Manhattan KS: Certified Nursing Assistant Holly Schmidt earned her stork wings earlier this week as two physicians battled over patient acceptance while common reason flew out the window. The 27 year old female patient presented to the emergency department in what she feared was active labor. She stated she was 36 weeks pregnant and having contractions about 4 minutes apart. Staff clinician Dr. Edward Santos jumped into the air clicking his heels upon this news as hospital policy dictated all pregnant women over 36 weeks bypass the ED. “Straight to OB!” he giggled with delight. Upon arrival however, the attending obstetrician, using Naegle’s rule determined that the patient was actually 35 weeks 6 days, 10 hours, 54 minutes and 6 seconds pregnant. As such, hospital policy dictates, all possible labors under 36 weeks be evaluated in the ED to determine true labor. Thus the patience was returned to the ED.
Dr. Santos was dumbfounded. “I thought I had this gal off to OB to deliver her baby. I look up at the ED triage board though, and there she was again, I about fell over.” Dr. Santos called OB to discuss the situation and spoke to Dr. Gary Parry who calmly explained, “Hospital protocol is that if they are under 36 weeks they are seen in the ED first, I cannot be bothered with Braxton Hicks, I am a busy man, please evaluate her.”
Dr. Santos began a frantic search for a nurse to act as chaperone while he performed the intimate exam, but due to an acute MI, two strokes, a two vehicle MVA with an ejection, and a fever of 2 days duration all the nurses were otherwise occupied. After a five minute search Dr. Santos finally gave up and checked the patient found her to be at 8 cm and in active labor. Naturally, after exiting the exam room, he found a female coworker: Ms. Schmidt. “Holly Schmidt! We need to get this patient back to OB right stat now!”
A nurse was pulled from the lesser stroke to transport the patient with Holly in tow, back to obstetrics from which she had bounced. “As we were about to get into the elevator to go up to OB there was a code blue called back in the ED so the nurse sprinted back that way. “I didn’t really know if I should continue on my own, as the nurse is suppose to give report to the accepting floor, or if I should take her back to the ED, where her nurse was. After about 10 minutes I was getting pretty worried, as was the patient, she said she had just peed the bed. Of course it wasn’t pee, it was amniotic fluid. I prayed the nurse would come back soon but more and more passed, as did the baby’s head, then shoulders. Good thing I was there or he may have slid right off the end of the bed.” Holly reported smiling ear to ear by the bassinet, in OB. “It is fortunate that I always carry a cord clamp on my name badge. Also fortunate that about that time the nurse returned and we were able to continue up in the elevator to the OB floor.”
Dr. Parry did ultimately accept the patient, as well as her new roommate upon arrival, though he was rather proud to be found to be correct, “See that woman is not in active labor, why she is post postpartum at best!”