I am here because...

It is 6 AM on Saturday morning. My feet feel like two stumps as I stand on them in the operating room. In this fog of fatigue I am wondering why I am here.

Literally, I am here because this woman is doing her best to bleed to death. By her best, I mean she has now lost close to two liters of blood. One and one half of those liters could still be circulating in her blood stream if she had listened to me ten hours ago. She presented to the emergency room holding her 14 week fetus that she passed at home around supper time yesterday. I was in the operating room and the intern on call retrieved a large piece of placenta from her cervix and managed to slow the bleeding. Medication decreased the flow of blood to a trickle.

As I arrived in her ER cubicle, she declared, "I am not having a D and C!" She proceeded to tell me that she had retained placenta with the baby before last and she was "treated very badly." She adamantly refused to have a surgical procedure to suction out the remaining placental tissue which had not passed. I sympathized and let her talk on. "I don't want blood because of AIDS. If you put me to sleep, you will sterilize me. You think I am a bad mother because I don't have custody of my six children." This last statement she volunteered when I ask her who was caring for the baby born less than a year ago.

While I have gotten use to people not taking my advice, this patient was particularly difficult to care for. Over the course of the next 8 hours I came to realize why she did not have custody of any of her living children and why she was afraid of sterilization. I am sure this option has been offered to her multiple times. I could never reason with her because I could not get two complete sentences out of my mouth before she began railing at me. We finally went to the operating room when she continued to bleed despite multiple medications and a repeat sonogram, done the way she insisted, which showed retained placental tissue.

She is now stable in the recovery room. She still has her uterus. She will be pregnant again, probably within six
months since her last child is less than a year old.

So I am here because....

Well, my answer this morning is, "I couldn't make a living as an investment banker."

I also know I wouldn't be any good at the law or half a dozen other jobs which would give me this kind of perspective. People fascinate me and I often feel privileged to have such a intimate view of their lives. I sound jaded this morning because simply put, I am tired. A couple of days off will cure this and I will be back for more.