158. Stream of Consciousness

40-something Cynthia came in to talk about pelvic pain, but the usual questions about pain (exactly where, what triggers, how long, how disruptive) were soon sidelined by the following:

I'm unemployed... I just found out he's addicted to pain killers... I'm impatient with my daughter... He's kind of abusive... I don't want to go to hell.

157. Update on Helena: a tough call.

Looked good for a few days, with baby now head first, mom could look forward to a vaginal delivery (she has enough problems without having to recover from an operation).  But the baby turned around, and the doctor on call that day was concerned that another "external cephalic version" (the process of apply gentle pressure on the abdomen to turn the baby) could disrupt some uterine-placental vessels, allowing mom's HIV to transfer to the baby.  Helena's viral load (the technical term for the amount of HIV in her blood) was very low, her HIV well controlled by medications.  Low but not zero, so the doc's concern was justified.  So he recommended and performed a cesarean.  A tough call.