Re: Today was a GOOD day
From: art fougner, md (evsono@pipeline.com)
Sun Mar 2 08:19:45 2008
I'd say Mom and Baby got lucky. But then I'd rather be lucky than good.
Art
At Sun, 2 Mar 2008, Dr Eberhard W Lisse wrote:
>
>The point is you got lucky,
>
>el
>
>On Mar 2, 2008, at 15:55, Meenan, Anna wrote:
>
>> As I said before, I was not around last Saturday, so I don't know
>> what transpired, but my guess is that the emergencies that postponed
>> the c-section happened sequentially, so that just about the time
>> they were ready to take her back, another occurred. Again, I was
>> not there.
>>
>> I did NOT let this patient push for an hour with deep variables, nor
>> would I let anyone do that. (The missing 34 minutes were spent
>> dilating from 9 to 10, getting nurse to chaperone for AROM,
>> performing AROM--I let the med student do it because it was such an
>> easy target-- and allowing patient to develop urge to push before
>> having her push.) She pushed for exactly 26 minutes. Heart tones
>> had excellent variability with small variable decels for the first
>> ten or 15 minutes, then got deeper. She had two contractions with
>> deep decels and I went out to tell the OB I was going to put on a
>> vacuum. She probably had one more while I was out of the room, and
>> 2 more after I returned, all with good return to baseline after the
>> contraction and good variability in between. (Didn't know anyone was
>> going to pick apart my management or I would have been more specific
>> about the EXACT sequence of events.) Do you race to c-section for
>> that? Just makes my point that I would not go to you for
>> obstetrical care.
>>
>> I don't see flaws in our system. You must work in a huge hospital
>> with unlimited empty OR's and bunches of scrub nurses and
>> anesthesiologists just sitting around twiddling their thumbs, even
>> on weekends. How nice for you. In the real world, there are plenty
>> of excellent hospitals doing excellent work with the resources they
>> have. BTW, my mother used to be a nurse surveyor for JCAHO and once
>> surveyed this hospital. She told me I was lucky to be working
>> there, because it was easily the best hospital she had ever
>> surveyed, of the hundreds all over the country that she had seen.
>>
>> It was a good day until I decided to tell my friends at OB-Gyn.net
>> about it. I'll keep my good days to myself in the future.
>>
>> Anna Meenan, MD, FAAFP
>>
>>> In a message dated 3/1/2008 8:44:44 PM Eastern Standard Time, annam@uic.edu
>>> writes:
>>>
>>> Yes, I think you must be a perfectionist, Allen, and I'm guessing
>>> most of your patients must be too. How sad for you. The patient
>>> and her mother (who is a very knowledgeable medical assistant, BTW)
>>> were ecstatic, and hugs were exchanged all around after the baby
>>> came. No one was unhappy. We all understand that the world is not
>>> perfect. Conditioning patients to expect perfection is what has
>>> gotten our profession into trouble in the first place. It is
>>> refreshing to care for patients who know that stuff happens and go
>>> with the flow.
>>>
>>> Anna Meenan, MD, FAAFP
>>>
>>> Anna, as I said before, I was not critical of your management of
>>> the case. I was just curious about your happy reaction. Why do
>>> you refuse to see flaws in your system? If your unit was so busy,
>>> why didn't you send her home right away instead of having her
>>> "waited and waited and waited" for a c/s? Complacency is an enemy
>>> for progress.
>>>
>>> And now since you are mean to me ... I am not sure I would let
>>> this patient push for an hour with deep variable decels. (Everybody
>>> got busy again, and when we checked her after 3 hours, she had gone
>>> from 1 to 9! Hooray! Broke her bag and got her started pushing.
>>> Deep variables with pushing..1 cm to baby in 4 hours.) I know it's
>>> unwise to argue with a good outcome, but I have heard of tragic
>>> ones under similar circumstances too. If you weren't so lucky,
>>> your good day could easily turn into a nightmare. Most patients
>>> can be very understanding when the outcome is good, she may not be
>>> so understanding if things had gone south.
>>>
>>> Again, I did not mean to offend you or rain on your parade.
>>>
>>> Allan
>>>
>>> >Watch the video on AOL Living.
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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