The process of delivering new life can be complicated enough when all goes well. It doesn’t take much to offset the normal flow of events, however, and an active herpes infection at the end of pregnancy is sure to throw a wrench in the works if ever anything could.
That’s exactly what we had on our hands one warm day last year when Suzy R. (name changed!), a first-time mom at 39 weeks with an active herpes infection who was slated for a C-section in 3 days, waltzed into our triage complaining of contractions and pelvic pressure.
“Mother of Christ,” Andrea moaned, rubbing both hands up her face and pausing when they reached the top of her head, her elbows resting on the desk before her. “Don’t tell me we’re going to have an emergency C-section on our hands today! We’re short staffed as it is!”
“Don’t get your knickers in a twist. ” Abby, our unflappable charge nurse, replied benignly as she looked over her assignments board. “Suzy’s been in here six times in the past two days. She was just sent home this morning.”
“Really?” Andrea’s head popped up between her hands and her eyebrows shot up nearly to her hairline. “I mean, seriously? What’s with this chick? Does she think we’re giving out door prizes or something?”
“Doubtful, though she may think that repeated pestering of her OB might make her plans to deliver early a bit more successful.” I surmised, tapping the end of my pen against one hand as I noted the name written in red next to Suzy’s patient information on Abby’s clipboard.
“Oh, don’t even–I can’t take this kind of joking, you two.” Andrea’s eyes widened with disbelief. “Don’t tell me it’s–”
“Yeah, she’s Dr. Angler’s patient. Who else.” Abby said flatly.
“And if someone calls him one more time, chances are good that he’s going to have that nurse for lunch, then come in and do a C-section if he has a moment.” I said, referencing Dr. Angler’s not-so-secret preference for C-sections.
Despite Dr. Angler’s reputation for favoring surgical deliveries, his recommendation in this case wasn’t wrong–not by a long shot. Despite Acyclovir since 36 weeks of pregnancy, Suzy had managed an active herpes outbreak at 38.5 weeks, just late enough to earn her a scheduled C-section. The chance of herpes transmission to the neonate via vaginal birth is as high as 33% during an active outbreak, and due to the devastating effects on the baby ranging from neurological deficits to blindness to kidney disease and a whole slew of other undesirable lifelong ailments, C-section is understandably indicated for these patients, and no one was about to argue with that.
As luck would have it, Andrea was up for taking triage, and with a grumble that turned into a smile just as she opened the door to Suzy’s room, she sallied forth, ready to take on her persistently pregnant primip and a veritable roomful of family members.
Two hours later, after quite a bit of walking, groaning, and griping, Suzy exited our unit once again, scowl on her face and discharge papers in hand.
I slid my wheeled chair over to Andrea, bumping into her as she finished up her charting. “Was that as enjoyable as it looked?” I asked with a grin.
Andrea elbowed me in the side, scoffed and blew her bangs out of her eyes. “You went in there for me once to check her. Would you have wanted to do that same routine four more times in two hours?”
This time, the surprise was mine. “Five checks in 2 hours? Geez, Andi, get ahold of yourself!”
“She insisted, damn it! She came in, we checked. She walked 45 minutes, we checked. She rested 30 minutes, we checked. She walked 30 minutes, you checked. I got the clear from a rather pissy Dr. Angler to send her packing, and we checked one more time, because hey, why not.” Andrea threw her hands in the air.
“And each time, through those nice, open lesions. Delicious.” Monica, who was charting nearby, paused to comment with a toothy grin.
“She has an appointment with Dr. Angler tomorrow afternoon, so hopefully she manages to hold off on visiting triage again until after we’re safely home for the night.” Andrea said.
“So after all this, is she still at a half centimeter?” I asked out of curiosity.
“Yeah, and that’s being generous. I think your little tiny fingers might be able to eek a half centimeter out of that cervix, but she’s still pretty much closed in my book.” Andrea replied.
“Soph is known for her cervical generosity.” Monica mused.
“What the heck does that mean?” I asked only to be answered with a rather unsatisfying shrug.
“It’s open to interpretation.” Monica smiled.
“Here’s hoping she and her fifty family members don’t darken our doorstep again til surgery day. Dr. Angler is just about over this madness. I’m amazed he didn’t talk to her himself today. He was just about that hot.”
But alas, Andrea’s parting wish wouldn’t come to pass, for as we furiously charted at the triage desk the next afternoon, our rooms so full that we were putting triage patients in pre-op rooms, Abby came moving swiftly in our direction from the main desk.
“What’s up, chief?” Monica asked, noting the quickness in her stride.
“Our favorite frequent flier is at registration.” She flashed us a longsuffering grin.
“Don’t you even–” Andrea began.
“It’s not you, doll. It’s Monica. And apparently, girlfriend is putting up even more of a fuss now than she was yesterday.” Abby said just as the sound of screaming outside the heavy double doors became audible.
“Wait, wait–it’s 3:30! Didn’t she just come from–?” Monica began, a finger lifted in protest.
“Yep, Dr. Angler saw her in his office at 2. Still just barely dilated, no contractions. But she left his office in a huff and told him she was heading straight here. He called about an hour ago to warn us. Turns out, she wasn’t kidding.” Abby rubbed her forehead.
“Well, she must’ve stopped for a burger or something. It isn’t but a 20-minute drive.” I said, a bit perplexed.
“Timing aside, she’s coming in hot again. I’d say put her in pre-op 3. Maybe Dr. Angler will make her every dream come true.” Abby shrugged.
“He’d better not. We’re practically swimming in patients today. We don’t have the staff for a non-emergent C-section, not to mention an emergent one.” I said, biting back frustration.
“Squeaky wheel gets the grease, chica.” Abby said.
“More like the shrieking air raid siren.” I muttered.
“Standby for assisting Monica should we head back to the OR. I’ll give your patients to….” Abby lifted a helpless arm in the air and shrugged in frustration. “Casper the Friendly Ghost or something.”
“Casper? I didn’t know he did L&D.” Andrea said, all grins now that she knew she wasn’t Suzy’s nurse yet again.
“If he is, he isn’t pulling his weight.” Monica heaved a sigh and stood up, straightened her back and marched toward the double doors.
But before Monica reached the doors, they opened, and within seconds, a clearly laboring Suzy appeared with our receptionist, poor Mrs. Andrews’s eyes like saucers as she assisted Suzy down the hall.
Monica paused, did a quick head-to-toe assessment of Suzy, and exclaimed, “Shit, Abby, get a chair!”
Abby, Andrea and I all leapt to our feet and dashed around the desk where we were greeted with the sight of a disheveled Suzy, her skirt and legs wet and reddened with amniotic fluid and bloody show. Her hands bunched into fists as her bulging belly, peeking out from under her shirt, tightened into what was clearly a strong contraction, visible even from five feet away.
Suzy’s voice rose with the contraction and the four of us took her from Mrs. Andrews, no time for wheelchairs. Abby and Monica had lifted Suzy off her feet, spiriting her down the hallway and through the double-doors into the pre-op area, Andrea and I mere seconds behind. But just as we rushed past Abby and Monica to open the door to pre-op 3, Suzy heaved one last moan, and through gritted teeth, gave the cry that every L&D nurse knows means, ‘stop everything and catch!’
That’s precisely what Andrea and I did, Andrea grabbing a towel and reaching under Suzy’s skirt to find a little head greeting her as Suzy gave one more Herculean push. And within seconds, there was a tiny, stunned neonate laying in Andrea’s towel, looking up at the five of us through bleary, confused little eyes.
Without so much as a word, Andrea handed the baby to Suzy, and the four of us moved Suzy and baby from the floor into pre-op 3, placing them in the bed as the newborn began to cry.
“Oh my God, oh my god! I told that jackass she was coming!” Suzy exclaimed, her tone quieting as she greeted her baby girl. “Hi, sweetie! God, were the last two days hell, huh?”
Abby and Andrea disappeared rather quickly after the excitement was over, but I stuck around a little while to help Monica settle Suzy and her newborn, then bolted out to check on my own patients. The intensity of the scene didn’t hit me until later in the shift when got a spare moment to sit down, and as I came to pause at the nurse’s station counter, I spotted three familiar faces sporting similarly dazed expressions sitting at the desk below.
“Dude, tell me I wasn’t dreaming. She really was only kinda dilated yesterday, right?” Andrea asked, the question both rhetorical and serious at the same time.
“Girl, you and I both know she was barely a half centimeter and thick as New England fog as of yesterday afternoon. And Dr. Angler would’ve never sent her packing if he had thought she was about to deliver.” I confirmed.
“So the Girl Who Cried Baby went into labor at less than a half centimeter and maybe 20% effaced and delivered her first kid…in an hour?” Andrea said in disbelief.
“Hey, it happens. We all know it does.” I shrugged.
“Doesn’t mean it isn’t mind-blowing when it goes down right in front of you.” Abby replied. “I wouldn’t have guessed it would’ve happened that way in a million years.”
“Dr. Angler is going to shit himself.” Monica closed her eyes and shook her head.
“Actually, he’s more likely to shit all over us.” I corrected with a half-smile.
“That’s not happening. Not unless he’d like to admit that his cervical exam was wrong, because guess who last checked our favorite pretending primip?” Abby realized, a sneaky grin spreading over her lips.
Abby’s prediction turned out to be absolutely correct. When Dr. Angler arrived, far from the hothead he usually was when things didn’t go his way and he had a nurse conveniently available to blame, he took the opportunity to commiserate with our shock at the course of events with Suzy R. We sat around for about ten minutes after he had gone in to check on Suzy, reviewed what had happened, scratched our heads collectively, and then the cocky OB-GYN was on his way.
It was yet another good reminder that despite a patient’s history, things can change on a dime in L&D, and as thorough and careful as you may try to be, when it’s time for baby to arrive, no one can stand in her way…not even an arrogant OB-GYN and a unit full of skeptical nurses!