TIMES I'VE HAD TO GET REAL WITH PATIENTS
Sometimes as a doctor, you have to speak the cold hard truth to get through to patients. I'm a huge proponent of respecting patient wishes, but there were times I've had to be very frank because I DO care and only want the best outcome for them. For better or for worse, I went there.
- •When domestic violence occurredThis poor woman had ovarian cancer. We were seeing her for her third cycle of chemotherapy. She had bruises in the shape of two hands around her neck. I can't even put into words how I felt. She said everything was fine. I told her she needed to get out of this relationship immediately and go somewhere safe. We contacted the Social Worker, who got things in motion.
- •When she wanted to leave the ICUShe became so septic and unstable after an incomplete miscarriage that she was transferred to the ICU and put on pressors to keep her blood pressure up. She wanted to sign out of the hospital Against Medical Advice because she wanted to go feed her dog. No, she wouldn't let a friend or family member do it. I literally had to say, "You may die. And then what will happen to your dog?" I felt like an ass, but she relented and she lived.
- •When she was hemorrhaging and refusing a blood transfusionShe was a Jehova's Witness and I respected that. But her husband dictated what blood products she'd accept. After a long failed induction of labor for a medically indicated reason, she had a C-section and hemorrhaged so much our only option was hysterectomy. We thought she was going to die. The anesthesiologist, high risk OB attending, and I asked her, "Are you willing to die on this table?" She said no because she didn't want to leave her kids without a mother. She lived and was grateful.
- •When she was refusing C-sectionShe had stalled out for 5+ hours in active labor, had chorioamnionitis (infection in the sac that holds the baby), and the baby was showing signs of distress on the monitor for well over an hour. Our team straight up told her that her baby could end up in the neonatal ICU. We, of course, had to respect her wishes. But I was so mad when the baby came out floppy with some of the worst cord gases I've ever seen and spent more time than he ever needed to in the NICU.
- •When she said her partner was faithful after I told her she had a sexually transmitted infectionShe was a sweet young lady who had had only one sexual partner in her life. Could she have had another partner? Sure. But did I believe that? No. I told her she needed to have a serious talk with this guy and both of them must come in for treatment. They got treatment, but she didn't dump him.
- •When she kept coming back for terminations of pregnancy.She was a struggling singer with a boyfriend (who I later found out was married). She didn't want to use birth control pills or anything with hormones because she didn't want to gain weight. She wouldn't use condoms because he didn't like it. I told her abortion should not be used as a form of contraception. I am pro-choice, but multiple termination procedures can lead to complications. I finally convinced her to get a copper Paragard IUD.