Recently, a blogger, who shall remain nameless, linked to my site stating that " if it weren't anonymous, it would be a lawsuit waiting to happen." I just wanted to reiterate that when I post patient related stories, the facts are altered and omitted to protect these patients and their confidentiality. I can't very well change the sex or the general theme of my posts, because, let's face it, I'm an OB/GYN and I only see women! I just wanted to get that off of my chest; I feel much better now!
I recently saw a patient in the office as a new OB patient. I noted from her chart that she was in her 40s, which, while quite common in more urban areas, is practically unheard of in this rural area of the country. I also noted, based on her stated last menstrual period, that she was nearly into her third trimester! Unsure of what to expect, I entered the room to find a very pleasant, very anxious couple. Ms.X had a long history of irregular periods, and it was not unusual for her to skip several months at a time. She stated that she had been very tired for several months, as well. Over the last week, she went to an urgent care center to be treated for symptoms of a URI. She also complained of nausea and vomiting, and, because of her remote LMP, the PA ordered a urine pregnancy test. It was positive. Unfortunately, the center did not do a pelvic exam, order an ultrasound, or a serum beta.HCG (!) So, this poor patient and her husband had no idea exactly how far she was into the pregnancy, and they had been agonizing for the past week, awaiting her appointment with me.
Ms. X has had 2 previous cesarean deliveries, and both of her children are in their 20s. One of her children is currently fighting in the war overseas. She is shell-shocked, and cannot believe that she is pregnant. Over the last week, the flutters she once attributed to gas pains, she now recognizes as fetal movements. On exam, her fundal height was greater than 34 weeks, and her cervix was 1 cm dilated. The fetal heart tones were nice and strong in the 140s. I don't have an ultrasound in the office, so I set up an appointment for a full ultrasound. It may feel like the shortest pregnancy on record, if she ends up actually being as far along as I believe her to be. Limited or no prenatal care can be problematic, especially in a patient that would be considered somewhat high-risk, based on age alone. I am anxiously awaiting the dating from the ultrasound to proceed with proper testing. The kicker of the story, though, is that her child that is overseas is coming home for a surprise visit, right around the time that the baby would be due to deliver. Her husband took me aside, told me of the surprise visit, and his eyes teared up as he asked if it would be possible to deliver the baby during the homecoming. I told him that I would do what I could, but given such little information at present, I could make no guarantees.
As they left, it struck me how this child is going to rock their proverbial world. Imagine, thinking you were done with child-rearing, looking forward to menopause and retirement, only to be faced with starting all over again! I've probably mentioned before that "the best laid plans of mice and men often go awry" is kind of like my own personal mantra. It just goes to show that sometimes you just don't know what life has in store for you. It is definitely a wild ride!