ever feel a patient places too much responsibility on you

  1. i had a patient come in tonight in active labor 37.3 weeks severely preeclamptic bp 180/110. she was obviously mismanaged by her doc if she actually had one. she was traveling to visit family when this happened had no idea of proper diet ,precations,meds etc. i get her on monitor get iv started, immedieately start mag, fht look terrible decels ,variables lates, decreased variability, no accels, calls placed to ob and ped doc on call. in the middle of all this the patient tells me please dont let my baby die! this just made me feel even more stressed at the moment.
    well we are a small hospital, we were extremely busy already for the staff we had available,. well to make thinks worse patient becomes complete and starts pushing baby brady down to the 50's with no recovery, scalp stimulation has no effect, had patient push hard finally delivered baby. apgars 4/7/9. baby had tight nuchal cord times 3. doc and ped make it in about 10 minutes after delivery. thank goodness every one is fine.

    it was very stressful, and the family pleading with me to not let the baby die just about over whelmed me at the moment. what a way to top off a already busy night. anyone else ever feel this way?
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  2. 20 Comments

  3. by   anitame
    Yes! Yes! and Yes!
    Sounds like a horrible night Mark! uuuggghhh. I'm glad you had a pretty good outcome, it could have been a lot worse (as you well know). It's a good thing she went to complete pretty quickly. Another family saved! I do know what you mean though, sometimes people just say that one thing that puts you over the edge when you're already worried enough about the situation. When you have a nasty strip it's like the weight of the world on your shoulders. Especially when you're in a small hospital and there's no doc.
    Anita
  4. by   Natalieboo
    Wow Mark! What was your response to her when she said "please don't let my baby die"? I'm so glad there was a good outcome to that mess!

    I'm afraid as a doula, a client might put to much responsibility on me about the way her labour/birth goes. I try during my prenatal visits to make it clear that I am just support and not decision-maker, but I might run into that situation some day.

    By the way..

    baby had tight nuchal cord times 3.
    What does that mean?
  5. by   canoehead
    Whoa Mark, way to go!

    Yes, I can see where you are coming from, and it really was just too much to deal with. I sometimes say something like I'll do my best, but I need to concentrate right now...or please let me think until this is under control...the questions can get hard, and it's worse when you are trying to save a mum and baby, while at the same time not wanting to leave the family hanging. You did good.

    (mark)
  6. by   mark_LD_RN
    natlieboo i could say is i will do my best! in my most reassuring voice. natlie nuchal cord X3 tight means the umbilical cord was around the babies neck 3 times and very tight. I had to cut it before i delivered the baby and unwrap it.

    this was one of them nights right from the begining, walked into a emergency c section when i walked throught he door at 06:30 pm, then came out to find my next labor patient screaming i had to take over her care because other labor nurse had to go help ship the baby from c/s who was doing poorly. i knew very little about her, i ended up being her nurse and the babies nurse it was just me and the doc in their. few hours later my cytotec induction starts going fast and we deliver, even that baby did not look good on strip had prolonged brady episodes with every push 2 hours of pushing to deliver it, baby did great. then the girl i delivered second fainted on way to restroom, her postpartum nurse that assumed her care come and got me patient was bleeding heavily i had to manually remove a clot from her and get her methergine.then about an hour later thats when the other patient walked in. i was there to 10:30 charting i got so far behind. Well the fun of working on an LDRP unit
    Last edit by mark_LD_RN on Jul 27, '02
  7. by   canoehead
    Good grief.
  8. by   SmilingBluEyes
    yes. i did. Once, a 15-year-old postpartum mommy got up to use the restroom for the first time. She had eaten dinner, nursed her baby numerous times and was taking PO fluids well. one teeny, tiny problem; she had YET to void! Some very "intelligent" nurse before me had already d/c'd her IV even tho she had not been up yet. Not good. Anyhoo, I went to get her up she says:

    "Am I supposed to hear freight trains in my ears? I can't BREATHE! I dont' feel too good" ---and proceeded to pass out.

    Got her vitals, b/p 88/44, hr was 130-something, resps too rapid for me to mess w/counting. Skin mottled, lips pale and diaphoretic she says to me :

    "please don't let me die, I think I am gonna DIE!!! Oh God save my life!" I have never seen anyone so frightened in my life to this point.

    Proceeded to start a 16g IV of LR open WIDE and massaged her ute vigorously and got out clots you might have mistaken for her LIVER. It was UNREAL. Poor thing, there she was, in Trendelenburg, me madly massaging her, the other nurse literally SQUEEZING fluids into her vein and o2 mask on, bleeding like I have never seen anyone bleed before...THE CLOTS!!......she was literally begging us to stop her from dying.

    I should mention, It was my first year out of nursing school ....I will NEVER forget the feeling I had, sick all over. And how LUCKY we were to have been able to reverse her shocky state fairly fast. I learned REAL quickly never, ever take anything for granted in nursing, especially OB!!!
    Last edit by SmilingBluEyes on Jul 27, '02
  9. by   Audreyfay
    Yikes! I've had that happen to me too! But, I think she was already 24 hours postpartum. The other thing is that it was a good neighbor who we were working on. Scary. Makes you respect every situation and be on your toes.
  10. by   live4today
    Hats off to all L&D nurses, post-partum nurses! :kiss I knew I did NOT belong in those areas which is why I've only "floated" to post-partum on occasion. I did work Newborn Nursery and Pedi, and that was more than enough from that side of the house. (You know...mothers....babies.....kids......OH MY!!!) :chuckle

    I remember passing a clot the size of a human liver the day after my first child was born, and all I got from the floor staff (only ONE on duty) was "The Major Nurse will not be in for a couple days, so we'll save it in a jar and refrigerate it until she comes in." Can you believe that shick??? Two days later she comes to work, checks me out, and says, "You're doing fine, honey. Nothing to be concerned about." I did NOT get seen by a doctor from the birth of my baby until six days after my baby was born. I had been discharged one day before my THEN spouse had to rush me off to the ER to be examined by some dumb smuck who left the vaginal clamps HANGING on my episiotomy site while he went to fetch the "real doctor". OUCH....is right!!! I screamed bloody murder. Nothing fancy about having a baby back then.....Oh noooooo!!! I am convinced that I am alive today because my mission on earth isn't over, otherwise, I should have died already more times than I've got kids. :chuckle
  11. by   hoolahan
    Ditto on the hats off! OB scares the living hell out of me! Such an emotional roller coaster, I don't know how you guys do it.

    I don't think in all my years I have ever had a pt beg me for their life, even with all the codes in CCU/ICU. I have had the opposite experience, having people beg me to let them die. If I had to choose, I think I would still stick w critical care as opposed to OB

    Good save Mark! I bet at that moment that woman couldn't have cared less if you were male female or purple, you saved her baby's LIFE!! That is awesome!!! :angel2:
  12. by   mark_LD_RN
    i am sure she did not care one bit,

    ob is one hell of a roller coaster ride at times. ob is definitely not for everyone, i think it takes a different kinda person to really enjoy it. good thing i am so different
  13. by   hoolahan
    Amen to that!!
  14. by   obtnt
    Dear sisters,
    These posts are soooo true to my career in L&D!! I just wish that those nurses who have said to me, upon finding out I was in OB, "Oh, you aren't a real nurse, you just ROCK babies"!!!!! could spend a few of these shifts with us! Also, I recently was told my old unit, has lost all of their experienced RN's due to administration's lack of support. It seems a certain MD (specialist), has decided to traumatize and harrass everyone and he has made it unbearable to stay. Now, this unit is extremely high risk, extremely busy, and now in addition to the stress of the job, there are no experienced nurses!! What would Mark have done if he had not known to cut the nuchal cord on his pt? The hospital will not censor or reprimand this dr. because he brings in big bucks for the hospital. I'm glad it's not me working there or especially me being a pt there. God help us all!! OB is definately an emotional roller coaster and we need all the support we can get.

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