And the consults continue

8/24/13

As I am sitting here, waiting for what will be both my first vaginal delivery both as an attending and in Haiti, I thought I might share with you some important things I’ve just learned about working at this little clinic.  [Specifically, these are things regarding agreeing to perform a delivery or any important job in an area where you don’t speak the language].  First and foremost, never agree to anything when your nurse isn’t at least partially fluent in english.  Now, I never really agreed to do anything . . . the physician here on call decided that she did not want to take care of the patient, so she told the nurse to come to me.  I really don’t mind the work . . . I was just studying prior to the consult (still no internet . . . not until Monday I’ve been told, won’t hold my breath).  Being told first that she is a multip (I didn’t ask that specifically . . . I asked, has she had babies before), then fifteen minutes later that she has never given birth before; Being told that the fetal heart rate is 16 (that’s right, sixteen) . . . freaking out trying to get a Doppler to confirm to find that the heart rate is in the 150s; Asking if the patient feels like she needs to push, and the response you get is okay; Waiting forever to just get shoe covers; unable to obtain any kind of history from the patient . . . and then being asked to write her orders, when you know they will not be understood or truly followed . . . all reasons why this whole thing was definitely not my ideal set up for a delivery.  I’ll let you know how it goes.

 . . . . it turns out that performing a delivery is much more fun than repairing a third degree [on a patient you did not deliver].  I must say, I was probably more entertaining here than I am with our folks in the states.  For those of you who have not worked with me on L&D, I have a tendency of being somewhat of a cheerleader.  Turns out,  I have not changed since residency, and have no problem coaching in english to a patient who has no clue what I am saying.  Eventually, we got things to work . . . a primip with no epidural (and no lacerations . . . I might add), and a beautiful 6 lb baby girl. 

I get the feeling that people are in more of a hurry to get people delivered here than in the states.  The nurses looked at me like I was crazy for not wanting to cut an episiotomy . . . and also acted like I was nuts for not wanting them to stretch out the perineum while she was pushing (yes . . . I did learn something about delivering women without epidurals in residency . . . and I apologize to all of the non-gynos reading this as this may have been a bit graphic, but it is part of what I’m doing here . . . what did you expect?).  

In the end, I really am here to help out and provide what little knowledge I have in attempts to maybe make the world a slightly better place.   I realized (especially today), that for most deliveries, we really don’t do all that much (especially here . . . where we really don’t’ have the means to make any type of intervention if needed).  That being said, they are still a very fun and fulfilling part of the job!