Sunday, September 20, 2009

Sometimes the best teacher ...

How much have you learned from those not given the title of teacher? Here is a story from my third year of medical school that reminds me how much I have learned from those we tend to think of as the supporting cast.

I was on my second full night of call in the obstetrical unit at the county hospital. Well Known College of Medicine staffed a large hospital primarily devoted to obstetrics in the poorest ward of Largest City, Texas. In the single month of my obstetrical rotation I delivered forty babies assisted only by the Licensed Vocational Nursing staff.

As medical students we joked that it was "see one, do one, teach one. " The chief resident would show you how to do a delivery. Next one of the third or fourth year residents would watch you do a delivery. You were checked off as a "delivery doctor." At that point you were on your own. The only condition was any repair of an episiotomy or laceration had to be inspected by an upper level (third or fourth year) resident. Legend had it a new third year student had once sown a vagina shut. I thought this unlikely and worried more about unrecognized third and fourth degree lacerations, the improper repair of which could leave a woman incontinent for life.

One reason that Friday night in October is so clear in my mind is it was the woman's first baby. It was also my first solo delivery. I had to cut a small episiotomy which I meticulously repaired but all senior residents were in the OB chief resident's call room. The most important thing about that particular night: It was the night the world learned Sue Ellen shot JR in the television series "Dallas."

At any rate this story is not about what the residents were doing. It is about a group of my real heroes in that chapter of medical school, the LVN's. I was convinced the LVNs knew more obstetrics than many of the attending staff. For the most part, the attending staff were just too busy to be bothered because they were putting together the next edition of a textbook.

Checked off by the resident from my last delivery, I took the patient to the recovery room and finished the paperwork in her chart. Out in the hall I heard a nurse call "delivery doctor!" Finished with one delivery, I rushed to help push the stretcher back to a delivery room for another.

No sooner than we had the woman on the delivery table and in the stirrups than I could see the baby's head crowning. I pulled on my gloves and helped the head out of the vagina. Immediately I realized there was not just one or two, but three loops of cord so tight around the baby's neck I could not reduce it over the baby's head nor could I delivery the baby.

Seeing the panic in my face, one of the LVN's picked up two Kelley clamps, and clamped all three of the loops of cord together. "Cut here, doc!" she commanded. I did just what she said. The cord fell away and the baby almost delivered itself into my waiting hands.

After placing the baby on the mother's abdomen, I looked up at the nurse. "You're gonna be alright, doc!" she exclaimed.

I thanked her and we both went back to work. Whenever I have a tight nuchal cord which needs to be cut rather than reduced over the baby's head, I think of that LVN working nights in a hospital full of medical students and residents. I doubt I was the only one who learned such a valuable lesson from her.
Sometimes the best teacher ...SocialTwist Tell-a-Friend

No comments: