August 11, 2006

• Where no man has gone before…

  First off, more excuses on pic posting…my operating system crashed and I am without my computer for a large protion of the weekend…fear not, all the pictures and crap is backed up and saved so it is not lost, but my comp will have to be reformatted and thus i am cut off from the world unless i come to the school library…something i love to do on my weekends anyway

  So yesterday I completed my very first breast and gynecological exam ever, and while admittably a little strange, was not as terribe as I feared it might be. Although, I remain a firm believer that the Ob/gyn specialty is not for me.

  Showed up to the clinics all dressed up in my slacks, button down and white coat, just as if i was a real doctor! I love playing dress up We divided up into groups and then met our patient and ta. For HIPAA reasons I will not give the patient a name. Anyway, we all introuced ourselves and then the TA walked us through how we were going to do the exam, and then she just had us dive right in and do it. Now there were a number of potentially awkward factors involved that could have led this whole encounter into the magical themepark of awkward land, such as:

  1. I have essentially only practiced either of these procedures for 1 hour of one day, and that was the day i learned them, and that day was approximately yesterday
  2. I was the only male in the group, and for that matter, in the room
  3. The patient knows the entire procedure and corrects you if you make mistakes
  4. the TA and the fellow med students are looking over your shouder the entire time, silently judging you (not really, but you know…)

  And yet, al these potentially awkward factors ended up combining into an excellent (albeit unique) learning experience. The patient was very, well, patient as she calmly disrobed for each med student, and we began by feeling along the axilla (armpit) working our way down and out along the lymph nodes and then along the arm. Next was the actual palpation of the breast, which we learned to do in quadrants with a circular sweeping motion and three levels of pressure to exam the skin, muscle and bone layers for nodules, masses, or lumps. The fingers are meant to be low, and using mostly the pads, and your knuckles should also be low with your wrist, not your shoulder dropped. Ideally, you should also have your cuffs rolled back, so the sleeves dont brush the patients nipple and cause discomfort. These are things i never would have thought about, but was enlighted to by the patient. Oddly enough, I had the best technique of the three of us students (athough not to say mine was flawless, i just needed correction the fewest number of times) you get a flow going and it actually starts to feel natural. Then we examined the area under the nipple, and finally performed a milking motion on the nipple checking for any discharge. So ended the breast exam…but we were far from over

  On a side note ladies, dont forget to do a self breast exam every month, and do it at around the same time each month, so you know if anything changes. The best time to self examine is right after your menses when hormonal influence is at it’s lowest point

  Next came the gyn…again, the TA walked us through the procedure, so it is not like we were just handed the speculum and told, hey go to it! I managed to insert the speculum without any trouble, which overjoyed me to no end. The strange parts were exhibiting posterior pressure in order to get the bill of the speculum underneath the cervix. You have to press HARD! The patient was pretty much telling me, no, keep going, keep going, it doesn’t hurt, and i am sitting there thinking, i dont know if i actually have the strength to depress this thing any farther…looks like i need to hit the gym! Manged to get it in, and examine the cervix, and then remove it without any trouble though, but i cannot emphasize how bizzarre and unnatural the entire process seemed to me as a man.

  Ordinarly the speculum part of the exam would involved a pap smear, but since the patient was being examined by three of us, and had already been examined by three other students earlier that day, we skipped that part. Again, clinical note female readers, one should get a pap smear done every year since cervical cancer is HIGHLY treatable if detected EARLY

  The final part of the exam was the bilateral, where we glove up (well actually we gloved up for the speculum, but i digress) and then insert two fingers into the vagina until we feel the cervix…we then feel around searching for again any irregularities and the like. And next we push up on the cervix with the hand inside, and down on the abdomen with hand outside and feel for the uterus. Did oyu know you could feel the uterus, least of all from outside the body? i did not, and i suspect neither did you. You can also apparently occasionalyl feel the ovary

  If i may follow a slightly vulgar, but interesting tangential observation…the two girls in my group had a significant amount more difficulty finding the cervix by feel than I did, and I realized that, despite the fact that they have had this examine and are much more familiar with it than I, it has aways been from the receiving end. This was more likely than not their first time placing their hand on or in another woman in such a manner. Whereas for me, previous intimate encounters I have had have taught me exactly where the cervix lies, as well as the most comfortable way to insert and remove fingers from the vagina (TMI, i know, but you were warned)

  makes you think huh? every little thing is a learning experience

  All in all, i dont know if i could technically call the experience fun, but it was definetly unique in my education, and one i suspect i will not soon forget.

  Next week, the rectal exam!

  -J

  • 8:11 pm
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