This question was originally posted on Quora.com and was answered by Rufus Holbrook, 20 years as a Maternal-Fetal Medicine Physician This one’s easy. While my 3 months on Internal Medicine were sad, boring, tiresome, and not at all rewarding, even worse were the two 2-week periods when I was on GYN. Now let me say that these 4 weeks were not depressing - just exhausting and difficult. There were 5 of us in the program at each year. In the 3rd year, 2 of us got sent to what Samuel Shem called “The Mount St. Elsewheres”, namely Malden Hospital in Malden, MA, and Framingham Union Hospital in Framingham. That left 3 of us at Boston City Hospital. When one of those 3 went on a 2-week vacation, that left 2 of us at Boston City. You know what happens when you have 2 people to cover a whole GYN service? You take what is known as “every other night call” or “36 hours on, 12 hours off.” Only for 2 weeks, but each of us had to do it twice to let the other 2 guys have vacation. So I come in at 730AM, round on the inpatients. Look at the surgical schedule. I might have been up all night - or not. Operate all day, with trips to the ER to admit new patients interspersed. See them, examine them, decide to admit them or send them home. 5PM. If I was on last night, I’m off. I go over the inpatients with the other guy, who is on tonight. I go home, to be back 12 hours from now. If I’m ON call, then I go see the inpatients, make sure nobody is getting sicker, and then wait to be called. The ER calls me all night, every single female with belly pain is my patient. I go see them, examine them, decide whether to admit them or not. If it looks like they might have an ectopic pregnancy, I admit them and might even operate right away if they look like they have internal bleeding. Meanwhile, more are stacking up in the ER. The other admissions are usually pelvic infection (PID), miscarriage, or things like twisted ovarian cyst, ruptured ovarian cyst, and suspected ectopic but not bleeding. Those can wait for a blood pregnancy test in the morning, but still need admission, a note, an IV, and bloods drawn. I do all this myself because I have nobody at all to help me. For each of these admissions, I label and then carry the tubes of blood that I drew to the lab myself, because if you call transport, they toss all of them down the elevator shaft. Then later on, I call the lab for all the results, because the hippie guy down there doesn't call the results back to the nurses. Sometimes he “can’t find” the tube of blood. Mixed in with the calls to the ER are occasional calls to “Pedi Walk-In”, the ER for children. I get called if a little girl has a problem relating to her “privates.” These usually are a suspicion of vaginal discharge, a little blood from the vagina, or a foreign body. Little girls LOVE to shove a rolled-up pea-sized hunk of toilet tissue up their vaginas, while shaking their head when you ask them about it. Usually I take a look, pull out the toilet tissue or marble or whatever it is, or swab for infection, and keep her on her mother’s lap or in the knee-chest position on the exam table, as those positions keep them from freaking out, for the most part. To look into the little vagina, I use a horse otoscope, or just a bright light while I press her hips apart with my thumbs. Rarely, there is trauma and after making sure it will heal and taking cultures and looking for sperm, I refer to Social Service who calls CPS. These are usually the 8-to-10 year olds. Sometimes if I know there are several female charts on the stack in the ER, I just sit on the curb where the ambulances pull up instead of trying to go back to my call room to sleep. Rapes - back then we had no special nurses to do the rape exams, so I did them, sometime 2 or 3 a night. Sometimes it was just a money dispute with a prostitute and her customer. But usually it was a teenager who got sexually assaulted. I examine her, take pubic hair, swab from vagina for STD culture, look for sperm under the microscope, make slides with the sperm, consider “The poor man’s Plan B” which is 4 birth control pills taken all at once, and maybe some antibiotics to head off her getting syphilis or gonorrhea. We didn't have AIDS yet. I examine her head to toe to make sure she doesn't have a concussion or a knife cut or a bullet hole. Then I write down the narrative she tells me about the rape/assault as best I can. Sometimes it’s a mess of nicknames and street names and isn't clear who did what to whom. I guess nobody ever thought of using a tape recorder for this. Sometimes the cops are standing by. I never knew what specifically brought the cops. Usually they were not there. They even called me once for a male who got raped, because they claimed that “I knew what sperm looked like under the microscope.” Finally I may operate another time, go to the ER to see the rest of the pileup, and then meet my team at 730 to round on the admissions. Those who had a negative pregnancy test get sent home (they can’t have an ectopic pregnancy if they aren't pregnant) and some might get put on the OR schedule along with the routine hysterectomies, D&Cs, tubals, and laparoscopies. I’ll probably be able to leave at 5 PM. UNLESS… the other guy is operating and somebody in the ER is bleeding. Then 36 hours turns into … 38,39..40? Source
