Tuesday, 10 September 2013

Pathway 3: Psych and Babies - Babies

I was expecting to like the NICU, but I found it really upsetting.  The latest research suggests that premature babies aren’t developed enough to be able to handle lots of stimulus from the outside world, so they are kept in warmed cots with blankets over the top in a silent room.  Any procedures that need to be done are co-ordinated to all happen at once so the amount of time the baby is handled for is kept to a minimum.  This means the parents sit and stare sadly at blankets over boxes whilst they wait until the allotted time when they are allowed to hold their child for a short amount of time, before being placed back in the box.  I can understand why this happens, and it was lovely to see the children progress from the sickest end of the corridor to the ‘almost ready to be discharged’ end, but I wasn’t expecting it to be like that so I found it really hard. 

I did like gynaecology, for the most part.  I stayed late on several occasions, and happened to be in the right place at the right time to be invited to scrub in on some surgeries, again showing that diligence and hard work pays off.  I got to help remove an ovarian cyst the size of a baby’s head and invited to help on some research papers which was pretty cool.  I liked that there’s a lot of flexibility in gynae, apparently.  You can do surgery or clinics, or both, and pick and choose which bits you want to do and which you don’t.  So, you could not do any oncology if you didn’t want to.  It made it quite a viable alternative to A&E for my future career considerations.  I know, I know, and so close to when I had finally made up my mind for that specialty, I’ve changed my mind again.  Well I haven’t changed my mind, I’m just keeping my options open. 
I was fairly horrified in the colposcopy clinics were they assess and treat abnormal cells picked up by the cervical screening programme.  The severity is graded from CIN 1-3 with 1 being some cells are abnormal on histology, and 3 being all cells are abnormal at histology.  The next stage beyond 3 is fully invasive cancer, so it is important it is treated.  CIN 1 will probably return to normal itself, but 2-3 definitely won’t.  Plymouth has two methods of treating it in clinic – either burning it off with a probe, called cold coagulation, or cutting it out with a heated wire, called large loop excision of the transformation zone.  I got to watch both types and it was probably one of the most brutal things I have seen being done to an awake patient.  Now you may think I’m weird, but I think the cervix is quite cute.  It’s like a little face with a mouth that goes “OOoooo” if you haven’t had children and smiles if you have.  I know, I’m odd but, it’s cute.  I can’t believe you can be so brutal as to cut it and burn it and make such a mess of it, and for that to be ok!  What probably made it worse was the lecture we had about risk factors, which basically said if you were more promiscuous, had many sexual partners and were sexually active from a younger age you were more likely to get the virus that causes this and have it for longer to be able to make the abnormal cells.  So although I tried not to, and obviously showed nothing externally, it’s hard not to pass some judgements about the ladies we were seeing. 

I got to finish with pregnancy and labour weeks which were very cool.  It was hard to take histories as the ladies are somewhat preoccupied and aren’t ‘ill’, so it needs a different approach to the normal history we would take.  That took some adjusting to and tended to make conversations a little awkward as I tried to remember all the extra bits that needed to go into a maternity history.  I got to scrub into caesarean sections and deliver babies, and I got to help with a natural delivery too, and delivered a real life, squirming, slippery, squalling baby.  It was surreal, mind blowing, amazing and fantastic.  A fantastic end to an amazing year.  I never would have imagined the things I’ve been able to do 3 years ago.  

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