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 Rima Dhillon, an FY2 at City Hospital Birmingham.
Why obs and gynae?
‘Why Obs and Gynae? You’re a woman you should be a GP, have a family and an easier life’…sadly even in this day and age that remains one of the most common responses I hear from family, friends and even some colleagues. Admittedly it’s a question I have asked myself on occasions following discussions regarding the demanding stressful work load, the increasing litigation, the unsociable hours, the plans for 24hour on site on calls and so forth. Despite external attempts to sway my interest I can unequivocally say that Obstetrics and Gynaecology is the only career path for me.
My reason for choosing Obstetrics and Gynaecology is a personal tale which began at Medical School. I was experiencing a phase I’m sure many medical students alike can relate to, that sinking feeling of ‘why am I doing medicine?’ It was an especially difficult time where I lacked interest in almost every aspect of the degree and seriously considered walking away. Thankfully my rotation in O&G rescued me from my abyss and it is suffice to say is the reason I progressed to become the doctor I am today.
Day 1 I was assigned to labour ward: ‘Observation of a C-section’ one of the compulsory criteria for passing the placement. Little did I know, as I scrubbed up, that I was about to experience a life changing moment, not just for the mother and father but more importantly at that stage, for myself. As I witnessed the registrar performing an elective c-section proceeding to the successful delivery of a healthy baby, I was immediately overcome by emotion. It was literally an epiphany moment, I knew instantaneously ‘THAT’ is what I wanted to do. As monotonous as medicine can become I stood there and truly believed that no two deliveries could ever feel the same. Each experience so unique to the mother and father and in return a unique experience for the doctors involved. The thrill and flush of excitement of being part of a life changing moment was so enticing. To acquire the skills, knowledge and responsibility to safely deliver a new life into the world is something I knew I definitively wanted.
From that day forth my passion for medicine and learning returned. While on placement I began exploring further into the fields of both Obstetrics and Gynaecology, learning of all the varied subspecialties. I found O&G to be a very broad specialty the beauty of it allowing for the development of both surgical and medical skills; a better mix, I believe, than any other specialty. In particular I found the infertility aspect of reproductive medicine to be of great interest; the concept of being able to help women desperately driven by maternal instincts to achieve motherhood holds such immense appeal. While on placement I undertook an audit regarding the initial assessment of women newly presenting to infertility clinics which was later presented at a Clinical Governance Meeting.
It wasn’t long before my honeymoon period with Obstetrics was rocked by the harsh reality of the unpredictability of medicine. A lady was rushed to theatre for an emergency c-section following signs of persistent fetal distress on CTG. Unfortunately despite the efficiency of the decision making and quick action taken, the baby delivered was still-born. It was an unexpected turn of events for the mother and father and left myself feeling a cocktail of emotions. Despair for the mother and father who were eagerly anticipating the delivery of their healthy baby, anger towards the unfairness of the situation, sympathy for registrar who had done everything correctly but yet had failed to deliver a healthy baby. While lost in my emotions I heard the grief-stricken parents shout out ‘You told us it was all going to be ok, you will pay for this’. Those words echoed around the theatre. Fortunately for the team involved the family’s attempt to take legal action was unsuccessful. I learnt this was due to the diligent and accurate documentation of each and every conversation, decision and action that had taken place. It was an eye-opening experience. I was no longer viewing O&G through the rose-tinted glasses I had previously, I was now alert to the degree of emotional stress and loss one can experience working in the field. It was a balancing act, would the elements of reward outweigh the challenges? By the end of my 6 week placement I knew the answer was a definitive “Yes!”.
As an FY1 I worked in general surgery and general medicine. While I enjoyed aspects of both i.e. the diagnosis-making and analytical thought processes involved in medicine and the practical element to surgery, it became clearer that Obstetrics and Gynaecology offered the perfect blend of both.
I am currently working as an FY2 in O&G at City Hospital, Birmingham; a bustling inner city hospital which serves a low socio-economic and high ethnic population. Commencing work in the specialty has truly opened my eyes to the pivotal role it plays within the journey of the female life. Involvement begins with assisting conception and infertility management for aspiring mothers, then leading to the safe obstetric management and delivery of new life. While the opposite end of the spectrum entails the removal of the ovaries and womb, the defining female organs, in order to treat disease and delay death. Along the way much of the work done is management of common female life issues such as contraception, treatment of menorrhagia and so forth. To play such an integral role right from assisting birth all the way to delaying death is ultimately what sets Obstetrics & Gynaecology aside from all other specialties and it is this role I so desperately seek to gain from my career.
Life, as we know it, is never straight forward and this invariably impacts on the work involved with a career in O&G. Thus far I have already encountered ethical and personal challenges in cases of teenage abortions and pregnancies in young girls who are victims of rape. In addition I have seen cases of FGM amongst Somalian women; these experiences have displayed the diversity of areas of interest within O&G and further substantiate my desire to continue learning within the specialty.
During my limited time working in O&G I have come across what I deem to be one of the most significant experiences of my working life. A unique case which raised multiple isssues; ethico-legal, moral and religious. A Muslim woman of term gestation was found to have an abnormal CTG and following a degree of convincing consented for FBS which showed a pH of 6.9. The unanimous decision amongst the team was to opt for emergency c-section, however on informing the lady and requesting consent it was a shock to learn she refused. Despite even the attempts of the woman’s husband to change her mind, she stood by her refusal on the grounds that it would be Allah’s wish should her baby die. As the woman was deemed to have the capacity to make the decision nothing further could be done without her consent. Sadly the baby soon died in-utero. Emotions of sheer sadness, anger and frustration were echoed by the entire department. This was a rare and disturbing case. Current law states a baby has no rights of its own until birth. This case was especially challenging as the baby was term and potentially could have lived had the law not prevented us from acting in its best interests. I felt question marks should have been raised over the assessment of the mothers’ capacity; if she knowingly refused a procedure to save her baby’s life was she deemed competent? This case also displayed to me how religious views can conflict with medical decisions and the challenge this poses. As a doctor my role is to assist where possible and reserve judgment at all times, however in this case where the patients’ views conflicted with my personal religious and moral views it proved difficult to remain professional. The issues and personal challenges this experience highlighted have excelled my desire to rise to meet future ones.
From my experience in Obstetrics and Gynaecology I have found myself gauged by both specialties. I am currently also exploring the subspecialty of Oncological Gynaecology and at present undertaking a small research project. My research looks specifically at the value of omental biopsies in surgical staging of Uterine Papillary Serous Carcinomas; I aim to publish my results later this year. Gynae-oncology is an area which interests me as it offers such large scope for research and the theatre cases are often extremely complex requiring multiple consultant and specialty involvement; cross-specialty work being something which appeals to me.
In terms of career goals and aims, while the research involved in gynae-oncology is of great interest, at present my real passion lies in the opposite end of the life cycle in reproductive medicine; specifically infertility management. The fascination for me here is the unique aspect of playing an assistive role in what is part of being human; the desire to reproduce and raise a child. This being said, I am still also very attracted to the challenges and thrills of working in obstetrics, it appeals to me to know not all my patients are ‘sick’ and that in many cases I will merely be assisting the natural process of the delivery of a baby to a normal healthy mother. Furthermore I eagerly anticipate acquiring and mastering the surgical skills I will require to be a safe and competent practitioner, to facilitate this I am attending a course later this year in basic surgical skills in O&G.
Through my experiences I have found O&G to be a truly stimulating career; ranging from the excitement and drama of working on labour ward to dealing with complex ethical challenges in gynaecology; namely abortion, sex selection, fertility treatment and so forth. The wide range of subspecialties allows one to tailor their interests accordingly; I have seen this through attending specific subspecialty clinics namely uro-gynaecology, diabetic/hypertension antenatal and infertility. The scope for the development of practical skills is also hugely varied ranging from ultrasound scanning to complex laparoscopic surgery. I feel no other specialty offers this varied degree of career options thus making it such an attractive field to work in.
I have witnessed firsthand the degree of stress and responsibility a senior doctor carries and while this has not deterred me from applying to the specialty, it has awoken me to the realities of working in a demanding high stress environment. I feel I have developed my coping and stress management skills from my experience as a junior doctor thus far during my time as part of the arrest team, attending emergencies and managing a ward of patients on a day to day basis. I have also seen how the importance of team-work is key, particularly on the labour ward where the integration of the doctors with the midwives is essential to providing high quality safe care to all. Belonging to a team, developing my communication skills along with the ability to delegate and take on leadership is something I crave from my career.
I am aware that a career in O&G will pose lifestyle challenges, I anticipate embracing these as I feel it is imperative to build and sustain a career in which I am truly happy. The varied range of subspecialties will allow me to tailor my career to fit in with my personal life whilst meeting my ambition needs and desires. Being female I hope to later have children of my own and having spoken with senior colleagues am aware of the option of flexible training should I reach that stage in my life. I have also discussed how the EWTD has now lead to much more controlled and safer working hours. In addition the run-through ST training programme also makes the specialty particularly attractive. I feel well equipped with the essential knowledge, experience, passion and drive required to pursue a career in O&G.