LEEP, OB/GYN Week 3

I just got sprayed in the face with cervix juice. I should back up. A patient was in clinic today for her second LEEP (loop electrosurgical excision procedure), which is a method of removing a portion of the cervix. This procedure is done when less invasive tests have shown the cervix to have certain stages of pre-cancerous cells. Practically the only way a woman gets these cells that slowly progress toward cancer is to be exposed to certain types of HPV, or human papilloma virus. The way a woman is exposed to HPV is unprotected sex, which can obviously expose her to any variety of nasty bugs. Anyway, this patient had a LEEP some time in the past, and her tests came back positive again for the late precancerous cells, so she came in to have a second LEEP. I've learned that the cervix doesn't have the same type of innervation as other parts of the body - you can hold onto it with sharp pinchers without anesthetic - but when cutting off part of it, you need to inject some anesthetic first, which is what I was doing. I had to jab a needle into the cervix, which is a firm muscle covered by mucous membrane, and inject. Because the muscle is so firm, I had to push on the syringe plunger quite hard, and I was trying to move the needle out slowly to get anesthetic both deep and shallow in the muscle. I pulled out a little too far, and all that pressurized fluid shot out straight back around the needle, and onto the most readily available surface, which happened to by my face. For things like this, I am a non-reactive person, which as a rule is a good thing whenever you have to do a procedure involving looking into the vagina. It just doesn't do to jump back and start wiping your face frantically when the patient is lying back in sturrups, speculum in place. Despite my mind working through the above concepts of nasty bug transmission, I was able to finish what I was doing and wash my face and glasses after I was out of the room. In all honesty, the incident wasn't a big deal; I was wearing glasses, so my eyes were protected, and nothing got in my nose or mouth, and all my facial skin is intact, so the risk of catching anything is somewhere around 0.00%. Still gross, though. Speaking of gross, I've noticed more random stains on my white coat this month than any previous one. I'm not sure I want to think about that.

On the obstetric side of things, I am up to catching 3 babies now. I've also helped with a few C-sections. It's amazing to me when the pale purple lump that initially is motionless starts flailing and crying. The first time I saw the baby in the warmer after a few minutes of being able to breathe on her own, I thought she was a different kid she looked so much better. They really pink up a lot even in the first minute. I may never use any of these skills or knowledge in my career, but it is quite amazing when I step out of the objective clinician's viewpoint and realize that I'm seeing a baby brought into the world.

Scott