Ob-Gyn Patient Logs
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I have described some patient encounters that have resonated with me. Although I have chosen to write about some tragic cases, this is not reflective of my overall experience. There have also been countless happy and healthy women of all ages with whom I have had the privilege of interacting.
Patient A: I found myself in an exam room attempting to take the history of a patient who only spoke and understood Spanish. She was in her late 50?s, extremely thin, and walked with the aid of a cane. Through many elaborate hand gestures paired with clumsy utterances of Spanish phrases (on my part), I managed to gather that she recently underwent open heart surgery, and during her hospital stay, had fallen and broken her hip; hence, the cane. She was so patient with my foreign language fumbles and we shared frequent giggles.
Her last pap smear to screen for atypical cervical cells was over 5 years ago. Upon pelvic exam, her cervix was irregularly shaped and bore noticeable discoloration. When I tried to collect cells, the instrument caused her cervix to bleed more than normal. My preceptor spent several minutes controlling the bleeding as well as taking biopsies. I stood next to her and held her hand as she silently cried in pain and fear. She had just gone through 2 major life-altering surgeries and now she had overt cervical cancer. I had gotten used to performing routine pap smears day after day, knowing that this screening test had helped push cervical cancer from the most prevalent to the 5th most prevalent cancer in this country, that I wasn?t expecting to see a patient with it, and especially not so far apparently advanced.
I wish I could?ve said something to comfort her when I was standing at the head of the exam table. I hope that just being there with her in that moment helped even a little. She still has a long and hard journey ahead of her.
Patient B: A sophisticated young woman came into the office with a desire to become pregnant. She was well-dressed, wearing tasteful jewelry, and had not a hair was out of place. In the past, she had been pregnant 3 times, but all had unfortunately ended in miscarriage during the 2nd trimester. As we prepared to do her pelvic exam, we explained to her that one possible cause of her recurrent miscarriages could be something called ?incompetent cervix? ? a condition where the cervix painlessly dilates resulting in the loss of the pregnancy.
The bimanual exam derailed our train of thought completely. Instead of feeling soft and healthy tissue, a large, solid mass was felt in the upper right portion of her vagina. It wasn?t bulging out, which would signify vaginal cancer, but the wall felt hard. Biopsies were immediately taken and she was sent for a stat CT scan. The report showed an extensive mass from her vaginal wall extending up to and blocking one of her ureters causing her right kidney to be backed up with urine. Due to the complexity of the problem, she was urgently referred to a gynecological oncologist.
She came into the office healthy and hopeful for a pregnancy. She left with a veil of uncertainty and a likely diagnosis of invasive cancer. She is only 28 years old.
Patient C: The midwife and I were reading the chart of the next patient waiting in the Labor and Delivery Triage area. I had to read the first page twice; the date of birth meant this patient was 13 years old. Her brief history read that she was also a rape victim. A man who was renting a room in her parents? house was the perpetrator and she hadn?t come to the clinic for obstetric care until she was 30 weeks pregnant.
As I caught my first glimpse of her in a triage bed with a full 38-week belly, I thought she could be 18 years old at the oldest. But as soon as she spoke, it was as if I was hearing the voice of a child ? soft, hesitant, and slightly higher pitched. I couldn?t help but think that if I had had a baby at 13 years old, this patient here would be my daughter, pregnant with my grandchild, and I would?ve been a grandmother at 26. This girl, who hadn?t even finished going through puberty, had the rest of her childhood and adolescence stolen from her.
And yet, she was a graceful new mother. After she bore her child, she cried joyful tears calling her baby her ?treasure? and ?angel? and vowed to take care of him as best as she could, even though she didn?t ask for him. Young in so many ways, but at that moment, she radiated maturity beyond her years.
Source: http://blogs.palmbeachpost.com/becoming-a-doctor/2011/03/15/ob-gyn-patient-logs/
Jill Duggan Palm Beach Woman Jill Duggan Palm Beach Woman Magazine Jill Duggan Jill Duggan Palm Beach Jill Duggan Palm Beach Florida