My Follow-Up Appointment and (Perhaps No More) Complication Update 5

I had my follow-up appointment today--two weeks after the insertion of laminaria, 13 days after the D&E procedure and 3 days after my apparent complication resulting in an unexpected and bloody trip to the ER this weekend.

I skipped work this morning, slept in a bit and woke up to find a voicemail from the head nurse at the hospital's family planning clinic on my phone. She had heard that I'd had trouble over the weekend and wanted to touch base with me. She seemed to have forgotten or not connected that I also had an appointment that day until I called to confirm that I should still come in for it.

My boyfriend and I went together to this appointment. Initially, I planned to go alone to this follow-up. Everything seemed to have been moving along smoothly, and perhaps in my occasional bull-headed independence, I wanted to go alone and not feel dependent on a boyfriend. That all changed with my trip to the ER, and I also realized that it was important to me that we go together, see this process out as a couple. And happily, he was the one who suggested that he take me to the hospital for my follow-up.

While we waited at the clinic, we sat in the OB/GYNE part of the waiting room for the first time. (For our consultation, we sat in geriatrics, and we sat in the same seats when we went for the laminaria insertion.) Our buzzer quickly buzzed, and we were taken back to a new exam room.

As we walked through the family planning clinic hallway, it felt like a trip through the past three weeks:

First we passed the consultation room where I sat 19 days ago. A young woman about my age sat in the same chair with the door open, waiting for the head nurse to come chat with her.

We then passed the exam room where I had the laminaria insertion two weeks ago today. As we walked by, the door opened, and a nurse walked out. I could see the curtain was drawn and knew that there was someone in there experiencing exactly what I did two weeks ago.

Then we turned a corner where we were led to a new room for my follow-up. My boyfriend and I laughed when we saw the room set-up. For the first time, the visitors' chairs were lined up with a direct view at the table's bottom end. These are VIP seats for vag exams, people.

"Uh, are you sure you want to sit there?" I asked him.

He shrugged and plopped into one of the chairs. "I'll move if they want me to," he said. Of course, aside from the boyfriend seeing my vagina on a regular basis, this is the guy who is disappointed I didn't show him any of the clots I passed. So why on earth would he be freaked out?

The resident who I met at my consultation and who conducted my laminaria insertion knocked and entered the room. She shook my hand and asked me about the ER trip.

I explained that my bleeding and cramping has dropped off, and she explained that she'd do a pelvic exam to check my uterus. (The head nurse explained they'd want to see if it felt "floppy," which would mean that there was more tissue hanging out in there.)

She first used a heated speculum (It was actually super hot, as it turned out, and freaked me out upon entering my vaginal canal. Yipes!) and then did a hand exam. My uterus felt firm, a good sign. No floppy = Great news!

The resident then asked me about the procedure itself, bringing up right away that she was sorry that she and the rest of the scheduled team had been pulled from my case last minute.

"Honestly," I told her, "I think we both felt like there was more disorganization than we expected. I expected to see some of the faces I had seen before, but that didn't happen."

She nodded and explained that the change-up with doctors was frustrating, and she, with the rest of the team, was pulled onto this emergency case that started at 1:30 and lasted until past 6 PM. (Jesus.)

"You know," I said, "I understand that that happened, and it's unexpected. But maybe more upsetting was that I felt like we had to argue with the nurses that I get the shots I needed. We had to remind everyone, and my charts were wrong."

The boyfriend chimed in here, explaining that he had to insist to two different nurses about my depo shot since it seemed they didn't believe me, their patient. He also said that the shift change was a bother, but it honestly didn't bother me as much as the frustration of insisting that you know what care you're supposed to have.

I agreed with him and then added that it was a great thing he was there since, especially post-op, I was hazy, and we were having to act as my case managers.

At this point, I started to feel the emotion of the day rising up in me, and my eyes were getting watery.

Damn it! I thought, I didn't think this would happen! I pulled it together, just barely, to keep myself from crying.

The resident kindly apologized again, and said she felt terrible because if they had been on my team, since they knew my case, it would have been handled better.

She then asked me if I wanted my pathology report.

This stopped me short, though I think I should have expected it. I have even in the last few days been eyeing the number for medical records, considering calling in to request mine. Since I never even heard that everything went okay, I was curious to see what my charts say.

But a pathology report? Suddenly feeling vulnerable from having talked about the day, I immediately said no. I was afraid of what I might learn from it--the sex of the fetus, its viability? I don't actually know. (Does anyone know what exactly I would learn from the pathology report? Would requesting my medical charts reveal this information to me too?)

With that, she said she would chat with the attending physicial (who was supposed to have operated on me, but who I had not yet met) about whether we should do an ultrasound. They'd both be back shortly.

While she was gone, the boyfriend and I chatted more about the day of the procedure. We both felt like we had said what we wanted to say and agreed that the resident was great. There's not anything she can do at this point, obviously, so her words were nice. However, it was the attending doctor who then entered the room who made me really feel better...

The attending physician immediately apologized for the disorganization on the day of the procedure.

In my I-was-raised-to-be-a-way-too-nice-girl way, I said, "It's okay."

She immediately responded, "No. It's not okay." And then delved into how sorry she was that the emergency case had pulled her off of my case and that I hadn't had the familiarity of faces I knew around me for the operation. She said while she was glad I didn't have to face the emergency situation that this other patient did, she didn't think it was fair that I was jostled around because of another case. Basically, I deserved better than I got.

I told her how much I appreciated her saying that, and I didn't repeat that it was okay. She was right, it wasn't okay. So much of what happened was not actually the fault of the OB/GYNE team (in retrospect, it was that fighting to be sure my care was handled by the nurses correctly that was most upsetting), though I did mention that I wished that my operating doctor had made an effort to see me before the sedation kicked in.

We moved on and discussed my complication. Based on my description of what I had passed--dark maroon but not brown in color, gelatinous and smooth, they thought it was most likely blood clots. Tissue would have been darker in color and have had more texture. Chances are less likely that there was anything left in my uterus and more likely that my body simply did not evacuate the way it should have following the procedure.

As I thought I had heard the resident OB/GYNE say on Friday night, the leftover tissue or clots in my uterus were measured at six centimeters on Friday night. While my cervix was completely closed already that night, I passed more and more clots and blood, including that one gigantic clot that must have been most of whatever was in there.

Given that news, the attending physician decided that it was best not to do an ultrasound at this point. 1 or 2 centimeters of tissue in the uterus is normal, she explained. Six centimeters was obviously not normal. But if she did an ultrasound today and saw, say, 3 centimeters of tissue, she'd have to do a D&C procedure, even if my body might still be evacuating clots/tissue. She preferred to avoid subjecting me to another surgery (me too!), and instead monitor my continued recovery.

If my bleeding picks up, then I will need to call right away and most likely have a D&C procedure. Given how things have been going, the doctors are hopeful (and "95%" sure) that I won't need any more procedures. I'm not totally out of the woods, but things are looking good. Some slight bleeding and cramping will be expected--a few days to a week or more, so I'll be diligent in keeping a watch on myself.