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How I managed my late-career switch from general practice to obstetrics

How I managed my late-career switch from general practice to obstetrics - Featured Image

 

Was it the thought of slippery little beings being delivered into my welcoming hands? Was it a feeling of bored complacency? Or – perish the thought – a midlife crisis?  The prospect of change enticed me when I applied for entry into the Advanced Diploma of Obstetrics traineeship. Naysayers and sceptics abounded, with sagas of sleep deprivation, eight-litre postpartum haemorrhages and lightning ambulance trips with arms, elbows and shoulders up vaginas supporting uterine inversions. “You’ll come crawling back to general practice begging for your job back” they sniggered.

My initial few weeks were a terrifying blur of inexplicable acronyms, abbreviations and staccato instructions yelled in rapid transit. “CTG” no longer meant “close the gap”, “stretch and sweep” didn’t connote house work, and third stage had little to do with opera. I learnt to wear only meconium coloured clothes, to roll up my sleeves before rupturing membranes, and that amniotic fluid rots the Velcro on shoes.

The seriousness and difficulty of my new challenge was quickly apparent. Simple procedures like cannulation, long forgotten, had to be perfected. My first few vaginal examinations during labour left me perplexed. Didn’t these women have cervixes?  I wish someone had taken the trouble to describe them as a stretched balloon with a hole, instead of the nose like structure to which I was accustomed in general practice. I now use this handy analogy as a teaching tool.

Twelve hour days, plus nights on call, with missed meals were followed by intense studying for the written and clinical exams. Challenging for the young, but nearly impossible in one’s sixties. My energetic, obsessive personality prevented me from leaving until every “i” was dotted and ”t” crossed, so my hours escalated in a malignant fashion, inversely proportional to my sleep time.  I hated living away from home and my long-suffering husband. My first rental accommodation was cockroach ridden, dark and depressing – a far cry from the beautiful rural farm that is my home. I missed my children and grandchildren, my friends, my life. Family events came and went in my absence. I suffered severe insomnia as well as horrific nocturnal leg cramps. I’d awake up to six times a night, screaming in agony, with my gastrocnemius muscles caved in. Initially I blamed my marathon walking on hard surfaces, until the correlation with the most stressful days became evident. How my neighbours must have loved me!

Learning skills from people the age of my children was humbling, and often humiliating. Negotiating different, and often aberrant, personalities amongst consultants was challenging. It was evident that one particular “boss” thought I should be at home knitting, while others patiently tolerated my slow but steady acquisition of skills. Another was openly disdainful. Initially, I simply tried too hard. To my horror, a patient complained that I hadn’t finished an examination when she’d asked me to do so. My boss had told me it was IMPERATIVE to complete this examination to avoid a dire clinical outcome and I’d gone at it like a bull at a gate. Naturally, I apologised, but my first ever patient complaint distressed me and crushed my already waning confidence.

The competitive atmosphere of the hospital took me by surprise. Gone was the collegiate atmosphere of General Practice. It was dog eat dog now! Fights for the caesarean lists, scrambling for labour ward shifts, crafty manipulation to avoid certain consultants. And I was as guilty as anyone! Those – like me- who were less aggressively competitive, missed out.

Surgery almost proved my nemesis. It had been nearly forty years since I’d graced an operating theatre or studied anatomy. Scrubbing, gloving and turning to tie up sterile gowns were nearly my undoing. Gnarled theatre sisters rubbed their withered hands with glee when I contaminated myself yet again, or forgot the name of some ubiquitous, obscure instrument! I mean, why the eponymous title for forceps? (Greene Armytage? Moynihans? Wrigleys?). Pointing or referring to them as “that one” didn’t really inspire confidence!

Surgical knot tying practice left my home resembling a sadomasochism den. Although I can certainly tie a hook on my fishing line better now! Other trainees learnt surgery so much more easily than I did! Yet, learn I painstakingly did. It seemed to take forever, but I can now perform straightforward caesareans, challenged occasionally by the odd impacted or high floating head. Instrumental births were difficult, but I am gaining my confidence. I passed my theoretical and clinical examinations with flying colours, and my “case syntheses” were marked as “excellent”.

After 18 interminable months, my traineeship is effectively over. Other trainees are progressing well but I still have a couple of skills to sign off. This, of course, presents a new challenge! I have begun ad hoc locums as an obstetrics registrar, but I am now the bottom of the pecking order as far as skills acquisition goes. Where to from here?

I look back at these 18 months with a mixture of horror and deep satisfaction. The knowledge that I was accumulating was massive and interesting, the studying strangely enjoyable, the care of mothers in labour and birth exhilarating. I’m often asked: ”Why? What are you planning to do with these skills?” My original plan was GP Obstetrics in remote and third world regions. Now I am assailed with self-doubt. Am I capable? Do I have the stamina? Can I cope with the stress and the inevitable occasional adverse outcome?

At this stage I can’t answer these questions. But the other day, as I delivered a beautiful baby boy with forceps, following a long and exhausting labour, I felt that slippery little bundle in my welcoming hands and witnessed the joy and relief on his parents’ faces, and all those negative memories flew out the window as I immersed myself in the miracle of new life, and felt so grateful to be a small part of this exquisite epiphany.

 

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