Angry Doctor

Thursday, November 17, 2005

Recurring Nightmare 2

Please read Foreword first.


Recurring Nightmare – O&G

Your lunch is interrupted by a page from the A&E. Per vaginal bleeding, positive urine pregnancy test.

Young woman, found to be pregnant last week. First pregnancy. No scan so far. Sudden onset of pain this morning at work followed by PV bleeding which has since resolved. Her colleagues sent her here. Her husband is on his way.

You ask her to lie down and you do a scan. The uterus is empty. No adnexal mass or free fluid.

You call the OT Reg for the day. She says they can fit her in after the last case, say about 4 pm. Get a consent.

You pull a chair and sit down by the young woman's trolley. You tell her the baby is gone. She starts to cry.

You tell her up to 50% of pregnancies end in miscarriages. You tell her sometimes women wouldn’t even know they have had a miscarriage but just thought their menses were late.

You tell her it wasn’t her fault and there was nothing she could have done to prevent it from happening. You tell her that even though you didn’t KNOW that was the truth.

You don’t know if she believes you. You’re not even sure she is listening.

She’s probably thinking about what her husband will say. She’s probably thinking about what her mother-in-law will say.

She’s probably wondering whether she can get pregnant again. She’s probably wondering if she has become less of a woman now.

You tell her you need to do a 'procedure' for her to clear whatever 'products of conception' which may still be inside the womb to make sure the bleeding stops. You tell her it’s OK to wait for her husband to come before she signs the consent, but she decides to sign it now.

She wipes her tears dry with her sleeve, takes your pen and signs on the line, and then thanks you.

You give the excuse that you have to arrange her case with the OT and leave her with her thoughts.

5 Comments:

  • What's so nightmarish about that?

    Of course it is a nightmare for the patient.

    But unfortunately we are in a profession where we hear complaints (patients complains of....) daily, and deal with their worst nightmares eg road traffic accidents, miscarriages, work accidents, cancer, heart attacks, erectile dysfunction.

    Who says being a doctor is a happy job? Far far from the truth.

    By Anonymous Dr Oz bloke, At November 17, 2005 11:13 am  

  • sometimes i worry that i might e infertile

    jus a woman thing i suppose

    By Blogger Smiles, At November 18, 2005 2:06 am  

  • This story is awfully familiar. As I was reading it, I remembered my first miscarriage. I went to KK A&E because of bleeding in early pregnancy. After a long scan, the lady doctor gently told me about the miscarriage. She said many things but it just did not register. I did not cry then, just very shocked. It's only when I got home that the loss has hit me. Even though I have 2 kids now, this scenerio is still deep in my mind. Everytime I read or hear something about miscarriage, I will ache inside, for the babies I couldn't see and hold.

    By Anonymous The MUMMY, At November 20, 2005 9:01 am  

  • Why do you sound like you feel that you are not helping your patients? In the PV bleed woman for instance, i am sure your explanation would have helped her in dealing with her loss. Even if you feel like you cant help by reversing miscarriage... remember that we have no control over a lot of things. And grief takes time... Doctors are not omnipotent... (although we like to think that, and take our patient's poor outcome too personally. )

    TTG

    By Anonymous TTG, At November 20, 2005 1:41 pm  

  • TTG, if you read the comment by 'the mummy', you will realise that what you told a woman at the time 'just did not register'.

    As for taking it personally, I give you this quote from The Godfather (the novel not the movie) when Michael said:

    "Tom, don't let anyone kid you. It's all personal, every bit of business. Every piece of shit every man has to eat every day of his life is personal. They call it business. OK. But it's personal as hell. You know where I learned that from? The Don. My old man. The Godfather. If a bolt of lightning hit a friend of his - the old man would take it personal. He took my going into the Marines personal. That's what makes him great. The Great Don. He takes everything personal. Like God."

    Every bit of it is personal to the patient, and I'm not sure we are better off thinking it as 'business' to us.

    By Blogger angry doc, At November 20, 2005 2:02 pm  

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