Shadowing

In the last week I've had two opportunities to shadow physicians, and I've seen two very different ends of the spectrum. The first physician is a family physician down in Hurricane, UT. I've shadowed him before, and I always enjoyed the variety of patients he saw. In any given day you see everything from shingles to sunspots. True, many of the patients were on the crazy side or looking for handouts, but in general they were just nice people who obviously had a lot of respect for this doctor. I was impressed by his dedication to his patients, and how he always took as much time as each case required, until every question was resolved or a plan was set to resolve it. Ashton and I have been less than satisfied with the OB doctors she's been visiting. They're in and out before you can ask any questions, and often shut the door on you when you're mid-sentence, so it was refreshing to see a physician who cares about his patients and physicians who trust and love their physician. It's that kind of doctor/patient relationship that's making me gravitate to family practice.

On Friday morning we started the day a little unusually. Ashton and I were driving up from Vegas, planning to meet Danny before he left for the clinic. As we approached the city limits I gave him a call to confirm the time we were leaving, and he informed me that he was in St. George at Dixie Regional because one of his patients was in labor. "Do you want to come watch?" he asked. "If that lady's down!" I replied with excitement.

After dropping Ashton off I was speeding back down South I-15, not wanting to miss a minute of the action. I got there just in time, and Danny showed me all the monitors and graphs he was watching to make sure the baby was doing okay. Just twenty minute after my arrival Danny announced it was go time, and we went into the woman's room.

She's had an epidural, so she wasn't in any pain, but you could tell she was exhausted from all the contractions and pushing. This didn't stop the nurses from screaming like taskmasters, demanding that she push and push, "just one more time." Finally the baby's crown emerged from the (for lack of a better word) orifice, and I was surprised at how small it looked. I thought the head was a lot bigger than that, I said to myself, remembering a movie I'd seen in Biology class. Danny had to use the forceps to rotate the baby's head a little, and as he braced himself and started tugging, the baby's head stretched into a cone shape, until its little nose popped out over the lip. Danny quickly suctioned goo out of the baby's nostrils. Another push and the baby's entire head popped out. Whoa! There's the big head! The infant's head hardly looked human, and I fully understood Bill Cosby's comparison of a newborn to a lizard. She pushed again and the whole baby seemed to slide out of her. This was the most shocking moment of all. Like Mary Poppins pulling a lamp out of her purse, Danny carefully extracted the 5 foot long baby and presented it to a nurse with a towel. It looked like an inflatable blow up toy, and its chalk white rubbery skin looked like something from a Sam Raimi horror flick. Apparently while the baby is squished in the birth canal all the blood is forced to the core, like when you pinch your finger and it turns white. It also had a hint of blue in its skin from minor hypoxia. It didn't even look to me like the baby was alive, but a few squeezes from a suction bulb brought the monster to life. The transformation that happened next was truly incredible. As the nurses toweled off the placental goo, the blood returned to the periphery and the limbs took shape. Soon the baby looked perfectly normal, like any other newborn. What a bizarre first five minutes of life.

While the nurses were tending to the infant, Danny was holding onto the umbilical cord, waiting for the last push and the placenta. The woman summoned all her strength for the last heave ho and out came the large sack of blood soaked tissue. I was startled by how closely it resembled all the drawings I'd seen in my physiology textbooks. What a remarkable organ. I decided that this was the perfect primer for me, with just a couple months away from Ashton having our baby. The rest of the day I was pretty tired from waking up so early two consecutive days, and I followed Danny like a zombie from room to room.

Yesterday was also an awesome shadowing experience. I arrived at TOSH in Murray at 7:15 and changed into scrubs in the locker room. The OR was buzzing like a beehive, with techs and nurses and physicians running from room to room like everything was a race. I followed Kevin, an anesthesiologist, around, and he is at the top of his game.

In all I sat in on two total knee replacements and a couple of knee scopes. I was shocked at how brutal surgery can be. The surgeon was hacking off pieces of bone, pounding in pins and drilling holes in almost a frenzy. Most of the instruments he was using looked like any power tool you'd find in a garage. Everyone participating in the operation was wearing a sweet helmet getup with a special oxygen tank that made them look like something between a HAZMAT worker and a storm trooper. Blood periodically sprayed on their hands and face guards, and chunks of fat and flesh seemed to spill everywhere. Each knee replacement took all of 35 minutes to perform, and the patient was shipped out to the recovery room while the assembly line brought in the next lucky winner. I was amazed at how quick and efficient everything was, like an orthopedic factory.

Shadowing Kevin is always fun because he makes it a stimulating learning experience. Throughout the operations he would pose hypothetical threats to the patients and ask me how I would solve them. He was constantly drawing diagrams and explaining complex principles of physiology, or teaching me what all the different drugs did. Each patient became a case study as we monitored their vitals and periodically infused them with this or that to counteract any negative responses. He even let me insert the LMA into the last patient. I was a little nervous as I tried to open her clenched teeth and feed the tube down into her larynx. He then had me set up the IV drip with antibiotic, which was even more nerve-wrecking than the intubation.

I was surprised at how different my two shadowing experiences could be, and at the wide range of possibilities in medicine. Anesthesiology involves the thrill of the operating room, has great hours and pays exceptionally well. Family practice sees a lot more patients daily, requires constant problem solving and allows for lasting relationships with patients. I'm glad I have a few more years to decide what I want to do.