Posted on 10/18/2007 3:50:02 AM PDT by 60Gunner
I had spent the first half of my shift in the "Fast Track" section of the Emergency Department. Cases that are a level 4 and 5 on the 5-point triage scale are sent to Fast Track in order to make room for the more acute cases in the main ER. Cases that rate a 4 or 5 are cuts, sprains, bumps, bruises, series antibiotics, migraines, the mother who brings her six kids in because the ER is her family clinic, and such.
(I am a fervent proponent of "Fast Track." It keeps the patients suffering from non life-threatening ailments from having to wait too long to be seen, and it keeps the really sick people from having to wait for a bed.)
But this night was tough. Every patient I had was a pregnant woman. One had a headache (she was dehydrated, and needed to drink enough water for two instead of only one). Another woman had abdominal cramping but no spotting. (fetal heart tones were reassuring, she was not spotting, and she turned out to have gastroenteritis.) Others were there for coughs, colds, fevers,and so on. In all cases, FHTs were obtained and the 'passengers' were all just fine. But I was ready to be done with pregnant women.
Don't get me wrong. I think that pregnancy is, in itself, an amazing process. But at the same time, even a "normal" pregnancy is fraught with danger to both child and mother. Pregnant women are like the X-planes of the 1950s: awesome things happen inside them, but they can self-destruct in spectacular fashion without warning and without the slightest provocation. Pregnant women scare the crap out of me.
Fast Track closed at Midnight, and I was assigned the Float RN position until 0300.
At about 0100, the medic call came, signified over the intercom system by a soft,sweetly-intoned, bong-bong-bong that belied its urgency. The MD picked up the phone to receive the report. As he took notes, his brow furrowed and he rubbed his forehead with his free hand. He hung up the phone and handed me the Medic Call sheet.
A pregnant 25-tear-old woman had an on-scene BP of 226/116. Heart rate was 52. She complained of severe headache and numbness to her left arm. ETA was 10 minutes. I groaned.
We had taken care of pre-eclamptic patients before. Magnesium is the weapon of choice because it reduces the risk of seizures associated with eclampsia. Lopressor (a beta blocker) is also favored because it protects the heart and lowers blood pressure. But since this woman's heart rate was less than 60, we could not give Lopressor and thus intended to use magnesium as aggressively as possible. She was really rummy from the Mag; her speech was slurred, her limbs were floppy. But her vital signs were great. So we sent her to CT. Since I was the 'float' RN at the time, I went with the patient. She was on a portable monitor so I could continue to see what her body was doing.
She made it through CT like a champ. No evidence of a brain injury was found. As we were exiting the CT control room I said to the CT tech with a sigh, "Taking care of pregnant women scares the crap out of me. It's like being a demolitions expert." The CT tech said a heartfelt "Amen!" We carefully transferred the woman from the CT table to the stretcher for the trip back to her room. I looked up to reach for the oxygen tubing, and then looked down at her.
At that moment, she seized.
I rolled her onto her left side and barked to the CT tech, "Get the doctor NOW!" The other tech in the room frantically stuck a Yankauer wand onto the end of some suction tubing and handed the wand to me. I suctioned the secretions out of her mouth to keep her airway clear and waited the thousand years it seemed to take for the MD to get there. He finally arrived, breathless, and asked, "How long has she been seizing?"
"About a minute," I replied. The seizure was just beginning to abate.
"Let's get her back to the room now."
We pushed her back into the exam room (which was only thirty feet away from CT) while keeping her on her left side. The seizure had stopped by the time we got her back on the full monitor. She then entered the post-ictal phase and became combative. She swung, punched, kicked, and screamed gibberish.
"Give her 1mg of Ativan. Ramp up the Magnesium to 4 grams per hour. Keep her in soft restraints. I don't want to lose that IV, and I don't want to intubate her. Get her back on the fetal monitor," the MD said as he left the room.
We followed the orders. The patient was hemodynamically stable soon thereafter, and the Ativan helped settle her down. But the problem was not solved yet. Her passenger was in grave danger, and she was not out of the woods yet, either.
The on-call OB-GYN came in the room and said, "Get her ready to transfer to the University. I've already signed the orders." I set about getting the paperwork ready while the patient's primary nurse continued direct care. Within the hour, the patient was on her way to the other hospital.
We heard the next day that the patient underwent an emergency cesarean section. The baby was in very bad shape and not likely to make it. The mom had a massive stroke during the procedure and was also not likely to survive. It was her first pregnancy.
ER Nursing Stories Ping!
I want happy stories, damn it.
Yeah. In Britain, 60Gunner could just have said “Sorry Lady, we’re full”.
(disclaimer: I am British)
Love your stories, but Damn!! That one hurts.
Uh huh, and how many of those were ILLEGAL aliens wanting to have their anchor babies.
I'm just sayin.
Wow, that's truly tragic. My wife is a RN in the OBGYN department at our only local hospital. She often tells me similar stories, but most of the time they have happier endings. I'm sure she would agree with your assessment of taking care of pregnant women being like working with demolitions. Recently she came home late and nerved out. She had a women in labor who was at 6CM and within 15 minutes the patient was fully dilated with the baby literally coming out. The doctor wasn't even in the hospital at the time and she had to deliver it herself. She had read about and heard stories of women in labor doing such things, but she hadn't witnessed such a thing while working.
b). Hopefully both the baby and parent survive without disability. Even if improbable, there is still hope that the two of them will make it through.
Thank you for the story and I pray mother and baby make it. Having gone through a troubled pregnancy, I can say from my end, thank you for what you do. It’s a gift that lasts for every lifetime in the family.
Very sad.
This brings to mind the stories of child birth in the sixteenth century. Back then women were at more risk from child birth than men were from being killed in combat during wars. The best example is Phillip II of Spain, the Spanish king who directed the Armada against England. Although a reasonably humane man in his dealings with his wives, he lost nearly all of them due to child birth and related complications. The horrible white, male, racist, sexist, homophobic, greedy doctors of the nineteenth and twentieth centuries changed nearly all of that, making child birth an ordinarily safe experience. However, terrible things still happen, as shown by this story.
Awful story. So sad to see it turn out that way :(
How sad. How very sad.
The Golden Motorcycle and the Kiss of Light
A little later, we were all in a prayer meeting. I had a couple of visions, sat back and I told the Lord, “You know, Lord, you owe me a chariot ride.” (I was thinking back to the episode at the dinner table earlier.)
All of a sudden, I had a shock because right in front of me was a golden motorcycle. On the side of the gas tank was a picture of an eagle. The motorcycle was vibrating as if the engine was running. The Lord Jesus laughed, and said, “Hop on.” Now if you know me at all, you will know that I am definitely NOT a motorcycle person, but I leaped on the bike. The next moment, this golden motorcycle took off and did some loops, then I became aware that I was holding onto Jesus, as I had my arms around Him.
Then we began to skim across different islands—Jamaica, Solomon Islands, West Indies, Malta, Azores, Fiji, Hawaiian Islands, Caribbean Islands, Greek Islands, etc., and all kinds of islands. Jesus was happy and He was laughing. He said, “I am going to kiss the islands.” This kiss was light, affectionate and joyful. We touched down in Fiji, and then I landed on my back somehow in Australia. I was then lying on the floor, laughing.
The “lightness” of God is powerful—it disarms the enemy. The Holy Spirit’s joy is a victory laugh. God looks at His enemies and laughs at them and has them in derision. One of the greatest spiritual warfare weapons we have is the spirit of laughter, that’s why religious spirits get mad when they hear it.
The kiss was also a sign of recognition in the early Church. In Romans 16:16, “Greet one another with a Holy kiss” was a sign of God’s love and also of recognition of a brother or a sister in the Lord. Jesus commissioned the disciples and washed their feet, it was also a recognition of one who was sent. “As the Father has sent Me, I also send you,” Jesus said in John 20:21.
In the dictionary, kiss is defined as: the token of greeting, love, affection and reverence, also associated with gentleness.
So people of the Islands—He is going to kiss you, He is going to touch you. This touch is joy and deliverance from heavy burdens. It is affection and revelation of the goodness of God. It is light and it is full of grace and favor. It is honey and oil and perfume.
“What is your take on Acts 15:20 (abstaining from blood) about eating meat? Could you freepmail”
If you are serious and not kidding, this is simply an admonition to avoid the pagan practice of eating blood. “The life is in the blood” (Lev. 17:10)
Pagans belived eating blood would enhance their lives. But the second reason is the blood is given in payment for sin. That’s why it wasn’t to be eaten instead.
Crikey, you write well! I was on the edge of my seat reading all that, glued. I could picture it precisely as you described the scene — some of the technical bits I had to imagine — but whoa! That was riveting prose.
Well written! Goodonya!
Ahem... picture the 3 little old ladies, belly up to the bar, lifting the bun and saying....
WHERE’S THE BOOK??!!!
Come on, 60gunner, you just gotta get all these stories into one package and sell it here on FR....
And let us know if baby and/or mamma make it... sad story.
<>< Must read
How’s that book coming? You’re going to make a lot of money when you finish it—you’re a splendid writer.
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