Let The Mayhem Begin
Posted by WhiteCoat on June 30, 2008
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
Wowsers! said
Unbelievable. Truly.
rlbates said
Priceless, indeed!
ernurse said
Good grief!!
Alex D said
Ha, ha, ha,ha,ha, completely funny.
Alex D
http://theapocalypsepapers.blogspot.com
Chrys said
You are too funny. Good story. Poor baby. :0
GuitarGirlRN said
This is why I go on vacation the last two weeks of July every year. Our new ED residents start work on the floor around the 15th each year, after two weeks of orientation.
By the time I get back, most of them have settled into their stride and are coping nicely.
medrecgal said
OMG…that was hysterically funny, even though it could very well have resulted in some problems for the poor baby… And it just goes to show that sometimes it’s experience that matters rather than credentials! I’d take an experienced OB nurse any day over a newly minted resident if I was in labor…no offense to the docs, but, there are times when you need experience! (Of course, the best scenario would be one where the doc and the nurse were both experienced! That’s one of the hazards of a teaching hospital I guess, and we’ve all got to learn somehow…)
kiwicuz said
Priceless. I was attempting to swallow as I reached the punchline.
teresaduncan said
That was awesome…what a great story!
Davey said
And now, having laughed my ass off, I have to go the ED and get it stitched back on.
Albinoblackbear said
Well I guess when it is the first time you’ve had your finger in a fetal anus via a dilated cervix your clinical assessment may be a bit off…
ouch.
SeaSpray said
I wonder if they have lived that one down yet? Bet they never make THAT mistake again! GEE!
Last year I read a med student’s blog where she said that between May and July…the monkeys (new med students) run the asylum and questioned what the difference in the med student’s experience was between Friday’s graduation and Monday and they are a doctor?
That was back when I first thought I might have to have the re-constructive surgery and new it was going to be in a teaching hospital…and so I was thinking that maybe April was the best month.
CardioNP said
I am awaiting an appointment at an academic center near me to be evaluated for surgery. (it is a uncommon procedure not done much outside of academic institutions)
When I realized it was going to be July when I got my appointment I was a bit disconcerted.
Let’s just say that if surgery is recommended, I may postpone it until September or October.
Nursecaz said
LOL I could so totally see that happening on my L&D unit…Today is July 1st and I have to work…I shall be performing my own pelvics tonight!
Happy Hospitalist said
That’s hilarious. You have earned yet another spot in my who’s your daddy posts
Happy
HyperAl said
OMG…how funny…but not really..OMG. I have a feeling everything went well..right?
Samson Isberg said
Who is calling who stupid here…calling for a STAT C-section for a normal breech presentation with a fully dilated os signifies a QUACK in my textbook. If you can’t deliver a breech presentation vaginally you have no reason to be on call on an obstetrical ward at all.
Shame.
Theresa said
Heck, I did the same thing a few months ago! However, I did NOT mistake the anus for a fingertip cervix. I mistook it for a head. Until 7 centimeters when it became apparent it was a butt. Sigh.
Rowan said
To Samson,
In the day of insane malpractice costs, in my experience there are few OB’s that will do a breech delivery vaginally. I know of 3 of about 50 that I know.
To, Theresa, the anus is commonly mistaken for the head and thus the reason I always confirm vertex position with an U/S when they present for delivery!
Kim said
Whoa. : 0
Frank Drackman said
I remember the OB nurses laughing about some Ukranian transitional Intern who stuck some Fetal Scalp Electodes up a woman’s ass instead of on the baby’s scalp. I think he knew what he was doing, the Women Loved the guy. And no, the Ukranian Intern wasn’t me.
TBTAM said
The OB chief should always check the intern’s exams. This is a case of poor supervision.
Glad everthing turned out ok.
HyperAl said
Samson Iseberg..that textbook must be very limited issue. Have not seen it.
Is it really an issue of “Can you do it?”. I think it’s more of, “Are you willing to take the risk”. Very few will and I applaud you for the willingness to take that risk. Remember the 18 years statute is a long time.
Vijay said
OMG!! They should’ve done a bedside ultrasound scan to check the presentation if they were in doubt IMHO
MadDoc said
One of my student deliveries was with a newly qualified midwife. A similar situation – examination – not fully dilated, mother insisting on pushing. Sudden chaos – the cervix seemed to hove into view. Was it? No – it was a face presentation and she had been feeling the inside of the baby’s lips on examination. The poor child looked like Mick Jagger when it finally emerged.
I foolishly mentioned this in my Obs Viva.
Mistake.
bongi said
i once saw a case where an obstetric nurse decided to pass a catheter to empty the bladder so that the baby’s head could engage. she placed the catheter nicely into the cervix and inflated the balloon, pushing the head further back. the nurse was the wife of the superintendent so i said nothing (until now)