Baby, Please Stop Crying
I expected a slow day because the truck generator is down. But as soon as we finished chart review, I saw a room filled with parents and their kids crawling around on the floor. We would only be seeing Obstetrics (Ob) patients in the morning then switch over to Family Medicine. I got to tag along with the residents as they interviewed the women who came in.
The Ob history seems awfully simple compared to the full history and physical I was taught at school. You ask about the most critical stressors first, like if the mother has felt any fetal movement, bleeding, discharge, pain, or contractions. You also ask if there’s been a lot of hand/foot swelling (probably to watch out for preeclampsia). Then there are more general questions, like if the mother is drinking plenty of water, since dehydration can cause premature labor, has been eating well, has a support system at home. The 2 main physical exam components are to measure the fundal height, which tells you if the fetus is growing at the proper rate, and to listen for the heartbeat.
This the second time I got to try and find the heartbeat. The first was with a breech patient. For some reason, it was really hard to find there and although the attending physician said that was it, I couldn’t tell the difference between the mother’s heartbeat and the child’s.
This time, I landed right on it. Working the audio Doppler is pretty easy, you just put it down on a right angle through some gel. Somehow, simple procedural things are always harder to remember. You should properly drape the patient and have lots of paper towels nearby to wipe the gel.
MayoClinic says a normal resting heart rate in adults is 60-100 bpm. A fetus’ heart rate is between 130-160. So you’re expecting to hear something much faster and higher pitched.Watching the resident and the attending work together, I found an easy way to differentiate between sounds if you’re confused. While listening to the abdomen, just feel for the mother’s pulse and make sure they don’t match up.
The last person I saw for the Ob portion of the clinic had me hold her 4-5 month old child. I haven’t had much experience with small children. My cousins are independent teens and my mom was around for my little brother. I put on the most non-threatening motherly face I could, with the obligatory cooing. She was not convinced. As soon as her chubby legs were lifted from her mother’s breast, her face transformed into that of a very upset little person. She started to twist about and claw at my arms, crying to get back to mom. Mom assured me that it was just separation anxiety and she was like this with everyone. I’m surprised that anyone could carry off a kidnapping with such an effective alarm system built in. I was standing less than a foot away from the mother and the poor girl was bawling her head off. Eventually it just became too much and we decided it’d be better to just drape the kid across her mother’s chest while we examined her stomach. So I am now shamefully googling “how to calm down a crying baby”, and taking notes.
The residents cleared out quickly once the morning shift was done. That left me and the Nurse Practitioner.
She had a lot of sports physicals to do today, and I watched her conduct one on a young girl who wanted to be on the soccer team (everyone wanted to be on the soccer team). This brought me back to my Physical Diagnosis classes. It was a basic run-through of a physical exam, minus the Mini mental state exam. I got to take care of the rest of the kids. I think I’m going to try and make the exam more in-depth so that I can get some practice in percussing for organ margins.