Obstetric Anesthesia Again

I also had my second month of obstetric anesthesia. The second time around, the rotation was noticeably smoother. Human experience is interesting in that we rarely notice ourselves change or improve. But when rotations are set a year apart, the difference between the two experiences is quite striking. I remember being apprehensive about obstetric norms, diseases, and expectations during the first rotation. Even though it's been a year since then, a year since thinking about pre-eclampsia, magnesium, terbutaline, and ruptured membranes, I've somehow retained that information and navigate it a lot easier. During my first month, epidurals still remained in a little black box; I understood enough but not everything. This time, I better appreciated the anatomy, understood how to troubleshoot, and became more comfortable with "difficult" epidurals. My success rate with patients with scoliosis, morbid obesity, and inability to sit still was much higher this time around. To myself, I was noticeably faster, efficient, and precise. My manual dexterity also got better in ways I don't understand. You don't really think that your ability to "feel" changes, but mine did. The epidural is a very tactile procedure; I got better at feeling spinous processes, determining the different ligamentous layers by their density, and moving the needle with controlled, precise intention.

Although we don't necessarily like to think about it this way, residency and medicine is a practice of refined learning. I am better now than I was a year ago. Did I provide substandard care a year ago? I don't think so. But I certainly provide better care now. The process of learning, improving, and training is necessary. We have to try, do, stumble, repeat before we can feel entirely comfortable and confident. Balancing this with appropriate patient care is hard, but luckily I think I have made it through the tunnel to the other side.