The first year resident was clearly anxious about the patient in front of her. We just delivered her a few hours earlier and she felt she was bleeding more than she should be at this point. She had gone through the first couple of steps in managing post partum hemorrhage without success. The thought of a young, otherwise healthy, 18 year old, new mother bleeding out terrified her.
The first time I talked to her on the phone I asked her to give another medication and order a couple of labs. Knowing there was another more senior resident also in house I asked her to see if he could come down and give her a hand as well.
An hour later she paged me again. The other resident was busy with an admission and she still was bleeding more than the typical post partum patient and a senior nurse agreed. Hearing the tension in her voice as I attempted to make dinner for my family, I paused and sighed. "I'll be there in a few minutes," I grumbled and threw on some scrubs and my white coat to head back into the hospital.
The patient had a nice firm uterus with a floppy, or atonic uterus being the most common cause of post partum hemorrhage. We reviewed the rest of the list of potential causes and moved the patient into a room, grabbed another first year resident, and did a more thorough exam to look for any unnoticed vaginal or cervical lacerations from delivery. We noticed a some dried blood coming from the opening of the cervix and I handed the resident an instrument to grab it. What we soon would deliver were three orange sized blood clots which prevented the uterus's bleeding from stopping on its own.
After the procedure, the three of us debriefed the procedure and spent another five or ten minutes talking about various post partum hemorrhage scenarios. We reviewed the delivery again looking for what we might have done differently and I reassured the guilt stricken resident nothing she did or didn't do contributed to this complication.
The pat on the back here wasn't the teacher encouraging the student, but rather the student thanking the teacher. Both residents were so thrilled and appreciative to have an attending not only come in from home to back them up, but to take a little time on a Sunday evening to talk about the patient in front of them and future patients they may encounter. Even teachers need an "atta boy!" every now and then.