#obsgyn

[mdrambles]

I’m gonna interrupt my regularly-scheduled programming of the cute kiddos I am privileged to see on the day-to-day and take a moment to talk about perinatal loss.

TW under the cut: perinatal loss, pregnancy loss, stillbirth, miscarriage, misogyny, grief/mourning... I dunno if this needs a TW but people friggen’ suck?

Disclaimer: I am a pediatric subspecialty resident, not an obstetrician/gynecologist. While pediatrics may be involved in cases of perinatal loss sometimes, it is not our main area of expertise and the cases in which we would be involved are infrequent. However, as pediatricians, we also take care of our patients in the context of their families, many of whom have suffered a perinatal loss.

I bring up perinatal loss in light of the recent tragic loss suffered by Chrissy Teigen and John Legend, which was met with an outpouring of love and support, but also, because people friggen’ suck, a whole lot of absolutely disgusting, garbage backlash.

Please see this post by an obstetrics/gynecology resident that provides very helpful education on second-trimester pregnancy loss and the various processes that hospitals may follow to provide comfort to families struggling to cope through their grief.

First of all, people all grieve and mourn in different ways. Everyone experiences loss, and they all experience loss in their own way. How they choose to express and/or share their grief is a personal choice, and no one can decide what is “right” or “okay” for someone else. To have the audacity to make disparaging comments about Chrissy Teigen and John Legend’s brave decision to share their grief and devastation is like attending a funeral and telling the family, “Ugh, how dare you do this for attention?”

Perinatal loss is something we don’t talk about enough. It’s common, but it’s stigmatized, and this stigma is 100% anti-mother discrimination (if anyone can think of a more inclusive term for this, please let me know; though not all mothers identify as female, I want them all to know that this discrimination against them is not okay).

Have you ever noticed that commercials for Viagra and Cialis come on regular television programming? Because male sex drive and sexual performance are considered NORMAL, COMMON issues in sexual health? Well, it’s time to wake the f*** up and realize that periods and pregnancy are NOT the only sexual and reproductive health issues that people with uteruses face.

Perinatal loss is common. It’s devastating. And the vast majority of the time, it’s completely out of the mother’s control. However, many mothers internalize these losses, which are often due to nothing more than sheer bad luck wherein physiologic processes just don’t quite align, as personal failures. I wonder why that is? It couldn’t possibly be because there’s a huge social misogynistic worldview that sees childbearing as your sole purpose in life if you were born with a uterus, could it? But of course, you should only bear children if you’re young enough (but not too young), old enough (but not too old), in a “stable” (read: cis-het) relationship, and gainfully employed; otherwise, you “don’t deserve” to have children, and if you choose not to have children, there’s something fundamentally wrong with you (because your sole purpose was childbearing, remember?).

YOU ARE MORE THAN YOUR UTERUS. (Furthermore: you and your uterus are NOT incubators for society’s gross anti-woman, anti-female, cis-het agenda.) You are a person who can make decisions about your life, your body, and your family. You are a person who experiences loss, who feels emotions, who has had to suffer and struggle. You are a person who has shouldered the judgments heaped upon you by society, borne of ignorance, misogyny, prejudice, and discrimination, but you are also a person who, in spite of this, has lived and loved and breathed. 

You are a beautiful person.

[journalofamedicalstudent]

Thoughts in Obs-Gyn

“How many body fluids did i just see. Pee, poo, amniotic fluid, blood. Wow.”

“Note to self: If ever I have kids, stick me with that epidural, FAST”

“How can a vagina stretch that much”

“Oh my God the attending’s gesturing to me to come sit in front of the vagina does she want me to actually deliver this baby”

“I am not ready”

“OH MY GOD IT’S OUT”

[haninditaharum]

Pembelajar

once my obstetric and gynaecology doctor said,

“Gapapa dek tanya aja ke dokter siapapun, saya yakin beliau juga senang jika ada yang bertanya. Orang yang mau bertanya, berarti orang tersebut mau belajar”

it means, jangan bangga dengan seberapa banyakpun ilmu yang kamu miliki. pembelajar sejati itu selalu merasa kurang, haus akan ilmu, dan cukup bodoh karena belum tau seluas apa dunia yang diciptakan olehNya.

bukan untuk merendahkan diri, namun sebuah upaya agar lebih banyak nikmat ilmu yang kau dapatkan :)

tak apa, kita belajar lagi ya?

[mdrambles]

Two Stones

This summer I had the privilege of doing three very different and very amazing electives, but I also had the opportunity to slot in a short horizontal elective in reproductive endocrinology and infertility (OB/GYN subspecialty REI). It was during this horizontal elective that I think I had a lightbulb moment for where I see myself along my career path in several years. On the second and final day of my horizontal elective, I was thinking that REI was something I found very interesting—the medicine was fascinating, the procedures were interesting and seemed fairly low-stress (read: they looked difficult to screw up) and the patients and their stories were all incredible. There were cases that made my heart soar and cases that broke it. Overall it was a specialty I could see myself becoming very emotionally invested in and very passionate about… But then a little girl walked into my preceptor’s office, a smooth, dark gray rock clutched in each chubby little fist. She was probably between 18-24 months old, running around everywhere and endlessly, gloriously curious about everything. A couple runs in after her, smiling sheepishly at my preceptor and me. “Sorry about that,” the woman said, a little out of breath from running after a bouncy set of blonde pigtails. My preceptor smiled warmly and welcomed them into the office. “Not a problem,” she said. “Who is this little monkey?” The little girl was scooped up and held tight as she squirmed and tried to return to her cheerful gallivanting around the office. “This is my niece,” the woman responded, eventually giving up and putting the little girl back onto her tiny pink-shoed feet. They tried to keep her distracted with snacks, feeding her halved cherry tomatoes and small pieces of bell peppers as my preceptor went through a detailed past medical, gynecological, and obstetrical history with the young couple. Their niece was much more interested in her rocks than what was going on in the office, setting them down for a few seconds in various places then going back to pick them up and run around with them in her tight grasp. Honestly, I wasn’t paying much attention to the consultation at that point. I was so enamoured with this little girl and the way that she amused herself with these two rocks—like they were the most interesting objects in the world. She was this bright light in the room, hovering here and there and darting from knee to knee as she crawled under the young couple’s chairs and tentatively stepped toward me only to run away again. Every time she approached me she got a little closer—first only one step, uncertain and wobbly. She retreated quickly behind her aunt’s calves. Then two steps, this time more bold, her eyes meeting mine and holding my gaze the whole time. I smiled at her and leaned forward just slightly opening my hands to her in a gesture of welcome. She ran back, fists still clenched around smooth stone, but looked back at me as soon as she had returned to the relative safety of her aunt’s lap. Finally, she walked all the way up to where I was sitting in my chair. She reached out with her tiny little hand (still chubby with baby fat, knuckles dimpling whenever her fingers extended) and dropped one of her stones onto my thighs. I smiled at her and whispered, “Thank you”, and she squealed with laughter and ran away again, this time tucking herself under her uncle’s arm. A few minutes later, she returned to retrieve her stone. The interview was coming to a close. I picked up the rock and she held out her outstretched hand expectantly, though her chin was lowered and she looked up at me shyly from underneath her golden eyelashes. I let the stone fall into her palm with a soft “plop”, and she grinned as her fingers closed around it. I walked with my preceptor and the couple (with their niece in tow) back to the reception area, where they booked whatever follow-up assessments or procedures were discussed in the office—I don’t remember what the arrangements were, but I could still feel the weight and relative coolness of the stone in my hand despite being clasped in a tiny fist for the majority of the last hour. When I left the clinic that day, I wasn’t thinking about the methods of IUI or the implications of surrogacy for infertile couples. I wasn’t reflecting on the many cultural complexities of seeking infertility assessment and treatment, nor was I even thinking about the relationship dynamics associated with REI. I was still thinking about two little fists and two dark gray rocks, two blonde pigtails and two big blue eyes. When I got home that day and my family asked me how my elective had been, I thought of one step forward that became a wonderful exchange of rocks and smiles. I told them my day had been a good one.

(Originally posted here)

[mdrambles]

Greater Plans

They named her Mary. She was beautiful; she was this tiny, perfect human being they fought so hard to bring into the world. Her life was joy and grief more profound than I had ever witnessed. 12 weeks ago, her parents were excited, overjoyed. Her older brothers couldn't wait til the day their mother would bring back their baby sister and they would get to love her and play with her and make her a part of their family. 11 weeks ago, her parents tried to explain that she wouldn't be coming home with them, even when Mommy went to the hospital. The cradle that both boys had grown out of would be empty even though Mommy's womb was still full. 7 days was all it took for their world to begin to collapse from the inside out. The ultrasound told them that there were multiple congenital anomalies that would be incompatible with life. The ob/gyn told them that it was in their best interest to abort. They disagreed. Mary was their baby and they wanted to give her the chance to meet the world before she met their Father in heaven. They wanted to meet their daughter in person, wanted to hold her at least once before they had to let her go. I felt woefully inadequate, standing in that room full of courage and strength and so much pain. Her birth was truly a labour of love--there were tears running down her mother's face, the suffering beyond a physical experience, as in the same moment there was the joy of her life and the looming grief of her passing. And then she was born and I listened to her heartbeat. Her parents wanted to hold her as soon as possible, but I was entranced by this little person who, against all odds, changed my life with the sound of her heart, the proof of her and her family's triumph against adversity. They asked us to palliate her, to bring as much comfort as we could to this peaceful little girl nestled in her mother's arms. But what could we do for a child that, once we swaddled her in blankets and settled her between her mother and father, seemed content to bask in the comfort of their love and devotion? What could we possibly offer that her parents, in that moment, would be unable to provide? Nothing. She did not root for feeding, the way we would expect a newborn to do, and she did not cry. She was a symbol of hope, faith, an impossible magnitude of strength that I felt so small and helpless beside. I just hope she wasn't in any pain, because she never so much as grimaced. Her parents were devastated, of course, when she was born. She was so quiet when she started to breathe that I worried maybe she wasn't breathing at all. She didn't open her eyes. But she did bring serenity to all of us who felt so raw, and her parents were smiling at her after the tears had dried. We were able to bring in a deacon and a priest to baptise her, bring her into a much larger family. They offered her blessings of comfort and peace, and performed her last rites at the bedside as well. The deacon said that "God had greater plans for her", and this resonated with me. She had already made such an impact on everyone who laid eyes on her--I could only imagine what she might do as one of God's littlest angels. We were invited to join in the celebration, and I tried to pretend my hands weren't shaking as I made the sign of the cross. It was such an honour to be included in the ceremony and I felt undeserving, like I was intruding on this incredibly intimate moment for this family. But they asked us to be there, and they thanked us for staying. I couldn't fathom what they thought they were thanking us for. Eventually her heart did stop its steady beating. She died as quietly as she was born. Her parents thanked us again. They were so grateful. I did not know how to react to such honest gratitude--I felt like we hadn't done anything for them, that there was nothing we could do to help but share in their experience and their suffering. One of the things that I still sometimes lie awake thinking about was that perhaps there was no expectation of us to do anything. Perhaps it was just comfort to know Mary was not unsettled or uncomfortable, spent her time with us content. Perhaps all they wanted was for people to know she lived, to meet her and touch her, hear her breathe and hear her heart beat, because everyone else was going to know she died and that would be all they thought of in association with her. She might be referred to as "the baby they lost", and we would be the people beyond her mother and her father that would understand and bear witness to the fact that she was a baby who was born, a baby who lived, a baby who will always be loved and remembered. The palliative care that we were trying to provide to this tiny baby seemed so minimal in comparison to the beauty she was able to bring into our lives.

(Originally posted here)

[witri19-blog]

Dulu Beliau terkenal dgn sifat pendiam nya. But when I was being his assistant at hospital that character has lost 😀 Thanks for being a good doctor for all this time, doc.. Sorry ya dok gak bisa saya tag,, habis dokter gak punya IG 😂 #kaleidoscope #2017 #hospital #healthy #obsgyn #doctor #doctorwho (at Rs. dr. Soeharsono (TPT) banjarmasin)

[avinalawya]

S : Koas senang dan puas mendapat jejaring di Banjarnegara O : Refleksi kasus 4/4, Tutorial klinik 4/4, Mini CEX 1/1, ilmu dan pengalaman ✔, surat puas ✔, tanda tangan konsulen ✔ A : Koas obsgyn post jejaring Banjarnegara 4 minggu P : Koas pulang Jogja, lanjut jejaring Muntilan 2 minggu . . . . . #salamVT #koass #obsgyn #banjarnegara #coasslyfe #belumselesaistase #masih3minggulagi (at RSUD Banjarnegara)

[highlightedkidneys]

Quick update

Finished my emergency medicine and family medicine exams this week. Both were pretty decent. Getting ready to travel this weekend, I’m starting my elective on the 6th