Be forewarned that this post is sort of TMI.
When I found out I was pregnant with our fifth child I was at a real loss as to where to have the baby. With Cheetah I had driven to a hospital downtown where she could be delivered by nurse midwives in a birthing tub...of course that's not what happened, she was delivered via c-section by an old grizzly man and a resident 11 weeks early but it was for the midwives I'd been driving downtown for all my appointments and paying for parking. The ideal new choice for me would have been to have been at the hospital five minutes from my house. It is fairly nice, has a level three NICU if something should go wrong, and the parking is free. There was only one problem, Dr. J and I had decided that five babies was our limit and since I was going to have to have a c-section anyway (the old grizzly man had to cut my uterus in a T with each cut going twice as long as normal because Cheetah had lodged herself in, and I'd be really hard pressed to find anyone being willing to do a vbac for me.) it was the perfect time to get my tubes tied. Originally Dr. J was going to do the big V, but the second he saw an opportunity to get out of that, he was all over it. The problem, that super nice close hospital starts with a Saint...and so I'd have to go someplace else to get my tubes tied after I had the baby which just seems ridiculous, why not get a two for one surgery? So we started looking at other hospitals. The next closest hospital to us could do the tubal but is really tiny and only has a level two NICU. After our experience with Cheetah that made Dr. J nervous. The next closest was the ones downtown...pay for parking. And then after that is this huge hospital on the North side of town that is totally lovely, like spa lovely, but is so far away that it just didn't seem that practical, especially if something were to go wrong. So I was in a dilemma, one that left me at ten weeks still debating who I wanted to see through this pregnancy. Finally I just decided to go downtown and my friend Anita, a resident I met during my previous birth, had sent me a list of her top three favorite doctors who serve that hospital. I'd decided I was going to go with the Mormon guy because I figured at least with him I wouldn't have to explain the fifth baby in my belly, but before I made the call I started to bleed.
So I called the ob/gyn office that is connected to my family practice doctor. I had initially rejected them because they deliver at the Saint. hospital and at the too small hospital but as it became obvious this wasn't just some spotting, I knew I wasn't going to have to choose between either. Unfortunately when I called their office they gave me the run around. "Well is there really any point in you coming and seeing us if you aren't really going to be pregnant?" "What?" I was thinking, "does your office not say OB/GYN...even if I'm not pregnant shouldn't I be able to come in for girl problems, and stuff coming out of my body in my opinion constitutes a girl problem?" Meanwhile the two front office staff girls (the one on OB and the one in family practice) chatted about it, asked a doctor walking by and finally told me I need to come in to get lab work done to confirm I was having a miscarriage. So I came in and had my blood drawn and then I had to go back two days later to have it drawn again. The second time the lab girl asked me what I was doing having the same test done. "Um, they are confirming a miscarriage." "Well why didn't you just go to the ER?" she asked. When I told Dr. J about it he was furious. "That tech has no right to ask you that, and she should not be dispensing medical advice. If she worked in my office I'd have her formally reprimanded" Ironically it feels like maybe I should have followed her advice. Instead I just sat it out, bleeding at home and taking it easy. After two weeks of passing material it seemed like the bleeding was finally starting to wane a little but then in the later half of the third week the bleeding increased again and this time it was accompanied by a horrible smell (TMI RIGHT). The internet told me to go to the doctor, my hubby told me to go to the doctor, my mother and sister told me, "GO TO THE DOCTOR!" I debated over the weekend going to the ER, but ultimately because I didn't show any other signs of infection and because I spend a lot of time listening to my husband complain about people using the ER for primary care problems I waited it out until my doctors office opened Monday morning although I did call them over the weekend to try and confirm that was the right choice but after pushing the button to leave a message for the doctor on call was sent to an answering service that said I had to know which doctor I was leaving the message for because they cover 600. It was not helpful.
So Monday as soon as the office opened I called and left a message explaining my whole situation and asking a nurse from OB to call back. Nothing. So after dropping Peach off at preschool I called the office and asked if I could schedule an appointment, again telling the whole story again. The girl went and got my file and said, "Well it was family practice who ordered these test so lets transfer you back to them." This was the first time I'd even heard the results of the blood work that confirmed I had definitely been pregnant (um yeah) and also the following test with dropping numbers that I was miscarrying. So again I had to leave a message for the family practice nurse explaining the whole story. And then I waited, and I heard nothing. And by this point I was just really upset, because I've been going through this for weeks and I need some return to normalcy and all I really wanted was someone to make an appointment for me so I could talk to a real doctor and confirm if this was or was not ok. So I said forgot this office and I called a girlfriend up and asked if she could watch Cheetah and another and asked if she could pick Peach up from preschool and I drove myself to the ER and again had to tell the girl at the front desk the whole story before she could start my chart.
After waiting for about five minutes they came and took me back to a room where the doctor came in and asked me to tell him what was going on. This was the fifth time I'd had to repeat the story that morning and with the added frustration of not being able to get in to see my doctor, and my just general emotional sadness over the whole thing I was a wreck. So I started the tale again but this time I was almost on the verge of hysteria. Wracking sobs were shaking my whole body. I would squeeze a sentence out and then I would sob and try and breathe for a second. Then I would cry another sentence out. He just sat and listened to me cry and then when the nurse came in who had to ask all the same questions he'd just asked to record in the computer he stayed and said, "You know I'm going to give you all the information you need," and then he told her the whole story while I tried to calm down. Then he reached out and patted my hand three times and said, "You're here now, and I'm going to take care of you." It was such a comfort to me that he took the time and it helped me relax a little as the nurses got me set up in a gown, took blood and then got an IV started. Then the doctor was back. "This is what I'm going to do," and then he proceeded with what was going to happen. He did a very messy, uncomfortable vaginal exam and then sent me off to have an ultrasound.
They did two types, the traditional belly one and the inter-vaginal kind. I cried through most of the ultrasound. I kept looking over and could see my empty womb and even though I knew I'd miscarried, I'd seen the evidence of it in my toilet over the last three weeks, seeing that empty hole in the image just put a finality on it I just wasn't prepared for. It was as if that hole in the film was a mirror of the hole in my heart, a testament to my arms that would be empty come June. "I'm sorry I have to press so hard," the tech said as tears silently rolled down my face. Then they put me in a room to wait while my blood test came back and my doctor got the results from my original doctor's office. Finally he came back, "Well," he said, "the fetus has passed and your hormone levels have dropped a lot but the ultrasound and the blood work indicate there is still a little tissue in there so I'm going to consult with OB and see what they want to do. Also your doctors office is horribly hard to work with, so I'm going to make sure those OBs are not on call first." Then he left the room. A while later he came back with the plan. "We are going to give you this drug for three days. It will increase your cramping and so probably your bleeding, but the plus side is it will hopefully expel this last little bit of tissue. You are going to go in Wednesday to have blood work done to confirm if this is true or not. You will make an appointment for the end of the week with this OB who made this plan where she will confirm either the tissue has gone or do a d&c." After three weeks of dealing with the underwhelming performance of my doctor's office it was so nice to have a plan. Finally after a morning of fears and tears I was on my way home with a prescription, appointment card, and lab work orders in hand. The only downside of my visit when at the very end a nurse pulling my IV asked, "So what was the verdict?" "Excuse me?" I asked, not entirely sure what she was asking about. "What is the outcome?" I gave her a blank look, then tears welled up in my eyes. "Oh," she says, "did you lose a baby?" I just nodded. What else was there to say. "I'm sorry," she said as she quickly moved from the room, but besides that one interaction everyone else made things easier. They had been efficient and caring. They had been absolutely complete in my care and they had not released me until they knew what was wrong and had a plan for me to follow. I was grateful for that. I saw the physician as I walked out the door. "Thank you," I said, "I'm sorry I've been so...emotional." "No, no," he said, "that was totally normal." So I guess he sees lots of crying girls.
I am not looking forward to the next three days of cramping, but I am looking forward to not bleeding anymore and normal hormone levels and hopefully the end of crazy monster mom. This has definitely been a horrible experience, one I pray I will never have to repeat. Just in case anyone is wondering I will not be going to my doctors office again. I'm definitely in the market for someone new, because this was a case where the primary care system really failed me but luckily there was a second system in place to catch me.
I think the take home lesson for physicians, your staff and office practices are a make or break for me. It doesn't matter how amazing or talented you might be, but if I can't figure out who to call when I have a question on a weeknight or a weekend, you have failed. If your office staff makes it exceptional difficult for me to schedule an appointment, you have failed. If your staff drops the ball and forgets to call with test results, you have failed. If it is difficult for an ER physician to get his hands on my medical records in order to better treat me, you have failed. I say it all the time to Dr. J and now I'm going to say it here, so much of my experience with an office is not actually with the doctor, but is just as important. Physicians take note from what I've learned from this experience or the many more I've had while taking my kids to the pediatrician or looking for a new doctor or changing doctors. You need a good website. It needs to be easy to find and easy to use. It needs usable phone numbers on it, forms I may need to fill out before I come to the office, and pertinent information like your hours, where you are located, and where I can call and leave a message for the doctor or nurse on call. You need good office staff. They need to be courteous and knowledgeable, and if they don't know what they are doing they at least need to know who to ask to figure it out. If they are not a people person then they should not be working with people. I realize that costumer service can be a rough gig, but I am always friendly and polite when I come in your office or call so they have no reason to take that out on me. You need to make sure your wait times are reasonable. You need to make it easy to get medical information, either when I move, or if I go to the hospital, or if I just need to know something that happened. You need to make sure that billing information is clear so that I can see what I'm actually paying for and you probably should make yourself familiar with the cost of things that you regularly do because sometimes I want to know how much things are going to cost me before they actually happen. You need to know that if your phone system doesn't start taking messages until your office opens, that those phone lines had better actually open when you do. Sometimes I've been counting down the minutes until you open and then I start calling and nothing makes me angrier then getting that message, "Please call back when the office has opened," for a good thirty minutes after the office has opened. A good office manager who can make this happen is a must and if in doubt find someone who can audit your office, who can come in as a "patient" and tell you where the problems lie. The final lesson, don't ever underestimate how much just a little care and concern mean to me. I realize you see this all day, and maybe to you it has become rote, but to me the patient or the parent of the patient this is something I'm really worried about. Sometimes I just need to hear the words, "I'm going to help you." Those can go a long way.