After being a Labor and Delivery nurse for a million years, panic does not factor into your work. In fact, I hate panic and everything that goes along with it. So, if you're going to panic, you are guaranteed to see me going in reverse, just to even things out. Panic does not get things done. Rational thought and purposeful action does. I had a perfect example of this yesterday.
The family had clearly conveyed their panic to the ER staff who was running down the hallway with the woman in a wheelchair, the family milling around, about to be run over.
"Please don't run in the hallway!" Just like in kindergarden.
They pull up to the Nurses' Desk and the Grandmother shouts something in a very very strong accent. Now I've travelled the world, I speak a couple different languages and understand a couple more. I had no idea what she said. I thought I heard the word "HURTING," though. The patient was invited to get up out of the wheelchair to fill out some paperwork. She moaned and squirmed. Now there are two type of moans and squirms that you quickly come to recognize. There was this kind which would be better translated as "Can someone please give me some attention" and then there's the real kind. We stood there expectantly. Her husband actually reached over a lifted her out of the wheelchair. Then her sister snatched the paperwork and began to fill out the 2-3 lines. As she is doing this, the Grandmother pipes up again: "WE GO TO RRRRRRRRRRROOM! WE GO TO RRRRRRRRRRRROOM!"
"Ma'am. Please keep your voice down. There is no need to shout." I take the paperwork from the sister and give it to the patient. "Please sign this consent for treatment."
I escort them to their room, give her a gown to change in to and show her where the bathroom is. "I can't! I can't!" the patient exclaims loudly.
"I'm sorry? You can't what? You can't go to the bathroom?!" I ask. She is flopping on the bed, acting like a dying fish. I'm going to ignore that. Her family is hovering, touching and chattering. "Please change in to the gown. I will be back shortly."
A couple of minutes later, I returned to assess the patient. I begin by asking her what brought her to the hospital. The sister began telling me about the patient's recent vaginal discharge. I interupted her: "She can tell me." Surprisingly, the patient could talk! She told me why she had come in and what she was feeling. I connected her to the monitors and examined her.
"Ok! You are one centimeter dilated." There's a surprise. "Since you really haven't changed from your last office visit, you are not in labor. But let's watch you for a little while to make sure the baby is fine and to see what your contractions do." She looked at me in shock, but agreed.
Over the next 10-15 minutes, I watched the baby and quickly decided that it did not look good. A pattern was developping that could indicate stress. I told the patient and her family what I was seeing and what we were going to do about it. The family was hovering over the bed, their nervous energy filled the room. Excuse me please! They didn't even have the sense to step back and let me help out the patient. I had her lie on her side to maximize bloodflow. I put on an oxygen mask to deliver more oxygen to the baby and I started an IV. I love starting IV. It's my favorite thing. It went in easily, but the patient began complaining of pain at the site. The family continued to hover. Grandmother muttered something under her breath. "I beg your pardon?" This time she said it loudly. I have no idea what she said. "I'm sorry I didn't understand what you said." The patient tells her mother to be quiet, but she repeats it anyways. I still do not understand and figuring it was causing the patient anxiety, I did not respond. Grandma lost it. She launched into a tyrade in her native language, not knowing that I can understand the majority of Spanish. "WHAT IS SHE DOING?! WHAT IS SHE DOING?! I TOLD HER TO MOVE IT AND SHE DOES NOT! WHY DOES SHE NOT?! BECAUSE SHE NEVER DOES!" I stopped what I was doing and looked at her in the eye. "This may come as a surprise to you, but I actually know what I'm doing and I'm actually really good at it. Now, I need you ALL to sit down." They did not. But at least Grandma shut up for 2 seconds. Ok, I'll choose my battles.
The patient asked that I remove the IV and put it somewhere else. I removed it and moved to the other arm to look for options. Grandma scuttled around to the side where I had been and began examining the patient's arm. Without a tourniquet, she decided on several veins and again began muttering in Spanish, wondering why I didn't put the IV there. Having examine the one side I returned to the original arm. Grandma did not move. "Excuse me please!" She scuttled to the other side and began doing the same thing. Ok, she's now on ignore. I restarted the IV and left to call the Doctor.
The Doctor came over from her office and upon examination of the patient decided that the baby would not withstand the stress of labor and decided to do a c/section. The patient and her family more than agreed. Unfortunately, I had to transfer the care of this patient to another nurse, as I had another patient who was progressing quickly. They apparently took the patient to the Operating Room, put in spinal anesthesia and the patient began to bleed profusely. I suspect she abrupted right there on the table. They delivered that baby quickly and all is well.
