Grandma   Marla   Julie   Carol

My patient Julie had just delivered her second child and the placenta came out whole, but she continued to bleed profusely. The year was 1987. I tried to massage her uterus one hand inside of it and another on top, but she would not stop bleeding. There was pitocin in her IV fluid, a drug given after childbirth to keep the uterus firm. I doubled the dose and had it running faster. But there was no response. I then told the nurse to give Julie a shot of methergine, a medication that is supposed to help the uterus clamp down. Still no response. She was given another shot of a stronger medication. Again she continued to bleed. Desperate, thinking that there may have been some small remnant of her placenta, I used a large curette to explore her uterine cavity.

That was when my intuition kicked in.

“You are harming her,” was the message. “Instead, clean Julie, take your gloves off and continue to massage her uterus from above just like the nurse was doing.”

I removed my gloves with trepidation and massaged her. By then, the nurses knew not to ask questions when I was doing something out of the ordinary.

At first, I smiled at Julie and told her not to worry, that everything was going to be okay. I held her right hand for a while, and wiped the sweat off her forehead with a small towel.

Julie’s uterus was still soft, as big as a large watermelon. As soon as I started to massage it, it started to firm out.

Then I felt I should change into my street clothes and go to my office because Julie was going to be okay.

How could I leave a post-partum patient still bleeding and leave? My intuition was so convincing, and when I looked into Julie’s eyes I could see that she was going to be okay. Sometimes, the more a doctor may want to intervene, the more harm can happen to a patient. Like in a trance I left the delivery room, went to the locker room, changed my clothes, walked to my car, and drove to my office.

My heart would not stop racing the further I went from the hospital and the closer I got to my office. When I arrived, I ran to the phone and asked to be connected to Julie’s room.

“How is she? I asked the nurse.
“Oh, she’s fine,” was her answer. “Her uterus remains firm and her bleeding is now a small trickle, normal for a postpartum patient.”

Carolle Jean-Murat, MD, FACOG

Grandma   Marla   Julie   Carol