24-Hour Shift in Gynecology as an Intern

For the past six weeks, I have been rotating again in the specialty of Gynecology and Obstetrics; honestly, one post isn’t enough for me to complain about how little I’ve learned in this specialty, but today we won’t talk about that.

I want to share with you, how my shifts have been in the different services of the On-Call Team at Ramón González Coro Hospital in Havana as Intern or who my mom says: My school day .

Morning

During the week, like this shift which was on a Friday, the mornings are handled by what we call the “Estancia”

The “Estancia” is a on-call team dedicated to attending to the On-Call Team from 8 AM to 2 PM. After that time, the nightday shift on-call group takes over.

In this rotation, the interns also do the “Estancia” on our on-call day, which completes the 24 hours of uninterrupted service.

This would make sense if it weren't for the fact that the “Estancia” service doesn’t need interns. It was designed to operate without the need for interns, as there are more staff present during the “Estancia” than during the on-call shift.

Also, during the “Estancia,” the hospital is full of doctors, so the “Estancia” doesn’t need to go out to attend to the different wards.

In the morning, there’s very little work. Usually, we take some vital signs from women in labor and place some CTGs (Cardiotocography) on those who are about to start induction.

Before 2 PM, we try to have lunch to be ready for the real start of the shift.

2 PM

The shift begins; our team leader and the residents arrive, and suddenly we have to work. Not before dividing ourselves among the different services of the On-Call Team.

These are:

• Emergency: Responsible for receiving pregnant women over 20 weeks from much of Havana.
• Perinatal: This ward is for pregnant women at risk of preterm labor or in the later stages of pregnancy.
• Pre-labor: This area is divided into Physiological Puerperium (natural birth) and Surgical Puerperium (cesarean birth).

So far, the service where I’ve learned the most is in Surgical Puerperium. Here, we monitor new mothers during the first four hours. During those first four hours, the general condition of the mother is constantly evaluated, and uterine massages are performed to check for any possible clots remaining in the uterus.

It’s work that requires attention every fifteen to thirty minutes, but you learn a lot.

My last shift was in the Perinatal ward, so let’s see how the night went.

Perinatal

The ward has two rooms combined, accommodating a total of 25 pregnant women and one bed for surgical new mothers (who need care).

During our rotation, there’s one week spent in this service. Luckily, I had already completed it and knew how the ward operated; everything should be in order.

The first handover of the shift happens at 2 PM. We arrived a bit late due to delays in assignments, but we made up for lost time.

Just two of us for 25 pregnant women, and the worst part isn’t that, but having to write up the 25 histories every four hours. The good thing is that between rounds, we didn’t have to do much.

At first, being so inactive bothered me, but from Pre-labor, we were informed that by 4 PM, the count of deliveries was already at 8. Too many for my liking.

At 6 PM, we took vital signs again and calmly wrote each history. This task took us an hour and a half.

If we were interrupted, we might not make it to the next round. Sure enough, around 5 PM, one of our beds had a woman go into labor. We had to urgently transfer her to Pre-labor and prepare the paperwork.

That meant modifying the clinical history and getting it ready for handover. The history was a mess and took us longer than necessary. In fact, we had to ask for help from the on-call team so one of our colleagues could come up to assist us in order to be on time for the 10 PM round.

By 10 PM, we still hadn’t been able to eat, and it was time to take vital signs again and write up the histories.

Writing was becoming a monumental task.

In one day, I completed more evaluations than in the entire rotation. Although I understand the importance of these evaluations, it’s time to digitize this record-keeping.

If you’re in the healthcare sector, how do you keep medical records (clinical histories) of patients during your shifts? We do it on paper, physically.

I don’t remember what time we were able to eat, nor do I recall if the day had changed. I just remember collapsing into bed, exhausted.

During those days, Cuba suffered a widespread blackout, which prevented us from communicating with our families or updating our patients. Few buildings were lit in the city. So, sleeping was difficult, not knowing about home or what was happening.

The next morning, the professor congratulated us for our work and the dedication with which we responded, and that felt incredible. Few professors know how to recognize a job well done, and that counts for double.

We signed off the shift and went to try to rest (the country remained in blackout).

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The shifts in Gynecology are very demanding. A delivery has no schedule and requires you to be at your best, without looking at the clock. This is admirable in the professionals who work in this specialty.

But to me, they’re crazy (though I admire them)

This time, I learned many more things during the shift (in day-to-day learning, I learned much less).

During my rotation in the fourth year, I felt like the On-Call Team didn’t really pass through me. Still, Gynecology and Obstetrics continues not to be for me.

One more experience, one less rotation, but I can’t say it’s one of my favorites.

I take away everything I learned, thanks to my on call professors and especially the patients who allowed us to care for them.

If you’re reading this and have ever been pregnant or have closely experienced a pregnancy, tell me how it was for you. If not, tell me what you thought of my shift.

I’d love to read your comments!

Right now, I’m rotating through Pediatrics, and as soon as I have a bit of calm, I’ll tell you how it’s going with the kids (better than I thought).

Read you soon!

[dahpilot]

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_{All images in this post are my own.}