A different type of call

*Beeep*

My pager goes off and vibrates as they call our car onto the air for a routine call. I sigh as I see we are doing a transfer from the maternity ward of one of our small community hospital to UConn medical center. "I probably cant count this one" I say to my partners as we pull out of the bay and onto the road. My disappointment is further fueled as we hear a call for an overdose coming over the radio as we are leaving the city.

We arrive on the maternity floor and the nurse gives us report, she mentions how quiet we all are and makes a joke at the other nurse at the desk.

"Here's a lively bunch"

I smile as I look over the paperwork, making mental notes for my report and trying to figure out how I can count this as one of my precepting calls.

"She came in for a checkup and has one of the highest urine proteins I have ever seen. She is also pre-eclampsic so we have given her labetolol and have Lactated Ringers running"

I look at my preceptor quizzically and he knows what I am thinking.... Why would you be running fluids into someone that is already hypertensive?

"She is a very pleasant woman, she is from Tanzania, this is her second pregnancy, she had a previous miscarriage, but if you ask her this is her first pregnancy. She does not know anything about the father"

These transfers are pretty routine for us. They tend to be uneventful (which is a good thing) but kind of awkward because you are in an ambulance doing vital signs every 15 minutes and there is not much care to be done.

Sometimes I hate myself for coming to conclusion based off of first impressions. She is a young immigrant woman living in a town where there is a large immigrant population living and working for the local mills and stores. So in my mind I put her into that category. Not maliciously mind you but just to start building that file in my head.

She is very pleasant and we talk about baby names and I tell her about my son. After hooking up the monitor and getting my baseline assessment I have run out of medical questions to ask so I do what I normally do and try and start a conversation. Thats when I begin to feel like an ass.

She has been in the United States for 6 years now and is just over a month away from her PhD in Anthropology. She already has a BS in sociology and a masters in cultural anthropology. We talked about the places we had lived and the differences in climate both weather wise as well as socio-economic. She was honestly one of the most intelligent and interesting to talk to people I have met in a long time.

I checked her vital signs every 10 minutes or so and we continued talking about her home in Tanzania, where it is very cold. You never really think about Africa as a cold place. But they have their mountainous regions where is is very much so. She lived near the base of Mount Kilaminjaro. She told me about driving down the road and seeing elephants, lions, zebras, giraffes, gorillas, and other animals I only see in a zoo or on the discovery channel. She talked about them like I would talk about seeing a hedgehog, squirrel, or deer on my way to work.

Too often we are blinded by our own preconceived notions of people. I am as guilty of it as the next man even though I try and put myself above that there are the inevitable times where I let it take over. A convenience of dealing with the many different people I do on a daily basis. I make no excuses for it and it is a part of my personality and thought process I would like to one day be rid of. I doubt that will ever happen but on days like today, it shows me that taking the time to talk to a patient can sometimes be more educational than you would ever think it could be.

I am glad I got sent on this call. It reminded me that no matter how many patients you take care of and however many situation you find yourself in to never take anything for granted and to take the time to appreciate the slow and easy "routine" calls.



***UPDATE****

My long time friend and colleague PMRN Cleared up a few things for me that I should have known.

1. The reason they were running Lactated Ringers is because "in pre-eclampsia you administer hypertonic IV fluids to speed up the process of getting rid of excess body water" Citation
2. Elevated proteins in the urine is a late sign of Pre-Eclampsia
3. since there's a loss of protein in the urine they're probably losing electrolytes renally more than usual (since proteins are big bastards), so the LR replaces em, while still being hypertonic enough to draw out all that third-spaced liquid


Seriously this man is a wealth of information that he can just pull out of a hat at anytime I need it. His blog is very informative and I would recommend it to anyone interested in Nursing or medicine in general.