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Monday
Jul172006

I've Done Some (ER) Time

My 4 day postpartum mama had some serious pain this morning. She'd been not feeling so fabulous in her bottom the last couple of days and a check of her bottom showed 2 of the sutures released (mom felt them pop when she coughed). They were interrupted sutures, to when they popped, it didn't release all of the work. We looked yesterday at her 3-day postpartum and could see the release, but otherwise it looked okay.

On day 1 postpartum, she'd told us about her tailbone hurting so badly she couldn't sit on her bottom. After much discussion, the suspicion was a broken coccyx and I explained how a chiropractor or osteopath can yank it back into place (with a finger in the rectum), but that she shouldn't worry about it just this moment if at all possible. She felt relieved that she had an explanation.

The other growing pain seemed deeper. She could feel the searing of the open wounds and said she felt "fillet'd" - not a pleasant feeling for a new mama.

This morning, dad called - I didn't go to the pool and couldn't figure out why I didn't - and he said mom was in so much pain she wouldn't eat because she was afraid she'd have to poop.

A hematoma?

I threw on my clothes and flew out the door. The apprentice was also on her hurried way.

Driving, I was stopped by a motorcycle cop - I was going 40 mph in a 25 mph construction zone. Yay. Double fine. Probably $500.

After signing the ticket, I drove more carefully to mom's house and went to her as she lay in the bed nursing her son.

She was in so much pain. Was it the sutures that released? Could they all be undone? Did she have a tear more extensive than we thought? (On Day 3, mom said she'd had some black stool - blood?) Was there a tear into her bowel?

Because of the amount of pain and her history, it wasn't likely we'd be able to get inside to see what the issue was without some serious medication. Since I don't carry any, that would mean a trip to the hospital.

I presented the options a little differently than that, of course. I explained how we'd have to go deeply inside and I knew how painful that would be for her. She understood how much it would hurt. I was also hesitant to wander through there if there was a bleeding hematoma.

Her big concern was taking the baby to the hospital... the horrible energy that's there. I encouraged her to believe we can keep the baby protected by a circle of love around him and if one of us wore the baby in the sling, he wouldn't be exposed to the yuckies in the hospital. After some talking, she decided to go in.

Trying to figure out who to call was a mess. Her doctor's office didn't answer the many numbers they tried. I'd called the midwives, but they were off the floor. I then called L&D and they said she'd have to go down to the ER, a GYN would come down and then if she needed to be repaired, she'd go to the OR. sigh So, we packed up and headed out in two cars.

Meeting mom at the ER, I had to walk a mile and a half to get a wheelchair only to end up back in the ER asking them for one. Getting mom into the chair, she began crying - and this woman has got some serious pain tolerance. She could barely move, much less walk. Her husband held her legs together as she tried to get into the chair. It was painful watching. I can't imagine what it had to have felt like.

We wheeled her into the ER area and I filled out the pre-triage paper and handed it to the woman behind the glass. I leaned down and said, "She's 4 days postpartum and is in horrible pain... bleeding" and the nurse blankly looked at me and said, "Everyone here is in pain." She said it would be a couple of hours before she even got into triage. I felt ill. I told her we'd called L&D and they told us to come down to the ER. She blinked and I could see the convo was over.

As I was walking out, the apprentice came through the door and said, "She's passing out," and grabbed a magazine to fan her. I went out and saw her and then went right back in, putting my mouth to the open hole in the bulletproof glass saying, "She's fainting and bleeding. She needs to be seen!" The woman looked at me and said, "I'll be with you in a minute." I went out to check on mom and she was not all there, her eyes rolling back in her head, her head lolling side to side. I went back in and said it again, "She's passing out! Please help us!" and she said she'd send a nurse out.

About 3 minutes later, the triage nurse sauntered out and asked what was going on. Mom looked like crap and I said she was fainting. He asked her questions and she slurred unintellible words - are you diabetic? (she was GDM) are you bleeding? (didn't I already say that?!) He led them through the magic triage doors and her husband, with the baby in the sling, went back, too. Mom had said a number of times that she didn't want the baby in the hospital and I offered to go into triage with mom, but dad needed to be with her. The door shut and the apprentice and I sat amongst the 30 or so other sick people in the waiting room.

I get nervous around sick people. I can't afford to be ill. I throw up a shield as best as I can, but sometimes things travel into me anyway. I didn't touch anything I didn't have to, but was very tired and when we were outside earlier waiting for mom, I'd sat on the floor. We washed our hands as soon as we could.

Not expecting to see mom for a long time, we were shocked to see dad pushing her back outside. What?!? They said her blood pressure was fine, she could wait in line. When dad asked if there was somewhere she could wait lying down, the nurse said there was nowhere back there. He said, "She has to lie down!" and the nurse said to go lay in the grass.

What the HELL?!?

I couldn't believe my ears. Mom still looked horrible and was crying in pain. I had another plan.

I told mom and dad we were going to L&D. I would get us help one way or another. We went upstairs to the OB floor and I explained to that triage nurse what was going on. They knew me from my phone call earlier, but reiterated we had to go to the ER since she was postpartum, but when I explained what had happened downstairs, several nurses and a doctor came into the hall to talk to mom. She was begging to lie on a bed or gurney... anything to get off her bottom.

She was wheeled into the triage room (we'd made it past a gatekeeper!) and was asked a few questions. As soon as mom was lying on her side, she was infinitely better, but still in excruciating pain. The doctor and I talked about a hematoma - that it sounded like one. She asked about what we'd seen, what we'd sewn, etc. and I answered all her questions as asked. The doctor asked the two nurses to please wheel mom down to the ER and get her seen.

I was so flippin' proud of myself I could scream.

We go downstairs and they open the door right next to the triage nurse who said, "WTF?! She is perfectly fine to wait. How did this happen? Where am I supposed to put her? Look at 'my' waiting room!" The one nurse said she was exhibiting signs of shock and she needed to be seen right now. You go girl!

The door closed, but I could see the triage nurse seething. He was pacing and gesticulating, but my mom had gotten past him. I could finally breathe.

A few minutes later, the nurse came out and said, "That was unnecessary, you know." I stared at him hard and said, "Apparently, it wasn't." I didn't let my eyes waver.

Time passes and we hear from dad that they started an IV and were going to examine her to see what was up. They told her the pain meds would go to the baby, so she declined. I explained to dad that they have to say that and offered to go out to my car for Hale's book and he said that it was okay. Next we heard, she'd had some morphine.

The apprentice and I went to sit and wait in the cafeteria and, after about 90 minutes, dad came in and said:

- Yes, a couple of sutures came out.
- It looked like she was having a reaction to the chromic gut (another doctor said, "that's why we never use that anymore" - I don't suspect we will be, either!)
- No, they don't need to suture her again, what was done looks fine
- They didn't find a hematoma (great!!)
- There was no tear into the bowel (fantastic!)
- She had to poop
- They are going to give her an enema, some Vicodin and send her home

We couldn't believe our ears. What was the cause of the pain? Apparently, no one had an explanation.

(This reminds me of the women who go in for serious pain and something obvious is overlooked. It makes me kind of nervous, actually.)

No fever. No signs of infection. Everything looked fine. Except the pain.

Looking at her discharge sheet, mom laughed her head off as the ER diagnosis was:

Constipation

I can imagine that triage nurse howling even now as he eats his dinner.

No matter. I got my client seen.

Right past the gatekeeper.

Reader Comments (11)

I once had a client that was hemorrhaging from a miscarriage - she was bleeding all over the triage gurney, yet they were totally going so slow.

ERs suck for anything obstetrical.

July 17, 2006 | Unregistered CommenterSage Femme

Oh wow, the triage nurse... appalling. I felt ill reading that... but I got a great giggle at the diagnosis!

July 17, 2006 | Unregistered Commenteranastasia_wolf

wow, you got past the fierce ER Triage Nurse! Excellent job on advocating for your mama!

July 18, 2006 | Unregistered CommenterJen

Isn't it amazing how ER's are?

I had a thought as I woke up this morning... do you think anyone calls 911 *from* a crowded ER?

It was on my list of options this morning!

And yes, I know ERs are so horrid for OB stuff. If we'd have gotten a hold of her old OB, it might have gone differently, but we couldn't get anyone. I knew the L&D nurses would take half a second to listen. Thank goodness they did.

I still think there's something more going on. I hope it resolves without intervention and we never know what it was.

July 18, 2006 | Unregistered CommenterNavelgazing Midwife

Sounds similar to my broken coccyx coupled with the wicked tear I lost all four stitches at 24 hours pp.
It took a while with teasing everything back into place (did not do anything quite so "personal" with my chiropractor) but it did go back in time for #3 to arrive.
Loads of sympathy for mama, hope she is feeling better today!!!
Lucky for her she has such a great advocate! ;-)

July 18, 2006 | Unregistered Commentermm

What kind of OB doesn't have anyone to answer the phone?!!?

A service at least.

Cripes.

July 18, 2006 | Unregistered CommenterAnonymous

It's good for me, a provisional midwife, to hear someone as experienced as you are have doubts about missing something with suturing. I have only sutured two bottoms, but I agonize over those bottoms every day until I see them healed (sometimes apparently miraculously) at six weeks. Good thing those bottoms are so forgiving! About "your" mama, good for you, what a wonderful advocate you are for your ladies!

July 18, 2006 | Unregistered CommenterOne Hot Mama

I can't help but want to complain to the powers that be at the hospital. The behavior of the triage nurse is simply inexcusable.

And I am SOOO proud of you for getting that mama the attention she needed. I am happy you were there to fight for her. You rock!

July 18, 2006 | Unregistered CommenterAnonymous

I have seen so many power mad nurses I just assume that that is what they hire them for-- I hate hate hate ERs- and beg to never be seen there. I also think that the way the medical system is going now it is the most common way people are seen - maybe they need an in-hospital clinic different than the ER so triage works fast to determine which side a person goes to see- and all the minor illnesses can be slotted to the clinic side and if there is a mistake in the triage they are still on site with asap labs...
I have some real ER horror stories but will not write.
I use vicryl - use to use chromic there are plus and minuses for both- also we use a post partum soak/sitzs bath that help with congestion and pain- after sutures you can use most of the herbs like lavender and manzinita/uva ursi and calendula but don't use the comfrey with sutures as it can make them dissolve more rapidly- in any case for this kind of pain I would probably throw in some St John'swort as well- something that is in flower now is melliot and we use that for soaks as well really helps with bruising

July 19, 2006 | Unregistered CommenterAnonymous

The ER nurse did exactly like she was suppose to. Triage the patients in the waiting room and take them back in the order of severity of condition. This mom's vital signs were fine. I'm positive there were plenty of patients without good vital signs. The ER does the best they can with limited beds and resources. Thank God for the ER, and the nurses that everyone seems to talk bad about because "omg, they didn't take me back first"

I can't imagine an OB/GYN with noone on call. Once again, thank god for the ER! ( that sees a wide range of medical problems)

July 19, 2006 | Unregistered CommenterJen

hard to say- I do know that if you think you are in danger- call an ambulance- you get seen faster- a couple samples of ER waiting I have experienced- DH had a massive brain hemorrhage (hemorrhagic stroke 10 cm) and also has a very high pain tolerance so when asked from 1-10 what is your pain level he said 5 ; ) - I had taken him in because he was not drinking and had had a headache for 3 days- wasn't opening his eyes and vomiting- although he and I both have had migraines I knew it was not a migraine!!! The just told me he was fine and it was just a migraine- BP 140/90, 8 HOURS after being triaged and yes waiting in a room on a bed they decided to give him some meds for his headache after this just one formality- where they took him in and did a scan- found the hemorrhage came back- woops they really screwed up- and transfered us to another hospital via ambulance-- all along his bp was raising while we were there--- luckily he survived with little problem---
1 year later he had an appendicitis- I had decided he had it before we left home- got to the ER and the triage nurse this time gave him tylenol or something else for pain and his fever dropped and his already good pain tolerance was reinforced and so when the doc finally examined him little pain- I had to insist that they do the blood work- and doc said how about imaging faster-- and yep sure enough appendicitis-- while waiting in a crowded ER one old lady sitting next to us who had a compound fracture, a diabetic and did not eat that day- was in danger of changing her status in the ER waiting room-- kids with ear aches were getting in before her- some nurses are incompetent and tons of people have been too scared by care providers to care for their normally sick family members- and some people are just stupid enough to think that because they have insurance they should be seen in an ER damm the costs--
I am going to believe that navelgazing midwife is giving us an honest account and am not thinking that this nurse was being responsive/responsible-

July 20, 2006 | Unregistered CommenterAnonymous

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