Friday, October 22, 2004

Twins & Friable Cervices

Today I had my last day of my maternity rotation and my first "high risk" patient. My patient was a woman who was 28 weeks (just passed the viability hurdle) pregnant with twins and in preterm labor. She was in the hospital in order to receive a continuous infusion of magnesium sulfate, a drug that depresses your central nervous system and smoothe muscle so that your uterus doesn't contract. The rest of you doesn't do much else either. Therefore, the nurse is responsible for ensuring the patient is breathing well and doesn't form blood clots in her entirely prone body. I got to do all sorts of fun, nurse-y stuff like range of motion exercises, monitoring reflexes, checking her level of consciousness and asking my patient what floor she was on, who she is, what day it was etc. If the patient doesn't know what you're doing i.e. why you are asking these questions, the whole orientation to place and time questions can seem a bit strange: "Oh Mrs. Smith, I'm sorry to wake you but I just want to ask 'What day is it?'" "My God, girl," she must be thinking, "look at a damned calender why don't you."

I also got to do my first urine dipstick. This is old hat for most people but I thought it was fun: you stick a special paper strip into pee (what did I tell you - fun or what?) and it turns all sorts of pretty colors: soft pink, purple, sage green, duck yellow. You match these colors against a legend which tells you all sorts of useful information like ketone and glucose spilling or specific gravity. I wanted to pocket a strip and see what colors my own pee yields but remembered that stealing is wrong.
Because today was our last day of this rotation, I was evaluated by my instructor. It was a positive review and my instructor stressed how effective my small talk and conversation is. She firmly believes that you obtain more information by chatting with patients instead of simply interviewing them. I hope this is right because I feel sometimes I am only chatting with my patients instead of ministering to them. I know that my chattiness will not fly as well in, say, the ICU or in pediatrics where patients may not be oh... sentient or conscious.

So pediatrics will be my nest challenge. This rotation starts on Thursday. Our instructor means business and we already have a pile or prepwork that must be done before then.

Yesterday:
Yesterday I shadowed the OB triage nurse. She checks out women who believe they may be in labor or have other pregnancy-related concerns or trauma and decides if they should be admitted or stay home. The only women who came to triage yesterday were not in labor. Instead, we had a succession of 3 woman who were concerned with some spotting of blood. Understandably, this is of concern to a woman who is pregnant and believes she may be miscarrying. One woman was particularly worried because she was also secreting a blood-tinged clear fluid. Well it turns out that all 3 of these women had had intercourse within the last 24 hours. Clear fluid? Oh yeah, that.
It turns out your cervix is "friable" i.e. very sensitive during pregnancy and any jostling or contact with it will cause some light bleeding. It's not dangerous to the baby or the pregnancy but doesn't it seem like the sort of thing a doctor or midwife would warn their patient about? Every time a woman comes into triage she must be given an ultrasound and have an examination by an NP or a phyician, no matter what. Think of the thousands of dollars that could be saved by this little bit of information.

We had another patient who came in because she was 6 weeks pregnant and was in a fender bender and wanted to make sure the baby was OK. Of course I am sympathetic to this woman's concerns but my goodness her bumper didn't even have a dent! My mother pointed out the gap between these desperately wanted and cosseted babies with the sad, barely-parented children I work with on Wednesday nights. V. sad.

This weekend is dedicated to pharmacology. I won't make my self-medicating joke again but am starting to feel like a broken record re. exams and things. It never ends.

Appriopriately enough, 9 months to go.

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