Wednesday, July 30, 2008

The medical student cervical exam

I was getting desperate while waiting to go into labor for the first time. My due date and come and gone and I certainly wasn’t getting any smaller. In fact, my edema was multiplying every day and looking at my elephant legs was getting a bit old. Not to mention the fact that I had already started taking my maternity leave and stopped working on my actual due date. A date which continued to mock me as each day went by with nary a bloody show or contraction.

When I woke up in the middle of night to feel a steady trickle of fluids, I was ready to do a little jig out of joy. Upon inspection, it looked like what I always imagined amniotic fluid to look like. I mean, I thought I could see vernix. This was a grand slam, home run. Labor and Delivery advised us to come in right away.

By the time we got to the hospital, I had already started having contractions, 7 minutes apart. The senior resident in triage seemed kind and capable. He asked me if it would be alright if a medical student followed me and examined me.

Being a clinician-educator myself, I didn’t hesitate. Sure. Why not? I didn’t work with students at this school (I would feel uncomfortable if there would be any chance of becoming this student’s supervisor someday after him performing a pelvic exam on me).

The resident talked the student through the exam and they took a swab of the fluid to examine it under the microscope together.

A few minutes later, the resident returned and informed us that I was not actually in labor and that we should go home and follow up for our already scheduled appointment in the OB clinic later that day.

WHAT? Was this a joke?

He said that the fluid was not amniotic fluid.

What is it then? I asked in a perturbed way as I lay in a growing pool of amniotic fluid on top of the paper sheet.

It could be urine.

I’m not urinating on myself! It’s amniotic fluid, I’m sure! At this point, I was feeling like I might hurt someone if they didn’t admit me right away and get me some pain meds. Can you check another sample? (said with a wee amount of bitterness)

He looked at me as if dealing with an out-of-hand customer at the customer service counter. Okay, he said, placating me, we’ll check another sample.

This time, he did the procedure and when he came back into the room, his look was sheepish.

Welcome to Labor and Delivery.



4 comments:

  1. Although it was amniotic fluid, glad the student suggested urine and not semen. On another note, being a clinician-educator as well, I'm pro trainee, go for it, make it a learning experience, we're all professionals. Draw my blood, put in my IV. But, given where I gave birth there was a near 100% chance I'd become this student's supervisor some (imminent) day, and hence, when it comes to pelvics, it was an apologetic, "I really believe in education but..." from me.

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  2. For my first prenatal exam, I allowed a 3rd year student (rotating in our family med dept) to do her first ever Pap smear. That's right...first ever. I'd told her I would get her some Paps on my patients. What better way to introduce her to my female patients than, "Hey, she did a Pap on me and I survived." My doc thought I was very brave. Once a resident at this facility, this student became my patient. Alls fair in love and training.

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  3. I let our NP put her first IUD in me. I screamed so loud the whole staff came running in the room to check on me.

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  4. No way.

    KC, I've been reading all of these posts with great fascination. Thanks for your spearheading.

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