Monday, November 06, 2006

You Just Never Know

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!


Jawndoejah said...

Though I have five already and am 36 years old, I'm actually hoping to have 2-3 more, which might happen to put me in my 40's if I am so blessed. I just don't want to miss it though like this woman has. I love knowing when my baby kicks and feeling the little one grow. I was actually disappointed when I had been trying to feel the fundal height at night myself, and thought it was low and maybe something was wrong, and the doctor found it way above my pubic bone. I wanted to know everything about my pregnancy, feel every moment. I'm a pregnancy junkie! Maybe I'll get to do it again.

Sarebear said...

Wow, it really sounds like it!

It'd be very shocking, and hard to come to terms with, but then also a happy and joyful thing, once emotional acceptance and adjustment were farther along . . .

That would be awesome, during the surprise visit, if circumstances, health, how far along, etc., allow, as well as whatever is different because of confabulated details.

Great story! Me, I didn't go into labor no matter what they did to me, so I suspect that my body just doesn't. Scheduling it is better than 36 hours of three separate failed inductions in the second overdue week . . . along with several hours at the last time of inept nurses sliding the thingie in and out of my veins trying to get a good one (ugh, hurt like the labor almost lol, pitocin induced but no progress ever).''Anyway. I'm all for scheduling next time instead of all the crud we went thru, plus it'd be better for the baby.

Anne said...

Oh, wow. It reminds me of my son's soccer coach a few years back. When I first met him I thought "how nice a grandfather coaching his grandson's team." Turns out he was the dad and was 56, his wife was 51 and their son had been born when they were 46 & 51 with two teenage daughter 13 & 15. And I'd thought I was old having my last at 40. Hope all turns out well.

Fat Doctor said...

I really think, just to be safe, you should make all your posts about people with penises from now on. Nobody will figure it out.

What The Hell Is This? said...

Wow.. could it really happen that you get into your 3rd trimester and not know it??? WOW. amazing and you are a great doc for even considering their wishes.

medstudentitis said...

Wow. I just couldn't imagine being in her position! Keep writing the blog, I love it!

Anonymous said...

OMG I would be totally flabberghasted if it were me. But what a wonderful gift. She only has to deal with pregnancy for 6 more weeks. I have heard of women not knowing they were pregnant. OMG.

Midwife with a Knife said...

I once delivered a set of twins for a couple older than 50. I have to say that sometimes these couples value surprise late-midlife child so much it can be so touching.

dr. whoo? said...

jawndoejah~ Whoa. Pregnancy junkie is right! I was such a miserable thing during my first pregnancy, I guess I didn't get much of a chance to savor it. Perhaps I'll be lucky enough to be pregnant agaian, and hopefully it won't be so miserable.

sarebear~ Sounds like you had a rough time! Sometimes inductions just don't work. After everything you've been through, a scheduled section will probably feel like a walk in the park!

anne~ Hi! Geez, 46 and 51! Crazy! So far everything is going well, and I will see her next week.

FD~ L-O-frigging-L! You made my night! Thank you.

wthit~ Hello and welcome! Apparently, it is possible to make it all the way to labor and not know you are pregnant.

How? I have no idea. I do know that when I was pregnant, I couldn't really tell definite fetal movements until almost my 24th week (anterior placenta). I *knew* I was pregnant, and I still wasn't sure, so it follows if one were 40-ish and pregnancy wasn't on the radar how one could rationalize away the symptoms. Thanks for reading!

medstudentitis~ I know, but what a blessing for them. Don't worry, I'm not stopping the blog...just drowning in work! :)

anon~ It is totally wild, I know. Their adult children are just in awe. Luckily, they are viewing it as a blessing, as well.

midwife with a knife~ Now that is just pure insanity...twins? Over 50? Ack. I feel way too old to raise multiples and I am only 31! Life is truly amazing.

dr. whoo? said...

Oops, forgot to post the update! She is 33 weeks, healthy baby, and everything looks normal. It is a no go for delivery during the homecoming (too early), it is more likely a little closer to Christmas. What an amazing Christmas gift!

Sarebear said...

Hey Dr. Whooo! Yeah it was. After failed applications of prostaglandin gel (well, they applied it fine, it did nothing), the doc recommended we go home and do the natural prostaglandin application.

Nothin' to get one in the mood more than being two weeks overdue, after a week and a half of in and out of the hospital and getting to know every nurse that worked there, labor, very personal exams, and then a doctor's prescription for "fun". Lol!

It didn't help, either.

Brooke (CrazyRN) said...

Wow! What an amazing story! I wonder if they have told their older children yet?

I bascially knew from the minute the little spermies got with the anxious egg that I was pg with all 3 of mine. I loved being pg, I'm strange I know. I think that's why I really enjoy being an OB nurse now.

You'll have to update us when she delivers!

dr. whoo? said...

crazyRN~ I am jealous of women with good pregnancies! Makes my job easier, though. Bless you for being an OB nurse. You are a special breed. I will definitely keep y'all posted! ;)