Repost: Let The Mayhem Begin

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I rarely do re-posts, but each time the new round of residents shows up in their brand new lab coats, it makes me think of this story. Today I was grinning on the inside yet again.

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Medical studies prove it. Interns are more error prone during the first month of their first year in training. July 1 is the “changing of the guard,” so doctors and patients alike – be careful out there.

In honor of the graduating students and the residents graduating to their new PGY year, below is my version of a MasterCard commercial for the best story I heard about a new resident on an OB service. First a bit of an explanation.

When a woman is in labor, doctors will periodically do a gyne exam to determine how dilated the cervix has become. When the cervix is only 1 or 2 cm dilated (sometimes called “fingertip” dilated because all you can get in there is a fingertip), delivery usually isn’t imminent. As the cervix dilates, you can begin to feel the baby’s head (unless there is a breech presentation and you feel a foot or the baby’s buttocks). When the patient hits 8 or 9 cm, the patient usually starts feeling a need to push the baby out. Grab your catcher’s mitt, because the baby is coming. A little more information about cervical dilation in pregnancy is here.

Getting back to the story … mind you that this story is hearsay, but it comes from a friend of mine who worked as a secretary on an OB floor, so I consider her a pretty reliable source. I also did an internet search to make sure that I’m not perpetuating some urban legend and I couldn’t find anything. So here goes:

Medical school education: $240,000
Brand new white lab jacket with embroidered name: $37.50
Four pack of Red Bull to keep you up all night during your first call: $9.00
Obstetrical textbook to learn about the stages of labor: $219
Three one-minute cell phone calls to the chief resident to update him on the patient who is pushing but whose cervix remains “fingertip” dilated: $1.20
Spanish-English dictionary to find out why the patient keeps saying something sounding like “debo empujar” (”I have to push”) and keeps calling you “pendejo“: $16.95
Watching the OB nurse double check the patient’s cervix, flip out, and call for a STAT c-section because the patient’s cervix is fully dilated, the newborn is in a breech presentation, and you’ve been sticking your finger in the kid’s anus instead of the mom’s cervix for the past 30 minutes: priceless

9 Comments

  1. The part of me that wanted to be an ob/gyn is obliged to exclaim, What about just delivering the baby? A breech presentation descended far enough to be that deceiving would be difficult and dangerous to extract by cesarean. Why not call the attending to evaluate for a vaginal delivery first?

  2. You make me SOOOO glad that the surgery (bilateral salpingo oophorectomy with sub-total hysterectomy) I just had (10 days ago) was in June… and not July.

    I remember wondering why my doctor bumped me up to June. Maybe it had to do with the intern thing? Or did it have to do with the Edible Arrangement I sent him (thanking him for taking care of me through thick and thin over the past three years)?

    Nonetheless–very happy to be intern free! :-) I’m sure “baby doctors” are fine people, but after my first and last experience in a teaching hospital (GWU in DC), where the intern and the attending misdiagnosed my endometriosis as GERD (!!), I ain’t never going back.

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  4. Habib Blacksheep, DO on

    When my wife gave birth the nurse told us the very same story. In fact, as soon as you mentioned breech and before I’d scrolled down to your priceless conclusion, I had it in mind.

    “She just doesn’t seem to want to dilate, chief! This mom is steady at 2 cm.” Legend or no, this one’s a keeper.

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