The Clinical Alarm Was Ringing — No One Listened

How Adriana Smith’s fatal headache reveals the cost of dismissal, delay, and missed judgment in maternal care

There are patterns clinicians are trained to recognize.

And there are moments we’re trained not to ignore.

A pregnant patient with a headache is one of those moments.

Not because every headache is dangerous—but because when something doesn’t fit, you have to stay curious.

You have to listen.

You have to know when it’s time to stop looking for reassurance and start looking for the rare thing that could kill her.

That’s what clinical judgment is.

And it’s what Adriana Smith didn’t get.

🚪 The First Visit Should Be a Door—Not a Dead End

Most pregnancy headaches are benign—tension, hormones, dehydration. But when the pain is new, intense, and unrelenting? That’s not routine.

Unrelenting Pain Needs More Than Tylenol

(And why trusting your neuro exam might not be enough)

When a patient walks into the ER with a severe headache, the first thing I assess is the pain—but not through a 1–10 scale.

Pain scores flatten what we need to expand.

Instead, I ask:

• When did you last eat?

• If someone hasn’t eaten in over 24 hours, that’s not routine—it’s a sign that the pain is intense enough to override basic drives.

• What did you do while waiting?

• If they say, “I sat stiff as a board, afraid to move,” or “I couldn’t even look at my phone—it hurt too much,”

• That tells me we’re not dealing with garden-variety tension or migraine pain. Something more serious may be unfolding.

🧠 In the Setting of Headache, Neuro Exam Is Key—But Imperfect

Once I’ve registered that the pain is severe and out of proportion, I move to the neurological exam. Because the question now is:

Could this headache be the first sign of something catastrophic?

But here’s the catch: