Thursday, January 14, 2010


Last night, I wound up going into the ER for abdominal and back pains. I had put it off for a day, called my OB, who said it was probably nothing, but if it continued, got stronger, and a few other things, I should go to the ER and get checked out. It could be baby related, or it just could be a pulled muscle, or a gallbladder problem that was presenting with unusually located pain. My OB is affiliated with a hospital an hour away, and he said a closer ER would be fine if it got to that point.
Finally about 8 pm the pain became so strong that my husband and I decided that a visit to the local ER was in order. We bypassed our small community hospital, in the rare event that it was a baby related problem, and proceeded to a larger hospital with a good OB unit. I expected them to send me to the ER, rule out any baby problems, and then look to see what might be going on.

When we arrived, we were ushered up to labor and delivery, since I was 20 weeks. The nurses were incredible--kind, patient, knowledgeable. They quickly reassured me that everything was ok with the baby; his heart rate was good, and there was no indication of premature labor. All this I was expecting...and then they left me there. THe RN finally told me that the on call certified nurse midwife would be in, but she was on call and was coming from home. They also told me it was probably a kidney infection but they'd have to wait for all the tests to come back.

It was after midnight before she got there. The CNM walked into the room, introduced herself, and began yelling--literally yelling--at me for coming into the ER. She said this was normal pain and that I can't come into the hospital in the middle of the night for a second opinion. She then said she had a hard enough time seeing her own patients and didn't want to see anyone else's. I answered, politely(because my husband was about to kick her out of the room), that I was following my doctor's orders in coming into the ER. She then continued to berate me for coming into the hospital for such a "stupid problem"(her words, not mine), and waking her up, until we had had enough and ended the conversation then and there. We never got an actual diagnosis, but my discharge instructions told me to drink lots of fluids.

The RN, meanwhile, ushered the nurse midwife out quickly, then stepped back in and closed the door. She had the hospital's complaint line in her hand and gave it to my husband.

I cried on the way home--from exhaustion, and pain, and simple shock at being treated the way I did.

But it made me think.

How do I treat my patients? Am I as kind and compassionate towards the 2 am call for a red, numpy knee as I am the 2 pm call for severe chest pain? Am I as reassuring to the 90-year-old lady with back pain that has since resolved as I am to the 9-year-old with a broken leg? How about the frequent flyers who call three times a week and pretend to be unresponsive when we get there? Or the 0130 call for a drunk? Am I always compassionate, concerned, and kind; or do I silently berate my patients for waking me up for "stupid crap."

It's a wake up call. Being treated the way no patient should ever be treated, especially when I am scared, and in pain, and emotionally vulnerable, and feeling how much that bothered me---and knowing that maybe I wasn't as compassionate towards that middle of the night call for leg pain last week as I could have been(understand, I have never and would never berate, humiliate, or otherwise emotionally hurt a patient the way this CNM did. But sometimes, I, too, fall into the thinking that it's "just a BS call" and get a little sloppy.). We aren't asked to judge our patients, even though it's so easy to do. And it's easy to forget, when we're being pulled out of a warm bed or ambulance in the night, that our patient is probably scared, in some pain, and just doesn't know what else to do but call for us. Most of the patients who call 911 and request help, even if they aren't truly sick and probably could have taken a car to the hospital, are simply doing the best they know how. Are there people who abuse the system? Absolutely--but does that give us any right to emotionally abuse them? Does it give me a right to give that patient any less than my best care, both physically and emotionally?

So as I head off to work, still somewhat reeling from last night, and still in pain, I pray that my patients today, in me, will see only love, kindness, and concern. For who knows--mine may be the only kind voice that they hear all day.