Strawberries

I am seeing a patient in the office who I should not be managing. And I’ll tell you why. It’s not because I am totally incapable of handling her. It’s not because I am incapable of learning how to care for her with the help of a doc who would be co-managing her with me. It’s not because she is now 30 wks pregnant, she has a BMI of around 50, (She literally said to me at her last visit, “Do you need me to help?” and then proceeded to lift up her heavy pannus so I could wedge the Doppler against her uterus to try to find her baby’s heart beat. It consistently says in her record “unable to determine size of baby by leopold’s d/t body habitus”), not because she has GDM and her blood sugars are through the roof, (though, on a positive note, she is consistently reporting them to endocrine). It's not because the list of risk health risk goes on and on. The main issue is that her care has been thoroughly inconsistent throughout her pregnancy. She has seen a doctor twice in her entire 30 weeks and she has seen a different midwife every single time she has come for a visit. Management plans have been made for her but not followed through on. There was a plan in her problem list to see someone from MFM between 28 and 30 weeks and she is now 30 and 4 and the MFM appointment was just made for mid March. The doctor who is supposed to be co-managing her is out of the country until the end of the month and now, because I have more space in my schedule than anyone else in our office, her next 5 visits are with me. So here I am, muddling through her problem list and hoping another risk factor doesn’t pop up and wondering if anyone will listen to me and not just think I am complaining if I tell them that I think she should be taken care of by someone other than me. I did actually mention it to the chief doc today at the hospital and she asked me to send her the chart. I’m hoping she agrees with me and helps to structure this patient’s care so it is a little less…disorganized.

Even more importantly, I saw the patient yesterday for a routine visit. She told me she was feeling the baby move, hadn’t had any bleeding or headaches or leaking of fluid and then she politely lifted her tire of fat for me. And then the weirdest thing happened. She started talking about strawberries like I have never heard anyone talk about strawberries. Here is a sample of what I heard:

Me: How have your blood sugars been?

Her: They’ve been good. Pretty good. Normal I guess. But you know what I’ve noticed? Whenever I have strawberries they go up. And I don’t even like strawberries! But I eat ‘em. My husband, he love strawberries. He do. He could eat strawberries every day of the week. Me? I like grapes. All kinds of grapes. Red ones, blue ones, green ones. I could eat grapes all day long. But strawberries, I don’t like ‘em. But when I’m pregnant, I eat em. And when I was pregnant with my son…I ate ‘em then too. And now, my son loves strawberries! But I don’t like ‘em. Unless I’m pregnant. Isn’t that odd? Have you heard of that before? Eating strawberries when you don’t like’em?”

Me: I’m…not…sure.

Her: Well, I’m just so excited to see if this baby likes strawberries or doesn’t.

I just did not know what to say. She would not stop talking.