An ER Advocacy Story

I had fallen asleep mere minutes earlier, when my sister Julia appeared at the side of the bed where I was sleeping at my parents’ house. I had driven across the country to be nearby for our sister Abby’s birth and postpartum.

“Meredith,” I startled awake. “Abby is having severe sudden pain in her abdomen. She’s crying out in pain.”

I ripped off my mouth tape (raise your hand if you resonate), and I stammered out, “Tell her to call her midwife.”

My sister wasn’t in labor. She had given birth 3 weeks prior. Her husband was now out of town for work, and Julia had been staying with Abby at her house, a block from my parent’s home.

I jumped out of bed and pulled on my clothes. I grabbed my keys and headed out the door as I called my sisters for more information. The midwife hadn’t answered, but there was no question, we were headed to the ER. Julia packed the pump for us to take, calmly took the baby and the (blessedly already pumped) milk and sent us on our way. My dad joined us.

On the drive I asked Abby about what she’d eaten; about whether she’d had any swelling, blurry vision, or headaches; about her bleeding; about sensitivity in her vagina or perineum. Everything had been normal. The pain was in her upper abdomen and making it difficult to breathe. (It seemed safe to rule out her uterus. Was it referred appendicitis pain? Gallbladder? Food poisoning?)

The ER was quiet. Too quiet. A short quiet line of quiet patient people stood before the quiet empty admission desk.

“What if we need to be seen more urgently?” I asked the security guard.

“You have to be like, eeehhh, I’m dying!” he answered.

Blinking, I said “Thanks. I’ll let you know then.”

Abby was pacing, the only thing to relieve her pain. Bending in half helped a little. I chatted with my dad and read the notice posted to the wall that yelled “It’s the Law! Es La Ley!” informing patients of their right to be treated in an emergency or in labor, even if they can’t pay. “That’d be the Emergency Medical Treatment and Labor Act,” I proudly flaunted my knowledge of federal law to my most beloved lawyer. We talked about advocacy and he said, “There’s no one I’d rather have with Abby right now than you.”

“I don’t know everything,” I said.

“That’s the thing about being an advocate. You don’t have to know everything. You just have to be someone who’s on their side.”

I was genuinely touched, but joked, “Wow dad, can I quote you on my patient advocacy website?”

“Only if you cite me as ‘Meredith’s Dad.'”

Finally a nurse showed up at the station and checked in the two people in front of us. Our turn. I had previously asked Abby if she wanted to speak for herself, or if she wanted me to speak for her. She said I’d have an easier time of it.

Patient advocate hat on. I smiled and approached the nurse desk with an air of urgency.

“Hello! My sister gave birth just over 3 weeks ago and is having severe abdominal pain and difficulty breathing.” I  banked on being seen more urgently if I cited her recent birth. I gave the nurse the other relevant details and she sent us to the waiting chairs. 

Ten minutes later I returned, “Hi! I know you’re busy tonight. My sister’s pain is worsening. (It was.) What can we do to get her seen more quickly?”

This nurse, like most nurses, really wanted to help us. She said, “Let’s get you started with this” and handed me a urine sample cup. Abby took care of that and we were immediately called back to a room.

I started my notes in my phone: every practitioner’s name, every test, every recommendation, every drug, every follow-up question.

The PA offered morphine. “You’ll have to pump and dump,” she said apologetically.

“Are there any non-opioid alternatives you can offer? She’d like to be able to breastfeed,” I explained. 

“Sure, we could do IV Toradol.” If you don’t ask about your options, you don’t have any.

An ultrasound found our culprit: a small gallstone, which had been temporarily stuck in a biliary duct causing a painful colic. Over our few hours in the ER, the pain entirely resolved as it had made its way out again.

What we learned that night is that two of our aunts, and our sister-in-law, had all similarly developed gallstones after giving birth. This is my thirteenth year as a birth professional, and I did not know until now that postpartum women are at higher risk of gallstones! This is supposedly due to hormonal shifts and possibly to sudden weight loss, causing the liver to release more cholesterol into the bile and impacting its ability to empty.

Our advocacy work continued that night as we asked the PA our questions, including what we should be watching for at home, and how we should know if we needed to return to the ER. I’ll spare you her exposition on the gallbladder as a completely useless, optional, superfluous, impractical, unhelpful, unwanted organ. (Note: because I disagree.) She had done the work we needed her for—a diagnosis and pain relief. And we were grateful! One week later, Abby has had no new pain.

And I am grateful. To have been able to be with my sister through every joyful or shocking twist of her matrescence. To have been trusted as her advocate. To have learned from good men like my dad and good women like Alicia how to advocate.

And very grateful for the little gallstone that backed its way out that night. One birth is enough for this month.

Always, Meredith

Read about how to become a certified Perinatal Patient Advocate.