Each year, the RCOG invites foundation trainees to tell us why they’ve chosen a career in O&G for the Why Obs and Gynae? prize.
This is a submission from Naila Khan, an FY2 at Queen Elizabeth the Queen Mother’s Hospital, Kent.
Why obs and gynae?
My keen interest in obstetric medicine began at a very early age when I used to watch Lord Professor Winston present ‘The Human Body’ in a documentary series. I became fascinated by the miracle of life, learning that every one of us possesses an armoury of instincts which keeps us alive. Stepping out into the realms of the labour ward for the very first time, it soon became abundantly clear that the most important weapon in a baby’s survival armoury is an astounding scream! From conception to delivery, the most sophisticated life machine on earth keeps our heart beating, overcoming the most daunting obstacles to complete the everyday miracle of new life. These physiological mechanisms amaze me – I am compelled by the development of a fetus harboured in its mother’s womb and intrigued by the multitude of reasons why things go wrong -and what may be done to prevent this from happening.
There is not one concise, compelling reason as to why I wish to work in the fast paced, dynamic field of obstetrics and gynaecology. A great number of people have inspired me throughout my medical career. My first clinical experience of the speciality was during a placement in medical school. Here I met the most successful, inspirational, career driven, determined female surgeon who inspired me to aim for her high standards of care and dedication.
My thirst for knowledge and experience in this field led me to dedicate a few summers during my undergraduate degree at The Royal London hospital. Here I obtained satisfaction from the interaction with primarily healthy women. I was also able to witness first hand how women’s lives can be transformed with the treatment of urinary incontinence or infertility. I encountered women with medical and surgical challenges, inspiring me to think laterally and exploring it further with my seniors. This experience strengthened my desire to study Obstetrics and Gynaecology further.
My commitment increased as I became actively involved in a number of audits in this field, such as protein creatinine ratio and 24 hour urine protein measurement in pregnancy. I learned to appreciate the importance of the audit process, presentation of results and the significance of closing the audit loop. I was also selected to participate in a paediatric audit which was conducted in order to identify the scale of maternal vitamin D deficiency in London and address the issue of the lack of guidance of London antenatal units on vitamin D. These results were published in the British Journal of Obstetrics and Gynaecolgy. This is a major achievement for me and I am aspiring to contribute to this amazing field by writing up case reports for publication on cervical myofibroblastoma and degenerate schwannoma mimicking an ovarian malignancy. I find sharing experiences like these with others rewarding.
During my final year in medical school I had the opportunity of doing a special study module analysing FVIII and VWF levels in cord blood of full term neonates. I was awarded a distinction for the quality of the work. This has encouraged me to seek out other research opportunities. I am particularly interested in research into proteomics which will enable non invasive testing of women with fetal aneuploidy. This interest in fetal medicine culminated in a placement at The Harris Birthright Research Centre, King’s College London. Here I learned the importance of ultrasound scanning both as a diagnostic tool and as an intervention. I had the unique opportunity to observe intricate diagnostic procedures such as amniocentesis and the management of a broad range of fetal abnormalities. The most memorable therapeutic surgical intervention was the correction of twin-to-twin transfusion syndrome. This astounding intricate procedure ensuring the survival of both babies was the point at which I felt committed to pursue a sub specialty interest in fetal medicine with dreams of becoming a fetal surgeon. I would like to do an MD in this field.
My final undergraduate experience was during my elective in Eastern Africa. My exposure to the healthcare system of Zanzibar provided me with a window into the extreme poverty that people there live in. This made me appreciate the ante-natal care and post-natal facilities that are available in the United Kingdom. Being one of the few medical students in the government run hospital I had the opportunity to deliver twins, one of whom had the umbilical cord tightened around his neck. This was a daunting experience but I stayed calm in the face of adversity as I quickly and sufficiently unravelled the cord from the baby. The feeling I got after having just safely delivered such a high risk pregnancy is indescribable. Faced with a woman presenting with complications during the latest stages of labour in a staff deficient, unfamiliar place is something which I will never forget. This was the most invaluable experience of my life, knowing that if I were not present at that specific moment in time the outcome would have been very different. The vast contrast between problems met in labour in Zanzibar and the United Kingdom highlighted the huge inequalities of health care in the world. Maternal mortality is high with haemorrhage and sepsis leading causes. Many women present late after a labour of 48 hours where the outcome is usually poor. A caesarean section was an extreme challenge because of the lack of facilities, staff and electricity issues. I witnessed women die post-operatively because of sepsis due to lack of hygiene and antibiotics. Seeing a new born baby lose her mother from a highly preventable cause of death was heart breaking. When I complete my training I will return to Zanzibar to help educate doctors and to try and make a difference. I know that this thought is idealistic but hope that I will follow it through.
During the last few exciting months I have realised how passionate I am about surgery. I take great pride in this, appreciating surgery as an art form ensuring suturing vaginal tears and caesarean section cuts result in cosmetically acceptable scars. My time spent as a foundation year 1 doctor were impressive, encompassing everything from the evaluation and simple incision and drainage of perianal abscesses to observing the intricate procedures of small bowel resection and mastectomy, but these do not compare to Obstetrics and Gynaecology. No other specialty offers the opportunity to be a surgeon and a physician or begins a surgical procedure with one life and ends with another heart beating in the same room – for me nothing can beat this. There is nothing more miraculous or rewarding than safely bringing forth another human being into the world and then providing comprehensive continuity of care for both baby and mother.
I am in awe of the surgical expertise of the inspiring registrars and consultants who perform life saving interventions in a calm, focused and confident manner. This speciality allows for the unique opportunity for early practical involvement, which makes gynaecological theatres and labour ward a thrilling place to be. I hope one day to acquire the skills and knowledge to emulate my seniors.
Labour ward is like a tornado sucking you in, enthralling you in exhilarating experiences, providing unique learning opportunities in every single one of the de livery rooms. There is never a quiet moment... and if there is you know something is wrong. Things can go wrong quickly and you have to be alert to this at all times – this is what makes obstetrics so special! I thrive on challenges and this environment is just that- challenging- not only in terms of practical skills, medical know how, inter-personal skills and teamwork but also sobering when despite all the teams efforts the outcome is not good.
This makes me appreciate that there are negatives to working in this field. Bearing witness to a maternal death recently was emotionally draining. I have experienced difficult on call duties and night shifts in an extremely busy obstetric department with over 5000 deliveries a year. The high litigation rate is something I am aware of. This has however not dampened my enthusiasm but encourages me to practice safely using the best evidence available.
Gynaecology is a broad spectrum speciality in its own right. From the nervous teenager awaiting her first speculum examination, to the ruptured ectopic pregnancy collapsed with shock in Accident and Emergency to the woman who has just been diagnosed with metastatic ovarian cancer. The vast array of clinical diseases and interesting presentations I have witnessed has been phenomenal. This has included a range of conditions – from the common menorrhagia, to the unusual benign tumour of degenerate ancient schwannoma of the female pelvis, to the very rare catamenia necessitating in hysterectomy and bilateral salpingo-oophrectomy to preclude debilitating pneumothorax formation during menstruation. A fortnight ago I had the rare chance of being chosen to present a case of a woman who presented with a ruptured cornual ectopic pregnancy to the entire hospital at the grand ward round. I received excellent feedback through the RCOG Tutor.
As my four month rotation draws to an end it has become clear to me that I have no other desire but to become an obstetrician and gynaecologist. It is the “Dorset naga pepper” of medicine – a spicy mix of medicine and surgery inherent in every week. Trickling like raindrops through the wards, wading through gynaecology theatres like heavy rain and facing labour ward like a tropical rainstorm reaching the calm rainbow in ante-natal and gynaecology clinics. The ability to adapt to rapidly changing situations is both intriguing and attractive. I have spent some mornings managing women with menstruation problems and spent the afternoon assisting the time pressurised instrumental delivery of a baby with cord prolapse, 5 minutes before cerebral ischaemia sets in.
I am particularly drawn to the run through training programme, as I am sure of my career choice. During my ST1 and ST2 years I will work hard to acquire generic skills and have my set of competencies to manage acute obstetric and gynaecological presentations during my on call duties. I have registered to sit my MRCOG part1 in March 2011 – I am dedicated to this speciality and although the requirement is to pass before entry into ST3 I want to expand my knowledge early.
My ambition is to work in a busy labour ward with a high risk population. The opportunity to scan and practice obstetric medicine is the career pathway best suited to my aptitude and interests. My ultimate dream is to become a fetal surgeon. The thought of being able to offer treatments like repair of a myelomeningocele in utero in the future is indeed a challenge and would be an ultimate goal for me.