Nursing Voices

Monday, October 23, 2006

Welcome to OB Triage

Sometimes I'm convinced that the management and physicians have conspired to place a glowing sign at the ER entrance that states (in large flashing pastel pink and blue letters), "All pregnant freaks and their families, WELCOME! C'mon in to OB Triage" To top it off, the sign is only lit during the most inopportune (i.e., already busier than crap) times.

Case(s) and point:

You are 26 weeks pregnant and have been vomiting for four days. You are starting (Starting?) to wonder if something is wrong. When do you come in to triage? 2:00am on a Saturday night.

You are 39 weeks pregnant and twisted your ankle while tripping over your toddler. Yesterday. Oh, and you don't have a car or money for a cab, so you've missed your last four prenatal visits, despite being high risk due to a history of high blood pressure, diabetes and a pulmonary embolus. When do you roll into triage by ambulance (thanks, glad I just paid my taxes so that you could spend about $1000 of my tax money for a ride... oh look, here comes the rest of your family, who got here in their CAR.)? 2:00am on a Saturday night.

You were sitting on the couch naked ('cause that's something I'd admit to my health care provider), 36 weeks pregnant, eating ham (I repeat, while sitting on the couch. Naked.), and your boyfriend took it upon himself to "check" your cervix, only he noticed some green funk down there instead. In addition (as if that were not bad enough), there was something pinkish on your boyfriends fingers when he pulled them back out. But it might be ham. (Gag. True story.) When do you come in to triage? 2:00am on a Saturday night.

You are 21 weeks pregnant and have not had a bowel movement in three (seriously, I'm not kidding) weeks. When do you come in to triage? 2:00am on a Saturday night. (because NOW it's bothering you?)

You are 24 weeks pregnant and have not felt the baby move for "a couple" of days, which concerns you, despite the fact that you weigh almost 400 lbs and probably have a foot and a half of adipose tissue between the baby and the nerves of your abdominal skin. Oh, by the way, you also have asthma and are having a coughing fit but forgot to bring your albuterol inhaler. What else do you take for your asthma? Nothing, just the albuterol, and since you usually feel worse at night, you use it an average of 6 times every night. (Pause, while nurse picks up lower jaw from floor.) And the icing on the cake, you are latex allergic and have a history of MRSA, so you must be kept in contact isolation. When do you come to triage? 2:00am on a Saturday night.

You have not received prenatal care during this pregnancy due to the slight inconvenience of being incarcerated for the last few months, in another state ("It was my boyfriend's dope in the car, I swear!"), and your mother only recently bailing you out. Now you're just curious how far along you are, and "Can we do an ultrasound to find out the sex of the baby?". When do you stroll up to triage? (Are you sensing a pattern yet?) With perfect timing, you, too, arrive in the middle of our "lunch time". (Looks like it'll be a couple of peices of the Halloween candy someone brought in, swallowed whole, on the run, again.)

Yes, there are quite a few legitimate patients who visit the triage unit amidst the chaos. I wouldn't be surprised if most of them get lost in the shuffle.

Hey, at least I still got my health.

14 comments:

MICU RN said...

Hilarious! I love it.

AtYourCervix said...

::chuckle:: I can *so* relate to this entire post ApgaRN. I still remember the one I had for c/o leaking brown discharge that "smells like chicken" according to the patient. Yes, you guessed it, at 0200 on a Saturday night.

It was diarrhea by the way. NOT coming from her vagina. UGH.

My co-workers still chuckle at the "smells like chicken" comment by the patient. Don't ask me how she thought it smelled like chicken. Cause it sure didn't. And it wasn't something I really wanted to know - at 2am on a Saturday night.

Laura said...

GAH!!!!
do we work in the same facility????

Marcia said...

Awesome. Hilarious. And, sadly, true.

dr. whoo? said...

LOL! I'm wondering if you are working in the same hospital in which I did residency, because these stories hit way too close to home with my own personal experiences. My favorite was a patient that took the ambulance in to triage at 4 am on a Friday morning, supposedly pregnant with twins, and having contractions. I, the dutiful intern, rushed right in with the ultrasound machine when the triage nurse was frantic looking for the heartbeats. The patient wasn't even pregnant. Nice. Thanks for sharing!

Anonymous said...

How about the chick that called yesterday with a complaint of no fetal movement for 12 hours....she said that she would come in in 6 hours, after she completed her work day!

Mama Mia said...

You must actually work at my hospital - I swear I met all of these patients!!!

Christynurse said...

And I thought that all of these patients had been shipped to our town, especially to torment me!! MY constipated 30 week patient (hadn't' "boo-boo'd" for 3 days!) needed to ride the ambulance to the hospital -- again followed by numerous family and friends.
These gals also love to haunt OB triage during open office hours. It would never cross their minds to call or go see their doctor when they can sit in a comfy high tech chair with their own private color TV and lots of attention from everyone that they call the minute their butt hits the door! Gotta love it!

Anonymous said...

Wow...thats pretty sad. As if I don't already feel like a hypochondriac because of you cranky nurses, now I'm being told by my O.B.'s triage department to go to the hospital because of low back pain and spasms (cramping). First of all, I don't enjoy going to the hospital. It's certainly not one of my favorite things. I would love to go to the dr to get evaluated but they wont call me back. And here I am left to wander the internet to figure out what is wrong with me. It's good to know that there's "caring" people in the O.B. Triage that I can "count on". Count on to make fun of me because my own doctor won't see me. You don't know everyones situation and just because they're not perfect like you with your billy baddass R.N. position doesnt mean they don't deserve to be taken care of when they're in pain and scared. Thanks for reassuring my faith in hospitals...maybe I should consult a doula instead.

Anonymous said...

The reason we get so upset with nonsense triage (by people who do not choose to contact their doctors or midwives first) is because they take time and resources away from patients who actually need our help!

Mel, GB, WI said...

Patients need to use some common sense and think about what deserves to wait until office hours or what does not. It would be nice if the Dr's office could educate pregnant women to call the clinic before they make any decision to go to the hospital for constipation or other common complaints of pregnancy. It is frustrating to see that the majority of patients who do not have insurance and that taxpayers are paying for have so many unnecessary triage visits prior to actual labor and delivery. I think that is why they are in there current situations because they don't have the resources they become dependent on relying for everyone else to take responsibility.

Mel, GB, WI said...

Patients need to use some common sense and think about what deserves to wait until office hours or what does not. It would be nice if the Dr's office could educate pregnant women to call the clinic before they make any decision to go to the hospital for constipation or other common complaints of pregnancy. It is frustrating to see that the majority of patients who do not have insurance and that taxpayers are paying for have so many unnecessary triage visits prior to actual labor and delivery. I think that is why they are in there current situations because they don't have the resources they become dependent on relying for everyone else to take responsibility.

Mel, GB, WI said...

Patients need to use some common sense and think about what deserves to wait until office hours or what does not. It would be nice if the Dr's office could educate pregnant women to call the clinic before they make any decision to go to the hospital for constipation or other common complaints of pregnancy. It is frustrating to see that the majority of patients who do not have insurance and that taxpayers are paying for have so many unnecessary triage visits prior to actual labor and delivery. I think that is why they are in there current situations because they don't have the resources they become dependent on relying for everyone else to take responsibility.

Anonymous said...

Patients need to use some common sense and think about what deserves to wait until office hours or what does not. It would be nice if the Dr's office could educate pregnant women to call the clinic before they make any decision to go to the hospital for constipation or other common complaints of pregnancy. It is frustrating to see that the majority of patients who do not have insurance and that taxpayers are paying for have so many unnecessary triage visits prior to actual labor and delivery. I think that is why they are in there current situations because they don't have the resources they become dependent on relying for everyone else to take responsibility.