Saturday, November 14, 2009

Rough Night

I had a rough night recently. I had a patient who was having her second baby and we had a less than optimal outcome. I think it sounds like the baby will be fine in the long run. Even intially the baby was doing better. But you know how these things can weigh heavily on one's mind. These outcomes are so far and few between so makes it even more uncomfortable when they occur. Even though you know you managed appropriately, you still feel a sense of responsibility. You also get a case of the what-ifs....what if I had done this at this point...or done that....or whatever. I even called the physician at one point to come in. He reviewed the strip from home and said I didn't need him. I was very p*ssed off. Some of our docs are very difficult to get out of bed, whereas others will come, no questions asked. I also called the doc back afterwards to review the strip with me from start to finish, which he did from home. I felt better after having done that. Anyway, I got the baby out and am praying this kid is ok.

Lately I feel like a failure as a midwife. It seems like I have these occasional spells where things seem to go wrong a lot. I begin to wonder if it's me, maybe I suck. That's a really uncomfortable feeling. I also start to worry that maybe my mental clarity is not so hot. Guess that can be due to fibro. But really, when I look at whatever has happened, it seems like I made the appropriate actions but yet, just feel like I still screwed up anyway.

For example...I saw a patient quite some time ago. The patient had a reactive RPR but a negative TPPA. So that means she doesn't have syphilis. I let the patient go but chased down a doc when I had a chance later that day. I asked him if I needed to be concerned and do anything further regarding the labs. He said no, just find out if she has previously had syphilis and been treated. I figured this patient, who was a doc patient, would be ok til her next visit. We could check on it then. Maybe this is the part where I was stupid? I should have called her at her home. And I didn't document that conversation. That was definitely stupid. Anyway, so another doc sees the patient and is concerned as to why we haven't 'done anything' prior to now. She wants to send the patient to the perinatologist. I related my conversation with the previous doc and apologize for not having called the patient back at that time to further ascertain what may have caused her RPR to be reactive. But she seemed perturbed.

Causes of RPR being reactive (other than syphilis) - pregnancy, connective tissue disease, bacterial or viral infections, advanced cancer, myeloma. There may have been a couple other things but can't remember now.

Ugh.

5 comments:

mitchsmom said...

No one is perfect...
don't beat yourself up about the RPR thing... and the other, you said that you managed it appropriately.

That "what if's" will eat you alive (I know)... just try to let it go and put that energy to the next patient & to maintaining your high standards.

I would be pissed about the MD thing, too, though... whenever there is doubt, there should be a mutual trust and respect to any reasonable request. (goes for any relationship)

Paula said...

Hey there, your job has a very high level of responsibility involved. I have a friend who is religious. I'm not, but I always find it comforting when she says to me, "Paula, you are not in charge. It is Gods job to bring those people the experience they need to bring them to their next lesson in life. If you are meant to be there, you will be. It will be jut the way it needs to be."

That doesn't mean I don't have to try, just that it isn't all my job.

But you cover a very high volume of births. I wonder if you would be comforted by numbers. It sounds like you have many many positive outcomes, many times assisted by your good care and guidance.

Small p.s.. If possible, would you not use abbreviations? We non nurse types are ignorant's, yet still very interested.

Beetus said...

Ciarin, you are an amazing midwife. Strong, compassionate and thorough. You are a gift to your patients and to midwifery!!

Some of what you describe sounds like growing pains. We all have them...at least those of us who strive to do our very best. Not all people are comfortable with that feeling.

You did an outstanding job with getting that babe delivered. Know, without doubt that you did. Then learn what you can learn from the experience. Sometimes they are small lessons in the scheme of the big picture but they bug us anyway.

I believe you are doing exactly what you were put on this earth to do!!!!! :)

Ciarin said...

You guys are so awesome - gonna make me cry! Thanks for the moral support :)

Joy said...

You do not suck! We really do all have our moments. *HUGS*