Ending on a Sad Note

There were a lot of different experiences I could talk about from my last day in the  ED, but the one that really stuck with me was my last patient of the day. The 20-year-old female came into the ED complaining of vaginal bleeding and extreme pain. She had gone to another ED a few days before where she had been told she was miscarrying, given pain meds and sent on her way. Now she was out of pain meds and wanted more. Nobody was really taking her seriously, since they had all had patients who faked pregnancy/miscarriage to get pain meds (how AWFUL is that, by the way???), but I wasn’t sure.

This was NOT my first patient that came into the ED with abnormal vaginal bleeding – but the first one who came in saying she had had a miscarriage. Our PA didn’t even believe that she had ever been pregnant, so she ordered a urine pregnancy test.

I walked into the patient’s room and told her we needed a urine sample. The look of anguish that washed over her face was heartbreaking, and I told her that I would help her as much as I could. Since she came into the minor trauma area in a wheelchair, I took her by wheelchair to the bathroom, and helped her obtain the sample. The urine sample was full of blood and tissue. So much for a clean catch. As we were setting up for a pelvic exam, the PA took her medical history and I found out that this was this girl’s sixth pregnancy, and I tried not to judge. I was happy that her partner was there with her and sorry she was in such pain. I helped her get to the bottom of the bed, expecting a normal pelvic exam. However, the exam was in no-way normal, and caused her a large amount of pain...

The MD swept into the room, took one look and told the girl (who was still whimpering) that she was still actively miscarrying, and called for more IV push morphine (I had already given her some 5 minutes earlier). When I came back from getting the morphine, it was just the girl and her partner in the room. I told her what I was doing, and that it was going to help with all the pain. Then I told her that unfortunately it was the end of my shift, and that I had to go. She responded with tears. I told her that now that they had figured out what was wrong, it was going to get better, and that I was sorry she was hurting. I reassured her that another nurse and NA were on duty, and that the MD and PA treating her were there for another 2 hours. She wasn't being abandoned. She calmed down and I walked out of the ED.

It was a difficult, emotional experience to end my preceptorship on, but I felt like we actually were helping someone - and that was positive and fulfilling.