After everything that happened with Wentworth, the majority of my questions stemming from that night are towards the Leduc Hospital. Most people would have to continue wondering the questions but I have been lucky enough to get the answers! It turns out that the doctor in emergency that night had read my blog and knew he could put my mind at ease about a few things. However he questioned whether I would appreciate a phone call from him or if that would just upset me further. Again, lucky for me, a friend of mine works in emergency (shout out to Katie) and the doctor was able to run the idea passed her, who in turn let me know he was available for an appointment if I was interested. Being the kind of person I am who highly values information, I was super excited that he wanted to talk and booked the earliest appointment possible. The receptionist was clueless to the situation and I wasn't up to informing her so it was set for February 8th @ 10:45am and as far as I knew I was going to get the standard 15 minute appointment.
Tyler & I went to the appointment together and left Dexter with a friend. My goal from the meeting was to find out what he thought was happening to me and why there was a delay before I got sent to Grey Nuns. I also wanted the meeting to be as positive as possible and although I am obviously upset about the result, I wasn't there to make the doctor feel bad or to pass blame.
I didn't know how to start the conversation so I said "I'm not sure if you remember who I am?" He said "Yes I do. I remember you very well." Then he pretty much launched into his story. First, he said that when he got the call from Grey Nuns that I had lost the baby, he was shocked. When I had left his care he hadn't thought I would lose the baby. He said he spend about 4-5 hours that day, looking over the file to see where he had gone wrong. He also spoke with the Edmonton Dr. Lee (as his name is Dr. Lee too). The Edmonton Doc (female) has been doing OB for about 30 years so she has a lot of experience with non-stress tests. She said that when she looked at my non-stress test, she would say it was non-reassuring based on her instincts. However, she couldn't pinpoint something on it for Leduc Doc to look for next time. There is a criteria checklist that they get taught in med school and my NST met all of them, so there was no fault in Leduc Doc's logic merely in his lack of experience...which can really be expected in our little city emergency room. In terms of why I wasn't hooked up to fetal monitoring the whole time, it's really not normal procedure. I was hooked up for like an hour I believe which is a lot, and since he felt the readings were reassuring, there was no need to stay hooked up.
I was in the waiting room for about 15 minutes before I got a room and my care was sporadic. One of the reasons for this is that emerge was extremely busy that night. The doc said he got about 24 patients between 11pm and 2am whereas he normally averages about 12 patients per night spread out the entire shift. I can appreciate that they were busy, but I still feel that the nurses could have poked their head in periodically to make sure I wasn't passed out (and I feel they should do this quick check round for every patient). If I could appeal to the hospital to make a policy change, it would be to implement this. And perhaps I will write a letter about this.
The second thing we talked about was the reasons for the transfer delay. First off, when I arrived I had high blood pressure, which was highly unusual for me as I have always had text book blood pressure. High blood pressure is often associated with pre-eclampsia which is also really dangerous. He was worried that if I did have pre-eclampsia and he sent me in an ambulance right away I could have had a seizure. There are some drugs the hospital can give to make sure that mom stays okay, but it has to be properly diagnosed with blood/urine first. He said that with bleeding you are concerned with baby, but with pre-eclampsia you are also highly concerned about mom's health. Also, because I was still ahead of the cusp for lung development (about 34 weeks is the cutoff and I was just shy of that), they would also give a steroid shot to make sure baby's lungs are ready for our world.
Personally I feel that pre-eclampsia was a logical first guess. It is/was very possible that I had it as I also had significant swelling. In fact, that night, it felt like liquid was literally pouring into my feet and they were SO swollen. I had decided to watch SNL with my feet up before going on with some things on my to do list. Also, in a lot of the information and cases I've read, placental abruption doesn't usually progress so quickly. It often takes days or even weeks if Mom is on bed rest. Taking that norm into consideration, in most instances the Leduc doc would have had more than enough time to eliminate or diagnosis pre-eclampsia before the placenta fully detached and baby would be in imminent danger. Which leads me to believe that what happened to me was unavoidable... and meant to be.
Secondly, with hospital procedure as it was when I went in, the Leduc hospital would have to qualify their request to send me to another hospital before it would be authorized. They use a system called Rapid and the call system really puts doctors through the ringer before they'll ok a patient transfer. Thus another reason why the doctor had ordered blood/urine tests and had to wait for the results. As it was, once I started having significant pains and he decided to call Rapid that night, it was a full 20 minutes before they gave the okay to order the ambulance for transfer. Then the ambulance took an additional 30 minutes to arrive as we were at the mercy of their geographical location at the time of the call (I remember from my ambulance ride that the attendant said something about them being in Thorsby and that they have a weird territory to cover).
All in all, I do feel like I got the best care available and no negligence was made. Before talking to the doctor, I had phoned two lawyers for a consultation and they gave me peace of mind that my situation didn't sound like a good case. I person can always wonder, especially when sharing the story with many others, but its easier for me if I think everyone did the best that they could with the information that they had.
The great news, is that hindsight is going to good use this time. The head OB doc from Grey Nuns has implemented a procedure change for Leduc Hospital. They have given Leduc the green light to send all patients who are 20 weeks or further to their hospital with no burden of proof on them. AKA they don't have to do blood, urine or non-stress tests (NST). The only time Leduc won't send patients is when they are actively pushing or in immenient danger, as there is a minimum 20 minute ambulance drive plus waiting time. I feel really good about this change and now feel comfortable reassuring people to go to Leduc hospital for care when pregnant. It is still your best option to be at A hospital then on the road by yourself on the way to a hospital. There's still some details to work out (such as do they want all patients even non-pregnancy related items like a broken wrist) but it's a positive change and I'm happy it's happened.
My mom and I had a discussion a few weeks ago about how going to Leduc was still the best decision I could have made. It was midnight so Dexter was sleeping and its highly unlikely that I would have decided to wake him up and drop him off somewhere so that Tyler and I could go to the hospital together since I didn't know how serious the situation was. Me driving to Edmonton by myself presents a whole lot of possible outcomes such as passing out or having a seizure on the way to the hospital, hurting or killing myself and possible others on the road. And provided I did make it to the hospital and they did rush my care in emerge (which I may have had to wait there) and they had decided to do a c-section, Wentworth still may not have survived and I may also have been in danger from excessive bleeding or something. It's possible that the result may have been the same no matter which path I took.
Lastly, I want to say how grateful I am that Dr. Lee spoke with me. He shared with me that this case affected him on a personal and professional level. He has a 6 month old at home and is a dad to three so he can easily relate to our feelings. This shook his confidence and he questioned whether he was up for continuing as an emergency doctor. I thoroughly appreciate that he related to me on a human level and not as a "Doctor God" as some may have. I think it speaks to his character that he was willing to meet with me and even initiated it. Honestly, I am an emotionally sensitive person, and it really hurts my heart that he is/was suffering through this experience as well. I did my best to assure him that I think he did his best and that I harbor no ill feelings towards him. While we are saddened by what happened with our second son, we are doing our best to look on the bright side and move forward with our lives. Wentworth will not be forgotten but instead of dwelling on sadness I try to use this experience to appreciate what I do have in my life.
I hope this entry will give some of my readers closure has it has for me.
