The Third Year
First Clinical
By
Phillip Van Swearingen MD
LSU Class of 1972
The third year started with excitement and anticipation, for this was the beginning of our clinical years. Now, we would be allowed to go into the big sprawling hospital known fondly as “Big Charity or Mother Charity”. Patient contact would become a reality and there would be real histories and physical exams to do as we had practiced during the second year under the guidance of Dr. Fred Allison. My heart pounded as I entered the classroom for orientation in the first clinical course of the third year- obstetrics and gynecology.
***
“This course is divided into three sections,” Dr. Joseph Crapanzano said to the forty of us sitting eagerly in front of him. Our class had been roughly divided into thirds and the other students who had survived the first two years were being introduced to surgery and internal medicine.
At least he seems friendly, I thought. He’s not talking into a microphone and he’s not twirling a slimy sinister looking mustache.
“I have divided this class into three groups. One third of you will be assigned to Family Planning, one third to the gynecology clinic and one third to the labor unit. You will spend four weeks in each section. Each section will provide its own orientation. I’m going to read off the names for each section now. Listen carefully.”
Gee, I wonder which one I’ll get. I looked around the room. Wonder if we’ll all still be together. I thought about three of my close friends who were scattered around the room.
“Those of you going to family planning are to go over to the first floor of the hospital and follow the signs. Those going to gynecology clinic don’t have to be there until two o’clock this afternoon. Go to the student lounge-and I don’t mean Joe’s Bar-and have a coke. Play bridge or something.”
I think I’m going to like this guy. I sat on the edge of my chair and waited.
“Those of you assigned to obstetrics are to remain here.”
***
At least Frank, George, Joe and I will be together. I reached over and shook Frank’s hand as the class assignments were called. Two of my other close friends were assigned to family planning.
“Do you think they’re going to let us deliver babies?” George whispered to me.
“That’s what I heard.” Damn! I’ve heard some whopper stories!
“Now, listen up,” Dr. Crapanzano began as he looked over the group and started counting. “You ten will be divided into two groups. Each group will work a twelve-hour shift. Each shift goes from seven to seven. After two weeks, the shifts will switch. This means twelve hours on and twelve hours off for those of you who can’t add. This includes weekends.”
There goes my fishing trip to Grand Isle. I let out a groan.
“Yes, you will be allowed to deliver babies, but only for those patients that have had one or more already. No first time deliveries. Those are called primigravidas for you who don’t know the terminology. You’re not allowed to use forceps or deliver a breech. I’m going to read off five names. You are to go to the labor unit right now. I understand that there are babies waiting to be delivered.”
“Are you scared?” George asked as he and I made our way through the hall and into the main part of the hospital.
“I’m terrified. But look at this, we’re wearing white coats. We’re upperclassmen. I even bought a new stethoscope.”
I’m scared, but I feel like a real doctor, now, I thought. Wish I knew what was going to happen next. Well, we’ll know pretty soon. Here we are. It’s the Labor Unit.
Five of us stood side-by-side outside the double swinging doors. I read the sign as it loomed ominously in front of us.
LABOR UNIT
AUTHORIZED PERSONNEL ONLY
“I guess that’s us,” George pointed at the sign as he timidly placed one hand on the door and started to push it open.
“Gangway! Move aside for the baby express!” All of us turned at the same time to see a stretcher-bed being wheeled rapidly down the hall. A scream pierced the air and echoed off the walls. I could barely see the head of a short fat man pushing the stretcher. The moving mound on top obstructed the view of anything else.
“I said, get out of my way. Hurry up! Move over or she’ll have the damn thing out here in the hall!”
“Oh! Jesus, God!” The pregnant woman screamed as she threw the sheet off her abdomen and tried to sit up.
We jumped aside just in time. The end of the stretcher hit the swinging doors full force and they flew open with a bang, which echoed off the walls. The stretcher was through and out of sight in an instant. I caught a glimpse of men and women, moving like a sea of scrub suits and surgical masks.
“Oh, shit!” Joe exhaled and looked at me. The doors swung open suddenly, just as he got the words out.
“I thought that I saw a couple of new starched white coats out here,” the charge nurse bellowed. “Are you my new STUD MD’S?” She continued in a slow menacing voice.
We looked back and forth at each other. “What’s a STUD MD?” I managed to mouth the words.
“Stud MD is what we call you new and fresh student doctors, O’ my green and innocent juniors!” The charge nurse stood in the doorway with her hands planted firmly on her hips and her feet spread apart. She must have been at least two hundred eighty pounds and filled the double doorway as she stood and stared at us, looking like an enormous drill sergeant.
“Yes’m,” I stuttered under my breath, feeling as if I should be standing at attention.
She laughed a deep chuckling laugh and turned so she faced the room beyond her before she yelled at the top of her voice. “Make way for the new STUDS! All hail the new STUDS. They’re a bit green about the gills! One looks like he could puke at any minute! Let’s baptize em!”
Turning back and facing us with a grin, which showed one gold eye-tooth, she asked, “Well, are you or are you not my new STUD MD’s?”
“Yes, that’ll be us,” I said as I tried to smile back at her, while trying to feign a sense of bravado.
“Good! Get in here!” She ordered, grabbing me by the arm and forcefully pulling me through the door. “Come with me quick. We’ve got one crowning. You others go in the locker room and put on a pair of green scrubs,” she ordered, pointing at the rest of the guys and then the men’s locker room.
“Yes’m.” they said in a hushed unison and headed for the locker room.
“And you, come with me,” She continued to drag me through the holding room and then through another set of swinging doors. “You don’t have time to change or scrub in. Just put on this cover-up and get in here.”
“But, I don’t know how,” I stumbled, but her firm grip held me rigidly upright.
“No buts,” She held the gown in front of me so I could put my arms through the sleeves, quickly stepping around behind me to tie it around my neck and waist. “Put these on,” She handed me a mask, cap and a pair of surgical gloves. “This is a ‘learn on the job’ class.”
“Shit, they’re putting her on the table!” I mumbled. I watched as two nurses lifted and pulled the pregnant woman onto the delivery table. It was the same one who had passed us in the hallway. They didn’t take the time to cover her, and I could see was her hugely swollen pregnant abdomen. I didn’t notice that besides visible pubic hair there was more hair coming from her swollen and separated labia. The woman screamed again. I felt something sour and bitter in the back of my throat.
“Try to hold that baby a minute, girl! We’re not set up! Here!” She pushed-no, she shoved me-between the woman’s legs as two nurses lifted and placed them in the stirrups. “Put these gloves on. One more push like that last one and the baby will be here!”
“I, I’ve never. I’ve never even seen!” Shit! What if I drop it!
“Like I said, this is learn on the job. Come on, you’ll do fine. I’ll walk you through it. This is this girl’s third baby. It won’t be a problem. Just stand there between her legs and get your hands up. She could pop this one out kinda’ fast-like.”
“Like this?” I raised my hands, nearly touching the swollen labia with the tuft of black hair rapidly swelling into view.
“That’s right. Put one on the baby’s head. You need to control the speed of exit or it might tear her vulva. If it does, it’ll bleed like Hell and you’ll have to sew a lot. You can’t spend a lot of time with this one. There are two more lined up and ready to go.”
Bleed! Sew! Two more lined up! I don’t even know how to tie surgical knots yet! I felt sweat trickle from my armpits and down the side of my rib cage.
I think I’m gonna’ pass out! I felt myself start to sway and things became fuzzy. The sweat was pouring off of my face. I started to reach up and wipe it from my eyes as I hoped that was the only thing making my vision fuzzy.
“Don’t touch yourself when you’ve got sterile gloves on.” A pleasant and kind female voice seemed to come out of nowhere. “That’s my job. Keep your hands on the baby.” I felt a soft gauze pad touch my face and wipe the sweat from around my eyes.
“Thanks,” I managed to say, not looking away from the goings-on in front of me.
“No bother. By the end of the morning, you’ll stop sweating,” she giggled. I felt the warmth of her body press into mine from the side and behind me.
“Do exactly as I tell you,” the older nurse interrupted her giggle. “Linda, step back a little and don’t stand so close. You’ll distract him.”
“Yes,m,” she answered. I sensed her move away.
“You want to control the head. When the next contraction comes, hold it so it doesn’t pop out of the birth canal. Just put some pressure on it. Do you see how much the vaginal opening is stretched?”
“Yes’m.” How in the hell can this baby get out? Its head must by humongous. How is this opening going to get that big?
“See how thin the labia are? If it pops out, it’ll tear right there,” the nurse pointed. “Ah, here comes the contraction now. Put your hand here. That’s right. Put your hand right on the head. Good, you might just be a natural. See, here comes an ear and a nose.”
“Please, God!” I prayed out loud. “Don’t let me drop it!”
“Keep both hands up now. Here it comes. See, the head’s out. Here come the shoulders. See how the body rotates so the shoulders will follow?”
The woman screamed and pushed hard. The next thing I knew, I was holding the entire baby. It came out in a gush of amniotic fluid and blood, which splattered all over my shoes as I had not had time to put on shoe covers. To my amazement, I naturally formed a cradle and held the baby in my left arm.
“Good catch!” the nurse said as she took a suction bulb and sucked the nose and mouth clear of the thick fluid. As soon as the nose and mouth were cleared, the baby took its first breath and let out a trembling cry.
Gee whiz. It’s alive!
“You’re not through yet, doctor. By the way, my name is Clara. You’ve got to clamp the cord and cut it. Here’s the plastic clamp. Clamp it about an inch from the baby.”
“Here?” I placed the clamp around the cord.
“That’s right. Now clamp this other one right next to it. Take the scissors and cut between the two. Next, take the surgical cord clamps and snap them onto the cord. You still have the placenta to deliver. Give me the baby. It’s time to show it to its mama and get it all cleaned up.”
“Is that my baby?” The new mother asked.
“Yes,” Clara said as she showed the baby to her. “It’s a nice baby boy. The other two were girls, weren’t they?”
“Yes.”
“What are you going to name him?”
“I don’t know. What’s a good name?”
“How about giving him his father’s name?”
“He done gone away for good. Left ‘bout six months ago.”
“I’m sorry,” Clara turned to me and continued, “It’s an all too frequent story around here.”
“What’s your name, doctor?” I looked at the woman who was staring at me intently. I had not been following the conversation, being more focused on watching the cord as it disappeared into the gapping vaginal opening.
“Me?” I asked.
“Yes, doctor. What’s your name?”
Doctor. She thinks I’m a doctor. And I’ve just delivered my first baby!
“What’s your name, doctor?”
“Phillip,” I answered, shyly.
“Then that will be this baby’s name. I’ll name him Phillip.”
I did not see Linda wink at Clara, nor could I see the smile that crossed her mouth. All I could see was the cord. I took a brief look at the cut end and noticed the blood vessels.
These were just pumping blood into that baby. Wow!
“You’re not through, yet,” Clara nudged me in the side, breaking the spell. “You have to deliver the placenta.”
“What do I do?” What’s on the other end of this cord? It feels like a big bass swimming under a log.
“Just hold on to the metal clamp and use gentle pressure. She’ll contract again and then it’ll come out just like the baby did. Don’t pull too hard. It has to come out whole or it’ll bleed like… Well, you don’t want to really know right now.”
“I think it’s coming. I can feel something moving.”
“There it is. See, coming out just like the baby’s head. Now, reach up and take a hold of it. That’s right. Now you can pull the whole thing out.”
“Like this?” The placenta felt slippery and I almost dropped it. I felt like a juggler in a circus.
“Yes, now put it over here on this towel and inspect it. You have to make sure that all the lobes are there. See, looks like it’s all in one piece. If any were left, you’d have to put your hand up in her and search for it. Then you would have to scrape it all out or she would bleed to death.”
That’s all I need. Suddenly, I felt unsteady and started to wobble noticeably.
“Sit down,” Linda said as she slipped a stool up behind me. I was not expecting the pinch I received as I began to sit.
“Linda!” Clara sternly stamped her foot. “Leave him be! He’s got a ring on.” Linda giggled and turned back to her clean-up duties. “Spoil sport.”
I found the stool comforting and the dizziness quickly passed. Now, I was at eye level with the vaginal opening staring at a trickle of blood pouring from it. The blood dripped unceremoniously onto the floor and also onto the tips of my shoes.
“Here,” Clara handed me a long metal surgical clamp with a piece of gauze clamped firmly onto the end. “This is called a sponge stick or sponge holder. Put two fingers into her vagina, spread the labia and then insert the sponge on the end inside to soak up the blood.”
“Like this?” I felt the sponge slip into the opening and saw it disappear. How deep does this thing go?
“That’s right. Now take it out, unclamp it and get another sponge. Do it again and again until it comes out dry. Then you have to look inside to see if there are any vaginal tears or if the cervix has been torn. I’ll hold the light so you can see.”
***
“Hello, there. I’m Bob.” I turned at the sound of the male voice.
“Hi. I-I’m Phillip,” I answered, my voice sounding as if it were coming from a deep hollow cave.
“I’m the senior resident. How did he do, Clara?”
“Just fine, Doctor. This one won’t be any problem. Have to keep Linda off of him, though. I think she’s taken a liking to him,” Clara turned and frowned at Linda, who acted busy with her cleaning duties.
***
At the end of my shift, I made my way home, crossing under the Claiborne Street overpass and down Perdido Street to the married student’s dorm, which was not to fondly known as ‘The Grey Monolith’.
I DELIVERED FIVE BABIES TODAY! My brain could not quit counting. Five! I fumbled for my keys and finally found the one to the apartment. I walked slowly down the hall and put the key into the lock.
“Five,” I said out loud as I entered the apartment and collapsed onto the floor.
