I have had a string of insanely normal patients lately. My luck has to break soon.
Wednesday, March 12, 2008
When someone comes to the hospital complaining of vaginal bleeding there are three possibilities:
A) They have forgotten, didn't hear, or their doctor forgot to tell them that spotting is normal following a cervical exam, stripping membranes or sex.
B) They are crazy.
C) It's not good.
Every time I hold my breath and say prayer that this patient is forgetful, deaf, misinformed, paranoid or crazy.
So, a young (very young) woman is brought in by EMS for vaginal bleeding. She is alone as the father of the baby is (and has been) out of town. She says she wore a pad in and sure enough it is saturated with blood. Crap. I give her a fresh pad, find fetal heart tones, and then call her OB.
Her doctor comes in with the ultrasound to check for placental abruption and placenta previa. Once cleared of both of those she proceeds to a cervical exam. When she spreads the labia the cause of her "vaginal bleeding" is painfully obvious. She has deep puncture wounds from a BITE on her labia that are gushing bright red blood.
"Who bit you?"
"You have a bite here. Who bit you?"
"I don't know what you are talking about."
The doc pokes at one of the puncture wounds. "Does this hurt?"
The patient yelps that it does in fact hurt but again denies that she has any idea what may have gone wrong down there.
Many stitches later, the "vaginal bleeding" was cured, the baby was thankfully fine and the patient still refused to explain what had happened. I wonder what story the boyfriend will get when he returns to town.
Posted by l&d.rn at 12:18 PM
Monday, March 10, 2008
I was putting a Foley catheter in a woman the other day. Simple, straight forward procedure that isn't particularly comfortable but most people say it wasn't as bad as they thought it would be and if they actually breathe when I tell them to, some say they hardly felt it at all.
I open my kit, put on my sterile gloves, get everything situated where I want it and use one hand to spread the labia so that the urethra will be visible. She lets out a long moan.
I stop. "Are you alright?"
Ok, I start cleaning the area. With each pass of the swab she lets out another long moan. "Are you really, OK? Am I hurting you?" (Sometimes people find the cotton a little scratchy and are very sensitive.)
"No, keep going."
So, with my still sterile hand I grab the catheter, tell her to take a big breath in and try and get it over with for her as quickly as possible.
Instead of taking in a big breath she lets out a series of moans. Then she asks, "Is that supposed to make you have an orgasm?"
Maybe coffee straw girl knew what she was doing after all.
Posted by l&d.rn at 11:03 AM
Wednesday, March 5, 2008
Ok, I know some of you must think that when I post about our "frequent flyer program" that I am being insensitive to poor first time mom's that just aren't quite sure about when they are in labor. You same people probably also think that we all laugh at these people as we send them home for being too dumb to know the difference between when they are in labor or they are having Braxton Hicks contractions. We don't. I am not talking about people that come in for a labor check, or two, or three or even four or five.
Last night, as we were reminiscing over some of our recently (and not so recently) delivered patients who were enrolled in our frequent visit rewards program we started to wonder which one actually had the most visits. The winner had a whopping 81 labor checks over a period of 2 1/2 months before she was finally induced at 40 weeks, probably because her doctors were sick of it. You can blame that one on them.
Now, when you come in to the hospital 81 times thinking you are in labor, especially when it isn't your first baby, to me that signifies a fundamental problem in following oral, written and even demonstrated instructions. And, had she have actually called her doctor first (the very first instruction always given) she could have saved herself some gas mileage on what I am going to guess is at least 78 of those visits. Although, that wouldn't be quite so dramatic and she would have missed the 18 phone calls always made to let everyone know that she had to go to the hospital again.
The point of that rant is to never fear, your nurses aren't thinking you are nuts until you have been there so many times that they have your name, address, social security number and the phone number of your seven emergency contacts all memorized, or of course you think your water broke but taste it to see if it was really pee and then admit it.
Posted by l&d.rn at 12:54 PM