Years ago when I was a labor and delivery nurse, a patient in my care had an eclamptic seizure. Before the seizure, the overall clinical picture did not indicate just how ill this young woman was. Her lab values were just slightly abnormal.
Even with the assistance of the translation phone, it was difficult to assess whether her pain was coming from active labor or a severe headache. Yet I had a terrible feeling she was severely preeclamptic and her condition was deteriorating in front of my eyes.
I shared this bad feeling with the midwife, who essentially blew me off, based on the patient’s relatively normal and stable labs. Based on my assessment of a severe headache and brisk reflexes, I requested that the midwife start magnesium sulfate to prevent eclampsia. But she felt that the patient would soon deliver her baby, and seizure prevention was not needed.
One hour later, the patient began seizing. She was stabilized and had a stat Cesarian section. The midwife later apologized for not listening to me and for not starting the magnesium when I requested it.
It was this experience that convinced me that listening to instinct is an important part of providing good medical care. Current medical knowledge and clinical skill is imperative; however, most providers will tell you that there are times when instinct trumps fact.
Patients too seem to have an instinct when something is really wrong. During my career, I’ve seen at least two young, healthy-appearing patients go into cardiac arrest, mere hours after telling a nurse, “I don’t feel right, I feel like I’m going to die.”
When a seasoned nurse tells me that she is worried about a patient based on her instinct, I listen. When a patient tells me that she feels something is very wrong, I listen. And when my own sixth sense starts to tingle, when that little voice tells me to look beyond the labs and really see that patient’s whole clinical picture, I listen.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.