The new interns are beginning to settle in to the hospital, the county schools are back in session, the college kids are back in Charlottesville, I have a new class of medical students, and my last child started college last week. It all takes me back to a time when it was a new beginning for me as well. In 1988 when I started internship it was still common for most interns to do a transitional internship, rotating on all the major services in the hospital.
My very first night ever on call as a newly minted M.D. began quietly enough. I was assigned to the Labor and Delivery deck, tasked with monitoring the laboring ladies and assessing any new patients in labor who might appear as well as assisting in any actual deliveries. As a medical student I had not paid very careful attention during my Obstetrics rotation since I was not going into OB. I was now regretting that I had not anticipated that this duty would be thrust upon me so precipitously.
Soon enough the chief resident went to bed and it was just me, the nurses, and the expecting moms hooked up to monitors whose functions I barely understood. It was actually quite peaceful, it was late, the lights were low, the monitors chirped quietly, and a kind of hush lay upon the unit.
Hours passed uneventfully until the spell was broken by the noisy arrival of the elevator, bright light spilling out from its doors, framing an anxious couple. She was obviously at term and he was possessively holding her around the shoulders.
“Can you help us doctor? I am in labor and I think my umbilical cord has fallen out.”
Her bathrobe fell to below her knees and I could not see anything obviously amiss so I steered them to an examining room.
I have been carefully trained in medical school (Georgetown) to not get distracted by the obvious and neglect to obtain a complete history and physical exam. And so falling back on my training I did just that. I began with a thorough history including childhood illnesses and proceeding through the dates and milestones of this up till now normal first pregnancy.
I must say the patient and her husband were initially rather agitated and insistent that I quickly examine her supposed umbilical cord prolapsed, but I was determined to move at a measured pace. Eventually my patient refusal to be rushed seemed to reassure them that I had everything under control and they settled down. The nurses also seemed to share the agitation but they too ultimately responded to my pleasant, unhurried demeanor. This was going great.
My physical exam was an equally thorough avoidance of the clinical problem at hand; my mentors would be proud. I began with the head and neck, even spending time to examine her eardrums and proceeded in a methodical fashion to examine every inch of this lady. Only when all of this was exhausted did I perform a pelvic exam on this lady in labor.
Sure enough a long loop of umbilical cord was immediately visible dangling below the examining table. Humm, I had better discuss this with someone more senior.
The nurses seemed somewhat alarmed again and suggested I skip the chief resident and call the attending OB directly. I called the attending at three in the morning and he groggily asked me what was going on. My classical medical education kicked in and I proceeded with complete recitation of the facts of the case, beginning with the childhood illnesses, proceeding through a complete physical (including eardrums) and finally much later culminating with the description of the finding on pelvic exam of “a tubular structure approximately three feet long, investing in a membranous fashion, and which could be considered consistent with an umbilical cord.”
There was a long pause, I think I had lulled him almost back to sleep, before he murmured, “What did you just say?”
I repeated my ridiculous description of what was obviously the umbilical cord.
“Stat her!” he shouted into the phone and hung up without another word.
“What did he say?” the nurses asked me.
“He said stat her.”
“What does that mean?”
“I don’t know.”
“You’d better call the chief.”
Still resolved to stay unruffled I called the chief resident and repeated my unhurried recitation and at the end got nearly the same reaction.
A startled “What?” followed by a question, “What did the attending say?”
“He said stat her.”
“Do it!” he shouted and hung up.
I relayed his message to the nurses. We all stood looking sheepishly at each other. We were supposed to be doing something critical but it was unclear what it was.
Just then the doors from the on call rooms burst open and the chief and the attending were racing neck and neck onto the labor deck.
I will spare you the grisly details of the proper treatment of a prolapsed umbilical cord, an acute obstetric emergency, except to say that a stat caesarian section was performed less than two minutes later while my hand was deep within the womb holding the baby’s head off the umbilical cord, my fingers only millimeters away from the excited scalpel descending.
Mother and baby did fine and the attending and chief were so relieved after the acute shock that they ended up commending me for uncovering this very rare complication.
For years the nurses repeated the story to the new interns, extolling me as the coolest intern under pressure they had ever seen. Even the chief, they would say, was more excited than he was.
When the interns would repeat this to me I would nod sagely, never letting on that I simply had had no idea of what I as seeing.
So welcome students, enjoy exploring that which is unknown to you. Just try to avoid those lessons that require you to count all your fingers afterwards.
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