April 13, 2014

spring time // a first time

1. spring time
this is my first spring in DC and it is just STUNNING.  never mind the fact that I've been on nights for 7 weeks straight and that my family has had a grief-ridden first quarter of the year; I LOVE SPRING IN DC. The heat and humidity of the summer hasn't yet set in but the cold has gone for good (I think!) and being outside feels great, the perfect remedy for my exhausted body and soul. I can't believe I'm just a few short months from finishing intern year.

PS: that is an elephant jump suit you see right there. spring present to myself and probably my favorite clothing item I own.  I literally want to wear it ALL THE TIME.

2. a first time
sometime in the past few months I was called to the ED for a gyn consult for vaginal bleeding.  This is probably the most common consult that the ED calls us for, so I didn't think much of it. But  this patient experience reminded me why I became an ob-gyn.  She was a 20-something year old woman who had just had her first experience with sex and had a vaginal laceration.  We ended up packing the vagina - or creating a pressure dressing but in the vagina - and then we just had to wait to see if the bleeding stopped.

The waiting ended up being the best part, because she and I just talked.  It was clear while I was taking my history that she really did not have a lot of information - and even less accurate information - about sex.  So when I explained that normally when women have vaginal bleeding after their first intercourse, it's not this heavy because usually it's from tearing the hymenal ring - the ring of tissue that is at the opening of the vaginal introitus.  however, many if not most women have already "broken" this ring through movement or tampons so many women do not bleed at all after their first intercourse.  A laceration or deep cut in the vagina is never normal after intercourse.  Then I asked her if she had other questions.  She paused and then asked me about the different holes in a woman's bottom - she wanted to be sure he went in the "correct" one.  So I drew her a picture (and gave it to her to keep) and labeled the urethra, the vaginal opening, and the anus.  I asked if she had more questions.  She did.  We ended up talking for about 45 minutes - her asking questions, me answering them.  They ranged from what were normal emotions after a first sexual encounter (anything, I answered, can be normal), to whether or not she should talk to the guy and tell him what happened after she left (communication is probably the most important component of healthy sex, I answered, if you don't think you can talk with someone, it's a pretty good indication that it's not a great idea to have sex with them) to anatomy including the location of this elusive g-spot (I drew more for her).   Those 45 minutes were such a luxury in a time when my job emphasizes speed and efficiency, but I felt like even more than fixing her laceration, I was hopefully affecting her entire sexual life and hopefully for the better.  Moments like this, of helping women understand themselves and their bodies better, especially in vulnerable and potentially scary times, remind me why I do what I do.

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