Sunday, January 25, 2015

NSVD: normal spontaneous vaginal delivery: that time when I almost passed out.

Yesterday was my post-call day. What that means is that I was "on call" or in-hospital for 24 hours prior, and I got to go home after watching 4 babies delivered in a foggy haze with judgment similar to after having 2-3 drinks, and pass on out.

I'm currently on my OB/GYN rotation with 24 hour calls. I grumbled about this initially, but the underlying reason makes sense: it's easy to think "YAY BABIES! WOMEN'S HEALTH! SURGERY! MEDICINE! ALL IN ONE PACKAGE!" but not think about what life could be like if you're up for 24+ hours straight, looking down the barrel of a vagina at some unholy hour with a mom that's been in labor for a ridiculous amount of time, who is now too tired to push.

That's why OB/GYNs are awesome. Really, who else can get a living parasite (beautiful, wonderful gift of a parasite) out of your body in <1 minute. OB/GYNs, that's who.

I've been through half of this rotation so far, and have done my GYN portion. I saw some serious surgeries: myomectomies with 5L of blood loss, periurethral abscess drainage with a 200 mL fountain of frank pus, D and C, ruptured ectopic pregnancy, etc. I have counselled women about birth control methods (IUDs galore!), talked about menses, done pap smears, and asked some seriously personal questions. It has been awesome. But nothing has been as nuts as seeing a person pop out of another person. 

I landed on labor and deliver at noon, after going through post-partum rounds in the morning with an great nurse midwife who, after asking if I had been on L&D before (labor and deliver...I hadn't) told me "things move fast...maybe you should eat something before you go to the floor." Me being, said no, I'll just go the floor -- after all, I've been on surgery, that's tough and I still got to eat.

One key point I missed there, surgeries, though not always, are frequently scheduled. Babies are not. I introduced myself to the team, and put my things away, and sat down to nutritious and delicious lunch of tofurkey and cheese when the intern pops his head into the break room and says, "three babies, NOW" and leaves the room. I freeze, tofurkey goodness having just touched my tongue, and staring at the spot where he just stood then at the nurse eating her salad sitting across from me until 10 seconds later she says, "Well...GO!"

I got my butt into gear, pushing my lunch back into it's bag, shoving a handful of chocolate almonds in my mouth, biting my tongue in the process, and dashing out of the room into the patient room.

Oh my. She was giving birth. Now, mind you, I have never felt like I was going to pass out during any of the other rotations I've been on. Guy throwing up straight up blood? I'm cool. Connecting the rectum back up to the sigmoid colon by shoving a big metal rod up the anus? No sweat. Cut open an aorta, get sprayed with bright red blood, stick a vacuum suction in it to stop it? My jam. Seeing a woman, legs spread as wide as can be, no epidural, supported by partner and mom, bearing down, sweating, and actively pooping, with clear amniotic fluid coming from her vagina...I think I'm going to pass out.

The midwife is there. The resident is there. They're supporting her, encouraging her, helping her with different positions, applying pressure to her perineum so it doesn't rip (yes, RIP) when a pot roast tries to come out a hole the size of your nostril. That's hyperbole, but you get the point. Meanwhile, I'm standing back, gloves on, prepared to be the most helpful med student I can be and watch, occasionally translating things to Spanish. It's amazing in how times of fear/adrenaline/whatever you want to call it, things you didn't think you'd remember from high school come back to you. Mind you, it was still quite poor given the context that I took spanish for 7 years.

Anyways, I'm standing back, staring at her vagina/poop/fluid amalgam, and I start to see spots and I think oh no, not here. NOT HERE. Baby >>>>> you passing out. So I squeeze my calf muscles, tighten my abs, squat ever so slightly, and valsalva (push down like you're going to poop) and try everything I can to increase blood return back to my heart and up to my freaking brain which is still seeing spots with my vision starting to narrow in on the sides so ALL I CAN SEE IS THE VAGINA/POOP MIX. Excellent job brain, wise decision.

Luckily, it works. Either that or it was the midwife saying, "grab some sterile gloves, you're delivering the placenta." Probably that -- I work well when given direction. Brain clears up, I grab some gloves, and watch for another 30 minutes while this amazing, incredible woman pushes and pushes and contracts and contracts her baby's precious little head out. And yep, it ripped when her baby's head popped out, and I cringed but she didn't care at all. Or maybe she did, but was too excited and overwhelmed by her new baby girl that she didn't care. I don't know, I haven't done it yet.

The rest is the resident walking me through delivering the placenta...the cord gets longer, there's a gush of blood, and out comes something that looks very much like it's a prop from Alien vs. Predator. Then there's stitching up her vagina and cleaning up the hot mess of blood/poop/fluid down there so we can lay her down properly. But she doesn't care. Why should she? She did it, she's got her mom and partner next to her, and she's getting ready to go to sleep (pass out?) with this new baby girl she brought into this world resting on her chest. 

Sunday, January 4, 2015

Belated candy gifts

Whoops, I meant to post this before the winter holidays were coming to a close. Whoopswhoopswhoops. But life got in the way. The making of the gifts, the sending of the gifts (after the traditional gift giving day because who can keep track of pesky USPS holiday hours?), the traveling, and all that relaxing.

But I took the pictures, and I made them, and so why not? Then it's all about figuring out what to say. Something clever? Something profound? Or just the recipe because who really reads this part anyways.

Let's face it, you're here for the food pictures, and the recipes. This part is mostly for me. It's like a diary but you can skip ahead to the good bits. I get to put my profound, life-changing thoughts out there and feel comfortable knowing that most people will scroll right by them. I'm not joking, that fact is actually relatively comforting and part of what makes blogging cathartic.

That and it's a way I can look back on medical school and say look! You can be creative! You can make things! You can write things, and have opinions all while creating tasty tasty treats! Fight injustice with your words, and make pistachio apricot bars while doing it! No, this post is not about pistachio apricot bars sadly, it's about candy.

The type of candy that doesn't need thermometers, or confectioners sugar, or melon ballers. There's nothing wrong with that, but that's just not what it's about right now. It's about making it happen when you're tired. It's about bringing it when you're don't have time to go to the shop, and bringing it damn well. It's about delicious candy. So feast your foodie eyes on my candy creations, and feel the comfort in knowing you can make beautiful, tasty things with little sleep and no thermometers, but with a lot of sass and love.

Pretzel Toffee With Pecans

1 cup salted butter
1 cup light or dark brown sugar (depending on how molasses-y you like things)
1 bag pretzel thins or saltines or ritz crackers, really any salted, crunchy cracker will do. The pretzel thins can be found in Trader Joes
8oz semi-sweet chocolate
Chopped Pecans

Line a 9x13 inch pan with aluminum foil, and spray that with cooking spray. Lay down a layer of your crackers/pretzels, etc. It's okay if they overlap a little, but you want a nice layer of it down. Turn your oven on to 350.

Mix the butter and sugar together in a medium saucepan over high heat and bring to a boil for 2-3 minutes. Really watch the color here, if it seems like it's getting too dark for your liking, turn it off. If you don't know what too dark looks like, keep it going for 2.5 minutes, and then turn it off. It's really an eye-ball it kind of recipe. If you don't use salted butter by the way, add 0.5 tsp salt to the butter-sugar boiling mixture.

Pour the mixture carefully over your pretzel layer, covering it completely. Don't worry if there's a little bit uncovered, it'll spread. Put that in your oven for 10 minutes.

Pull it out, and let it sit for 1-2 minutes to harden slightly. Then pour the bag of chocolate on top, the heat from the toffee will melt it, and spread it evenly over the toffee. Sprinkle with the chopped pecans, and some salt.

Put it in the freezer for 20 minutes, pull it out, and use whatever tool you want (hand, dull kitchen knife, etc.) to break it into pieces, and enjoy!

Trail Mix Bark

8-16 oz bag of semi-sweet chocolate
Dried apricots, chopped
Dried cranberries
Other toppings you want (white chocolate, pretzels, other nuts, other fruit)

Take your 9x13 pan, line it with aluminum foil, and spray it with cooking spray.
Put the chocolate in a microwave safe bowl, and put it in the microwave on medium high for 30 seconds, pull it out, mix the chocolate together to distribute the heat. Do this for 30 seconds until the chocolate is melted and viola! This is how you melt chocolate evenly in the microwave.

Spread that over your 9x13 pan. Sprinkle the dried fruit on it, and push it down so it sticks in the chocolate. Then add the pistachios and push down. Then sprinkle the salt on top. Put it in the freezer for 20 minutes, and break it up, and you have bark!

Trail Mix Bites

Same ingredients as above
Heavy duty plastic bag
Put your dried fruit and nuts out so you can grab them quickly, because the bites dry quickly.

Lay out a large piece of baking sheet paper. Melt your chocolate. Use a spatula to put it inside a plastic bag. This is a messy, messy process. That's okay -- don't wear your nicest whites is my only advice. Cut the tip of the bag off, and squeeze out dollops of chocolate onto the baking sheet. As soon as you're done, place one dried fruit and nut in the center. Do this quickly, the chocolate dries fast. Then salt it. And you're done. Let it dry and enjoy.