ObGyn Posting

Hey y’all!

(I don’t take selfies as much as I used to but these are some selfies I managed to take in the past three months).

Okay, so this post is probably going to interest the medical followers. Sorry non medical followers.

I felt like writing a post about my ObGyn posting.

As i already told y’all in one of my earlier posts, we do three months in each posting.

In ObGyn here, they have five units. So, you rotate through three of them and every month, you do one outside posting. The outside postings are Labor ward and Gyne emergency.

I started my housejob with my labor ward posting so you can imagine how horrible it went. I did not get to do much cuz i was new and i was really just trying to understand how things work here.

I remember them asking me to take a pcv sample in a capillary tube on my first day and i was struggling. LMAO.

Anyway, i’d rather not talk about how shitty that week was.

Ive been taking advantage of my labor ward calls because I know I did not do much during my labor ward posting. I’ve repaired perineal tears, induced labor, augmented labor, monitored patients in labor, assisted in caesarean deliveries. So I can confidently say I’ve learnt some stuff. Abi now? 

We have like 8/9 calls every month. Ward calls, labor ward calls and gyne emergency calls.  Yes, I said ward calls and not unit calls o. Makes no sense, I know. How can you be on call when you don’t even know the patients? You just basically hope for the best every time. So we  have 5 wards in total so you’re on call on two wards everytime you do a ward call.

So we drop our numbers on the board so the nurses can call if they need the Doctor around and I shit you not these nurses can call for the most ridiculous things.

phone rings at 1am

‘Hello, am i speaking with the doctor on call on W4 big?’

‘Yes, you are. Any issues?’

‘Ehn Doctor, theres a patient going for elective CS tomorrow morning and she has not signed her consent form’

‘um you actually want me to come get a consent at 1am? Okay then!’

I obviously did not go as they will all be alright when they get the consent in the morning. Surprisingly, this is not the worst call i’ve gotten. Also, apparently, if the nurses don’t like you, that plays a huge role on how terrible your call can be because they will practically call you to come because a patient has a headache.

What we do when we are on call is basically give IV drugs and manage any situation on the wards. So imagine units not dropping worklist (names of patients that are on IV drugs) and having to go through the case notes of all the patients and make your own worklist. I’m sure you’re thinking ‘It’s not so bad’. Yeah, it’s not until you have to give drugs at 10pm, 1am and 4am and you’re thinking and convincing yourself that you did not make a mistake with this medicine thing.

I remember someone asking me about the most common cases here. In this environment , i’d say the most common cases are

• Preeclampsia and PIH
• Post partum hemorrage
• Malaria in Pregnancy
• Leiomyoma
• Cervical cancer
• Hemoglobinopathies in pregnancy
• HIV in pregnancy
• Threatened abortion/miscarriage.
• Ectopic pregnancy

I don’t know if it’s just this hospital  or these are also common in other parts of  Nigeria generally. (I’ll add more as i remember)

It is so sad though that most of the patients only come here when they’re almost dead or when they’ve been  mismanaged by doctors in random hospitals. I mean, I know it’s a teaching hospital but damn… can these rubbish private hospitals make life easier for everyone.

I just finished my Gyne emergency posting yesterday and I actually loved it. I thought it’d be horrible because i had not worked with the house officers doing the posting with me and I just assumed the worst tbh but i was pleasantly surprised.

My typical day in Gyne emergency.

I get there 8/8:30 am.

Drop my bag and take all the essentials ( like pens, money, prescription sheets, continuation sheets e.t.c.)

Wait for everyone to get there. Even on Thursday when i thought i was late, still got there first.

 The registrar gets there around 9:30am. But obviously if they bring a patient, he’ll have to come earlier.

Usually like two patients come before he gets there so we the house officers start seeing them and filling out some routine investigation forms and other forms as required (by using our initiative obvs)

Malaria is very common here so once a patient comes in complaining of feeling sick, we just fill the form for them to go do the test. It’s free actually and the result is usually out in one hour. 

 We have two nurses working with us and two bed spaces. 

We basically see patients till 5pm. Most times we don’t even get to leave at 5. Yesterday was actually the earliest I’ve left and it was 5:30pm. 

The gyne emergency room is located in the O&G clinic area so they bring a lot of ‘stable’ patients which I think is bloody irritating. This is supposed to be gyne emergency not the place for ‘oh this patient  is here for her routine clinic day to see a DOCTOR but she has a headache’

I’m sorry what? That’s the bloody point of a clinic visit. See the doctor and complain. Or am I missing something?

We get cases like that a lot but obviously if we have a real emergency, we ask them to wait. 

The most common emergency cases here are;

– Incomplete abortion (most of them are bleeding and require MVA).  

– Ruptured ectopic pregnancy 

– Eclampsia

– Severe preeclampsia

– PPH 

So because it’s Nigeria and things don’t work as per everything is upside down, we have a gyne emergency bag. The house officers are responsible for the bag and it’s contents. The bag when stocked contains disposable speculums, urinalysis strips, iv cannulas, glucometer, needles and syringes, oxytocin, MgSO4, pregnancy test strips, misoprostol, gloves and other consumables. 

 The main purpose of this bag is to make your life easier. I’ve been to A&E where asking for ordinary glove is like asking for a unicorn. The nurses yell and tell you to ask the patient’s relatives to buy gloves And I’m like ‘Ma, there is a reason this is the emergency room. Did they plan to come here that they’ll have spare gloves in their bags because I’m not understanding.’ and then she goes ‘ Doc, I’m busy. Ask other patients if they can give you one’. It was then I knew I definitely don’t see myself working here. God forbid.

This place can be really frustrating.

Sadly, patients pay for some of the things in the bag like the sterile speculum, urinalysis, pt. They also replace the drugs used when they buy theirs but the whole point is to try to save the patient when every single thing is working against that. 

It was when I got back to Nigeria, I knew patients buy their own needles, syringes, gloves, cotton wool and even methylated spirit. It’s sad tbh. 

Before I turn this post to a ranting post, let me stop here. 
For the curious ones wanting to know how house job is, this post was for you and I hope you enjoyed reading it. I was going to write about the different cases and their managements but that’s why you have your textbooks. Go and read ya book. Tanz much. 

Thanks for stopping by though. It was my wordpress anniversary two days ago.  I can’t believe it’s been a year already. Thank you guys for always reading and commenting. 

– TOSIN