Tuesday, July 27, 2010

An expert opinion doesn't replace human kindness

Towards the end of my women's health rotation I learned a lesson that I hope to never forget. My preceptor and I were seeing a patient that was a 33 y/o G3P3 that was complaining of amenorrhea, a positive home pregnancy test and mild abdominal cramping. She stated that she had recently returned from out of town attending to a parent that is dying from cancer and been under a great deal of stress. She has a history of irregular menses and stating dates of last last menstrual that would place her at 10-11 wks gestation. The WHNP performed an initial ultrasound in the office but we were not able to see any sign of a viable intrauterine pregnancy. In fact the only thing of note was a thickened endometrium lining but not much else. The pt had a positive hcg with ok values but we weren't sure what to do. We consulted the on-call OB doctor handling complicated OB patients and he instructed us to ask the pt "how much she really cared about this pregnancy?", and to offer her the opportunity to terminate it now. This advice did not sit well with either of us. We instead ordered serial hcg's and scheduled her for a more detailed ultrasound later that week. Although this pregnancy was unexpected for her, we felt that unplanned doesn't always equal unwanted. In hind sight we felt the worse that would happen is finding out a few days later that it may not be viable.
When the pt returned, her values had improved accordingly and the more detailed ultrasound showed a viable fetus around 6wks. I shudder to think of what harm we could have caused by just following the expert, some life situations require us to pause and take a breath not forgetting to impart some human kindness.

2 comments:

  1. Wow, this gave me the chills. It is amazing to think that this pregnancy could have inadvertantly resulted in termination despite the woman's desire to "want" or not "want" the pregnanc. YOu hit the nail on the head that "UNPLANNED" is not synonymous with "UNWANTED" as a matter of fact, many of life's greatest rewards are those that arrive unexpected!!!!!

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  2. I wonder how they were going to terminate, anyway? Methotrexate? D&C? This whole thing doesn't make sense to me. Sounds like a "middle of the night" kind of response from a hassled OB. Sad.

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