By Emily Krause
This article contains description of labor and delivery.
“We need to do a C-section” the resident says before running off to start preparing for surgery. Right away, nurses start moving to the operating room (OR) and to get the patient ready. The patient had just revealed her sexual transmitted infection (STI) to the intern, which is a contraindication to vaginal delivery. The laboring soon-to-be mom is 9 cm dilated (a patient needs to get to 10 cm to deliver), so time is essential. My heart starts beating fast, and I am just watching. I am only a few hours into day one of shadowing Dr. Rachel Chan Seay (A02) at Johns Hopkins Bayview Medical Center in Baltimore, Maryland.
I am already awkward as a student shadowing in labor and delivery; not knowing where to stand so as not to be in the way. Now I am going to the OR. And I have no idea what to do. After putting on shoe and hair covers I’m ready to enter the OR and watch a C-section. The nurse scribing tells me where to stand so I am not in the way but can still see the surgery. I know everything to do to keep from fainting: keeps you knees from locking, slow deep breaths, and most importantly, if you feel faint, slide down the wall. Better to sit down than hit the floor. I make it all the way through delivery (mom and baby both made it through well), but something happens during the stitching that make the walls close in and my stomach queasy. I slide down the wall and not long after a nurse comes in the room and walks me out. While embarrassing, I learned it does get easier – over the course of the next four days I observed two more C-sections and two hysterectomies without any problems. With each procedure I gained a better sense of where to stand and who to ask my questions. I grew comfortable enough to ask a nurse where I could stand to see the surgery closer. She showed me where to stand and instructed “Don’t touch anything that’s blue,” in order to safely remain outside the sterile field (the very clean area where surgery takes place).
In addition to learning some of the technical aspects of surgery, I learned more about myself while watching these surgeries. I really enjoyed the OR and can see myself as a nurse working there. It was also incredibly gratifying knowing how important surgery can be for a patient, whether that is having a baby or being relieved of pain. I also gained a greater understanding of identifying problems and of patient and provider communication. The C-section was only an emergency because the providers did not know about the STI until close to delivery, otherwise the surgery could have been scheduled.
Dr. Seay said “We see the things that we look for.” If a provider is not looking for an STI, they are much less likely to notice it. This can be applied to many different situations. If a patient comes to the office reporting a symptom, rather than jumping to a conclusion about what might be the cause, it is much more effective to make a list of all possible causes and then systematically “remove” things from that list as you further talk to and examine the patient. If a provider too hastily decides what they think may be going on, they can miss the true diagnosis.
Making assumptions can also pose a problem when establishing trust between a provider and patient. It can be embarrassing to talk about one’s health, especially about an often stigmatized health condition. By really listening when a patient talks, without judgment, the provider can help create a safe environment for the patient. Patient education also communicates to the patient that the provider is interested their health. When a patient knows more about their body, they gain confidence in advocating for themselves and in taking an active role in their health.
My career goal is to become a Women’s Health Nurse Practitioner. When I am a provider, I will create a safe environment for my patients by asking about their health history in private, to help ease their self-consciousness. If I have to tell a patient they have a health condition, I will take the time to explain it, how to take care of themselves, and really make sure they understand.
I am so thankful I had the opportunity to shadow Dr. Seay this summer. The experience helped solidify my desire to help women with many different aspects of their health care needs. I am excited to begin this journey after I graduate this spring.