Suggestions? a vent, too

[Guest guest]

Hi, all! I had this occur last week, and I'm still spitting bullets over it.

I think I did what I could, but I'm sure it will happen again before this

pt's pregnancy is over.

Last week, I did a home visit on a pt of mine who is an illegal

immigrant--thereby ineligible for Medicaid or any other insurance. She is

17 wks pregnant, with a history of hypertension, and a previous stillborn at

20 wks due to HTN and PIH, oligohydramnios. She has a history of hepatitis.

Her liver profile is lousy, as are her creatinine levels. She has a constant

headache. She had meds adjusted, and spent the last of her food money on the

new meds, but couldn't afford the newest med. Without Medicaid or friends

who drive, we had just resolved the transportation issue the week before by

mapping the bus routes and schedule for her--in Spanish, since she spoke no

English. But this time, I didn't feel that she was a bus candidate. I got a

BP of 160/132, both arms, and also in LLP. She had an intense headache and

stomach pain. I realize that PIH isn't usually diagnosed until 20 weeks, but

this pt was already known to have kidney insufficiency and liver problems.

Anyway, I needed to call the high risk docs, and of course, they wanted her

into the hospital immediately. Big problem--how do I get her there? I

ultimately ended up, after many phone calls, finding an ambulance transport

for free--they did us a favor. It was the ONLY way I could get her where she

needed to be. Well, the docs then pitched a fit (though they had said she

MUST come in) because she came by ambulance! I would have used another

transportation method had one been available, for crying out loud. Then they

said that she is NOT to be admitted " under any circumstances until the baby

is viable at 24 wks " . I realize that viability isn't til 24 wks, but what

about getting the BP down? Where do we draw the line? Just because the baby

can't be salvaged at this stage doesn't mean you can't try to better the

mom's condition so the baby has a better chance when s/he is viable.

<grumble>

The high risk clinic agreed with me, and supported my actions. The docs said

I " should have called a cab " for her--we already paid out of agency funds to

get her to the very first appt--$60! We can't do that again, what else did

he think we could do???

----Jeanine

----Jeanine