Overwhelmed and Gruesome: Dear Diary…

Zak Muggleton-Gellas, Year 2

Taking after our dear friend Bridget Jones, in all her expertise, I decided to begin accounting my experiences while on placement. To look back, to laugh, or most likely cry, at what rancid-smelling adventure I might encounter. On a frightful Tuesday afternoon, as a naive, know-nothing-at-all second year, I spent a night shift in obstetrics and gynaecology. I have swapped out names for the confidentiality of those involved. 

13:36→ Hello, future reader. I am currently absorbing the laughter and stressed aura of the medical students accumulating in the APL. Diana and Bob have reminded me that I want to document this monumental event. I will try to update as much as I can.

20:07→ Just arrived, and was met by three nurses looking confusedly upon me. My heart stopped. But they soon warmed up to me, I can only assume because I looked like a deer stunned by headlights, and unlocked the door so I could enter. Everyone looked incredibly tired and overworked. I am now waiting in the room for the consultant. I didn’t realise that not knowing her last name, or where I’m going, at all, is a large problem. I’ve been showed the main social room, and am now waiting. Feeling nervous but happy to be here; at least if the consultant never comes to meet me here then I’ll bumble to reception in due course and ask. I also have a mask on to mask any bad breath after my twiglets. Win.

20:17→ What a delightful woman. Met with lovely smiles as always on O&G. Just a few delightful phrases that the consultant Holly said: ‘this is going to be carnage,’ and ‘we will either be running around or sitting on our arses.’ I luv et.

21:31→ Just finished ward round. Going to ask to be lead through a patients notes to learn a thing or too. Everyone is lovely; one of the patients remind me of every person from home. She is 36+6 (36 weeks and 6 days) currently, with covid and can’t seem to escape the hospital after weeks and weeks. Risk factors rocket with c-section early, but she’s trying her best to manipulate the doctor. Let’s see if I manage to see a birth.

23:05→ Just saw my first birth. What a whirlwind. The birth was a suction cup (called a ventouse) with an episiotomy. There were a lot of fluids, everywhere, being mopped up by towels, unsuccessfully. Upon examination you can just see the hymen, with a tube being inserted into the urethra to empty the bladder into a bag.

After the head was delivered, and after an episiotomy with a lot of blood, the baby rotated beautifully (called restitution) so that the amniotic fluid could escape and also so that the shoulders can be delivered. No pulling occurred so no brachial plexus (nerves of the upper limb) injury. The baby’s feet were blue (which is normal) but the head was pink and perfused. The doctor put her hand underneath the neck and held the baby as it came out.

The umbilical cord was blue (a bit like the colour I’d imagine an ice dragon to be) and the placenta was like a big veiny balloon. I felt quite emotional when the baby was delivered; very broody. The mother looked relieved, and her first words to her child were ‘wow, she’s ugly.’

Also in practice, what you might expect a lot of blood to look like is not a lot of blood. It’s frightening. Additionally, I was told that men find it easier to get a job due to the fact there are less in the speciality, article pending. I don’t have time to dwell on this right now, though I get the sense it’s not exactly a complement. It seems too big. Self-deprecating medical student is more my style, anyway. 

Pizza now. I even got a present from the mother! (my own mother is suspiciously silent). Wow.

00:23→ An unfortunate woman has a baby in the transverse position, with pubic symphysis pain (stretched or torn ligament) due to falling in the road, going into the splits, and landing in the most unfortunate position. I wonder if this is the moment I get to see a c-section.

01:44→ Woah. Just saw a caesarean section of a woman with a BMI of 58. The subcutaneous fat layer required two doctors to hold it back. It was much faster than I expected. The baby was covered in a nature-made Vaseline. The layers cut through were skin, subcutaneous, rectus sheath and then uterus; all with a spinal block (the lady was awake). Then came suturing and a lot of bleeding, because the tissues were not of good quality due to diabetes. We were then whisked to a room with a woman that had a baby that was becoming bradycardic (heartbeat slowing) with each contraction. I have never felt so out of place in a room; she kept screaming ‘why is there so many people in this room?’ whilst looking directly at me. This was accompanied by screams and gas refills. The cannula used was comprised of a large grey needle. So I stealthily moved over to the side of the room out of view and then snuck out as soon as I could. So up and down. Will leave at 2:30 I’m deciding.

02:30→ Waiting for my expensive Uber in the dark. Decided not to go into that delivery room again; from outside, I could still hear every step of the way. Then had a delightful gentleman asking me for a cig and then telling me ‘urine for a treat.’ I was just hoping there would be no urine coming my way. What a night. Ready for whatever comes next.

I sincerely hope that this has been interesting.

Here’s some abbreviations I encountered:

• Multip → more babies
• 37+2 → 37 weeks and 2 days
• Not in labour → not labour until contractions or 4cm
• Singleton → only one child
• Cephalic → head near the birth canal
• OBS chole → obstetric cholestasis causes a build-up of bile acids in your body, causing itching of the skin but no rash.
• CxDil  → (dilation)
• Syntotoxin → womb muscle stimulating drug (OXYTOCIN)
• Liq→ amniotic fluid type (clear is desired)
• Epidural → anaesthetic