A day in the life of an inner-city midwife
I work in an inner-city hospital with many low-income patients. Recently the obstetrics and gynecology clinic was so packed that every room was full, triage was backed up, and we had to go on diversion from 911 calls. It's hard to choose just one most memorable patient, so below is a sampling of the patients from that day.
Patient A came in for a follow-up exam from a hospitalization caused by, “taking a pill from her friend to cause an abortion.” She initially came to the ER hemorrhaging and with severe leg pain – an acute deep vein thrombosis. She needed a post-op exam and contraception. My recommendation was an intra uterine device, as I was not giving her oral contraceptive pills. She at least realized that she was lucky to be alive.
Patient B had a history of a full-term delivery, then a preterm delivery without any prenatal care, and now was complaining of abdominal pain. She reported having multiple sexual partners and did not use any protection. I diagnosed pelvic inflammatory disease. I did quite a bit of education with her about planning pregnancies, risk of sexually transmitted disease, and HIV exposure. I told her about the many complications that HIV positive patients experience and the high incidence in our area.
Patient C was registered as a gynecologic patient. She had a recorded blood pressure of 170/100, a lab result with hemoglobin of 6, platelets of 76. She said that she was pregnant and had been HIV positive for 10 years. She reported no prenatal care and had a CD4 count of 176. I did a fundal height and found her to be 22 cm, with no fetal heart tones and a positive urine pregnancy test. She had a stat sonogram and we discovered that she had a fetal demise, AIDS and HELLP syndrome.
Patient D had a history of narcotic use, was on methadone and reported a history of using heroin “only once” in order to qualify for the methadone program. She was admitted to induce labor. Her family was not aware that she used narcotics or methadone.
Patient E was in labor and deliver. She had family members fighting over who could be in the room for delivery. Some of them were asked to leave by the nurse, but hid in the bathroom instead. Hospital security and 911 were called. After the baby was delivered, all of the family members left. They had no interest in staying to see the baby.
Even though it sounds like a TV show, these are real-life patients. This was just one more day at work in our hospital.Tell us about your most memorable patient by December 15, 2010, and you'll be eligible to win an Apple iPad!