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Saturday
Aug132005

Weird Day

#1

A woman calls who'd had her first baby UC. She's now ending the first trimester and called with concerns.

She woke up and within a couple of hours, had an amazingly painful headache and was seeing "squiggly" lines in her vision. She can't see clearly still. She began feeling a tingling going from her head down her left arm and it remains that way (at least at the time of the phone call). (No history of migraines.)

Listening, she began saying she felt she was anemic and that she was going to start drinking an anemia tonic.

As she stopped talking, it seemed like she was waiting for me to say something.

Alarmed, I said that I felt she should be seen. She doesn't have an OB (probably planning to UC again), so I suggested she go to the ER to be checked and possibly an ultrasound to make sure the kidlet was okay.

In my head: Possible pre-eclampsia? Possible hydatiform mole? Stroke? Screaming high blood pressure?

I know one of the latest Midwifery Today articles talked about jumping to the absolute worst conclusion and how important it is for a midwife to not do that - what we learn is CAUTION - but goodness, someone describing those symptoms?

I explained it could be anything from she slept funny on her neck and the nerves are tweaked to something very serious, but that I wasn't qualified to make that call. The docs in the ER would be.

Her answer:

No.

She said she wasn't having an ultrasound under any circumstances and was not going to go to the hospital. I was taken aback (and it was in this moment I remembered she was a UCer) and had to re-group and figure out where to go from there.

She said she really felt it was from her anemia and she just needed some supplements to take care of it. When I countered that anemia doesn't hammer into your head that way or cause the symptoms she is describing, she acted as if she didn't hear me.

I asked her what she would say to a girlfriend that called her with those symptoms and she said she'd tell her to increase her iron and supplements.

I was so confused. Why did she want to talk to me in the first place?

So I asked.

What is it you need from me?

She said she'd like to come in for an anemia test - isn't that just a simple blood test?

Aside: Excuse me, what's with the tunnel vision on anemia? Does she not hear herself?

She wanted to come in today, but I am not in the office until tomorrow, so I told her I'd see her at 9am tomorrow.

At a birthday party today, I talked to my co-teacher and asked what the heck do I do with this? I told the woman I had to chart her refusal and my recommendation and she said that was fine. I told her if it stayed the same or got worse, the ER was the safest place for her.

I asked my co-teacher:

If someone wants to UC and UP, why the hell is she calling me to do a hemoglobin on her? Doesn't she already "know" that her iron is low and what to do with that? What information is the test going to give her that she isn't doing now? (I actually will call her and ask her that question to see if she even wants the $25 test.)

In my thoughts:

Is it okay to use someone for what you want while also speaking passionately/rabidly against them? Is it okay for that someone to allow themselves to be used if they see the game being played? What is my liability in all of this? If I do a hemoglobin on her, is she my client then? Do I have her sign anything releasing me from liability? (It's amusing in my mind as I have said I will never allow the law to control my actions with a client - I have added to that sentence, "when the client uses their brain about what they want to do."

I figure I'll go in, poke her finger, tell her the results, and send her on her way with zero counseling.

I will be a WHOLE lot more careful about sharing information/advice from now on. Most women want to know what I have to say or what I think might be going on. Hell, I'm hired to do that! It was odd (and not in an ego sort of way, either) having someone not give a flip about my concern about her health. Very weird.

I hope she doesn't die of a stroke.

#2

A mis-invite (a person invited to a party during a drunken moment that wouldn't have been invited in a more sober moment) and her lover honed in on me when they heard I was a midwife. The pregnant woman/girl is 17 and said she is pregnant with twins and due in December. I did not sense a baby in there at all, much less two of them. But, that's beside the point.

Her lover of a minute and a half is 18 owns everything, does everything, IS everything bigger than everyone else in the universe. "My dad has a camera like that, but it is MUCH more expensive and the lens is WAY bigger than that one." sigh

When we were introduced, I smelled cigarette smoke. During the first ten minutes of sitting at the same table, the non-pregnant lover said she wanted me to talk to the pregnant woman/girl about smoking during pregnancy. I looked at her as if to ask, "yes?" and she nodded.

I explained what happens to the placenta as a woman smokes, that she is already working hard to feed the babies, possibility of prematurity, etc. As I started talking, she hid her mouth with her hand and lowered her head and let her hair fall in her face.

I tapped her hard on the arm and made her look at me.

I said that if she was old enough to bring a baby into the world, much less two of them, she was old enough to suck it up and listen to reality. She blinked and I plowed on.

I told her that I did care what she did after the baby was born really, but that I didn't care what she did after the baby was born (you have to hear my inflection - it isn't translating well here), but while she is pregnant, she is growing two brains, two hearts, four legs, etc. and she needed to remember she was creating their bodies for life. I asked if she'd had an ultrasound (stupid question) and said that when she wanted to smoke she had to look at the pictures of the babies to remember why she was sacrificing; it was merely the beginning of a lifetime of maternal sacrifice.

Odd other comments included body image talk (she's a big girl) and I said my pat line: you are growing two humans, not getting fat! Her partner said, "She's 17, she's real concerned about her weight." I laughed nicely and said, "I'm 44 and concerned about my weight! It's the way of the society we live in."

Such a weird day.

Reader Comments (2)

I _SO_ enjoy reading your insights, Barbara. Indeed, I find sometimes women such as the UC woman you mentioned, are rather...in denial about the more important issues and focus in on a peripheral in error.

I also _LOVE_ your sharing the story of the young couple and the issue of smoking.

I learn so much from you.
Hannah
www.millinersdream.blogspot.com

Barb,
The UC story really chilled me. As much as I respect the choice to UC, I agree that a UC/UPer who won't really even hear the advice she is asking for is in a conundrum, and it puts you in a very awkward (and perhaps legally precarious) situation.
I think the fact that she cancelled is good. And yet, I sure as heck hope she is OK. Her symptoms raised my alarms bells, too.
d.

August 21, 2005 | Unregistered Commenterbirthingway

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