Meeting with Hospital Administrators

Four months after my non consented surgery, I complained to the hospital.

I sent a really long email to the Patient Advocate, who I actually know a bit personally and have worked alongside. Having formerly worked at the hospital I birthed at gave me a fortunate inside understanding of who could process complaints and who to go to if they were ignored. It was unfortunate in the way that it made relationships extremely awkward in a small town.

After I emailed the advocate, I didn’t hear back… for weeks. During these three or four weeks I followed up with voicemails and emails on her work phone and work email address as well as texts to her personal cell phone. Finally, about a month later, she answered, citing a personal reason. At the time, I believed her, but after meeting with her, where she asked me to retell my experience, I didn’t hear back from the hospital for another two months.

The person in charge of L&D and the ER Department was the next person to call me.

She was the same person I spoke to before I gave birth, upon the Patient Advocate’s suggestion, when I had original concerns about delivery as a person who was sexually abused as a child.  That conversation seemed very far away, and very different. That conversation took place in the Fall of 2016.

Back then, the administrator seemed like she really wanted the birth experience to go well for me and told me she would meet with her nurses about “my situation” and that I just need to remind the nurse that is assigned to me when I come in to deliver to ask my consent, as I have a history of abuse.

This should have been a red flag. Instead of the nurses already having a culture of informed consent, she was placing the responsibility of informed consent squarely on my shoulders – something that is legally their job. That’s right, she asked me to remind her employee to do her job.  And that is how this administrator, I learned after delivery, approached her work: she sees pretty much everything as the patient’s responsibility.

This is obviously a problem when of course a) it isn’t the patient’s responsibility, and b) to complicate matters, the patient is in labor, and not really in the strongest state to advocate for herself. I don’t say this to at all imply that laboring women are weak – obviously the opposite, they are indeed extremely strong – but laboring a lot of times takes all of a woman’s energy, focus, and attention. It is all-consuming. Especially, during transition, when I entered the hospital. This woman actually expected me to have an in-depth conversation at that point with my assigned nurse about informed consent. I was concentrating so much on contractions one on top of the other that I could hardly catch my breath, let alone assert and negotiate with a nurse about my rights to my own body. It’s like trying to negotiate after a car accident where you lost a leg and are losing a lot of blood. That’s the kind of fear that was coursing through my veins during a first birth at this tiny hospital in the dead of winter.

So, this woman, we’ll call her K, wanted to meet with me. We agreed to go over my daughter’s heart rate strip before the c-section. K told me that she “would not lie to me” and that she would “tell me if the doctor could have waited” to see if I needed a c-section.

As soon as I sat down in K’s office, at this point, 7 months postpartum because of my months of PTSD and the Patient Advocate’s and hospital’s delay, she launched into a phony apology for my experience. It went south from there.

She took out a copy of my baby’s heart rate reading. The first few hours had been held by a doppler by my husband, as I was on my hands and knees, and they apparently didn’t have enough nurses on available to hold it. So my husband did their job, while they left me alone for hours. This to me communicates that the job of getting fetal heart readings is not very important in practice, but is required by policy. If the job was so important, of course they would only let a trained nurse do it, right? Fetal dopplers commonly mistakenly pick up the mother’s heart rate instead of the baby’s and make them pretty unreliable. In addition, these readings were VERY spotty, and missing minutes. Interestingly, no one was concerned about this from about 10:30pm to 2am, my only laboring hours in the hospital.

And of course, no one at all was interested in the non existent heart tracings from my nine hours of labor prior, at the movie theater, in my living room, and in my bathtub. Because that wasn’t on their watch.

The last few minutes of the heart rate strip were from the internal fetal monitor, screwed onto my baby’s head against my wishes, without my consent – and frankly, from my birth preferences, against my consent, after the locum on-call doctor whom I had never met broke my water, also against my consent. My doula stood silent, and my husband watched. I seethed in anger, in an unfortunate drugged delay, fighting to stay awake and not pass out from dizziness from the double dose of Fentanyl. I tried to lift my head and make eye contact with everyone, but no one looked at me. They all looked down between my legs.

K said she had a nurse print out the strip and that the nurse had made some kind of sound and said that she would have also recommended a csection. I asked why. This is where K had quite a lot of trouble explaining.

She couldn’t tell me how long a decel had to be and at what heart rate or how many decels until a c-section was called. There was no policy, “no magic number,” she said. That means, that if another woman had gone in and her baby had the same heart rate strip, that policy does not dictate that she would for sure have had a csection. Which means that my csection was a subjective decision, without my consent.

This was disturbing to me, as not only had I asked specifically in my birth plan for a second opinion if a csection was recommended. Of course there was no second opinion, and no one on staff able to offer one as the locum doctor was the only one there…or so I was told. (I found out later that my OB and another were both in L&D hours before I delivered, and perhaps during my delivery, helping another woman that I met at a library play group avoid a csection by turning her baby.)

My csection had not been treated as a recommendation, but as something that they were going to absolutely do to my body, whether I wanted it or not. It was this scenario that gave me nightmares for months, and of course re-traumatized me and brought up core beliefs I had developed being abused as a child, such as: my body is not mine. People can touch and violate me at their whim and there is nothing I can do to stop them. That’s a pretty disturbing core belief, one I learned to believe when I was about five years old, and again at seven. Again, from my forced surgery, at age thirty-three.

I asked why other women who have multiple decels are not given csections. I had met many of these moms in local mom groups who were treated at the same hospital. She couldn’t tell me. She said they were looking for late decelerations that come at the end of contractions, as those are dangerous. I asked if I had those. Well, no, she admitted. Was my decel particularly long? She said it looked to be about 4 minutes. In my chart it was written as 6 minutes. Was it exaggerated to justify the doctor’s decision to operate on me? Again, she said, there was no magic number.

I remember how ready everyone was for my surgery. That they rolled me into the surgery room and everyone was waiting, scrubbed up. They immediately lifted me onto the table. But not rushed. Nothing was rushed, but getting me there happened quickly. The distinction is important. It was done quickly, but not as if it was an emergency… more as if they had to get it done and over with. Like a job. Like a very busy day at the office. The surgical team, except for the surgeon, was silent. And it seemed to me, a little reluctant, or confused. Definitely tired. Perhaps, resigned to a plan that they had long ago agreed to go through the motions with.

This to me all percolated in my head into one big scream: this doesn’t need to happen! I knew, even before I could verbalize it, before the feeling formed to thought – that there were other motives at play here, and my and my baby’s health were not the motivation.

As soon as the surgeon took her place at the end of my cold metal table, she looked relaxed, smug, triumphant. She said, “You can’t control everything, Sara.” She said it unkindly, with a sharp “I told you so” tone. “Sometimes you just have to let go and let God.” Then she was silent as she sliced into my body. She didn’t speak to me the rest of the surgery, or after she pulled my daughter out. She left without looking at my face, or making eye contact, or saying anything. I didn’t even see her for a day or two. I could feel the discomfort of everyone in the room. Someone told me in a sweet, cheery voice that they were going to shave me now. I almost laughed. I might have rolled my eyes. Why was she telling me this? Why would I care, when I was about to be violated in the worst way possible, someone cutting me, reaching into my body, and pulling out my baby, who I wanted to push into the world? It was ludicrous. No one was on the same page. It was 2 a.m. on the Saturday before Christmas. Snow was falling lightly outside. The roads were icy from multiple snow storms. Everyone wanted to be at home in bed. Especially my surgeon.

Strangely, K didn’t mention the prior decel that had happened minutes before that had caused my nurse to originally panic and call in the doctor. The decel that recovered before my doctor entered the room and right after she had overdosed me with Fentanyl and I had been given an epidural. Was it even in the chart? I asked her, and she looked. She said it was hard to read before they placed the internal monitor. That the dopplers pick up the mother’s heart rate a lot. I told her I thought I was supposed to only be monitored 20 minutes out of every hour anyway, per policy. She said they might have been so busy that the nurse just placed it and left so she didn’t have to worry about returning to the room every hour. That sounded lazy, and like a staffing issue to me.

Then she told me that the month of December they had had an infant death in L&D and the staff was anxious, that it had been a hard month. There was an influx of births that they had been unprepared for. She said she kept coming in to the locum doctor on call and would ask her staff what they were doing there and that they said they were short staffed. This is coming from the woman who was supposed to be running the department.

As if all of this wasn’t unsettling enough, she crossed the line into my personal business. She told me that my perception of what happened was probably “vastly different” than that of the staff that night, because my “hormones were out of whack” and the nurse had drugged me (her words, and she laughed and slapped the table as she said this). She told me that I had been holding onto this for a long time, and she narrowed her eyes at me and lowered her voice as if she was scolding me like a small child. She told me that I needed to let it go for my mental health. She told me patronizingly that she was concerned for my mental health. She told me that she had two daughters who had also been sexually abused as children and that she had been in an abusive relationship. One daughter has gotten over it, she said proudly. But the other, and here she made a face of pity and disgust, the other is still stuck in this victim position. She said she didn’t want me to get stuck here. That it was time to move on. What did they have to do for me to let this go, she asked? Is there anything else they can do?

I was horrified at her unprofessionalism and incompetence as an administrator. As someone no doubt sent to interfere and try to mitigate a possible potential lawsuit, she had just spoken to me like a child and revealed extreme incompetence in her ability to manage an L&D department. I told her I didn’t want what happened to me to happen to anyone else. I told her that she had suggested I share my experience with the staff the last time we spoke.

“I don’t know if that would be beneficial for both you and my staff,” she said, and looked at me cruelly. Uh huh. I asked her what she meant. She repeated her line. I stared at her.

The meeting had gone nowhere, fast. I looked at the clock. Well, I need to get back, I told her. I reached for the heart rate strip copy. May I take this? She laughed. “No, unfortunately I can’t give that to you. I would get in trouble with medical records.”

After this meeting, I emailed the Patient Advocate and told her some of the inappropriate things that K had said to me. I told her I knew I had a legal right to that heart rate strip and asked what I had to do to get it. I didn’t hear back for a couple weeks from the “advocate,” –  after I had called Risk Management and told them I was looking for the investigation letter that I had never received and that I wanted that medical record.

The new person in Risk Management got me the record within two weeks. She spoke to K, who told her that my strip would be hundreds of pages. When she printed it out, it was about twenty.

I’m not naive, I know the hospital is not my friend, nor my advocate, nor on my side. But as a customer who paid thousands out of pocket for the birth of my child, I expected them to at least pretend they had my health interests at least somewhat at heart.

I knew it was going to be a long and rocky road, but I pressed on.

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