Let me tell you about my biggest regret in all of residency.

I was a second year resident at the time. One of my clinic patients showed up in labor, but I was stuck working a 24 hour shift at a hospital shift on the other side of town. I was sad because not only did I see her regularly in clinic, but with an uncomplicated prenatal history for a third time pregnant mother, I figured it would be an easy quick delivery. I told the covering resident to wish her my best.

The delivery was a nightmare. Throughout her labor, there continued to be signs of fetal distress unless she was positioned a certain way. Although she proudly declined the need for an interpreter at our clinic appointments, she ended up requesting an interpreter at the hospital as she wasn’t able to follow the speed of everything happening – and because her first language was not a common one, the hospital was unable to provide more than a phone intepreter. Eventually she was brought to c-section. The resident later described to me in horror that her placenta was floating on a pool of blood in her abdomen. Her uterus has ruptured despite having no  risk factors that this could happen. The surgeons kept calling for more back up until there were four OBs in the room trying to sort out the situation. She lost over 4 liters of blood and ended up intubated in the icu.

I thought about visiting her in the hospital next day, but I didn’t. I thought perhaps  with an intensive care team, an OBGYN team, and a following family medicine residency team as well as her supportive family, I didn’t need to be one more face interrupting her rest. I felt guilty for not being at her delivery, despite the obvious impossibility of being in two places at once. So I decided I would see her at her follow up clinic visit.

The first thing she said to me was “You never came to see me”. Her face fell as she said this. I felt awful. I should have visited her. There’s no reason I could have at least provided some support after such a traumatic situation.

Fast forward to this week. Another of my clinic patients showed up in labor. I had missed her last delivery a couple of years ago as I was out of town, and she had been disappointed I wasn’t able to make it. We had a fairly strong patient-provider relationship as I have also taken care of her family members in the hospital and in clinic throughout other difficult times and I had now taken care of her through two fairly rocky pregnancies. She had decided this would be her last baby and we had signed the paperwork for a tubal ligation in a clinic visit months before. She had a lot of risk factors for excess bleeding, but I had prepared myself and notified the nursing team and OBGYN team about this possibility. Her labor was awful. Her epidural didn’t even touch one half of her body, and for hours she attempted labor before we eventually diagnosed her with arrest of labor and took her down for a c section. The c section was a little bloodier than average, but her uterus was firm and she had her tubes done at the same time. We cleaned up feeling good about our decision, until the OB surgeon and I were called back to the OR for continued hemorrhage. She ended up getting massively transfused with an urgent hysterectomy. It was terrifying. If it wasn’t for her anesthesiologist and the nursing team getting the blood products in and the transfusions in as fast as possible, I don’t think she would have made it. I luckily was able to stay with her throughout all of it, assisiting with all the surgeries. After it was all done, I updated the patient’s mom, who was holding the sweet bundle of joy who was otherwise doing well, then I went home.

I didn’t want to cook so we ordered pizza. I took Toddler and Dog outside to frolic despite the mud. I fell asleep early after telling my husband the story of my day (which I immediately regretted after he started googling pictures of hysterectomies).

This time I went back in to see her the next day. She was sitting up in bed, having just transferred back to the regular OB floor. I learned I was not the only repeat visitor. The OB surgeon came in early this AM after working an overnight shift at another hospital. My patient didn’t recognize the OB without all the masks and gowns. The anesthesiologist had also stopped in and told her she likely wouldn’t have made it if that had happened in a hospital room or if her nursing and OR teams hadn’t been so good. My patient told me that almost everyone from yesterday had told her they all went home and held their families close after their shift, and she asked how I did after such a long day. We talked about all of our babies as I showed her pictures of my Toddler, which we never had really done during any of the clinic visits. We talked about all the things that happened during her delivery day from start to finish. She remembered realizing how scared we all looked in the operating room, and she remembered the anesthesiologist telling her she needed to hang in there for her kids.

I’m glad I went in for that repeat visit. I meant to do it to support her, but I realized how much seeing her, improving and recovering, brought me closure after such a long trying day. I’m going to miss her when I move on from residency in a few months. It felt oddly similar to the first story I shared above, and I am grateful for being given the second chance to make the right decision.

Kicks