Sunday, April 15, 2012

primum non nocere

I dedicate this blog post to my friend, Lauren B., who has dealt with more than her fair share of 'hospital idiots' and will truly appreciate my sentiments ... as well as to any other readers with similar experiences to mine.

Just to give you a brief background as to why I'm writing this -- I went to the hospital last night.  After having regular, intensifying contractions for 3.5 hours ... my obgyn thought it would be a good idea for me to go to L&D to "rule out labor."  My contractions continued the entire time I was in the hospital (from 10:30pm until 4am) and were 3 minutes apart ... lasting for 60 seconds each ... and moderately painful.  However, because my cervix wasn't changing ... it was deemed to be "false labor."  While I was there; however, my blood pressure began acting up (as it tends to during late pregnancy) so some tests were run to rule out preeclampsia.  So far -- so good -- all normal.  I think the basic plan at this time is to keep a close watch on my BP at my regular prenatal appointments and wait to see what happens.

While I was just sitting around ... contracting on the monitor ... I had awhile to take in my surroundings and reflect on the experience.  I quickly noticed that I was more afraid being IN the hospital than if I had just stayed home.

primum non nocere
a Latin phrase meaning, "first, do no harm"

A lot of you may have heard this expression before as it is both part of the Hippocratic Oath taken by all physicians as well as the nursing principle of "beneficence."

When I was initially admitted, I had a great nurse who made me feel safe and well informed.  Unfortunately, at 1am I was "traded" to a nurse working only a half shift (why hospitals allow this ... I do not know).  When my "new" nurse flitted into the room, she immediately began rattling off a million "care plans" for me that were completely different than what my previous nurse had discussed with me and didn't make any sense.  Ultimately, I do not think this new nurse had received a full report on me ... so she was doing some guess work ... and getting completely confused.  It also probably didn't help much that she was a young, beautiful, giggly blond ... not that I wanted her to look like Nurse Rached ... just that she didn't exactly command my confidence.

Basically, she entered the room solely focused on my blood pressure and ignoring the fact that was I was in the hospital to "rule out labor."  When I had last spoken to my first nurse, she was to return to check my cervix for "progress" in 30 minutes after noticing my regular contractions.  My elevated BP had just been noticed and a urine sample had been collected.  Hypertension was not the reason I was at the hospital.

"New Nurse" burst into the room carrying a 24-hour urine collection container and rattling on about "you are admitted for 24 hours for BP ... need to get labs ... unsure if you need IV fluids ... yadayadaya."  When I asked her about checking my cervix, she looked puzzled and said they weren't going to check me again since I was admitted.  Ummm ... that's what I came in for, lady, to "rule out labor" ... if you don't recheck me ... this was a waste of everyone's time.  But before I could speak ... in walked a "tech" with her IV cart.  She informed me that she is going to draw PIH (pregnancy induced hypertension) labs on me ... and also that she was supposed to be off tonight to drive her sister back to NYC in the morning ... so she's upset that she's at work.  "I'm sorry," I say.  How else to respond?  Then, a third nurse pokes her head in the room and hollers "did you know she had ketones in her urine?"  The nurse stops the tech from drawing my blood, and in she walks with IV fluids.

At this point I am extremely confused about several things:  1. why my new nurse seems to have no idea why I'm in the hospital ...  2. why I now have no idea why I am being "admitted" to the hospital ...  3. why I'm getting IV fluids if I have high blood pressure ... and 4. why there are 3 medical personnel in my room who have not introduced themselves and are not explaining anything to me.  

Again, I do not get a chance to ask any questions before the tech pokes my vein and begins to tell me (after Justin told her I am an RN) that "she graduated nursing school in 2009 ... but still has not passed her boards ... but 'her day will come, one day' ... and that the hospital isn't supposed to, but they let her do everything an RN does anyway."

Last time I checked, that is not something you should say aloud to a patient while you are working on them.

"New nurse" then hung the bag of IV fluids on the pole ... not using a pump ... and "wide open."  WHY would you do that for someone with high blood pressure?  She settled me in for the "night" (at this point I still haven't been told how long I'm staying) and left the room.  Once the door was shut, I was finally able to speak to my mom who was staying with me (Justin left to care for Jackson at home).  I had so many concerns ... like knowing that this nurse was going to let my IV run dry (she did) ... and knowing that neither my contractions nor my baby's heart rate was being picked up by the monitor now that I was on my side (it wasn't) ... and figuring that my "new nurse" wasn't going to reposition the monitor straps to obtain a reading (she didn't) ... and wondering how long I was going to be in the hospital in the care of these people.

Over an hour passed ... and "new nurse" finally came into the room to tell me my labs were normal.  It was then that she noticed my IV was dry, got a new one, then promptly forgot to start it (that bag of fluids never even entered my vein).  When I brought up the whole "rule out labor" issue again ... she responded "Oh, you're not in labor!  You're not even contracting anymore."  In saying this, she was staring at the monitor strip that wasn't showing my contractions since I had laid down ... but still ignoring the fact that it also wasn't monitoring the baby.  I simple responded "yes I am ... every three minutes," to which she chuckled.  I decided at this time to sit up and reposition the monitors on my own belly to help them begin tracing again once she left the room.  It worked.  My contractions and baby's heart rate were back on the display screen.  

Thankfully, my obgyn was in the hospital due to another laboring patient and was able to stop my by room.  He addressed both my labor and my BP concerns (giving me the opposite explanation that "new nurse" gave), explained what was going to happen, and cleared me for  discharge.

I suppose it was a good thing that I went to the hospital ... maybe ... to at very least make my physician aware to closely monitor my blood pressure in the coming weeks.  However, it certainly did not augment my confidence of the care I might receive when I am in "true labor."

Please, if you are a healthcare provider -- remember that your patients both want and need to feel included in their care plan -- that they deserve professionalism and a voice -- and, please:
primum non nocere.


Crystal said...

Oh Jenny, What a nightmare! At this point I would highly consider putting a birth plan together and having your birth partner on board so he and/or she can be your voice!, and possibly labor at home as long as possible. Did you swell after all that IV fluid?

<3 Crystal

Lauren said...

Amen sister! That was crazy. Not that I'm surprised at anything anymore. But thanks for the shoutout. :)