Thursday, I had the opportunity to rotate through the GYN clinic at the Health Department. There were four students in all: a 2nd year medical student (me), a 4th year medical student, a CNL student, and an undergraduate nursing student, plus a PA, three physicians, several nurses, and a sonographer, all clamoring for four exam rooms and an ultrasound room. So, space was a little tight, but we made it work.
The first patient I saw I actually went in with the fourth year, considering I had never been alone interviewing a patient before and haven't gone over any GYN stuff in class yet. So I was understandably nervous.
The woman had been seen before and had a pessary placed. For those, like me, who have no idea what a pessary is (it's especially interesting hearing people talk about it for a good 15 minutes before you actually learn what it is), it's a piece of silicone placed into the vagina to hold something, such as the bladder, uterus, or rectum, in place. In this case, it was the bladder. This woman had been having problems with leakage and whatnot, and was incredibly thankful for the pessary, because it changed her life so dramatically. Later, I went in with the physician (without interviewing first) to see another patient with urinary incontinence, and the pessary was an option provided to her before surgery. She was miserable, unable to travel far away from home due to her inability to hold urine. Since the pessary was just placed, we don't know how successful it will be, but if it helps her at all, it will undoubtedly provide her relief, and hopefully she'll be able to avoid surgery. Certainly an interesting introduction to the world of Gynecology.
Of course, the cornerstone of RAM is to treat people who don't have access to healthcare, and one of the patients we saw was uninsured and referred due to an abnormal pap smear. As far as I could tell, pap smears themselves are offered free in this particular area by both the Health Department and the Health Wagon, as well as RAM itself. But I couldn't tell what the course of action was if a patient came in with an abnormal pap smear. That's one of those tests where an abnormal could mean nothing (especially in young girls), or it could mean cervical cancer. In this patient, the pap was concerning enough that we went through a colposcopy, where the cervix is visualized with acetic acid and iodine, and then any abnormal areas are biopsied. The highlight of this patient encounter for me was inserting the speculum, which I did successfully without assistance.
One of the things I loved about the GYN clinic is that all the providers were more than willing to let us take the wheel and interview the patients and start to perform procedures. Obviously, they were standing next to us and guiding us, taking over when they knew we were out of our depth, but for the most part, they were willing to just let us do our thing. It was nice, especially as a second year with no experience in doing these type of procedures before.
My last experience of the day was watching an IUD get placed. After watching from the back end, I think I can confidently say that I do not ever want to have one of those. They have to clamp the cervix in place in order to insert it, and it has wires coming down from it to aid in the removal 5 years down the line. It was neat to see, don't get me wrong, but I can't imagine ever having that done myself.
All and all, it was a great first day, and I'm excited to see what else I'll get to do throughout the weekend.