From Postpartum to Postop

IMG_0994Chandra Anokye
McMaster University
Class of 2016

It was an ordinary Wednesday in clerkship. Handover went smoothly, and postpartum rounds were going well. New moms on the ward were happy and healthy. Aside from the fact that CaRMS applications were opening at noon, it seemed like just another day in the life of a clinical clerk. If you squelched the nervous excitement induced by CaRMS opening (were we really going to be residents so soon?), everything was great. Blood pressures on the ward, other than ours, were pristine.

I started to experience a cramping flank pain by midmorning. Really, it had started the Monday before, but I’d chalked it up to exhaustion from a long night on call. Or maybe some weird peri-menstruation cramps, even though the timing was off.

I fidgeted in my chair as I scribbled away at SOAP notes. Just make it through the morning, I thought. Ibuprofen was waiting in my brilliant orange bag downstairs in the resident room.

The cramps persisted.

When I finished postpartum rounding, I headed downstairs to Labour & Delivery. I was one task closer to my promised ibuprofen. I checked in on the labouring patients I was following, and shot the breeze with one of my fellow clerks.

Finally, it was noon. All was quiet on the ward, so I nipped over to the resident’s lounge to grab a bite to eat. I could finally get some ibuprofen, glorious ibuprofen. I swallowed a tablet, and settled in to eat my lunch. I was quite uncomfortable, with this dull bilateral flank pain gnawing away at my back. Surely, I thought, the medication will do the trick. I just had to wait.

I was to be sorely disappointed.

Within the next half hour, the pain exploded into a 10/10 throbbing flank pain. I started doing what is best described as the “nephrolithiasis rock” on my seat. There was a staff person in the room and, not wanting to be yet another self-diagnosing student, I tried to keep my cool.

Within minutes, nausea overwhelmed me. I ran to the women’s change room. I’d like to say I made it to the toilet, but that would be a lie. I threw up. Many times.

I’d had appendicitis three years previously, but this was nothing like what I’d had then. It made appendicitis feel like a walk in the park. The pain rolled through my body, twisting around my lower quadrants.

I wobbled back to the lounge. I had to give up the pretense. I was sick.

What happened after that was a bit of a blur. One of my classmates walked me downstairs to emerg. I was triaged by nursing quickly. Unfortunately, there was a crisis in the main department, so the triage doc was held up for 3 hours. Those were the most agonizing hours of my life. Pain and nausea filled all my senses to the point where I prayed I would just pass out.

Finally, the triage doc walked through the doors like an angel descending from heaven. He ushered me quickly through the emergency department, where only the day before I had been doing consults of my own.

“Looks like kidney stones,” he said.

Morphine and Zofran dripped into my veins. Morphine just barely took the edge off, but Zofran was like magic. I was in imaging within minutes. Everyone seemed to know I was a clerk. Maybe my scrubs gave me away. I didn’t care, I just wanted it to stop.

“What do you see? Any stones?” I couldn’t help but badger the ultrasound tech. He shook his head and readjusted his probe.

“Are you sure you emptied your bladder?” The tech wanted to know, for the second time.

Unless I had somehow gone into retention, I was sure I had. A radiologist appeared beside my bed. After some discussion, they decided my bladder was indeed contracted, and what they were looking at was a large – very large – cyst. There was no Doppler flow.

It was ovarian torsion.

Quickly, my wonderful OB/GYN team appeared. It was strange, having been at handover with them just a few hours before, and now having them at my bedside, consenting me for surgery.

By the end of the evening, I was waking up in recovery. My chief explained what they had done. A 10 cm cyst, torsed 4-5 times, and necrotic. It had probably been torsed since Monday, when I had first felt twinges of pain and nausea. They couldn’t help but perform a salpingo-oophrectomy.

I mourned the loss of a part of myself, but I knew I had been in excellent hands. And the operative pain was such a relief compared to the torture of torsion.

I was wheeled up to 6GI, where, to complete the irony of my day, I had recently finished my six-week surgical core.

The first ovarian torsion I had ever seen had been my own. Experiential learning doesn’t get more real than that.

Being so quickly transformed from the confident clinical clerk to the helpless patient awaiting results from my physicians was a well-timed reminder. It was a reminder that our patients are not different than us – and that our care as members of the healthcare team is meaningful. I was like any other patient: scared, in pain, and full of unspoken questions. It was humbling.

Compassion and kindness are part of our job, just as much as providing evidence-based management plans. Even in the throes of my suffering, I was struck by how kind and empathic the OB/GYN team was. I had become their patient, and in doing so I was able to truly experience good medicine. All the components of becoming an excellent physician culminated there, on the ER stretcher, where I could so clearly see the fusion of medicine and humanity

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