OB/Gyn at ARMC in Colton

Its a sunny day in Riverside- the high will be 78 degrees which is the norm in the beginning of November around here. We have veteran's day off, but I have not left the house yet because the Santa Ana wind is blowing at 20-30mph out there! Over all it has been interesting. Driving through the parking lot freeways on the morning has really been affirming the way I generally feel about this area. Think of the Weeds theme song- "Little boxes on the hillside..." There is a lack of variety compared to the bay area, and the people and generally a little nicer up there.

ARMC in Colton is a federally funded community hospital- Obama-care if you will. For the most part, it is a well-oiled machine. Some departments are functioning a little more smoothly than others. As it is a teaching hospital, you find that the lower you are on the totem pole, the more scut work you do, but you learn tons doing it!

All of the rotations I have had so far, I have been extremely blessed to follow an attending basically on my own. I even had 3 to myself during pediatrics in Humboldt. In this hospital, I interact with the attendings very little in comparison. The downside is that I don't get to see the way they interact with patients (very few still see clinic patients in person), the upside is that I get to interact with patients and learn what style works best for me. I research my patients' charts, take my own history and perform my own physical exams, write up my own SOAP notes, update the problem lists, and then formulate a plan going forward complete with which labs, imaging, and education is necessary. At this point in my third week, I have learned the basics and read enough that most of the time the attending checks my work and signs off on it. The only time I get to spend with the attending in the room is when I need him/her to check out something that deviates from normal in the physical exam, or when I need to do a quick abdominal or vaginal ultrasound.

This clinic is an especially important experience for me because I am helping high-risk OB patients, which unfortunately there will be more of as time progresses and society's habbits are too slow to change. Weight management, diabetes (both gestational and chronic), and twins are all sent to our clinic for the high-risk days. So we have these complicated cases, and we're expected to get through 45 patients in the morning and 35 in the afternoon on most days! Add to this a small amount of clinic space, too few computers, illegible handwriting in charts, nurses that are impossible to find sometimes or clearly do not feel like helping (although some are much nicer and more willing to help than others), and you get the ultimate high stress environment. Its no wonder the attendings mostly never leave the physician break room- its a war zone out there :)

I think what also makes clinic so difficult is the paperwork- there's a huge learning curve in the beginning getting used to it all. They expect you to only spend 30 min with returning patients and 45 min with new ones, but on the first day you're not even familiar with the charts, paperwork, EMR, or even where things are in the hospital yet (if you're completely new to the area like me). By the end of the second week I was golden in terms of all of that, but at the beginning of the second week we had new students from Western come, and training them was like the blind leading the blind. There is no real official orientation, so med students help each other as much as we can, while also trying to get our own work done.

The labor and delivery floor works much differently than clinic. Our duty as med students is to help out the flow of the prep room, which is like emergency triage for pregnant women. We see the patients, find out what they're there for, present to the residents, and help see to it that they are admitted, watched, or discharged smoothly. On the floor, we chase residents around making sure that we help them with efficiency, scrub in on bilateral tubal ligations, cesarean sections, dilation and curettage procedures, and vaginal deliveries. We can follow the uncomplicated patients and personally help with placenta and baby delivery. We can also shadow attendings in the gynecological surgery OR and scrub in on procedures like total hysterectomy and total salpingo-oophorectomy (removal of uterus and ovaries). Overall, if you are ambitious and determined, you get to see tons.

So overall, this has been an incredible learning experience. I practically feel like a resident with the responsibility I have and the skills I have acquired. This rotation alone has actually gotten me more excited about residency because I feel like its less of a mystery to me now, and I know that I can do a good job when the time comes. Although its not easy, it is also not thankless- the patients are very gracious and nice here and you get the feeling that you're really helping make their lives a little better one visit at a time.

This windy day off is a perfect day to catch up on quizzes and reading, so I am signing out and heading down to Denny's ;) I'll check in again at the end of the rotation. Next up is orthopedic surgery back at DMC in San Pablo.