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Lessons in humility

I started on my labor and delivery (L&D) rotation last Thursday--and it has been challenging, to say the least. The most difficult part of L&D also happens to be the part on which everything else hinges: the cervical check. Deciding whether to admit a patient? Do a cervical check! Wondering if it's time to call the anesthesiologist for an epidural? Check the cervix! Questioning the progress of labor? Cervix!

Why is this such a problem? Imagine introducing yourself for the first time to a woman who (at worst) is screaming and writhing in pain and (at best) is extremely uncomfortable, then saying, "I'll need to check your cervix." Translation: We just met, and you have a human being trying to escape from your body...but can you please get in a frog-leg position so that I can stick my hand in your vagina? Not only is it painful for the soon-to-be mom, but given my lack of experience with palpating squishy objects that are hidden from my vision in narrow spaces, the resulting pronouncement is essentially meaningless: "Umm...so I think that the cervix is about 3-4 cm dilated, 80% effaced, and baby's head is at -1 station." Recheck by chief resident: "So...she's actually 9 cm, 100%, and +1 station."

Fortunately, all of the attendings and upper level residents are unbelievably supportive and patient. After the scenario I just described, I apologized to the attending for my faux pas, and she said, "Don't apologize! This is for your learning. You got to have the experience of doing an exam that was a 9 but felt like a 3!"Is there such a thing as a 9 that feels like a 3? Probably not...but I appreciated her kindness.

The past few days on L&D have been busy/crazy/challenging, especially the daily (hourly!) lessons in humility that come from being an M.D. but having no idea what to do. On the bright side: I'm getting paid for it! (And I have back-up, so moms and babies are still getting good care.) Hopefully the embarrassment will pay off and I'll become an expert at sterognosis!

In other news: we had our first visitors last week, and it was great! Here are some pictures.



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Location: South Burlington, VT, USA

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