Working in the DR has made me grateful for a lot of things that I never considered before. For example, when I would walk into a labor & deliver (private!!) room in the US to deliver a baby, everything would usually be set up for me: the patient would be draped, my sterile gown and gloves would be ready, all my supplies would be arranged, and I would easily have access to anything I needed, but if something wasn’t available I could ask for it and easily obtain it (medications, different surgical instruments, etc). When one of these things didn’t happen, I have to admit I would feel annoyed, even sometimes rolling my eyes that this wasn’t ready for me. Don’t get me wrong- it’s not that I felt entitled as a medical student, it’s just how most residents and attendings would react to this situation so I guess it’s a learned response, albeit a kind of lame immature one. Clearly, none of this exists here in the DR.
When I am walking briskly (no one seems to ever be rushing here, even if the patient you are transporting to the delivery room has a head hanging out of her vagina) to the delivery room I know that I can’t expect anything. Sometimes I walk in to the delivery rooms and they are still blood all over the table and floors. Sometimes, I walk in and there are no open tables for a delivery. Sometimes, when it’s a great day I have a clean and ready table. As for the rest, even on good days, it’s up to me. Before I tell a patient she can go ahead and push her baby out, I have to walk down to the pharmacy and ask for what I will need during the delivery-sutures, tools, gloves, local anesthesia, cord clamp, you name it I better ask for it otherwise I am going to be out of luck! Sometimes, this happens quickly. Other times, the people in the stock room don’t seem to care that there is a baby threatening to pop out of my patient and they take an unbearably long time getting my order ready- yes I’m sure that I need that needle driver! Once I return to the delivery room, I have to arrange my own sterile zone with the supplies that I got from the stock room. If everything goes well, I get the baby out without having to give an episiotomy (something I still cringe when doing). Now what do I do with the baby? In the US, there are tons of people in the room- family, father of the baby, nurses, other physicians, etc. Sometimes there is a nurse or resident or medical student in the room, but most of the times there isn’t. So the way that I learned you ask for something is by yelling as loud as you can: “Where is the pediatrician? Give me oxytocin!” Sometimes it comes quickly (Gracias a Dios!) but other times it takes a few yells and my building anxiety that whatever I said in Spanish isn’t clear or is just plain being ignored. The operating room is run mainly in the same way. Sometimes there is a scrub nurse who will help out. But for the most part, the lowest ranking resident is expected to set up everything for the surgery, including the trip to the stock room and arranging the surgical tools for the procedure (something that is usually done by the scrub nurses).
It was a tough transition at first and some days I still struggle when I realize that I have to be the one who has to draw the blood if I want to know if my patient lost too much blood during a delivery, but I can say it’s a good learning lesson. I have learned how to be more decisive, gained some clinical self-confidence, and learned how to yell a bit- all things that I’m proud to have learned.
I would like to take this moment to tell all scrub nurses back home and to those at the future hospitals that I will work at THANK YOU. Thank you so darn much for taking care of these things. Thank you for making it possible for me to walk into a room and focus all my attention on the patient and her care. Thank you for doing a job that I’m sure can be annoying at times and definitely tends to be thankless. I appreciate you so darn much. I will never again roll my eyes when things aren’t ready for me- I will know that I have the capability to do it all myself but I will be grateful for any help you can provide.
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