Back in the days before RRC limits, 36-plus-hour shifts were quite the norm. I recall during my PG 1 year, on the tail end of a marathon shift, I picked up a chart with chief complain: “23 yo female – aspirin OD 4 hours ago, depressed.” As I continue to date myself in these columns, I’ll add that among the common OD drugs back in the day were aspirin and phenobarbital with a gastric lavage chaser.

Entering the room, I met a pleasant looking young lady, a little like the actress who plays Bones on the TV show. Trying to be as compassionate as I could muster in my sleep deprived state, I asked what was going on in her life. She said, “No one cares about me. My boyfriend ignores me much of the time; people at work barely talk to me. My family, who lives out of town, never calls. It’s just like I don’t exist.”

At that moment, physiology reared its nodded-off head and before I knew it, I was jerking out of a momentary LOC. My eyes caught her just staring at the floor, and she would no longer talk to me. I felt so guilty that I actually visited her during her inpatient stay and had the chance to apologize and offer encouragement. At least, as of a year later, the psych resident caring for her reported to me that she was doing well.

Like seeing this patient at the wrong moment in time, many an emergency physician often has a level of angst when managing a pregnant patient’s higher-acuity illness. This month’s section targets acute respiratory infection during pregnancy. As with our other topics in this series, we will attempt to unravel the complexities of acute medical illness, amplified by the altering variables of the gestational state.

As core measures were spliced into the hospital process DNA, I like to joke that the most common organism causing pneumonia is “staff.” Much of the evidence-based [or baseless as the case may be] practices we follow have rarely been validated in pregnant women. So we offer, in our column, what we believe to be one rational approach to managing CAP, influenza, and varicella pneumonia in pregnancy. Our mottos:

“Fools ignore complexity. Pragmatists suffer it. Some can avoid it. Geniuses remove it. Simplicity does not precede complexity, but follows it.”
-Alan Perlis