Saturday, October 24, 2009

Patients (patience)

Here are some patients I have had recently...and their families in some cases...

18-year-old multip who has class B diabetes and hypertension - she was being induced for these reasons at 38 weeks. Trust me, that baby needed to come out...much safer out than in as momma was very non-compliant (I hate that term but appropriate in this case). She had been on insulin prior to getting pregnant. They stopped the insulin when she got pregnant and she was to do diet and exercise. I thought that sounded a little odd but whatever. She came to us late in the pregnancy because she didn't like the care she was getting from her previous doctors. Or perhaps they wanted her to do things like eat right, monitoring, etc. Low and behold, we asked the same thing. She would apparently just not show up for NSTs and things of that nature. She also comes with an overbearing mother. Her mother is very much focused on looking like someone who knows something about everything. When I met her on L&D, she informed me that her daughter has diabetes and htn....uh yeah, I kinda got that from her H&P, from the midwife who scheduled the induction. And that might be why we are checking her blood sugars periodically and told her she could only order certain foods from the menu. How's that for a clue. The mother than proceeds to ask me all kinds of questions such as...

  • Shouldn't she have the baby 2 hours after water breaks?
  • Won't she have a dry birth?
  • I've seen a baby with a rash because the water was broke for 6 hours (huh?)
  • They'll start with a low dose for the epidural right?
  • It goes in the spine right?

And on and on in that vein. The patron saint of patience must have been by my side as I answered all her questions that had nothing to do with the real concerns (a wbc over 17, baby sky high for even a multip, etc). And it isn't like I broke her water, it was spontaneous.

A patient came in through triage, after being seen in the office by the nurse practitioner. Her first visit with us was at 27 weeks. Then she disappeared. Now she's 36 weeks, contracting, blood pressure is up - lovely. Who needs that silly ole prenatal care - blood pressure issues are no big deal!

Another patient unfortunately had to have a c/s for CPD (this is actually a rare diagnosis - it gets tossed around a lot though). The baby was in the 9-pounder range, momma was a very large lady with a smaller pelvis :( Bad combo and unfortunate for her. We tried everything we could think of to get her dilating better and get some descent of that head, but nothing was working.

I have a momma in the office who stinks of cigarette smoke and has some very strange dreams about chihuahuas.

I have to start taking notes on things I want to blog about. I'll be thinking 'oh, I need to share this, this is good!' But now I can't remember a d*mn thing!

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