Junior Fellow Essay
The Life of a Junior Fellow in the 21st Century Lindsey Evans,
MD
T
he rhythmic chirping of frogs in the dusky tropical night hums in my ears as I write this story, accentuating the feeling of distance from the familiarity of my recent training. I started my fellowship in Global Women’s Health with such momentum that it’s often been difficult to take the time to mentally digest or to recount the influx of experiences, joys, and tragedies. Several months ago, I received a call from the head administrator of the hospital requesting assistance in the transport of a patient from a remote location. The patient’s baby, he’d been told, was footling breech, and an obstetrician was requested in case of precipitous delivery during transport. I agreed to go and was whisked off into the soggy black night to a two-seater plane stocked with a delivery kit. While in the air, further details were revealed. We were headed to a village in the mountains near the Venezuelan border deep in the jungle. An ink-black sky stretched over our plane during the hour commute, and, as we began our descent, all I could make out were traces of a thick tangle of trees and mountains on either side of us. My mind raced. “Surely, this is not where we are going to land.” A thin dirt airstrip that had been cleared through the thick jungle wobbled below us. It was outlined by a series of
From the Department of Obstetrics and Gynecology, University Hospitals/Case Medical Center, Cleveland, Ohio. Dr. Evans is currently completing a 2-year Global Women’s Health Fellowship at Georgetown Public Hospital Corporation in Georgetown, Guyana, South America, through Case Western. WONDOOR (Women, Neonates, Diversity, Opportunities, Outreach, and Research) is a global health education program sponsored by University Hospitals/Case Western and is grounded in the belief that all women deserve access to excellent medical care, both in the United States and abroad. In collaboration with the government of Guyana, WONDOOR has started the country’s first postgraduate training program for obstetrician–gynecologists. The American Congress of Obstetricians and Gynecologists’ Junior Fellow Congress Advisory Council sponsored an essay contest to promote a positive perception of the specialty. Of the nine essays submitted, this essay was chosen as the winner. Corresponding author: Lindsey Evans, MD, Department of Obstetrics and Gynecology, University Hospitals/Case Medical Center, 11100 Euclid Ave., Cleveland, OH 22106; e-mail: [email protected]. Financial Disclosure The author did not report any potential conflicts of interest. © 2014 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/14
VOL. 124, NO. 5, NOVEMBER 2014
bonfires that the locals had lit in an effort to guide our pilot to the landing area. Villagers poured from the forest beneath us from dark crevices between the trees. We landed neatly between the tall flames, and I was escorted out of the plane and into the night. A young, nulliparous Amerindian girl lay resting quietly in the health center. The local midwife explained that she had travelled alone via canoe from a village 5 hours away after her membranes ruptured. They had only examined her once, about 10 hours prior, for fear of inciting an infection. I gingerly examined her, expecting to feel a foot or perhaps a cord, but instead was met with the familiar landmarks of sutures between my fingers. Four centimeters. “We’re concerned for obstructed labor,” the midwife explained. “She’s had ruptured membranes for 30 hours now.” “I’m confused,” I started, “I was told there was concern for a breech baby?” “No,” I was informed. The message had not been relayed clearly through the radio transmission; they had called only for a transport plane. The patient was nevertheless brought to our plane for transport to the city for care. She would need oxytocin. The villagers waved as the plane doors closed; the pilot prepared for takeoff—but instead of the roar of an engine was met with the steady creaking of frogs and a faint putter of machinery. “Bloody overheated,” he muttered. We were informed the engine needed “rest” and would be ready shortly. Sensing my panic, the midwife briskly escorted me back to the clinic to see a few patients who had not seen a doctor since their admission. Impromptu rounds ensued on a 68 year-old man with presumed diabetic ketoacidosis and a 43 year-old woman with suspected dengue. Thirty minutes passed, and I returned to find my patient lying quietly in the plane on a mattress squeezed onto the floor, the fading airstrip fires dimly lighting the scene. Lost in thought, I turned back to her, suddenly noting a new figure nestled between her legs—a baby lying as still and hushed as its mother, with a fat, glistening cord stretched under her skirt. A small puddle of blood collected under her, yet she remained expressionless. As stoically as she had
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rowed her canoe through the jungle, she had delivered her baby unassisted without a sound. The remaining villagers watched wide eyed as the midwife and I scrambled to clean the baby, cut its cord, deliver the placenta, and tend to the new mother. In a flurry, the delivery was finished and the young woman sat upright with a shy smile—she still hadn’t said a word.
The patient would still go with us; she needed treatment for malaria that was unavailable at the clinic. The plane started smoothly after it had rested sufficiently. As we huddled in the back of the plane, it rose over the mountains and back toward the coast, and I found myself smiling as well. Life as an obstetrician– gynecologist was certainly more than I had expected.
Special Member-Only Access to Ovid Online College members can access many of the world’s premier medical journals online through Ovid. In these highly cited journals, you’re sure to find the content resources you need to answer your clinical and research questions and advance your medical knowledge. Ovid offers you: s&ULL TEXTONLINEACCESSTOSELECTED,IPPINCOTT7ILLIAMS7ILKINSPUBLICATIONS s!BILITYTOSEARCHACROSSTHE/VIDPLATFORM s!CCESSTO/VID-%$,).% To access Ovid online: s6ISITWWWACOGORGANDCLICKONh2ESOURCESAND0UBLICATIONSv s#LICKONh!RTICLESAND2ESOURCES vANDCLICKONTHELINKTOh3EARCH/VIDv s3IGNINUSINGYOURE MAILADDRESSANDPASSWORD rev 11/2014
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Evans
Junior Fellow Essay
OBSTETRICS & GYNECOLOGY
The Life of a Junior Fellow in the 21st Century Lindsey Evans,
MD
T
he rhythmic chirping of frogs in the dusky tropical night hums in my ears as I write this story, accentuating the feeling of distance from the familiarity of my recent training. I started my fellowship in Global Women’s Health with such momentum that it’s often been difficult to take the time to mentally digest or to recount the influx of experiences, joys, and tragedies. Several months ago, I received a call from the head administrator of the hospital requesting assistance in the transport of a patient from a remote location. The patient’s baby, he’d been told, was footling breech, and an obstetrician was requested in case of precipitous delivery during transport. I agreed to go and was whisked off into the soggy black night to a two-seater plane stocked with a delivery kit. While in the air, further details were revealed. We were headed to a village in the mountains near the Venezuelan border deep in the jungle. An ink-black sky stretched over our plane during the hour commute, and, as we began our descent, all I could make out were traces of a thick tangle of trees and mountains on either side of us. My mind raced. “Surely, this is not where we are going to land.” A thin dirt airstrip that had been cleared through the thick jungle wobbled below us. It was outlined by a series of
From the Department of Obstetrics and Gynecology, University Hospitals/Case Medical Center, Cleveland, Ohio. Dr. Evans is currently completing a 2-year Global Women’s Health Fellowship at Georgetown Public Hospital Corporation in Georgetown, Guyana, South America, through Case Western. WONDOOR (Women, Neonates, Diversity, Opportunities, Outreach, and Research) is a global health education program sponsored by University Hospitals/Case Western and is grounded in the belief that all women deserve access to excellent medical care, both in the United States and abroad. In collaboration with the government of Guyana, WONDOOR has started the country’s first postgraduate training program for obstetrician–gynecologists. The American Congress of Obstetricians and Gynecologists’ Junior Fellow Congress Advisory Council sponsored an essay contest to promote a positive perception of the specialty. Of the nine essays submitted, this essay was chosen as the winner. Corresponding author: Lindsey Evans, MD, Department of Obstetrics and Gynecology, University Hospitals/Case Medical Center, 11100 Euclid Ave., Cleveland, OH 22106; e-mail: [email protected]. Financial Disclosure The author did not report any potential conflicts of interest. © 2014 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/14
VOL. 124, NO. 5, NOVEMBER 2014
bonfires that the locals had lit in an effort to guide our pilot to the landing area. Villagers poured from the forest beneath us from dark crevices between the trees. We landed neatly between the tall flames, and I was escorted out of the plane and into the night. A young, nulliparous Amerindian girl lay resting quietly in the health center. The local midwife explained that she had travelled alone via canoe from a village 5 hours away after her membranes ruptured. They had only examined her once, about 10 hours prior, for fear of inciting an infection. I gingerly examined her, expecting to feel a foot or perhaps a cord, but instead was met with the familiar landmarks of sutures between my fingers. Four centimeters. “We’re concerned for obstructed labor,” the midwife explained. “She’s had ruptured membranes for 30 hours now.” “I’m confused,” I started, “I was told there was concern for a breech baby?” “No,” I was informed. The message had not been relayed clearly through the radio transmission; they had called only for a transport plane. The patient was nevertheless brought to our plane for transport to the city for care. She would need oxytocin. The villagers waved as the plane doors closed; the pilot prepared for takeoff—but instead of the roar of an engine was met with the steady creaking of frogs and a faint putter of machinery. “Bloody overheated,” he muttered. We were informed the engine needed “rest” and would be ready shortly. Sensing my panic, the midwife briskly escorted me back to the clinic to see a few patients who had not seen a doctor since their admission. Impromptu rounds ensued on a 68 year-old man with presumed diabetic ketoacidosis and a 43 year-old woman with suspected dengue. Thirty minutes passed, and I returned to find my patient lying quietly in the plane on a mattress squeezed onto the floor, the fading airstrip fires dimly lighting the scene. Lost in thought, I turned back to her, suddenly noting a new figure nestled between her legs—a baby lying as still and hushed as its mother, with a fat, glistening cord stretched under her skirt. A small puddle of blood collected under her, yet she remained expressionless. As stoically as she had
OBSTETRICS & GYNECOLOGY
1031
rowed her canoe through the jungle, she had delivered her baby unassisted without a sound. The remaining villagers watched wide eyed as the midwife and I scrambled to clean the baby, cut its cord, deliver the placenta, and tend to the new mother. In a flurry, the delivery was finished and the young woman sat upright with a shy smile—she still hadn’t said a word.
The patient would still go with us; she needed treatment for malaria that was unavailable at the clinic. The plane started smoothly after it had rested sufficiently. As we huddled in the back of the plane, it rose over the mountains and back toward the coast, and I found myself smiling as well. Life as an obstetrician– gynecologist was certainly more than I had expected.
Special Member-Only Access to Ovid Online College members can access many of the world’s premier medical journals online through Ovid. In these highly cited journals, you’re sure to find the content resources you need to answer your clinical and research questions and advance your medical knowledge. Ovid offers you: s&ULL TEXTONLINEACCESSTOSELECTED,IPPINCOTT7ILLIAMS7ILKINSPUBLICATIONS s!BILITYTOSEARCHACROSSTHE/VIDPLATFORM s!CCESSTO/VID-%$,).% To access Ovid online: s6ISITWWWACOGORGANDCLICKONh2ESOURCESAND0UBLICATIONSv s#LICKONh!RTICLESAND2ESOURCES vANDCLICKONTHELINKTOh3EARCH/VIDv s3IGNINUSINGYOURE MAILADDRESSANDPASSWORD rev 11/2014
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Evans
Junior Fellow Essay
OBSTETRICS & GYNECOLOGY
