Serena Williams almost becomes a maternal mortality statistic

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Serena Williams holds many wonderful statistical records in tennis, but recently she nearly became a tragic maternal mortality statistic. Her experience further illuminates the shape of the maternal mortality problem.

Maternal mortality is disproportionately a problem of black women with pre-existing health conditions. All too often it involves poor medical care, specifically assuming pregnancy complications are rare when they are common. In Williams case, she literally had to save her own life.

Serena Williams literally had to save her own life.

According to Vogue Magazine:

Though she had an enviably easy pregnancy, what followed was the greatest medical ordeal of a life that has been punctuated by them. Olympia was born by emergency C-section after her heart rate dove dangerously low during contractions…

The next day, while recovering in the hospital, Serena suddenly felt short of breath. Because of her history of blood clots, and because she was off her daily anticoagulant regimen due to the recent surgery, she immediately assumed she was having another pulmonary embolism.

Williams had a history of a near fatal pulmonary embolism. A blood clot that developed in her leg traveled to her lungs and almost killed her. The problem was so serious and the risk of recurrence (and death) was so high that Williams needed to take anticoagulants daily. This is a major isue in and of itself but is further exacerbated by pregnancy which always increases the risk of blood clots above a woman’s pre-pregnancy risk.

A history of pulmonary embolus requires specialized management in pregnancy. The best daily anti-coagulant, coumadin (warfarin) is teratogenetic. Pregnant women must be switch to an anti-coagulant compatible with pregnancy, typically injectible heparin. The anti-coagulant must be carefully dosed during the last weeks of pregnancy and suspended altogether during labor in order to prevent excessive bleeding at the time of birth; the risk of excessive bleeding is even higher if a C-section is needed.

In the immediate aftermath of birth, the risk of blood clots remains very high so anticoagulants must be restarted within 6-12 hours after vaginal birth and between 12-24 hours after a C-section. While anticoagulants are suspended, the mother is extremely vulnerable and should be monitored closely.

Instead, Williams had to diagnose her own life threatening complication and then convince the nurse of its seriousness.

She walked out of the hospital room so her mother wouldn’t worry and told the nearest nurse, between gasps, that she needed a CT scan with contrast and IV heparin (a blood thinner) right away. The nurse thought her pain medicine might be making her confused.

The nurse thought the pain medication might be making her confused? Did the nurse have any idea of the risks to this particular patient? Apparently not. Instead, like all too many people who care for pregnant and postpartum women she assumed that everything was fine.

But Serena insisted, and soon enough a doctor was performing an ultrasound of her legs. “I was like, a Doppler? I told you, I need a CT scan and a heparin drip,” she remembers telling the team. The ultrasound revealed nothing, so they sent her for the CT, and sure enough, several small blood clots had settled in her lungs. Minutes later she was on the drip. “I was like, listen to Dr. Williams!”

Williams was absolutely correct. She needed an immediate CT scan (the appropriate diagnostic test for a pulmonary embolus) and IV heparin. Instead she was subjected to a useless screening test that wasted precious time. There is no excuse for the delay in her treatment.

But this was just the first chapter of a six-day drama. Her fresh C-section wound popped open from the intense coughing spells caused by the pulmonary embolism, and when she returned to surgery, they found that a large hematoma had flooded her abdomen, the result of a medical catch-22 in which the potentially lifesaving blood thinner caused hemorrhaging at the site of her C-section. She returned yet again to the OR to have a filter inserted into a major vein, in order to prevent more clots from dislodging and traveling into her lungs.

These were unfortunate complications that could have been predicted, but almost certainly could not have been prevented. Preventing a pulmonary embolus took priority over everything including bleeding into her incision. You can replace blood loss, but it is almost impossible to save someone from a massive pulmonary embolus. The decision to place a filter into her inferior vena cava was the appropriate response. It’s an invasive procedure but it prevents blood clots from traveling to the lungs and eliminates the need for any anti-coagulation.

Williams’ near death experience highlights the failure of our healthcare system in preventing maternal mortality. We know who is at risk and we know how to minimize that risk, yet in practice we ignore those risks, fail to employ the interventions that are needed, and falsely reassure women when they tell us they are ill.

The true scandal here is not that Williams nearly died; that was foreseeable. The scandal is that Williams had to save her own life; that’s inexcusable!

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  • The Computer Ate My Nym

    A post-partum woman with a history of DVT/PE? Who let her leave the hospital without lovenox? Post-partum is THE most dangerous time, even greater than during pregnancy.

    • The Computer Ate My Nym

      Recent surgery is not an absolute contraindication to anticoagulation. We bring cardiac patients out of surgery on heparin drips. It’s doable, just needs good nursing care. Certainly restarting lovenox 12-24 hours after surgery is lower risk than letting a woman with a history of thrombosis go around unprotected after a c-section.

      • Azuran

        I was given heparin injections for 2 days after my c-section. And I have no coagulation problems nor had any complication. It looked like it was the standard protocol of the hospital.

  • attitude devant

    It is soooo hard to disabuse post-partum nurses of the illusion that they work on a low-risk ward. It leads to some avoidable complications. Absolutely true story: Recently had a mom with platelets very low, 50K. She labored (no epidural because of the platelets), delivered, and (with prompt administration of pitocin and massage) had a very low blood loss. Score!, right? Placed orders for continued oxytocin for 20 hours and breathed a sigh of relief.

    Not so fast! I got called to her bedside four hours later for a post-partum hemorrhage. Turns out her nurse had turned the pitocin, the ONLY thing standing between her and hemorrhage, OFF for an hour so she could take a nice long shower, just two hours after delivery. I could’ve cried. The nurse was trying to be ‘nice’ to this mom who had had a tough labor. Some ‘nice,’ to have a manual evacuation of a liter of blood from the vagina (with only IV fentanyl for pain relief).

    To make it worse, this is one of our better nurses. She just didn’t think. And didn’t run it past me.

    • fiftyfifty1

      “Recently had a mom with platelets very low, 50K.”

      Interesting. I didn’t realize that 50,000 was considered “very low” in a postpartum woman, rather than just “low.”

      In any case, your case reminds me of a patient I had in residency with a woman with normal counts but known intrinsic platelet dysfunction. The plan, made along with her heme/onc and MFM, was a platelet transfusion immediately upon admission (plus, of course, “tone,tone,tone, tone, tone,tone,tone”) All was well until somebody from the blood bank canceled her order without informing anybody because “her counts were normal.” Luckily, unlike with her 2 previous births, this time she had a dysfunctional and longish labor which gave me time to realize what had happened and reorder the plates before the baby arrived. And later I filed a formal near-miss report.

      • attitude devant

        You’re Heme/Onc, right? They were 50K antepartum. If they’d been any lower we would have had to transfuse platelets in labor. We treat labor like surgery. If you have a patient who is not bleeding, you would let her get down to 20K before talking transfusion. But if you had to take that patient to surgery, 50K would be your cutoff. We use that surgical cutoff as a proxy for labor. You have this huge area of oozing sinuses after the delivery of the placenta, and you can manage most bleeding by making the uterus contract strongly. Am I making sense?

        • fiftyfifty1

          You’re totally making sense. I had just gotten hung up on the low vs very low description. 50K in most medical situations is not very low, but it makes sense what you say re the surgery cutoff being a proxy for the vaginal birth cutoff. Then to make it worse, TOL is no guarantee of vaginal birth. And 50K at the start of labor is no guarantee of 50K at the end of labor. I am rapidly seeing why you call 50K “very low.”

          And no, I’m FP, not heme/onc. Have delivered no babies since residency.

        • The Computer Ate My Nym

          You’re Heme/Onc, right?

          Haha, very funny. Platelets of 50K? Next round of chemo’s a go!

          • attitude devant

            Marrow killers, all of you!

          • The Computer Ate My Nym

            Sometimes you must destroy the marrow in order to save it.

    • For years, I worked on a postpartum ward that included a “intensive care room” for immediately postop patients or those with pre-eclampsia, severe hemorrhage, HELLP Syndrome, etc. plus 40 “ordinary” new mothers. The management considered 3 nurses and 2 nurses’ aides adequate staff for day and evening shifts, 2 nurses and one aide for nights. Postpartum patients are “well”, aren’t they?

      • Heidi

        That’s ridiculous. I was one of those “well” patients but I still needed things. I needed diapers, bottles, maybe a midnight snack, and I went through at least a gallon of water as I was sooo thirsty the first few days, but then I also needed my pain medicine every 4 or so hours. They took my blood pressure at least once a day. There’s no way 40 mes could be manageable by 2 nurses and one CNA.

        • The hospital assumed that you could get out of bed [after all, having a baby is “normal”] and tend to yourself. In fact, in our mini-ICU we had some very sick women who needed one-on-one care [sometimes 2 on 1]
          I agree it was absurd. It was one of the reasons I left hospital nursing in 2001 and went to work in a Women’s Health Center, which involved a lot of teaching and support, and which I found very gratifying.

    • Daleth

      She just didn’t think. And didn’t run it past me.

      Jesus. I didn’t even know nurses were allowed to do that (turn off IV meds without a doctor’s order).

      • attitude devant

        Truth be told, I didn’t either!

  • PeggySue

    I don’t recall if the original article or something else I read noted that she was delayed in getting the CT scan because the protocol was that the less expensive ultrasound had to be done first, and only if it was not conclusive then the CT scan could be done. In her case that was an unneeded delay especially with her symptoms. I have seen similar “protocols” and I think they come from cost containment perspective–like, our doctors in my last year or so with hospice had to demonstrate the need for a more expensive opiate by trying the patient on morphine and charting that it didn’t manage pain. Extra suffering for the patient.

    • FallsAngel

      That was my thought too when I read the article.

    • fiftyfifty1

      If an ultrasound was required first with their protocol, then that is the worst protocol of all time. No matter what you find on the ultrasound, you still will need the CT:
      No clot found on US? Well maybe that’s because a clot came from elsewhere than the legs.
      An “unconclusive” area found on the US? Well maybe that’s because most of the clot has already broken off and flown to the lungs.
      A clot definitely found on the ultrasound? Well we know she’s formed a clot and now we need to know what’s in her lungs.
      Any way you have it, with shortness of breath and a high risk situation, you need that CT. And Serena was about as high risk as you can get.

  • no longer drinking the koolaid

    This is a major problem highlighted in the NPR/ProPublica series about maternal deaths, “delay and deny”. Symptoms are discounted and/or dismissed partly because staff think they are uncommon, but may be because getting the diagnosis involves a lot more work for already overworked staff, And management requires more work beyond that. Not an excuse for a patient needing to diagnose themselves and then having to tell staff how to save their life.
    Pretty sure she may also have PPD with some PTSD thrown in.

    • PeggySue

      I won’t speculate on her emotions, but her body has sure taken a lot. She’s amazing. And that baby, my heavens what a gorgeous baby!

    • Jen

      How can NPR call the staff of the maternity unit overworked when they’ve dumped all of the well-baby care onto the new parents and their families?

      • Because the staff/patient ratio is constantly being revised so that fewer (expensive) nurses need be hired. I don’t want to go back to the days when nurses were making $8-10k p.a. as they were when I graduated nursing school, but it did mean there were a lot more nuses at the bedside, since there was no great savings in hiring fewer nurses and more nurses’ aides.

  • yentavegan

    Serena or Olympia would have not have survived in a non-hospital birth center. And yet I am wondering how many pro-home birth lurkers are here, reading this post and working out scenarios in their minds how a midwife would have been able to manage this birth. Right? I know you and I know you are here and you still believe in spite of all this evidence that Hospitals and Doctors and Medications are the evil interventions and a Holistic Midwife with herbs and oils could have handled this pregnancy and birth better.

    • The Bofa on the Sofa

      Right. And again, ti’s another example of how the problem is not intervention, but the lack thereof.

    • kilda

      they’re probably thinking that the C section was the cause of all the trouble, hence everything would have been just fine at home.

    • PeggySue

      Someone was on twitter talking about how Black women’s health would be improved by making midwife and doula support widely available. You can imagine I had a big reaction to that, and I mentioned that both Serena and her baby would likely have died with that model of care.

      • EmbraceYourInnerCrone

        How the hell would a doula help anything unless it was a doula who was hospital and doctor friendly who would be an advocate for the mother when the mother was not feeling well/feeling something was wrong/etc, someone to push for additional pain management etc if the mother was not being listened to. (I used to think that’s what a doula was supposed to be but most I have met are very woo-y…

    • Serena was not a low risk patient from the beginning. Elderly primip with a pre-existing medical condition? No birth center should have agreed to accept her, even if she’d begged (which she was smart enough not to do)

      • Daleth

        Elderly primip with a pre-existing medical condition? No birth center should have agreed to accept her, even if she’d begged

        But a whole lot of them here in the US would have accepted her. That’s the problem. When morons are running some of the birth centers, you need the law to spell out what the morons have to do to keep their license.

        • Merrie

          Dunning-Kruger. You need a medical education to know how bad these conditions can get. Even if you don’t ever use some of the stuff that you’ve learned, you need it for background. If you don’t have said medical education, you can’t know how important it is to have it. CPMs think that since they’re never going to do pitocin or IVs or any of this other stuff, they don’t need to know anything about it. Wrong. Only by studying it will you know about when it IS necessary, even if you won’t personally do it.

          • The Bofa on the Sofa

            Dunning-Kruger.

            I’m not convinced it’s that. “You don’t know what you don’t know.”

            I think there’s also a serious of denial. They know what can happen, but just insist it’s not going to happen tot their patient.

        • Agreed. And the US needs Federal oversight of the education and licensure of midwives, and uniform standards of acceptable practice.

          • Daleth

            Not sure we even have federal oversight and licensure of MDs. All professional licenses are handled at the state level. There are nationwide exams (boards) for doctors, though. But I think the difference is that those exams are designed by committees whose priorities are doctor competence and patient safety, which AFAIK is not the case with the midwifery exams.

          • No, there isn’t. But the medical profession, largely under the aegis of the AMA, has been pretty good at policing themselves, and insisting on rigorous state licensing exams and continuing education to maintain licensure.

            Unfortunately, there is no similar professional organization for either nurses or midwives which is so strict. [The ANA is not really a nationwide spokesman for the profession of nursing]

          • Daleth

            Unfortunately, there is no similar professional organization for either nurses or midwives which is so strict

            You have hit the nail on the head. We have no mechanism for federal regulation of professions, and the national organizations that would normally self-regulate aren’t doing so in the case of midwives.

        • sdsures

          Wasn’t there a recent SOB post about a mom/baby who died at a birthing centre because they accepted Mom as a patient, when they never should have accepted her in the first place?

          *trying to find it* Maybe it was a post on the FB page?

          • Daleth

            There are way way way too many such stories.

    • Erik Victory

      It’s always great to speak up like yentavegan has – it’s impossible to keep up with all the weird, fanatical niche communities continuously metastizing on the internet & this post alone has introduced me to a new one to just be aware of.

    • Christine O’Connor

      I had two home births. No way would I think it smart for someone with her health history to have a home birth.

  • Dr Kitty

    Dr T- you forgot the DOACs!
    Most of my young PE patients are now on Apixiban/Rivaroxaban/Dagabitran, not Warfarin.
    You still can’t conceive on them, but they’re a lot more user friendly.

    I find it amazing that Serena even put herself in for a tournament as soon as she did. Withdrawing is hardly surprising given that she’s still recovering from pregnancy, abdominal surgery, PEs, IVC filter etc at what is the upper age limit for her sport.

  • Reya

    I am not a social justice warrior or a fan of that for the matter, but I have to say this is the way women’s complaints are mostly treated and dismissed by the medical systems.Their complaints are considered exaggerated, hysterical, unreliable and considered to be the cause of either anxiety, or hormonal imbalance or some other kind of BS.

    • Casual Verbosity

      I have to agree with you. You needn’t look any further than the way women with endometriosis are treated: “Oh it’s just a bit of cramping. Don’t be so dramatic.” The worst part is that women are often the enforcers. My sister has endo and found that until she got to her gyno, the most empathetic doctors were men because they hadn’t experienced period pain before, whereas female doctors tended to be dismissive because their periods didn’t hurt that much.

      • me too

        That’s been my experience too. Women doctors refused my requests for anxiety medications for pap smears, yet insisted that I needed the test every year. When I went to a male gynecologist, he not only prescribed the anti-anxiety pills with no argument, he also told me I don’t need the “annual” every year!

        Same thing requesting a c-section. Women obstetricians insisted on telling me about their own vaginal deliveries and insisting that I should “at least try” for vaginal birth. Male obstetrician scheduled the section.

      • Emilie Bishop

        I found a lot of dismissive attitudes from both male and female doctors with regard to my endo symptoms. I’m experiencing some weird things now a year after my hysterectomy and ovary removal–almost like PMS with sore breasts, pelvic pain, nausea, mood swings–but in theory I should have nothing of the kind because I have next to no hormones. I’m afraid to ask doctors simply because I don’t want another long run-around. Usually medical providers I saw for endo-related issues would brush off new symptoms as “women’s bodies are complicated.” If I never hear that line again, I will die a happy woman.

        • Women’s bodies are complicated?! Yes, they are, but it is the job of the freaking doctor to figure out why the body isn’t working as intended and to fix it if at all possible! Men’s bodies are also complicated, but their complaints aren’t dismissed this way.

          Grrrr …

          • Emilie Bishop

            Right? I was told cervixes just bleed sometimes during pregnancy, then learned I had a cervical polyp that was bleeding. I was told women just bleed mid cycle sometimes, then learned I had a thickened patch of lining after I begged for a d&c. I was told pelvic pain would go away if I just did yoga, then learned my ovaries were adhered to other organs after my hysterectomy. And more. I’m just thankful none of this has been life-threatening.

          • Who?

            The word ‘just’, like the word ‘should’ is a huge red flag. If someone ‘just’ needs to do something, or something ‘just’ happens, it is very important to fully understand exactly what fits into those four letters.

            And don’t get me started on ‘should’.

        • Women’s bodies are complicated?! Yes, they are, but it is the job of the freaking doctor to figure out why the body isn’t working as intended and to fix it if at all possible! Men’s bodies are also complicated, but their complaints aren’t dismissed this way.

          Grrrr …

      • Caylynn, RD, MPH

        Yes! The doctor who finally suspected I had endometriosis (and did my first laparoscopy, confirming the diagnosis and cauterizing the lesions he found) was a male. All of my female gyns up to that point (I was a young, Catholic virgin who felt more comfortable with female doctors) had dismissed my pain.

        Since then I’ve had several laparoscopies, all with female surgeons, and despite them finding stage 4 endometriosis every time, and me complaining of constant, daily pain, it’s only now, at age 45, that they have finally consented to hysterectomy as a way to hopefully manage the pain. It was always “oh, you’ll want children someday,” or “oh you’re too young” even though my husband has had a vasectomy! And yes, I know hysterectomy doesn’t necessarily help endometriosis, and that there are other issues in performing a hysterectomy on a young woman, but still, the attitudes of female gyns were pretty paternalistic!

        There was the one gyn who claimed I couldn’t possibly have had the endometriosis return, and my constant pain was muscular. I think I know the difference between muscular pain and other kinds of pain, considering I’m a marathon runner and group fitness instructor. Muscular pain has never been sharp and stabbing, and left me doubled over, nauseous. Endo pain has.

        • Doll Parts

          How does a gyno not know that it is EXPECTED for endo lesions to regrow???

      • Empress of the Iguana People

        I generally prefer my male ob, though I have to say his junior (female) partner is more understanding now. She developed PPD and I suspect her son’s birth was harrowing.

      • Doll Parts

        I was in pain for a decade. Got so bad i was in pain 75% of the time. And no doctor even bothered to think it might be endo. I lost my ability to have the children i wanted because endo had overrun my entire abdominal cavity while doctors told me to take a few ibuprofen.

        • Casual Verbosity

          That’s terrible. That just shouldn’t happen.

        • RMY

          I’m so sorry. Doctors are the worst. It took me YEARS and multiple doctors to get diagnosed with PCOS (since, you know I’m thin, and only heavy girls have it). PS- no kids either, doctors don’t want to put me on anything for the very high male hormone levels that seem to be wrecking my uterus’ receptivity – they keep telling me that it doesn’t matter.

      • guest

        And this is why I stay with my gyno even though wait times at appointments have been as long as 2 hours. She was the first doctor to take my complaints seriously and diagnosed my long term pain issues at the first appointment. When I was considering a MRCS there was no “oh you should just try a vaginal birth”, when I had horrible morning sickness there was no “that’s just pregnancy”, and when I was done having kids and wanted a permanent solution it was just “here’s your options” no “are you sure that’s what you want to do?”
        I will say that after my experiences with her, I will no longer tolerate a doctor that doesn’t provide the same level of care. I have fired very nice doctors who kept blowing me off and kept doctors that I may not “click” with but that treat my problems seriously.

        • Who?

          Exactly. I have friends, but for professional advisers I want serious, respectful people.

    • Tigger_the_Wing

      I heartily agree, and could write an essay just listing the misdiagnoses, and missed diagnoses, in my own life.

    • Claire Secrist

      Well, I am a social justice warrior, and the entrenched misogyny, ableism, and racism of every aspect of society is why. What you’ve just said here is like the hoary “I’m not a feminist, but.”

      • Reya

        Depends what YOU understand by a feminist. Am I an advocate for the shallow “women shouldn’t shave and should take revenge on men for all the centuries of mistreatment”? Not in the least. Am I concerned that we are still misunderstood and mistreated in some cases (way too many in so many countries)? For sure.

        • anh

          I think you probably have no idea what feminism is

          • Reya

            I think most self entitled feminists today have no idea what it actually is, that was what I was aiming for.
            People tend to focus on details nowadays and loose sight of the bigger picture. Everyone is eager to help, join causes, like and share stuff and to feel they make a difference, but forget to properly inform themselves, and actually get involved. It’s all shallow and mostly for appearances.

          • anh

            Yeah that’s all right wing propaganda designed to discredit people trying their damndest to fight the hellfire in our country right now. Well done regurgitating it

        • LaMont

          Do you believe women should be *required* to shave? Actual feminism is all about choice and not having society tell women they *must* waste their time conforming to what others say. No one is trying to *force* women to not-shave, but there are people who want to force women to shave, by rampant public shaming of those who don’t conform. And “revenge” is a petty, dismissive way of saying “redress actual grievances,” but ok.

          • Reya

            Let me rephrase that in this case. I am one of those who believe there are bigger problems regarding women and their safety that need attention, besides the trivial things some self entitled feminists around the net advocate for. You made a very good point about choices, that indeed being one of the main issues.

          • swbarnes2

            Can you point to, say, two mainstream feminists advocating for punishing all men? Or two who think that shaving should be forbidden for women?

            Or are you arguing that access to contraception is trivial? Or that women being doxxed and receiving endless rape threats and death threats for displeasing obnoxious men is “trivial”, and not worth complaining about?

          • attitude devant

            You’re confusing me. What do you mean by ‘self entitled’? Do you mean ‘self-titled’ in that they title themselves? Or are you just saying they’re entitled?

          • Sarah

            Ok, well you decide where to direct your participation and advocacy and leave other women to make that same decision for themselves. There are a great many problems facing women in the world, none of us can solve all of them, and there’s room for all those wanting to improve the situation to choose where their interests and talents can best be deployed.

          • TheArtistFormerlyKnownAsYoya

            You haven’t got a clue what feminism is about.

        • attitude devant

          (please be a Poe! please be a Poe!)

    • mabelcruet

      There is a lot of data indicating that there is a gender disparity when it comes to pain-women are perceived as being in less pain, or being too emotional/overwrought and exaggerating their symptoms.

      • Doll Parts

        There is also a HUGE race disparity.

    • Petticoat Philosopher

      That sounds like something worth being a “social justice warrior” over to me…

    • MaineJen

      Proud SJW and feminist here, and you’re right 🙂

    • Bombshellrisa

      Many doulas and home birth advocates are much the same. “Medicine, you don’t need modern medicine! Just take these herbs and tincture that have not been proven, it’s the way women have always done things! Pain relief administered by a medical professional, you don’t need THAT, just climb into this tub and we will play some music and light candles to help you.”

  • Tigger_the_Wing

    What a shocking story. Poor woman! That gorgeous little girl could have lost her mother because of a lack of communication.

  • namaste

    I think it was you, Dr. Tuteur, who said that the most chilling words one can hear from a patient is “I think I’m dying” because they’re probably right. Good for Serena for advocating for herself. Jeez, how did staff miss so many obvious red flags?

  • Heidi

    I’m shocked the nurse thought she confused from pain medicine. I’ve seen my share of people experiencing confusion from a medication reaction and nothing like that has come out of their mouth.

    • Mel

      I had an awful night three days after Spawn was born where the combination of a few days of exhaustion, magnesium sulfate, Narco and hormonal maternal aggression combined together to convince me that my nurse was out to get me. Dead serious; I thought she was trying to kill me. I woke up my husband and babbled a bunch of completely nonsense about my thoughts of where my blood pressure readings were and how the nurses were failing to get them adjusted accordingly because they were out to get me.

      At no point did I say anything nearly as coherent as “I have a pulmonary embolism; I need a CT scan + and IV of heparin right now”.

      My husband realized that there was no way I was going back to sleep without him doing something so he mediated a peace conference between me and my nurse. I felt much safer afterwards and went back to sleep.

      The next morning I decided that Tylenol was doing plenty for pain control and stopped the Narco.

      • Heidi

        That’s been my experience with confused patients. They either think staff or a loved one are out to get them or the room is filled with snakes, spiders, bugs or some other creepy crawly.

        • Who?

          Or Darth Vader, who my son (now 26) sees when he is ‘confused’ by medication.

          • BeatriceC

            MrC started singing about unicorns in a medication induced haze. He vaguely remembers that. I remember it vividly, and still giggle about it.

          • rosewater1

            A friend of mine, during labor, said there were elves and Disney characters standing around her bed. She had quite the conversation with all of them. She said afterward, “I think the staff was laughing at me.” Ya think?

          • Mariana

            With my first csection I was afraid I would float out of the tiny glass pane on the wall of the OR, and even told my doctor “oh, I’m glad you had the nurses tie my arms to the table (I had an IV and a pressure cuff), or I’d just float out of here…”. She looked at me funny and wasted no time getting the baby out of me. I was tripping the whole time (and it was only an epdural). Then last month I had my tonsils removed. When I came out of the anesthesia the doctor asked if I was in pain, and I said “yes, I think you left the X-ray film in my throat, I feel it stabbing me right here, it hurts really bad” (it hurt really bad and I was sure I had swallowed a small X-ray film, like the one used by dentists). Thankfully he could get past the bizzare notion of me having eaten the X-ray and recognized I was in a lot of pain. He quickly called the anesthesiologist and asked for more morphine. It was such a relief when that horrible pain went away.

        • FallsAngel

          My dad was sure some aliens were locating him via radio waves. When the nurses asked him where he was (to assess mental status) he would give the name of the wrong hospital so the radio wave people wouldn’t know where he was. He told us this later.

  • Amy Tuteur, MD

    Postpartum floors are noted for their poor nursing care. The nurses have little experience managing complications. The old joke is that the best thing about the postpartum floor is that it’s located NEAR a major medical center.

    • momofone

      I was fortunate not to have any complications after my son’s birth, but I had a postpartum nurse who was annoyed that I didn’t want the pain pills she was offering*, not necessarily to use then, but “you know, I always accept them even if I don’t need them–you can save them up and use them later or give them to someone else who needs them. I like to keep them for my husband. (Wink)”

      *Tylenol was doing fine for pain management

    • BeatriceC

      The more of these stories I read, the more I realize how extremely fortunate I was to be pregnant in the city I lived in at that time. While it wasn’t official or anything, my hospital had a corner of L&D that was reserved for antenatal/high risk patients. Several of the nurses there had been worked in ICU’s previously and were the ones typically assigned to those rooms. I really didn’t realize this wasn’t a common set up until I started following your blog and reading more about the state of maternity care in the US.

    • FormerPhysicist

      Even in a pretty damn good hospital in Boston suburbs, I still had a nurse take me off the monitor because it was uncomfortable for me when I asked her to re-adjust it. Idjit. I’d been admitted at 11 pm two nights before a scheduled c/s so the doctor could do the c/s in the morning because my body was showing signs of pre-E. Yep, 2 hours later I buzzed the nurse, yeah, I”m in full labor. Had to call my OB in at 4:30 am instead of 7 am or 9 or whenever it was supposed to be.

      I think my OB reamed out the nurse. And she should have.

    • Therph

      Because the pharmacist shouldn’t be the one pointing out the patient needs an ICU transfer…

      Post partum RN called me since the patient’s systolic blood pressure was in the mid 50s, convinced it was a medication reaction from something received during section. She didn’t even think to start fluids until I asked which one was hanging due to concerns of medication compatibility, and pitocin had been turned off due to her worry it was also contributing (?????WTF). Hemoglobin had dropped several points in a handful of hours. Yup, internal PPH.

  • Empress of the Iguana People

    Jays, that poor woman. Glad she’s doing better now, but for a less healthy, less well known woman?

    • Caylynn, RD, MPH

      That’s what I was thinking as I read this. What would happen to a woman who was less able to advocate for herself? Or who staff would not have listened to at all?

      • Roadstergal

        She’d likely be a statistic. It’s horrifying.

    • attitude devant

      I think that famous people often don’t get very good medical care and that the reasons for that are complex. If you read Gilda Radner’s memoir, she was always on the move and getting catch-as-catch-can visits, often with fairly quacky providers (coffee enemas were involved) so it’s small surprise her ovarian cancer was symptomatic for a long time before it was diagnosed. Sometimes they choose hospitals because they will accommodate their entourage or it’s close to where they’re hanging out rather than for the excellence of the staff. Olympia was born in West Palm Beach. It’s been a long time since I lived in Florida but I don’t think that’s exactly the best OB unit in the state.

      But then again, I wasn’t there, so I’m only speculating. I’m just glad she’s ok. She’s a figure of near-mythic stature to my daughters.

      • BeatriceC

        It hasn’t been all that long since I lived in South Florida. And Miami-Dade county is where I lived when I was pregnant and I had absolutely top notch care. I’m pretty convinced if I was anywhere else both I and YK would have died. Editing because I forgot the point of my post. Anyway, Miami Dade has some amazing hospitals along with some shitty hospitals. Broward has some really good ones too. Palm Beach has good, but nothing particularly special, at least as of five years ago.

        • attitude devant

          You delivered at Jackson Memorial?

          • BeatriceC

            For one of them, yes. Also had care at South Miami and Baptist until they decided I was too complicated. Jackson is terrible if you’re only a little bit sick. But if you’re critical, it’s the best place in South Florida.

  • mabelcruet

    What’s very scary is that Ms Williams must be supremely fit with phenomenal respiratory and cardiovascular reserve, which may have helped her a bit. Any ordinary mortal may well have succumbed quicker. And from what I’ve seen of her, she’s confident, intelligent and very well spoken-someone with less insight, or less able to verbalise their concerns, or who trusted the nurse without question, or who wasn’t confident enough in their own conclusion or confident enough to keep pushing-that sort of person (which is more like the rest of us) may have received a poorer standard of care, or no care at all.

    • kilda

      if she wasn’t famous, would she have gotten the same standard of care? Doubtful. If she was a lower middle class black woman with lousy medical insurance, would they have listened to her at all? She’d be dead. Someone definitely dropped the ball here, because this was a very forseeable complication and the patient shouldn’t have to be the one telling the doctors what to do about it.

    • Sarah

      In addition, she’s someone with huge financial resources. She could’ve thrown as much money as she wanted at her obstetric care. And yet something like this happens. Terrifying.

    • guest

      When I worked at a local hospital, we’d have weekly meetings to discuss the notable preventable patient deaths and injuries that had been reported around the country, and talk about action plans to prevent things like that from happening in our own hospital. Strangely enough, many of the worst cases we discussed were from small private hospitals and clinics that were only available to the very wealthy. Many simply did not have the same safety protocols as other hospitals, and the staff were less experienced.

      Often these places were so focused on promising a celebrity or VIP a 5-star hotel, spa-like experience that they paid no attention to whether or not they actually had the resources to properly treat the patient.

      Really, if you are in serious danger or dealing with trauma, you are much better off rooming with the homeless guy at the county hospital, where you will see the most experienced surgeons and nurses who deal with crisis all day, in an environment that is subject to regular inspections and audits.

      • mabelcruet

        Yes, I agree with that. There was a case in the UK of a man who died following routine hip surgery and a surgeon, David Sellu, was initially imprisoned after being found guilty of gross negligence manslaughter. The conviction was later quashed on appeal and it was discovered that the private (non NHS) hospital where the patient died simply wasn’t set up for severely ill patients or emergencies, and hospital management had failed to disclose a lot of evidence of their poor facilities and poor staffing at the trial.

      • Doll Parts

        Joan Rivers died in one of those places.

  • MaineJen

    Absolutely unacceptable, for Williams or for anyone else. The NCB rhetoric of “everything is fiiiiiiine” has absolutely pervaded modern OB care, to the point that we’re pooh-poohing the legitimate medical concerns of people who KNOW their medical situation, and KNOW the care they need. Those nurses need some re-education stat.

    • AndreaRealMPH

      Here, here. My personal experience is that when people have had certain conditions for years whether they were/are pregnant or not, the immediate drug regimen tends not to have a huge effect on their perception of “hmmm I’ve felt X before and Y worked, let’s ask.”

    • Steph858

      Whatever happened to the NCB rhetoric that ‘Women know their own bodies much better than doctors’? I guess that’s only true when the women in question are asking for herbs, crystals or unicorn farts; any woman who asks for real medicine/treatment can be safely dismissed as ‘confused’, ‘overreacting’ or [insert woo code for ‘hysterical’ (the old-timey ‘wandering uterus’ diagnosis, that is) here].

  • Daleth

    Why on earth hadn’t her doctors already prepared a protocol for this before she went in for her c-section? They knew she had a history of blood clots. That’s why she was on Heparin. And they knew she was off the Heparin in preparation for her c-section. WHY WHY WHY didn’t they just decide in advance, “Ok, if she develops symptoms of a PE, she needs immediate Heparin and a CT scan”?!

    • mabelcruet

      It sounds like a complete failure of communication-surely with her history she was referred to a specialist obstetrician, or do the respiratory/general medical physicians not talk to the obstetricians?

    • kilda

      exactly, this is why I say someone clearly dropped the ball here. This was a complication that couldn’t be prevented but should have been anticipated, and a contingency plan ready to go.

    • PeggySue

      I spoke to a woman the other evening–highly intelligent, an engineer, white woman–all positive factors for being heard–who finally had gall bladder surgery. She had a TWO YEAR history of developing intense abdominal pain, being sent to the ED, being screened out for anything like a AAA or a bowel obstruction or cardiac, being given pain meds and sent home. She didn’t know what was wrong, but she knew it was a pattern, so finally she said to her doctor on the last episode, “I’m sick of this, it has been coming back for two years now, there has to be something wrong, can we find out?” Her doctor said, “Oh really? I didn’t realize that.” THAT is the provider and the EMR, the EMR apparently doesn’t show much of history, and most providers and staff DON’T READ THE NOTES from prior visits or other writers, because they have no time. And I have heard that directly from providers and their staff. So, the patient has to remind their own provider of their own medical history, their pre-existing problems, etc., etc. Which many patients don’t really understand. It’s stupid.

      • BeatriceC

        I was practically housebound and labeled a drug seeker for repeated trips to the ER with intense abdominal pain. After about a year and a half I finally went to a different hospital group and they discovered my gallbladder was a disaster. Then six months later I had appendicitis. That was not a fun year.

      • Dr Kitty

        That is one benefit of the NHS GP. You’re the spider at the centre of the web.

        We get all the hospital letters.
        Part of our job is to read them and put together a big picture.

        For example- if one of my patients goes to several different ERs over a two year period with cuts, bruises and broken bones I’m going to want to have a chat with them.

        It’s either domestic violence, or a drinking problem. OK,
        once it was roller derby, but that’s the exception!
        I wouldn’t expect the ER doc seeing them to pick up on multiple attendances at various ERs, particularly with a “walked into a door” story.

        For my patients I usuallly have electronic notes going back 15 years in front of me, and paper records going back to birth in my file room downstairs.

        • PeggySue

          I should clarify that the EMR certainly will produce the prior history and I, for one, always perused it; what is true is you have to specifically look for the notes, and often people don’t. The focus is on what’s in front of them–current test results etc.

      • Who?

        My daughter had a similar year, had her appendix out (the pain was in the spot that makes doctors think of the appendix), was thoroughly investigated for kidney/bladder trouble, and ultimately found to have h.pylori. An easy fix for what was an apparently complex problem.

    • swbarnes2

      Should they have put her back on heparin after the surgery, or was it medically sound to leave her off it for a bit while she was recovering?

      (EDIT I guess she was in the 24- hour recovery period where she should not be on the drug)

    • FallsAngel

      Now isn’t that a good question, instead of blaming the nurses. And to be fair to the nurse, to talk about needing a CT and heparin is a little strange, too.

      • fiftyfifty1

        ” And to be fair to the nurse, to talk about needing a CT and heparin is a little strange, too.”

        I agree it was the doctors’ responsibility to have a plan in place. But to say “I can’t breathe, I am having a PE, I need a CT scan and heparin” is not even a little bit strange. A PE is a well known medical problem that every nurse has learned about during training.

        • FallsAngel

          According to the article, here’s what she said (not a direct quote) “She walked out of the hospital room so her mother wouldn’t worry and
          told the nearest nurse, between gasps, that she needed a CT scan with
          contrast and IV heparin (a blood thinner) right away. The nurse thought
          her pain medicine might be making her confused.”

          She didn’t say she was having a PE (according to this article). Of course, we really don’t know what was going on, this is not a first person article.

      • AnnaPDE

        From a patient who is struggling to breathe and seems to be aware of her own medical history? Not really.
        And if said nurse does find it strange or not something she can reliably deal with, the simple answer is to escalate it to a doctor who can, not to just go “don’t worry, you’re just a bit confused”.

        • FallsAngel

          There’s no evidence that’s what the nurse said.

      • Daleth

        Why’s it strange?

  • The Vitaphone Queen

    Oh sweet niblets, baby Olympia is SOOOOOO ADORABLE!!!

    • sdsures

      I know, right????

    • Roadstergal

      The photographer captured a great ‘go get ’em!!’ moment from her.

    • mabelcruet

      She’s hit the jackpot when it comes to her parents-Serena is gorgeous, intelligent, driven and a superb athlete, and her father is the same (maybe a little less athletic). Olympia for President 2058!