Among the many specialties which medical students can choose, obstetrics and gynecology (OB-GYN) is one that requires a variety of practices, such as regular checkups for women, delivering newborns, and gynecologic and oncological surgery. The specialty often involves lengthy days in a very unpredictable field.
To shed some light on what exactly an obstetrician does, Marisa Chavez, a graduate of Stanford University's School of Medicine and an OB-GYN at an urban clinic and large Level I trauma center in Atlanta, offers a glimpse into a typical day on the job.
6:00 a.m. — Alarm rings. Time to prepare for a potentially long day and night. OB-GYNs frequently take 24-hour shifts, and today it's my turn.
8:00 a.m. — Patient hand-off. I call the OB-GYN who was on duty yesterday for an update. If there are no gynecological surgery cases, such as a scheduled C-section, I typically go to outpatient clinic. The hospital is relatively quiet today, so it's off to clinic for me. This also means I get to eat breakfast.
8:30 a.m. — At the clinic, we usually see routine gynecologic cases, such as annual exams and infections, for Medicaid and uninsured patients in the area. Our patients generally lack reliable access to care, so we often act as their primary care providers. Thankfully, we have a multidisciplinary integrated care model, so patients can easily access other specialties.
10:00 a.m. — I get paged to the emergency room to see a 30-year-old woman, who is 30 weeks pregnant. The patient arrived at the hospital after waking up in a pool of blood at home. I see her name on our list of high-risk OB patients, so I call the ER with standard trauma orders to keep her stable until I arrive.
10:15 a.m. — I race from the clinic to the hospital, and thankfully the bleeding has slowed to a trickle. Paramedics report about a liter of blood loss, so I check the status of the fetus. We discuss blood transfusions, and she appears hesitant.
She eventually agrees to receive blood only if her life is in immediate danger. We also discuss the modes of delivery she may need. Given her current hemodynamic (blood flow) stability, we admit her to the hospital for observation.
12:00 p.m. — A scheduled C-section on a 26-year-old. In her third pregnancy, the patient has requested tubal sterilization, so we prepare for this as well.
2:00 p.m. — My resident and I finish the C-section. I get called on a 20-year-old, who, at 41 weeks, needs labor induction. I examine her and give inducing medications over the next 24 hours.
3:15 p.m. — I grab a quick bite to eat during a brief lull.
4:00 p.m. — Rounds on the maternity ward. Many patients with male newborns request circumcision, so after obtaining consent I perform any circumcisions requested.
6:00 p.m. — Quick check on the patient who was bleeding earlier. Her bleeding has stopped, but I plan for further observation.
7:00 p.m. I make it home to catch dinner with my family, which is waiting for me. I hope for a quiet night while I'm on call.
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10:00 p.m. I get a call from the clinic's labor and delivery unit about an 18-year-old who is contracting every two minutes. The nurse says she is not dilated, but she asks for my recommendations. I instruct her to start intravenous fluids and testing to assess risk for pre-term delivery.
10:45 p.m. — Follow-up call on the 18-year-old, who is still contracting. I review her test results remotely and determine it's safe to administer medications to stop her contractions.
11:30 p.m. — Another follow-up call on the 18-year-old. The medication is effective, and the patient stops contracting. Fetal monitoring is normal. Her risk for pre-term delivery is low, so we send her home with an appointment to return within the week.
3:00 a.m. — A colleague wakes me up with the news that a patient is in active labor, so it's time to drive back to the hospital. It seems there is always a delivery in the middle of the night!
8:00 a.m. — Time to hand off these cases to my colleagues. I check in briefly with the higher-risk cases, and then it's time to go home and rest.
Given the variety of career options that are available to medical students, as well as the potential changes in the landscape of healthcare, it's important to know what your life may be like within whatever specialty you choose.
Ibrahim Busnaina, M.D. is a graduate of the University of Pennsylvania School of Medicine and coauthor of "Examkrackers' How to Get Into Medical School." He has been consulting with prospective medical school applicants, with a special focus on minority and other nontraditional candidates, since 2006.