Complications

It was a routine dilation and evacuation for a miscarriage. I was assisting the doc, passing off instruments and keeping an eye on the patient. It sounds strange but I like working with miscarriage patients, because it feels like one of the few patient populations that I can really make a difference with. They're going through a rough time, and it seems to me that having a supportive, caring but unintrusive caregiver means a lot to them.

Everything was fairly routine. The doc was a tad concerned that the patient had 3 c-sections and no vaginal deliveries - which meant she really had none of the advantages of being multiparous. If she had given birth vaginally her cervix would have been much more pliable, and we needed to dilate her to about 6 mm. I wasn't aware that the doctor had another concern in mind. We did the procedure under ultrasound guidance by the resident, which is pretty unusual. Usually no ultrasound is needed.

So we're humming along and everything is going normally... until we start applying the suction. The patient started yelping in pain. Now, pain in a D&E is normal and expected. But that little alarm went off in my head and I couldn't really decide whether the woman was just overly expressive or was experiencing an abnormally high level of pain.

I spoke to her softly and tried to soothe her - which is hard to do without physical contact, but I couldn't do that with a pair of gloves on and the doctor constantly needing me to pass off sterile surgical equipment. She continued howling.

Then, by the doctor's facial expression and the way she seemed agitated and rushed when she asked for more 4x4s or more suction or this or that... it became obvious this was far from routine... it became glaringly obvious when we started reaching about double the amount of blood and tissue I'd expect from a 6-7 week miscarriage in the suction containers.

The doctor removed the suction from the cannula in the woman's cervix, and blood started flowing out of it as if it was a kitchen sink faucet at about half of it's max flow. And it didn't stop. At this point, I snapped in to the mode. That zone you get it in when you realize you have a sick patient on your hands and you have to do something about it or they may die.

[I'll finish this later, I need to study for midterms. So I'll leave you with that cliffhanger.]