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Difficult client (fwd)From: Robert J. Woolley (wooll005@tc.umn.edu)Fri Oct 31 19:11:55 1997
>From the midwife list. A story worth reading. (It starts ho-hum, but has quite an ending.) I've never heard of a case quite like it. Forwarded for interest value, not to solicit further advice. ------------ Forwarded Message begins here ------------ From: HockIsUs <HockIsUs@aol.com> Date: Fri, 31 Oct 1997 19:40:13 EST To: midwives@lists.alaska.net Cc: midwife@fensende.com Subject: Difficult client Hoping some of you can impart some words of wisdom for me in regards to this difficult client: 28 yo G1 who presented first trimester to our office (joint CNM/MD practice) requesting CNM care. Sees my partner & I throughout pregnancy, always has more than the usual amount of questions, but not a problem. Husband comes to most visits with her. She works as nursing assistant at another local hospital. We (my partner & I) both had a sense of her being frustrated with the lack of "control" over normal pregnant events; starting at about 28 weeks, wants to know "when am I going to go into labor", "when is the baby going to drop", etc. Suspicious thing, though, was that after she'd come in for an appt. with me, the next day she'd call my partner and ask all the same "tell me when" questions; and same thing when she saw my partner for appt. When confronted on why she was turning around and asking each of us the same questions, she said "I just forgot what was said at my appointment; I get so nervous, I forget. I'm so nervous about not being able to know when I'm going to have this baby." No evidence of abuse, bad home situation, lack of support, etc. So this past Tuesday, she comes in for her appt. with my partner, and she's 34 1/2 weeks. Asks when she's going to be induced!! Explained that she's no where close to induction/post-dates, and her pregnancy is totally normal without complication--trying to reassure her everything is normal. Starts getting angry, states she's "tired of being pregnant!", can't take it anymore. After an almost hour-long session with my partner, goes home very upset. Per usual, calls me Weds., stating she's "swelling up like a balloon--I know I've got toxemia." Bring her in for eval, everything's totally normal, go through another hour-long talk on dangers of delivery at this gestation for the baby. Ask her if she knows someone who had an early delivery; she says no, just can't tolerate being pregnant anymore. Again very upset, but denies any other source of stress, and after offering much support, she goes home with husband (who is trying to support her and make her understand what we're saying at the same time--very supportive to her). So on Thursday, she calls office in AM, demanding to be seen, she's "in full- blown toxemia." Talk with her on the phone again, states she's gained 5 pounds over night, and is now having blurred vision. Bring her in to office, totally normal; explain to her again (45 minutes out of an over-packed schedule) that there seems to be an underlying concern or stressor- she gets mad that "you're just not listening-- I'm jsut sick of being pregnant!" About an hour after she leaves office, shows up in labor triage with complaint of SROM. I'm at the hospital as well, pushing with a client, so a resident (very good, nurturing-type-personality resident, by-the-way) screens her, does a spec exam with cultures and wet mount (everything was negative/normal), not having any contx; cx is 1 cm/thick/high, and sends her home VERY ANGRY after same discussion of why delivery at this gestation is not normal. About 2 hours later, she shows up in labor triage again, with c/o "definitely ruptured now- it's running down my leg." And indeed, it is. The fluid is blood-tinged, and she's now officially 35 and 1/7 weeks. So I talk to her about collecting a vag-pool for lung maturity, she agrees. Put the spec in, and can see that the cervix has multiple "scratch" marks on it!!!!, and this is where the bleeding is coming from, along with clear fluid from the cx. I question her about this, she denies anything, but it's so suspicious. L/S and PG come back mature, so she goes into spont. labor shortly thereafter, normal labor/delivery, and baby is born with very poor resp. effort, and is now in NICU on a vent!!!!! Mom is happy as a clam, doesn't seem at all bothered by the NICU/vent, says "the neonatologist says he'll be fine." ARRGGHH!!!!!!!!! Any tips on how to now deal with her????? THanks much! Lori House-Hewitt In Mid-Michigan, passing out gobs of candy tonite! ------------ Forwarded Message ends here ------------ ---------------------------------------------------------------------------
--------------------------------------------------------------------------- Bob Woolley -- --------------------------------------------------------------------------- St. Paul, Minnesota
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