Trusting your own instincts

As a young physician it is nearly impossible to trust your own instincts. This,I assume, stems from the fact that you are always surrounded by other physicians with more experience than yourself. It is natural to assume that those around you are right and you are wrong. This changes over time and eventually you become the experienced doctor, and then you must fight the assumption that those young people around you know nothing and your instincts are the correct ones. It would be nice in medicine if people could make decisions in a way that would not belittle the young and inexperienced but it many times just does not work that way. One of those times was many moons ago in South Chicago .
I was a med student early in my 4th year. I was on my first Obstetrics rotation at the Chicago Osteopathic Hospital. It was a sweltering hot summer night in the ghetto of South Chicago. Our patients came to deliver their babies after virtually no pre-natal care. It was a continuous stream of vaginal deliveries this night and the routine was for the med students to admit the pregnant patients. Our intern was supposed to help verify that what we said in our exam was correct. The resident on call was basically there to take care of "problem situations" and C-sections if needed. The intern was a guy named Abe and he made no bones about the fact that he did not like OB and that he only cared about getting thru to morning without any catastrophes. The resident that night was a guy named Rocco. He made it clear that his ass was not interested in normal vaginal deliveries and that he was very interested in laying down all 300lbs in the call room for a long summer siesta. There would be hell to pay if some dumb ass med student woke him up for no "good" reason. This is where it got interesting!!
I admitted a 27 year old patient who was clearly in premature labor at 36 weeks gestation. She was accompanied by her auntie as so many of our patients were. As usual there was no father present and also as usual she had not seen a OB/GYN physician during her pregnancy. On vaginal exam and on abdominal exam it appeared to me that the patient was in labor and that she was very large for her 36 weeks. It also seemed to me that there were 2 babies in her uterus!! My instincts told me that there was one head in the cervix and one head in the patients upper abdominal area. The auntie told me there was a strong history of twins in the family. I immediately told Abe the intern of my diagnosis of twins and asked him to wake up Rocco. He examined the patient and told me that my exam was in error and my reasoning was flawed. He said that he made the same error before and that the firm mass in the upper abdomen was the butt of the baby and not the head of a second baby. What did I know. He was more experienced and he must be right. Afterall, I was just a med student. I explained to Abe that I still thought intinctively that this women was carrying twins and that it was the only diagnosis that was consistent with the physical exam and history of this patient. I did not tell him that I thought I had way better instincts for clinical medicine than he would ever have--- but I thought it! I certainly did not go out of the chain of command and wake up the feared Rocco.
Well the night progressed and in what seemed like an avalanche of babies my "twins" got to the delivery room at about 3 AM. Abe was doing the delivery and I was in the delivery as an assistant. All went well and once the baby was out Abe starts to deliver the placenta--gentle traction ever so carefully so as to not rip the placenta, just like we had been taught. At this point I am starting to relax because clearly Abe was right and there were no signs of a second baby. He is feeling all cool and again explains to me how easy it is to think there are twins when there are not and that I should not get down on myself for being wrong. He proceeds to tell me that as I get more experienced I will get a better "feel" for the Obstetric patient. Just then at the exact moment he was delivering the last of the placenta we both saw it. We saw ever so clearly and ever so sadly the tiny right hand of the SECOND baby. Well all shit hit the fan!! Abe starts screaming--GET ROCCO!! Get ROCCO!! The patient wants to know "whats wrong, whats wrong" and I am immediately feeling sick that I did not have the convictions of my instincts.
Rocco came screaming into the room to basically deliver the second baby with the hand presentation by turning it into a breech(foot first) delivery and pronouncing the baby dead. Once the placenta had been delivered by Abe the baby was without oxygen for at least 10 minutes.
It was that case that taught me to trust MY instincts and not those of others. Common sense is not all that common and if God has gifted you with great instincts you should never ignore that which makes good sense. I was told by many physicians that I had natural instincts for Obstetrics and I am sure that it is this heart warmed story that convinced even me. Conviction of my instincts has served me very well through the years as a CV surgeon and I am sure it would have served me equally well if I had persued my first love--OB/GYN.