Date: 11/30/15

Location: Maternity
Tonight marks a month that Ive been working on the fifth floor of Swedish Medical
Center, the Maternity floor. For the first two weeks, I worked solely on the Antepartum wing;
after that, I began floating around the entire floor which includes Labor and Delivery. My lack of
diligence in writing diary entries for this new rotation has to do with a couple of things, namely
laziness and being busy with homework and other responsibilities I didnt have over the summer,
but a lot of it has to do with the fact that it isnt as interesting or action packed as I thought it
would be. I feel no shame in admitting that.
When this floor was first announced, it was touted as the gateway to getting into the OR,
since C-sections are performed on the floor and wed have the opportunity to watch those.
However, upon arrival we discovered that we werent cleared to watch C-sections yet. Which
really sucks because on my very first night, a patient at the very end was going to be induced into
labor. She had a really cool case of having a breach pregnancy, which means that the babys head
isnt oriented down towards the cervix, but its butt is. This becomes a problem because when the
baby is being delivered, theres the chance its head might get stuck in the passage because of the
orientation of the head. Breaches arent unusual, but what made this cool was that the lady was
having twins. So, the first would be delivered naturally, and the second would be delivered by Csection because the second baby was breach. It was cool that I got to learn all this, the OB
fellows were nice and let me tag along when they were debriefing the patient about all this
craziness that was about to go down, but then I wasnt allowed to see the actual delivery.
That is one thing thats nice about this floor. There are a lot of learning opportunities in
the form of asking staff. There is a far greater physician presence on this floor than Ive been
exposed to in the past, probably because its so imperative for these women to have someone
nearby at all times (which is why on L&D, each nurse gets assigned only one patient, which
means that no NACs are needed on the floor). This is true especially for Antepartum, where
there are a lot of high risk pregnancies, most commonly because of PPROM (premature rupture
of the membrane, ie water breaking far before its time), pre-ecclampsia, advanced maternal age
(AMA), GDM (gestational diabetes mellitus), and more. As you can tell, Ive really become
familiar with the lingo of maternity, of which there is a lot. Ive had the opportunity to really pick
it up because I have so much time Im not engaging with patients. Which is cool, because I never
realized how significantly different maternal medicine is from anything Ive seen before. On the
other floors, even though I was technically on different units with different specialties, at the end
of the day I was dealing with mostly geriatric patients and their needs or illnesses sort of blended
together. At a certain age, people dont just have one problem but several, and so I saw those
similar themes throughout all the floors even though there might be one problem in particular
that stood out. So I got pretty comfortable with the patient population. But maternal medicine is
like a foreign planet to me. Novel medical considerations, casesI mean, Ive been hearing a lot
about how women get put on magnesium treatments, and depending on the dose it can treat a
wide variety of conditions. So its things like that which maternal medicine so different, almost
nothing seems common to anything Ive seen before.
Of course, the greatest difference is the patients themselves, and this has been the point of
my greatest disillusionment with the floor. Even though these women need to be in the hospital
and they are often in dire medical conditions, they dont need care the same way that patients on

the other floors have needed help. For the most part, these women are completely independent
and content to just sit in their rooms all day and not be bothered. It also doesnt help that the
nurses are each assigned one patient, so it isnt very likely that they need help with anything
because theyre not juggling a million patients. From what Ive seen, the nurses are always busy,
so its not like theyre twiddling their thumbs, but theyre not busy with the patients themselves.
Theyre always just charting away or something. Which leaves me with even less to do. Not that
I havent tried getting into patient rooms and chatting with these women. But for the most part,
they seem to prefer being left alone to rest, even though many of them are bored out of their
minds. Maybe I just havent been trying hard enough. If I was able to strike up conversations
with these women, which did help pass the time on my previous floors, I would probably learn a
lot more about pregnancy and pass the time better. As it is, Ive been filling up my time doing
mindless paperwork or turning over the beds in OB Triage.
The one learning experience I did have was when, in OB Triage, the fellow was
explaining to a patient that they would be discharged home. The patient was uncomfortable with
this because she had come in with an elevated blood pressure due to pregnancy which hadnt
happened for her first child, and her own PCP expressed that she should go to the hospital.
However, the tests (they checked for protein in the urine and did an US) didnt show that there
was any cause for concern, which is why she was being discharged. However, she was worried
that she would go home and something could happen to the baby, and then the medical staff
would just say were sorry, but the tests showed everything was fine. This patient really felt
like she wasnt being reassured properly, and that they were ignoring the fact that it was her body
that was going through this process. The fellow I was observing seemed nice enough, and she
wasnt cold in her speech, but she was standing at the foot of the bed. She tried to salvage the
situation by going to the patient and holding her hand, but it was after the fact and it was too late
(she should have opened with that when the patient first expressed distress). Respect for patient
autonomy and really helping them understand is even more important on the OB floor because
the patient is doubly scared, for her own health and that of her baby. If theres one thing Ive
been made aware of, its that these pregnancies dont always end happily, so its good to be as
cognizant of that fear as possible.