Monday, April 20, 2009

"See one, do one, teach one"

Back at Famous College of Medicine when I was learning to delivery babies the motto of the OB department was "see one, do one, teach one." This was my experience in the first two days of the rotation. We arrived on a Friday and I was on call that night. Paired with another medical student one of the junior residents took us to a delivery room and carefully walked us through a delivery from positioning the patient, to putting on the gown and gloves, to the careful (and artful) act of holding the baby in our non dominant hand while we clamped and cut the cord with our dominant one.

Yes, I trained back in the days where the dads did not get to come to the delivery room. I also trained in a hospital so big and so busy that there was no room for a father in delivery. FID as I was to later learn in my residency program where fathers took a special class to earn a pass to the delivery room.

So, imagine that it is my second day on my medical school OB rotation. At this point in my career I have delivered five babies. I am just beginning to be comfortable with the process. Looking down the hallway I see a nurse pushing a stretcher from the triage area. One the stretcher is a woman with the largest abdomen that I have ever seen. "Delivery doctor! I need a delivery doctor!" the nurse calls.

Delivery doctor. That's me. I run after her and in to a delivery room trying my mask on as I run. After we get the woman over on to the delivery table I check her cervix and note that it is completely dilated.

"I gotta push doc!" the woman pants.

"Not yet!" I yell. "Let me get my gloves on." The art of gowning and gloving myself is as difficult as delivering the baby.

About the time my gloves are in place her bag of waters breaks and out comes a tiny four and a half pound baby. I suction the baby's nose and mouth, clamp and cut the cord and put the baby on the woman's abdomen just as she says, "There's another one coming."

"No, no," I say. "That is just the placenta."

"Doc, I have had babies before. Trust me. There is another baby coming."

At that moment I look down and see two tiny feet at the vaginal opening. It dawns on me why this woman's abdomen was so large and yet the baby I had just delivered was so small. She is pregnant with twins and the second one is breech.

"Get me a resident!" I yell. See on, do one, teach one did not extend to twin deliveries or breech deliveries either.

Again I ask the patient to please just breathe for a moment while I try to do the same myself. Suddenly through the door comes a resident I have never seen before. He looks at me and in a very self important voice says, "What have you got here?"

"Twins. The first one is delivered and this one is breech." I say stepping aside.

"Shit!" he screams. "I am a family practice resident and I have never delivered a breech baby." Then he yells, "Get a resident in here!" I guess he had done something that I had not which was read the chapter on Multiple Gestations in the textbook.

At this point the patient is no longer able to help herself and she pushes. I step up and delivery a small breech baby boy, who after I suck out his nose and mouth begins to scream his head off as if he knew how ill prepared these two doctors were for his arrival.

Now having read all the complications of both multiple gestations and having had more than one complicated breech extraction, I still marvel at how I managed to do a breech delivery before I ever even saw one.
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