Tuesday, June 30, 2009

Starting to feel "real"

Remember in the Velveteen Rabbit? How you know when things become real because the get all beat up and whatnot? Yeah, I'm pretty sure that's what it's like when one becomes a "real" doctor.

It's been a hard 6 days (only 6? yikes...). But I'm starting to get it. A lot of the struggles are systems based: who to call for what, what I'm expected/allowed to do without an attending/who's nice/who isn't, etc.

Yesterday, a nurse paged me:

"Dr. G, I'm calling about Patient X. Dr. F came up earlier today to evaluate her bleeding. She gave Pitocin. But the patient is bleeding again. A lot. Gushing."

My stomach jumped to my throat. I pulled it together, asked about her vital signs, asked if she had an IV and what was running. And then I said I'd be right up.

When I walked into the room, the nurse gave me a run down of the patient's bleeding. She'd had a Cesarean section 11 hours earlier, and she'd been alternately trickling and gushing ever since. She was tired, pale, and still bleeding. I took a breath, and reached for a pair of gloves while asking for a fluid bolus and a stat CBC. I did an internal exam and found a few small clots, which I removed. Suddenly, I felt something shift inside me, and the "real doctor" in me came out. I turned to the nurse manager who had joined us, and asked for 2 mg of morphine, because I knew that whatever I was going to do next was going to be painful. Because the patient was "stable," I knew I could wait for pain relief. But I also asked for more meds, some of which I planned on inserting in the patient's rectum (yeah, no one likes that, but it works). Once the morphine was in, I did the most aggressive exam I've ever done, medicated the patient, inserted a speculum, and removed about 200 ml of clot from the uterus. Then I watched the cervix, saw that it truly wasn't bleeding, and felt the uterus contract into the firm ball that we love.

I'm still not sure how I knew what to do. It was almost an out of body experience. I kept communicating with the nurses and the patient, telling everyone what I was going to do and why. I know that I told the patient over and over again that we were going to take care of her, that she was going to be fine. I heard my voice, calm and steady, even though my thoughts were frantic: please stop bleeding pleasepleasepleaseplease. But she did. I did the right things, and she stopped bleeding. And she didn't even need a transfusion.

And later, in my inbox, I found an email from the nurse manager to me, my chief, and my program director, telling us that I was very impressive, both "professional and patient centered in a somewhat hectic situation." And I felt like a real doctor.


twinsetjan said...

I'm so proud, K! You showed real courage...taking action and doing what needs to be done when you're really scared...even though you are really scared! They should name the baby after you!

Liz M. C. S. said...

I wish I felt like a real anything! Move to MN in time for me to give birth? (uh, you have plenty of time)

twinsetellen said...

wow. congratulations. this feels way more significant than being hooded, Dr. G.

Lola Goldberg said...

It's one thing to experience the transformation as you did, but having your efforts appreciated and commented on in the e-mail must have been extremely satisfying. I'm sure the memory of this one will always be with you. Well done, Dr. Gibbins.

Kristin said...

i'm back from 2 weeks in colorado (intense weeks but lovely) and then 1 week of catching up. FINALLY going to knit tomorrow at the Phoenix! yes it's the 4th of july but Laura B, Ginny, Sandy and Linda all say they'll be there...
so here i am, catching up on your life, via your blog.
ok, um, wow.
your writing style (and/or my empathy) had me right there in the room (and in your mind) with you.
i liked the part when you said you knew you were about to do something really painful.
i have to say, karen, if i had to have a doctor do something harsh to me, i would want a doctor just like you.
you remind me so much of a line in an adrienne rich poem: "unavoidable violence with such restraint"
you did a good thing for that person, karen. and her family...

here is the poem-

Your small hands, precisely equal to my own -
only the thumb is larger, longer - in these hands
I could trust the world, or in many hands like these,
handling power-tools or steering-wheel
or touching a human face...such hands could turn
the unborn child rightways in the birth canal
or pilot the exploratory rescue-ship
through icebergs, or piece together
the fine, needle-like shreds of a great krater-cup
bearing on its sides
fingers of ecstatic women striding
to the sibyl's den or the Eleusinian cave -
such hands might carry out an unavoidable violence
with such restraint, with such a grasp
of the range and limits of violence
that violence ever after would be obsolete.

take care and post to us in rav so we can all say hi, huh?

Paula said...

Oh, wow! Of course, you're a real doctor! Your years of hard work kicked in, and your heart told you how to reassure the patient and the staff. So very proud of you!

Caroline said...

Hi there! Just saw you post on Ravelry and thought I'd check out your blog. I'm an L&D nurse and love this story =) I work at a teaching hospital and we get med students all the time and we just got a batch of new residents in the last week or so. I remember being new (I've only been a nurse for 8 months so I'm still pretty new) and always try to be kind to all the newbies. Great job keeping your cool and doing what you had to do!