OB/GYN: patient comfort & ovarian torsion

So. A few things to follow.  First just finished my 24 shift. I dunno 24 hours isn't that bad if you don't have to do it all the time, which according to the OB/GYN attendings you do.  Not to mention the malpractice insurance and suits are SO out of control. I guess several of them were being sued because kids they delivered turned out to have learning disabilities or Austism.  The saddest thing is lots of these doctors loose because  ingenius lawyers or the truth that we don't know what causes Austism-- so they use theories of anything and everything  including hypoxia during birth.

Anyhow. So the patient I described in my previous post, in the botched DiVinci robotic surgery. The one with the bowel perforation-- she's someone I have to 'round' on (check up on) everyday.  Anyway she's not doing particularly well.  She's a rather anxious person and who can blame her after being admitted for what was supposed to be an outpatient surgery and now she has tons of complications. Not just the bowel perforation which healed by the way. But also now multiple blood clots in her lungs. And today she was told she needs an MRI because they were concerned about her mental status because she forgot the word for 'hairbrush'.  Anyway I think they are only freaking out because she has had so many complications-- that they are trying to cover their asses.  But in the meantime, she's closterphobic and these tests are racking up a large hospital bill that she can no longer afford.  I was faced with an ethical dilemma when she asked me up front, "Ignore your job for a minute. Would you get the scan done?"  because the answer for me is--- no.  But if i tell her that and if i'm wrong-- then I could be sued for it. So when do you stand up for yourself and for your patient's comfort and when do you cover your ass (CYA)?  Its a shame that medicine has become more CYA than not. I ended up telling her that if she doesn't want the test she doesn't have to have it. But she should talk to the neurologist who ordered the test to make sure they had good reason for ordering it, being sure to tell them all of her problems with it and see if they thought it was necessary or if it was CYA.   It was the most legal way I could tell her-- no you probably don't need it without making the decision for her.

So there was a patient who was admitted before my shift for extreme abdominal pain.  She had multiple imaging studies that showed this odd mass that nobody could identify.  So when I got on shift, we all debated what it could be but decided to do exploratory surgery. She has been in pain for at least 24 hours and nobody could figure it out.  The image was blurry, and the mass could be attached to the uterus or the bowel or ovary or floating alone.  And the surgeons argued about who would have to go in blind, so the OB/GYN decided to just do it. Anyway we get in there and its a quick surgery. Because the mass is huge and purple and... it turns out to be the ovary and giant baseball sized ovary. And the blood supply is twisted on itself. This is a condition called 'ovary torsion' it is very rare.  Most people hear about it in males, the dreaded twisted testicle that causes extreme pain and is an emergency.  Its easy to twist testicles but very hard to twist the ovary.  Anyway I got a picture. Its something that you only read about in textbooks...