Monday, December 20, 2010

Putting "Listen Up, Doc" into practice

If you've read Chapter 4 of my book, or if you've tuned into any of my "doctor" blog posts, you know I'm a big fan of my rheumatologist. Today, he can practically do no wrong - I trust him completely, and our doctor/patient relationship works like a well-oiled machine.

But it wasn't always that way, and my appointments weren't always as easy or effective as they are now. I had to work hard to improve communication and to assert myself during our face-to-face time, gently reminding him that I am more than just a series of blood tests, a message he heard loud and clear, once I started voicing it.

So when the situation demanded that I put my assertive ways into practice during my hospital stay when I gave birth to Bernadette, I jumped at the chance. I've learned in the past that if I want to make the most of my medical treatment, it's my responsibility to speak up and make sure I'm heard. Here's what happened:

During my delivery, one of my attending O.B.'s (not one of my four perinatologists, mind you, but a fellow who was working with them), recommended that 120 mg of steroids (solu-medrol) be administered over the course of delivery - 1 dose before delivery, and 2 doses after. He said that this was standard procedure when there's been a history of prolonged steroid use, and I agreed that that is typically the case, and that, indeed, I was guilty as charged of having a long, sordid history with prednisone. Of course, I also knew that the increased dose of steroids during delivery wasn't an absolute necessity. I explained that, in fact, during my first pregnancy, my doctors and I had thoroughly discussed whether or not I should use them, even consulting my rheumatologist in the process, and we all decided to not to use them during delivery. The effects of the drugs -of which there are many - weren't desirable, and everyone agreed I'd be okay without them, which I was. Thus, I assumed, and the doctors had agreed during an appointment mid-pregnancy, that I could do without the steroids again this time.

That said, this guy wasn't really backing down. I'm sure his doctor's manual said that when a patient takes steroids on a semi-regular basis, that patient must have a boost of steroids during any medical procedure which may cause unnecessary stress to the body (i.e. childbirth.) So while I voiced my opinion based upon past experience, the guy was adamant. I asked that we get a second opinion from one of my regular perinatologists, and while he agreed, he went ahead and ordered up the three doses so the nurses would know how to administer them, just in case. However, because my delivery progressed so quickly, the first round of steroids didn't arrive in time from the hospital pharmacy...so I no longer had to worry about dose #1. Now I just had to convince all of the attending nurses that the 2 remaining doses weren't necessary either.

When the time came to take the next dose (shortly after delivering), a new nurse came around to administer the 2nd shot of steroids. At that point, I was looking forward to a little rest after such a long 24 hours...and the last thing I wanted was a big old dose of hyper medicine. So again, I pleaded my case...and asked that she check with the doctor who had just delivered my baby. (I'd had the wherewithal to mention it to her as I was pushing...and she agreed that the steroids weren't necessary, but she hadn't rewritten the original orders yet.) Having checked with my doctor, the nurse agreed that no steroids would be administered at this time.

Two doses avoided...one to go.

Next came the shift change. The night nurse now on duty still only had the original doctor's orders to go by...which, of course, indicated that I needed a third and final dose of steroids. Per the notes, she was to give them to me at 11pm...and once again, I explained the situation, and asked that my doctor be consulted. The nurse made the phone call, and the order for the final dose of steroids was removed from my chart.

Mission accomplished! I'm so glad I stuck with it - I've had high doses of solu-medrol during past hospital stays, and I really didn't like the effects of the drug. And I give the nurses credit - they were unwilling to stray from doctor's orders, as they should be, but because they were sensitive to my pleas, they took the time to double check and get the answer I wanted. Three cheers for good nurses!

In an upcoming post, I'll tell you about another interesting situation I had during my hospital stay with Bernadette. Once again, I had to tie on my assertive patient cape...so stay tuned!

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