30 Something Baby Doc

We had a very busy night call a few day ago. The physician team was short a resident on labor and delivery and there were multiple patients laboring and close to delivering. The residents were scrubbed into a C-section and I was the only available physician. One of the nurses called me to her room urgently because she was concerned about her patient who had a C-section 1 day earlier. The patient stood up to feed her baby, then collapsed to the floor. When I entered the room the patient was very pale and sweating. The nurses was also concerned because she couldn't alleviate the patients abdominal pain following the surgery which she thought was very unusual. We were all thinking the same thing.

Could this patient be bleeding internally????

I examined the patient completely and reviewed her vital signs. All the objective signs told me that this patient wasn't hemorrhaging internally. But the nurse was persistent that something was wrong with her patient. I reassured the patient and her husband that everything looked OK at the moment and the fainting episode was likely due to the large amount of pain medications she had received. I got called away to another emergency , an hour later , the nurse contacted me to give me the lab results on her patient who passed out. Her blood counts were stable and not dropping. The latter reassured me that everything was OK, but the nurse was persistent that something was wrong with her patient and her increased pain was concerning.

I was going to blow the nurse off (feeling she was being overly paranoid) but her persistence compelled me to get an ultrasound to scan the patients belly. When I did, I saw that the patient had a large amount of fluid in here abdomen that was most likely BLOOD. The patient's pain had also become unbearable.

We rushed the patient back to the operating room and opened her incision and discovered she had one and a half liters of blood in here abdomen. We immediately controlled the bleeding and cleaned the blood and clot out of her abdomen. The patient did very well following the surgery (and a few blood transfusions).

The husband came to thank me after the surgery and express his angers toward the nurse because he felt she was ignoring his wife's complaints. I informed him that their nurse was instrumental in discovering his wife's internal hemorrhage and had likely saved her life.

I went to personally thank the nurse for her persistence.

I need to really LISTEN to others more.