for years!!!  Does it get any better???!

~~~~~~~~~~~

Both lens 1 and lens 2 are completely accurate.  But which of these I choose to view life by...in Alaska, and in all life's chapters....was and is entirely up to me.  And the same for you!  You can CHOOSE to live your life with reflection upon the good and the hope!  Chronic joy is one condition by which we can choose to live life.  Happiness...not always.  But joy....yes.  :-)

Philippians 4:8   Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable--if anything is excellent or praiseworthy--think about such things.

Matthew 11:28   "Come to me, all you who are weary and burdened, and I will give you rest."

Psalm 118:24   This is the day the Lord has made; let us rejoice and be glad in it!!