Errrr....

So life got the best of me, and well....I got busy.

This one wasn't the patient....it was totally the doc.

A woman came in to deliver baby number 10. She was nearly 40, advanced maternal age and probably, while most of us would have been long done having kids she and her husband, who were both very religious were going to let what may happen, happen.

Her OB was out of town, and since she is in practice by herself, another doctor was covering for her. He came in to deliver the baby and after the delivery asked if they were doing her tubal the next day. The woman's husband spoke up and said, "No, we would never do that."

"You're going to have more kids?" the doctor asks.

"God tells us that may be in his plan for us."

"God talks to you?"

From the completely mocking tone I can tell this conversation is going downhill fast.

"Yes"

"You should be evaluated for that."

I try and change the subject to the baby quickly which seems to work but only temporarily. Before the doctor leaves the room he sneaks up behind the dad and bellows out in an ominous voice. "This is God...Get a tubal."

I wanted to die.

Who would believe it?

I have had a string of insanely normal patients lately. My luck has to break soon.

More Vaginal Bleeding.

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?"

"Huh?"

"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.

I feel violated.

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?"

"Yes."

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?"

"No."

Maybe coffee straw girl knew what she was doing after all.

I know what you're thinking.

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.

Stand Up Kind of Guy

A few weeks ago I had a very young patient come in laboring. I really felt for her because in addition to being young she was also alone and probably scared to death. She also had with her a really sweet birth plan that included being able to labor naturally and the father-of-the-baby showing up and being supportive. After talking with her for a little while I found out that the first part was probably going to be a go (IE. her reasons for not wanting an epidural did not include 1) needles hurt or 2) my mom/boyfriend/husband says I am not allowed) but getting a supportive dad to show up when he hadn't been involved for the past 6-7 months might not go so well.

I got her all set up and as soon as a better room opened up I moved her up to a room across from the nurses station so I could keep a better eye on her in addition to giving her access to a jacuzzi tub. I guess she must have taken care of the second part of the plan because a couple of hours into her labor the FOB shows up. To put this VERY mildly, the guy looked rough.

Before long, I am glad I moved her to the room that I did because it allowed me to hear a little better what was going on in the room. My patient was doing a fantastic job but it was obvious that dad was one of those guys that handles crying/screaming and probably any uncomfortable situation by acting like a jack-ass. He is yelling at her to "just get the damn epidural" and it doesn't take too much to realize that he is really agitating my patient. I get her alone and I ask her if she wants him to leave. Big tears appear in her eyes and I can see that she knows that her plan isn't working. I tell her that is it her choice and to just give me the signal and he is out of there.

All it took was two more contractions of him acting a fool and she wanted him gone. So in I go to try and get a guy who can quite obviously pick me up (and probably another nurse too) and run off with us, one under each arm, to get gone. I also call security, stat, for help.

I tell him he has to leave. He doesn't take it well. How dare I take this experience away from him? He loves her so much...blah, blah, blah. You know, all the stuff that being completely absent through the pregnancy clearly indicated. It quickly turns into a shouting match (or at least he was shouting) and we have three nurses and one of out scrub techs in there trying to ease the situation and move him towards the door.

Minutes pass. Where is security? The shouting continues. The four of us start herding the guy in the right direction while he is spewing off threats about how we all better watch ourselves because "I'll be back" Terminator style. We finally manage to get him to the elevator and when the doors open who is standing in there but the security guard?

Nice dude. We call you up here stat and you take the time to get on the elevator with 17 other people.

Now, we get strange calls to L&D all the time of people asking for weird and completely non-L&D related things but about 4 minutes past bar closing time the phone rings. It's A-hole. He is now obviously quite drunk and in tears about how sorry he is and how he is a total fuckup. Plus, he needs a ride home. Ugh. Tell me where you are buddy and I'll call you a cab.

At least my patient got half the delivery that she wanted, at probably a little closure as a bonus.

A Lesson

Lesson for you: Fetal Fibronectin Test (fFN)- a test where a swab is taken of the vaginal secretions at your cervix and looks for a protein (fetal fibronectin) that can predict if you are going to go into preterm labor within the next two weeks. It is usually used in high risk pregnancies or women experiencing signs of preterm labor.

A few nights ago a woman came in 24 weeks pregnant complaining of preterm labor. She had a history of 3 prior deliveries all between 24-30 weeks and also had no prenatal care for her current pregnancy. Obviously, we were all more than a little concerned for her. The midwife on call, who is very sweet and very hands on with her patients orders a fFN, and while this is something that is usually left for the nurses to collect she wanted to do it herself. I went along to assist.

After you collect the sample (on a long q-tip like swab) you place it in a long narrow container and send it to the lab. I hold the container for the midwife and most unfortunately her hand slips and now the sample has been smeared across my bare hand.

While I head to the sink and start scrubbing, she prepares a slide. I figuring she is looking for a "ferning" pattern that would indicate that the patients water is broken. Instead, once we get to the back and look under the microscope it turns out the patient has a raging trich infection.

Lesson for me: wear gloves any time anything with bodily fluids has even the most remote chance of missing its intended target.

Would you like fries with that?

This is an old story but since a coworker brought it up the other night I have been reminded, and thus shall share. I am afraid the nurse who this particular story is about may never live this down but in her defense, she takes it well.

As many of us know, and some have yet to find out, labor can induce nausea and vomiting. Despite that, this does not deter people from stopping through the drive through on the way to the hospital. Anyway, my coworker (who I will call Betty) was taking care of a patient who came in because her water broke. She wasn't contracting at the time, and feeling like it might be her last meal for a while apparently stopped off and Micky D's for a #1 Super sized with cheese.

As labor karma would have it, she soon kicked into active labor, and before long was begging for an epidural. Betty got her bloused, call anesthesia and returned to the room to sit her up. As soon as the patient swung her legs over the edge of the bed, she lost the previously mentioned #1 Super sized with cheese and Betty was the unfortunate target.

I can't really blame her for what happened next as I am a sympathetic puker myself. Betty, feeling the strong urge to vomit that can't be ignored makes a beeline for the patients bathroom, swings open the door and aims for the toilet. No sooner has she let all restraint go than she realizes grandma-to-be is taking some personal time in the loo.

Let this be another advertisement for visitors not using patient bathrooms.

Happy Valentine's Day!

A twenty-something weeker showed up last night, with the very concerned father-of-the-baby, complaining of vaginal bleeding and passing clots. This, never being a good scenario, demanded immediate attention. I put her on the fetal monitor and am able to get a good tracing of the baby, who appears to be quite well. Next come the questions.

"When did the bleeding start?"

"About a couple hours ago."

"Did you wear a pad in?"

"Yes but there was nothing on it"

"Were you having bleeding that's heavy like a period?"
(At this point her doctor has wandered into the room and is standing patiently by the bed.)

"Not really, mostly just some spotting and clots."

When was the last time you had sex?

"Valentine's Day."

Since this was nearly a week prior, I quickly rule it out as the immediate cause of her bleeding. The doc has now poked and prodded his way around assessing her belly and is asking me for a sterile glove.

He goes to examine her and starts pulling out large clots. But wait. Are they clots?

On further inspection, perhaps they are strawberries.

"Honey, did you put strawberries in your vagina?" I ask.

She looks at her companion sheepishly. He answers for her. "I guess we forgot about those."

Needless to say, I am eating my Cheerios plain this morning.

We see normal people too.

I recently had a patient get upset with me that I didn't remember her when I took care of her earlier in her pregnancy when she came in to be monitored for decreased fetal movement. I can understand the natural human inclination to get your feelings hurt when you learn that you aren't "memorable" and the wounded look on her face was a good indicator of that. I tried to explain to her without being too weird or scary that it was a good thing I didn't recall her visit several weeks prior. I have a feeling if I could have pointed her in the direction of this blog the point would have been better made.