I’m holding my eyelids open and giving myself pep talks along the lines of, “awake for 15 hours? what’s to be tired about that?” “7pm? You’re not even halfway through a 30hr day,” and “halfway through a weekend call is not the time to make career decisions.” So I thought I would energize myself by relating the horrible tales that have been parading through L&D today.

This morning the day team came to talk checkout from the people who’d been on call overnight. The second patient in labor was a 16yrold girl with her first baby. Her parents only recently discovered this, and are furious with the father of the baby and his family. Being her legal guardians, they have ordered that this group is not allowed in her room. She herself was so upset by the commotion her own family was making that the doctors got security and ordered her family out. So she was in labor for 14 hours by herself; except for the phone, on which her boyfriend, also 16, was listening. It took her two and a half hours of active pushing, to exhaustion, to get the baby’s head out, because it was flexed a little bit funny. (She was also on magnesium for seizure prophylaxis because she was being induced for severe pre-eclampsia.) It seemed to take forever for the baby’s head to come out; it was one long head; it seemed to go on for a foot. Then the shoulders got stuck a little bit. Through it all she pushed bravely, didn’t complain at all, and did exactly as she was told; all this with no one there except me and a couple of nurses to hold her hand or encourage her.

Then, after the baby got out, he wasn’t moving or crying at all, and she started bleeding profusely. So the nurses were in one corner, bagging the baby quietly and rubbing it to make it move, and there were three doctors around her, pushing pitocin, cytotec, and hemabate (and don’t ask me what those last two are!), and trying to compress her uterus to “achieve hemostasis.” Which was almost more painful for her than the actual delivery. After some fifteen minutes, her bleeding just about stopped, and the baby was wiggling and making a little noise. It turns out that babies whose mothers have been on magnesium often have atony, lack of reflexes, and so on, although he had a very bad case of it. Later reports from the NICU say he’s doing very well.

Before her delivery the young woman had instructed, as legal guardian of her baby, that she did not want her parents to see it, just her boyfriend and his family. And since they weren’t allowed in her room, they could only see the baby in the nursery. This afternoon, as time came on for shift change, the nurses were in a furor because her father was calling, making all kinds of unreasonable demands for them to police a list of who is and is not allowed in his daughter’s room; all this, after she bled half to death, and spent the entire day alone in her room, because the visitors she wanted were not allowed, and her own parents did not want to see her.

Now, admittedly, a 16yrold having a baby is not an innocent victim of parental oppression. But neither was her father taking a route calculated to draw her closer to himself. Biblically, I think, the two young people ought to get married; or if not, the young man should pay child support. So for the young woman’s father to try to separate them so completely, after ignoring his daughter long enough for the situation to develop, is way out of line. I’m once again glad I had no authority in the situation, or the temptation to let the young man in by a back way might have been overwhelming. It now turns out that the “father’s” family is pursuing genetic testing, because they have reason to believe he is not even the father. So she’s even less innocent than I thought.

This afternoon a woman came in to triage, 33 weeks and some days pregnant with twins, accompanied by her 6- and 3- yrold children. Who immediately began to pull all the things out of boxes (cue-tips, tongue blades, gloves, papers) around the triage room, to run in circles, and to duck into other curtained triage rooms, disturbing the other patients. At first the resident thought it was just wishful thinking when she said her water had broken. But on ultrasound it turned out that, although her membranes were intact, she was a couple of centimeters dilated, and mostly effaced, and having regular small contractions. So he said to admit her, give her steroids to help the babies mature, and give her magnesium to slow or stop her contractions till the magnesium could take effect. After going down to smoke, she declared that 1) she had no one to take of her kids, and no money to feed them with, and 2) if God wanted her babies born now, she didn’t want any magnesium to stop it. She would allow the steroids, though.

As you can imagine, the resident and nurses were extremely frustrated. At first the nurses were very concerned about her children, but it gradually appeared that there is enough money around to buy plenty of pop and cigarettes, and that there are several female friends/relatives/acquaintances in the background, although way too many members of her “support structure” are in jail. So then they became upset with her for suckering them into feeling sorry for her. The resident, having finished his shift, left. So the new nurse is starting her medicines, and can’t figure out the contradictions about magnesium. I went to have a talk with the lady, see if we could discuss God’s will and medicine. But she’s just saying that. She’s not really thinking, and she’s not very concerned about the babies. She says since several of her friends have had preterm babies which did just fine, hers will be ok. The thing about percentages and luck/providence, and difficulties with twins, does not get through to her. So I was friendly about finding names for two girls at once, and ducked out. (Her boyfriend is in jail for abusing her, and she’s boasting about how handsome he is.) (Discussion of her case introduced several more terms and practices which I was too innocent to know about, and the nurses enjoyed me and the resident blushing at the definitions.)