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Cautionary tales - Dr Chris Mitchell
Former RACGP president Dr Chris Mitchell explains how to save lives when you don’t have all the answers.
I WAS working my way through my obstetric term, doing a routine admission for Kate, a young primipara with mild hypertension.
Kate was bright and bubbly and looking forward to her first child. She talked about herself and all the jobs she had to do at home to get ready – like most mothers to be, she had a lot better things to do than hang around the maternity ward.
Kate looked really well with no proteinuria.
I arranged routine bloods and after a few other admissions and maternity discharges I followed up her results, confirming a normal urate, LFTs and platelets and went back to the delivery suite.
After just a few hours I was called back to the ward. Kate was a little drowsy and mildly confused with a dull headache, her blood pressure was still okay but she just looked unwell.
If I hadn’t seen myself how bubbly she was on admission I probably wouldn’t have been so concerned, but I called in the consultant.
I’d learned lessons from patients before Kate and could recognise when someone was sick even if I wasn’t sure why, but it’s still always hard to call in a senior colleague on a hunch.
My hunch was that she could be post-ictal with eclampsia, but there really wasn’t much to support the diagnosis.
The consultant had been at the beach with his children, but came straight in without question.
By the time he arrived things were more obvious: Kate’s blood pressure had started climbing alarmingly, she now had heavy protein, and her repeat bloods had come back with urate up and platelets down. We shared with Kate our concerns and I’ll never forget the last words I spoke to Kate.
I explained I felt she had eclampsia and that we needed to take her to theatre. She asked when, I said “now” and she started fitting and fitting and just didn’t stop.
The caesarean was fast. I had to break away and resuscitate Kate’s daughter so I could arrange the helicopter retrieval to North Shore.
I never saw Kate again after the transfer, though I followed her course daily by phone. She made it through.
Her baby was initially flat with terrible Apgar scores but recovered quickly and though premature did really well too.
The lessons: trust your instincts; always be there for colleagues when they call; and when you need something urgently, do whatever it takes; and finally, even when you don’t have all the answers you can still save lives.
And remember, the quickest way to get a theatre going is to take your patient there yourself! We started resuscitation and had her to theatre and scrubbed within minutes.
Eclampsia is really scary; it truly can come so suddenly like lightning from a blue sky.
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