Guardias Uno, Dos, Y Tres

So Monday night was my third guardia. I am now half way through. I am tired and am in total awe at the ability of these interns to pull 36 hour shifts every 4 days and be functional and highly successful in all of their responsibilities. Tuesday was actually the first day in my life that I have ever fallen asleep while standing up (in my defense, I was in the ultrasound room and it is dark and cool and their are these machines with soothing images on them, and the doctor that runs the ultrasound room is more or less an asshole, so I was trying to go to my happy place). I was giving an ultrasound to a patient and I kept falling asleep while I was moving the rolly thing across her belly. I think it was just for a second, but what if it was for a minute or more? I'm sure the patient knew or was scared shitless.

My first guardia was a night of watching. Occasionally I felt around for a cervix (which I always failed to feel) and stuck the little heart beat magnifier thing to the big belly for about 10 minutes while not hearing anything. I was exhuasted by my uselessness.

Guardia numero dos was a bit better. Partially beacuase 2 of the interns on that night spoke pretty damn good english, so if there was ever something I was really not getting, they could explain it to me in English. This meant that I spent much of the night speaking English. Plus, by then I had sat in the hot seat twice under the eyes of Pacheco, so I had a slightly higher level of confidence. My Spanish was rolling a little more and I was getting more comfortable with the interns and students. I even delivered one myself with the kind tuttelage of Totti. Things were all calm and happy until the end of the shift (I mean like 15 minutes until the end) when one of the interns was in surgery, Totti was delivering a baby, and another woman was crowning in her bed. He looked at me and said. . go get ready. I must have looked terror striken because he finished birthing baby number 1, re-gloved himself, and delivered baby number 2. Then he took off and left me to stitch up with another intern watching over my shoulder. It took me like an hour to make 6 or 7 stitches.

Ahhh. . stitching up. . .so the first time I ever put a needle into human skin was last Wednesday when I stitched up my first episiotomy. Episiotomies are not easy things to repair- they aren't surgical incisions into durable skin. They are more or less tears in uncooperative mucosal tissue that continues to tear and ooze blood if you don't make the right kind of stitches. All this to say that I am not really as good as I'd like to be at the whole stitching up process (In confession, I'm not sure all of the vaginas I have repaired look like they are supposed to). I don't know what I am doing, and I don't always understand the guidance that everyone gives me, plus the guidance changes drastically depending on which student, intern, or doctor is giving it. And it's not like the repairs made by the students, interns and even some doctors are works of art. Really, as I mentioned before, I'd be pretty pissed if my vagina was subjected to the 'repairs' performed by some of the less diligent students and the lazier doctors. But, the whole idea of us practicing sans any experience or strict observation is emblematic of the fairly large ethical dilemma both Erin and I are facing down here, but I'll get to that later.

Guardia numero tres. . Monday night was intense. It was relentless. The new (absolutely gorgeous) hospital wing opened on Monday, so we were in the much larger, air conditioned space (which was the nice thing about the night). Usually there were 5 to 7 patients at any given time in labor (everytime one patient gave birth, another one stepped up to take her place). And it seemed like the births came at least once an hour, if not two an hour, so there was no rest for the weary. And to make everything harder, there were only 2 interns on Monday night. That makes: 1 attending for partos, 1 attending for surgeries, 1 attending for peds, 1 intern for partos and surgeries, 1 intern for peds, and me. Plus a very capable pre-intern who showed up at around 10 or so. I was thrown into a c-section as the only assistant of a doctor who was not so pleased that his assistant didn't have a fucking clue about what to do and couldn't speak any Spanish. Thank god for the nurse - the surgical nurses here are so incredibly patient and gentle. The beginning of the night was spent with an attending who doesn't believe in automatically doing episiotamies. . I like him. I delivered three babies with help, but mostly I checked cervixes. I touched lots and lots of vagina.

I want a shirt that says, 'I touched lots of vaginas in Leon, Mexico.'