Shame and Salvation - Miercoles

Wednesday was a rough day and a great night. During the day, I delivered a baby and when I went to repair the tear, I fucked up. Dr. Pacheco was called away and two very capable students were left to help me. And it was going fine, until suddenly I wasn't understanding their directions and it seemed like I had totally misapproximated the edges of the tear (truth was, I was fine, I just needed to do another layer of stitches to, I just didn't get what they were seeing). Then I made a really bad stitch, so everything had to get cut out. This was when the tears of frustration and mortification and guilt and dissapointment started welling up in my eyes. Dr. Pacheco gave me a pep talk (don't think you can't, if at first you don't succeed, you need to hide any uncertainty from the patients, don't shatter that patient illusion of doctor as infallable, I am very proud of you, etc., etc., etc.) and he finished up the stitching. And then I made a half hour lunch break into a two hour lunch break, because I'm one of the strange, somewhat spoiled, very oblivious foreigners.



I'm 26 and I still deal with my stress by crying - sigh. . not so professional and oh so inconvenient. It has so many undesirable effects. . like the poor students felt so guilty, and Dr. Pacheco felt guilty. I just want to remain composed, but the more I try, the more the flood gates open. . I'm just a hopeless cause.

But a shitty day turned into a great, get back on the horse kind of night. I had Guardia with David, Mario (Peds), and Liliana. David and Liliana were the interns responsible for births. Liliana went to c-section and stayed there all night - through all 9 of them. . all 9 of them with only a 10 to 15 minute break in between. That's a new definition of hardcore. I stuck with David in the Partos part of the ward. Things were pretty mellow for a good portion of the night - just a few births that David did since the attending really couldn't stand my presence. David even had two tears so bad that the doctors stepped in to help repair (of course I felt bad for David, but secretly this made me feel a little better - even the surgeons to be need help with stitching sometime - but that's just secretly). I spent the bulk of the night tactoing (yes that's a made up Spanglish word) cervixes and dopplering baby heart beats (the new wing has dopplers for those of us with poorly trained ears).

The baby (shit) storm hit around 1 or 2, I don't really remember. David had just finished with one birth when another woman (Gravida 6) went from about 0 dilation to 10 in 10 minutes. That's really fucking fast. It was beyond an easy birth (I mean, she barely had to push). The doctor helped a lot, but I did some stitching, which was really the horse I needed to ride again.

Then all of the doctors disappeared. I don't know where they went, but they were gone. That was when woman one went up, woman two started to crown, and woman 3 followed shortly after. David handled woman 1, I coached woman 2, and I think the Dr. or David or someone else, I don't know attended woman 3. My woman actually took a while. . it took a lot of pushing and a lot of pain and a lot of exhaustion before her baby came down. She was pissed at me by the time I finally got her into the stirrups. So I was alone and trying to breathe deep, thinking, I can do this, I can do this, I can do this. It was a mantra of desperation. David came in when he was done with woman 1 and I had a flicker of hope, but then he got called to attend woman 3 - all hope was shattered. The problem was that the baby was just not lowering. . .nothing was happening. (And even if there had been someone around to call for, I don't know how to politely call for help in Spanish). The Doctor eventually showed up, stuck his hands inside the woman's vaginal and did some head rotation, told me where to put the episiotomy, and pushed with all of his might on her belly. Pop!

And then I successfully sewed up the episiotomy - without anyone watching over my shoulder or really telling me where to stitch (not saying that I liked this sitution, but it was that do or do thing). The worst part was that she was in so much pain. I gave her lots of topical anesthetic, and I asked for them to push more anesthetic into her doppler or IV, but no one was around to do it, and I had to proceed. At the end she said, 'I'm never going to forget this.' Ugh. . I felt awful. Still, despite the pain, I think it was successful. . I hope it was successful. . people said it was, but it's a sort of unsettling feeling being all on your own and responsible n' shit. Welcome to doctoring, eh?