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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