Help me decompress

Got a call this afternoon from ED stating a service pt with 31 week twin pregnancy and known previa was en route to hospital on MGSO4, ruptured, bleeding and seizing. Notified OB on call, then per MD, called ultrasonographer, ped, anesthesia, 2nd MD assist, extra RN on call (none of which are in-house on weekends), RTx2, opened our OR. RNs over to ED to meet the patient and assess FHT's while pt is stabilized, but no FHT's could be found by doppler and pt is in fact bleeding. U/S still not in-house, so pt was transported to L&D for U/S by MD while the OR team assembled.....pt sobbing, "What's happening to my babies?" as we prepped for possible C-section, awaited labs, etc....MD unable to find FH's via U/S on pt, who is morbidly obese and in hysterics. Tensions are understandibly high as we mentally prepare for what appears to be the worst (plus we have no NICU- closest one 20 minutes away). Fiance at bedside sobbing as well.

We just can't find anything on this enormous woman- no FH, no sacs, nothing- and so beta HCG and Upreg sent, which confirm what we are beginning to suspect: the patient is not, and has not been, pregnant. When told there was no pregnancy, the pt simply stated "Oh. Then I must have miscarried a while ago." OR team was thanked for their promptness and sent home, we put the OR and LDR room back together, and pt was sent back to ER for evaluation.

My emotions have run from initial panic, then autopilot/we-have-to-save-these-babies mode, suspicion, disbelief, anger, sadness (poor fiance has been fooled all along)- the whole gamut. Obviously the pt. has issues to be addressed, and that is sad as well. I'm relieved that we didn't have the emergency on our hands that we thought was happening. But I cannot help but feel angry at this pt. Her selfishness put those who were trying to save her and her 'babies' at risk. Thank goodness no harm came to them while en route to our facility. Or that a true emergency didn't roll in during this nonsense. Factor in the mental and physical strain on our staff, the resources wasted, taxpayer expense for this 'emergency' and my pressure climbs.

I suppose I should see the good in the situation: we worked well together and were prepared to go to the OR, resuscitate, etc. If nothing else, it was a good drill. But again, I can't help but feel angry at the pt. for essentially making a mockery of what we do as professionals. She will likely never be held accountable for her selfishness- if she even has an inkling of what it was like for us and her SO to be in that situation.

Apologies for the wording/rambling- I am just fried right now. Anyone else ever had a similar situation?

did anyone ask her who her ob/gyn was???

what a nut! send her the bill!

man i feel really sorry for u right now. that is awful for someone to do something like that and waste time and energy. what if another emergency had come up and resources were not as available because of her story. Where did she get twins from anyway if she wasn't preg.????? Weird i tell you.

We did ask- her 'OB' is as non-existent as her fabricated pregnancy was. Calls to area hospitals requesting AP records yielded nothing (now we know why). Given the gravity of the supposed situation, we couldn't waste any more time calling around. Many patients who come in to our facility are late entry into care/no AP care patients. A good number of them only know their OB as "the one on XX Street." I kid you not.

And believe me, I'd love to stick the patient with a hefty bill. Alas, like many of our patients, her care is paid for by you and me. I have to hand it to her, though- the patient must be smarter than she looks. Somehow she was able to come up with the twin/previa/eclampsia scenario and fool us, even if only for a little while (the bleeding was apparently her menses).

We did ask- her 'OB' is as non-existent as her fabricated pregnancy was. Calls to area hospitals requesting AP records yielded nothing (now we know why). Given the gravity of the supposed situation, we couldn't waste any more time calling around. Many patients who come in to our facility are late entry into care/no AP care patients. A good number of them only know their OB as "the one on XX Street." I kid you not.

And believe me, I'd love to stick the patient with a hefty bill. Alas, like many of our patients, her care is paid for by you and me. I have to hand it to her, though- the patient must be smarter than she looks. Somehow she was able to come up with the twin/previa/eclampsia scenario and fool us, even if only for a little while (the bleeding was apparently her menses).

are you a supervisor? report the incident to your don who should report the case to the state and or have quality assurance investigate legal avenues with this.

as a relief sup myself, i would have called the administrator on call and/or hospital lawyer on the spot.

She needs psych care stat. So sad, so sick. Yes, I have seen similar sicko scenarios in my 9 years as a nurse. One very similiar to this one, except only supposed to be a singleton pg, 9 mo along. Also was never pg, no way, no how. It was so sad. She was really delusional and just plain sick. Often wonder what happened to her in the time since.

Also know of a personal aquaintance who lied about a twin gestation, purportedly losing one first, then the other, WEEKS later at HOME. All lies, all to get attention. Needless to say, I had nothing to do with her after that. She was someone I "thought" to be a friend. Lived in Upstate NY. I will never forget what she did, as she lied about all this about 2 weeks after I personally suffered a pregnancy loss. I just have to remind myself, she was mentally ill to do this and just pray for her......

I am sorry you were subjected to this. It won't be the last time, if you spend any amount of time in OB, sadly. Please don't let things like this jade you.

I am sorry you were subjected to this. It won't be the last time, if you spend any amount of time in OB, sadly. Please don't let things like this jade you.

Unfortunately, that is true. I have had a couple "pregnant" pts show up in L&D who are not even pg. One woman went on and on about her symptoms, the contractions, yada, yada. During her admission history, when you get to the part about previous surgeries.... she had a hysterectomy several years before.

I've also seen this - several years ago we had a brand new ( new to us had 20+ years of ob/gyn experience) OB, it was his first full weekend oncall and we had someone come in by ambulance 8mos preg and heavy vag bleeding - which brought the same sort of panic i'm sure you felt - we have no nicu - our nearest is 180 miles away - no OR/Anes/OB in house - it's like the wee hours of the am. The "preg" women was mentally impaired, obese, living in a homeless shelter w/ s.o. who was sooo excited about this baby. Well long story short she was wasn't pregnant at all - when she first got to our unit she was indeed bleeding heavy - and as others got a history ( very convincing one) etc - i tried for ht's - and the panic was setting in when none could be found - the OB got there did bedside u/s - saw nothing. Poor new OB prob though what kinda of town did i move too LOL.

Certainly is a waste of time and MONEY!

5 words: Medicaid fraud and abuse department

Wow - that's an amazing story. I've heard similar types of stories but have never seen anything like that up close and personal.

I certainly can't offer any sage advice, but I do understand why you have such conflicting feelings about it. Yes, the woman needs help, but I think it's completely understandable that you feel some anger towards the situation as well.

Amanda

Why is it that there are laws against misuse of law enforcement resources (anyone remember the girl who "disappeared before her wedding last year and pretended to be kidnapped) but when it comes to the health care system, people can misuse and abuse all they want without consequences?

I would be equally frustrated about this situation. Like you said though, at least you know you're prepared if this ever does REALLY happen!

Hey there-

What you have described is pseudocyesis. I understand how ticked off you must be after rallying to give this woman and her potential kiddos the best shot, but ya gotta know she is one sick not-a-momma.

Pseudo pregnancy is actually pretty interesting stuff from a psychophysiology perspective. Many of these women will present with signs of true pregnancy; engorged labia, softened cervix, elevated fundal height etc. (mind driving hormones?) These may be physiological manifestations of a psych issue, or more troublesome, they may be heralds of some endocrine/neoplastic pathology.

I am glad you gave your best. I would hope to have that much energy and caring directed my way if I ever need it. (knocking on wood).

For true kookiness-check this out

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224276&Ausgabe=227643&ArtikelNr=49310&filename=49310.pdf

I should have added that the pt was in our MH/Crisis unit by end of shift yesterday. I'm still a little wired from all of this. While I emphathize with the pt., I cannot help but think about the thousands of taxpayer dollars wasted as we jumped through so many hoops for nothing. I wish I could sit her down and make her think about what happened from a caregiver's standpoint. Moreover, I am concerned for her children at home. I really do hope she gets the psych care she needs.

Thanks for all your replies- they help evaporate some of the steam!