The Point of No Return

It seems to me there inevitably comes a time during the course of a natural birth that the woman finds herself at the end of her rope, convinced that she cannot go on. For some delightful folks (usually those who considered themselves too smart to attend Prenatal Classes, or believed that their Internet education would suffice), this point is shortly after they walk in the door. For the more hardier women than myself, those who choose not to have an epidural, the point still comes.

Today was the perfect example. My patient was a quiet woman, having her fourth child. She wanted as natural a delivery as possible while being induced. No pitocin (to give more contractions) and no epidural... she just wanted an amniotomy (to have her water broken). Ok. That's fine. I'd like for her to have the delivery she wants. So I shift into Natural Labor mode and start to wait.

Two hours after the Obstetrician broke her water, she was still not contracting any more than when she'd arrived. We sat down and discussed starting pitocin to give her a bit of a boost. She agreed that that would be a good idea, so I started pitocin. Very slowly... we were still aiming for a delivery without an epidural, which is significantly harder with pitocin.

Four hours later the patient was really beginning to hurt and requested that I examine her. She still had not changed. Tears filled her eyes. Before getting discouraged, though, I reminded her that this was not her first baby and that it could, and probably would, speed up significantly in the next few hours. She agreed that she could continue for another hour.

The next hour, I examined her and she had progressed a dramatic amount to 6 cm. She was clearly going very fast, but the pain was too much. She'd reached the point of no return. It's when the patient wants the epidural but in reality she's in the end stretch and very capable of achieving the delivery that she wanted! My patient wanted the epidural and no encouragement I could give was going to change that. I called the Anesthesiologist.

When he walked in the room, I thought I'm going to examine her one more time, just on a hunch. Sure enough was 10cm. Complete. Her entire labor was 1.5 hours. Incredible. Now tears of joy were running down her face.

Cancel That Amniosure!

It's Memorial Day here. For some random reason they've decided that this is one of the holidays that we get paid time and a half for, so I signed up to work it. Holidays are interesting days to work. Since the Doctors offices are closed, you are suddenly, unintentionally running a clinic. A continuous parade of patients, in and out, all day long. It's not my favorite thing to do, but it certainly opens my eyes to what the physicians have to deal with every day.

There's always one patient that tops all of the others. This one was a 20 year old who called Dr. G with the complaint of green, frothy discharge. Ugh. Just imagine that conversation... So Dr G. calls the L&D unit, telling us "Some girl is coming in with green, foamy discharge." It's your turn to take a patient! If I say it first, does that mean it's fair?

HOURS later, the girl shows up. She bounces up to the Nurses' Desk, all cheerleader-ish and bubbly. Her long blond hair has been carefully curled for the occasion. She's all smiles and giggles when she asks "Is this Labor and Delivery?" Yes, Honey. And I wouldn't be so bubbly if I had green discharge foaming out of my vageener!

She's assigned to another Nurse who takes her in the room across from the Nurses' Desk. "Order me an amniosure, will you? I should just rule out meconium." An amniosure is a test we do with a swab to determine if the leaking fluid is amniotic fluid or not. The Nurse wanted to make sure that the girl's amniotic fluid hadn't broken, leaking green amniotic fluid, which would mean that the baby had pooped in the water.

We sit at the desk, cringing, waiting for the Nurse to come out with her first impression. I almost want to vomit, thinking of what she was having to look at. Then the door swings open and the Nurse steps out, pulling the door closed behind her. "Cancel that amniosure!" she hollers, "they had SEX! It's SEMEN!" She practically spits out the words in her disgust. I look up from behind a computer screen. The door to the patient's room has swung open and looking out are two faces with bulging, horrified eyes.

Off Time

As you might have guessed by now, I'm not a huge fan of Nursing. There's a big difference between Nursing as a profession and the actual work. I actually love the work. I love the skills and I love having the ability to help create a positive experience in people's lives. That being said, I also love my days off! One of the few great things about Nursing is the flexibility that we have. For example, right now, I have five days off. Five days off in which to do absolutely nothing, if I choose!

In my time off, I try to run a little hobby-internet business, with the help of some open source software. Thanks to proponents of the open source software industry, such as Ronald Bongo, I've found some great software to help me with my little business.

The State of Nursing

I graduated with a Bacheloriate in Science in Nursing from a well-known University in Canada. An important part of the curriculum was teaching us that Nursing is a profession - one that we should be proud of. Now, many years later, I cynically snicker at this idea. Everyday I get up and put on my scrubs (making sure that they are the correct, designated color). I punch in like a factory worker. If the census is low, I am sent home like an expendable resource... I could go on, but if you're a Nurse, you know what I'm talking about.

This weekend, I got an even more bitter taste in my mouth. We found ourselves looking after a young woman who's medical issues extended far beyond Labor and Delivery, into the vast unknowns of cardiac and respiratory. Multiple tests were being done and Physicians we had never met were coming to the unit to see our patient. I began to notice something very strange. These Physicians did not even look at us. They did not speak with us, consult with us, or even acknowledge our presence! It was the freakiest thing ever. As L&D nurses, we are always very involved in our patient's care. We develop close relationships with our Physicians and are constantly discussing the plan of care. This time we were completely left out.

It occured to me that this must be how things are on other floors. Nurses are not considered a valuable resource, no matter how idealistic we would like to be. The state of Nursing disgusts me.

A Slow Shift

Our only excitement today was a brainless little girl who came in because she was "feeling bubbling" on her cervix. I get the biggest kick out of how all of us Nurses just stand there looking at the girl. How do we manage to keep a straight face?!

Other than Bubbly Cervix, we did pretty much nothing all day. That's never a good thing. Today our talk was about plastic surgery. We rooted through every plastic surgery website we could find, ogling at all of the befores and afters, and discussed all of the wonderful things we would do to our bodies. We found this site where you can take a Beauty For Life Quiz which basically gives you a personalized beauty plan specifying your best age to have different cosmetic procedures.

A Nurse's Work

I am beat. Most 9-5ers don't get this, but working three or four 12 hour shifts (as a Nurse, anyways) in a week is full-time! I can't count the number of times I've had people say to me: "Oh my gosh! I wish I had a job like yours! You have so much time off!" Are you freaking retarded?! Ever notice that I leave before the sun is up and get home when it's gone down?! I hear it at home, too. "Why can't you get the groceries? You're off for the next three days..." "Do you mind going to the Post Office for me? It's just that you're off today and I'm only off on the weekend..." Ugh!

So I feel the need to educate people. 3x12=36. Add a few hours of overtime or the inevitable having to stay late and you're well over 40 hours a week. That's not sitting at a desk job, either. Our job is literally dealing with life and death. Everyday. I'm not being dramatic. It's a fact. It's on your feet, physical and mental work, organizing, coordinating and planning, holding 100 pound legs up for 3 hours work. Get it? So, your sleeping until 0730 is what I need to do on my day off. And the stuff that you do when you get home at 5pm - that's the stuff I need to do on my day off.

Ok. I'm done.

Ramblings of an Overtired Nurse

Do all nurses get in the most random conversations at work? For the most part conversations go downhill very quickly around a Nurse's Desk. On the rare occasion, however, we manage to avoid the gutter. The other day, we were having this discussion about bed linens. Who knows how we got on to that subject... One of the girls declared she was a "Sheet Snob." All of her bed linens had to be of a certain quality or they just would not do. Haha! Personally, I'm not so picky. I'm just happy if they're clean and allow me a good night's sleep!

I am, however, needing to decorate my master bedroom (currently stark white and empty!) so I am constantly on the lookout for decorating ideas including bedding that could serve as inspiration. I'm flip-flopping between what style I want... BeddingStyle.com has just started carrying a new brand of luxury linens, Tommy Hilfiger Bedding in it's online store. These linens come in a wide range of styles, many of which are currently on clearance. They also carry several other well-known brands such as Laura Ashley, Echo and Michael Kors. Love his stuff! Hey - it's better amusement the pretending to catch up on CEUs!

Spectator Sport?

I apparently missed the vote, so can someone tell me when Labor and Delivery became a spectator sport?

I had a very nice family in labor today. For the most part, in our fairly quiet suburb, our patients are nice, normal people. Things were going along very nicely until the parents asked if their 14 year old son and their 5 year old daughter could stay in the room for the delivery. Now, I know that as nurses we're supposed to be supportive, non-judgemental, blah, blah, blah, but are you serious?! What normal, healthy young man wants to look up his Mother's swollen cooter without being scarred for life?! I can understand having young women... a good dose of reality could do wonders for birth control, but a 14 year old boy?!

I give them the routine answer... if there is an adult available to be solely responsible for just that child, then it's fine. Inside I'm thinking: WTF?! Needless to say Dad did not want to be responsible and when it came down to it, Dad was the only one who stayed. Thank-God for small mercies. Another child saved.

You Might Be a Nurse If...

• Discussing dismemberment over a gourmet meal seems perfectly normal to you.
• Your idea of a good time is a full code at shift change.
• You find humor in other people's stupidity.
• You believe in aerial spraying of Prozac.
• Your idea of comforting a baby is to place him in a papoose restraint.
• You believe that shallow gene pool should require a diagnosis.
• You believe CHOCOLATE is a food group.
• When you are out in public, you compliment complete strangers on their great veins.
• You have ever referred to someone's death as a transfer to the Eternal Care Facility.
• You have ever had to leave a patient's room before you began laughing uncontrollably.
• You think caffeine or Diet Coke should be available in IV forms.
• You believe that "too stupid to live" and "too stupid to breed" should be diagnoses.
• You want the lab to order a 'Dumbshit Profile'.
• You believe that the waiting room should be supplied with a Valium salt lick.
• You have ever wanted to hold a seminar entitled 'Suicide...Doing it Right'.
• You've been exposed to so many x-rays that you say, "No, I don't worry about birth control........I've been irradiated."
• You don't think a referral to Dr. Kevorkian is inappropriate.
• You have your weekends off marked and planned for a year.
• You have discovered a new condition that you call Hypo-Xanax-emia.
• You plan what you are having for dinner while doing a gastric lavage.
• You know that drug seekers will be allergic to all medicines except Demerol.
• You encourage an obnoxious patient to sign out AMA just so you don't have to deal with them anymore.
• You have the bladder capacity of five people
• You believe that unspeakable evils will befall you if the phrase, "wow, it is really quiet" is uttered.
• Your diet consists of food that has gone through more processing than most computers.
• You have ever answered a "lost condom" phone call.
• Your most common assessment question is "what changed tonight to make it an emergency after 6 years?"
• You have ever had a patient look you straight in the eye and say, "I have no idea how that got stuck in there."
• You have ever had a patient say, "but I'm not pregnant, I can't be pregnant, how can I be having a baby?"
• You have ever had a patient control his seizures when offered some food.
• Your feet are flatter and tougher than Fred Flintstone's.
• Your immune system is so well developed that it has been known to attack squirrels in the back yard.
• You get an almost irresistible urge to stand and wolf your food even in the nicest restaurants.
• When checking the level of orientation of a patient, you aren't sure of the correct answers.
• You always try to schedule days off around the phases of the moon.
• Your alcoholically challenged patients know you by your first name, and can point to "their room."
• The hems of your scrub pants are held in with 3-0 chromic or steristrips.
• You refer to motorcyclists as "organ donors."
• You are the only one at the dinner table NOT allowed to talk about your day at work.
• Your idea of fine dining is anywhere you can sit down to eat.
• You've ever had a patient with a nose-ring tell you "I'm afraid of shots."
• You believe that the sight of a full moon can ruin a perfectly good day.
• You stare at someone in utter disbelief when they actually cover their mouth when coughing or sneezing.
• Your family members must have a fever of at least 105 or be missing a limb with active bleeding in order to receive your sympathy.
• You've ever sworn you are going to have "NO CODE" tattooed on your chest.

Happy Mother's Day!

Ahhhh! Mother's Day! Out of the great and deep goodness of my heart, I thought I would suck it up for all the Mothers I work with and pick up this shift.

Would you believe that by noon we had no patients?! There are days when we run our asses off, so if there is ever a day like today, you sit and laugh and talk and don't feel in the least bit guilty for it. We ordered lunch from Maccaroni Grill (including dessert!) and had the best day ever!

Sorry About your Penis

You'd think after doing this job for over a decade that I wouldn't get surprised anymore. Then I have a day like today that reminds me to double up on the Zoloft.

I had an awesome patient today with an awesome labor. Pleasant, fun and done in 3 hours. What more can you ask for? But while I was busy in my patient's room drama was unravelling in the next room.

Scene 1: The Next Room
Patient: Our Doctor said we could have 2 people back in the operating room with me.
Nurse: I'm sorry, that's against our hospital policy.
Patient: But our Doctor told us we could!
Nurse: Well let me check with the Anesthesiologist and my Charge Nurse.

Scene 2: The Nurses' Desk
Nurse: Charge Nurse, my patient tells me that her Doctor told her that she could have 2 people in the operating room with her.
Me (not the Charge Nurse, but I can't keep my mouth shut): We don't care what her Doctor told her. Her Doctor doesn't write the hospital policies! It's against hospital policy and we, as Nurses, cannot be responsible for another body in the OR!
Charge Nurse: Right. I'll go in and speak with the family.

Scene 3: The Patient's Room
Charge Nurse (being far too sweet, just because she is): Hello. My name is Charge Nurse. I understand that you would like to have 2 people back in the Operating Room with you. Unfortunately, that is against our hospital policy for several reasons...
Patient's Husband (AKA Bastard): STOP. STOP. STOP. STOP. STOP. You can stop right there. We are related to the Doctor and she told us that we could take 2 people back there. Now, I'm a lawyer and I don't think we're asking for anything exceptional.
Charge Nurse: Actually, you are...
Bastard (interupting again): I am a lawyer. You can stop talking and you can leave the room right now. (Translation: I have a very small penis. Hopefully being a lawyer makes up for that.)
Charge Nurse exits stage left.

When this sort of thing happens, whether it happened to my co-worker or to me, it feels very personal. Can someone help me understand where people get off?! I do not allow my loved ones (not that they would ever) to talk to me that way. Why is it that strangers think they can?! And what is our recourse as Nurses and Employees when this sort of thing happens?

Covering Shifts

I don't know why I consent to this, but somehow I always end up covering these partial shifts while someone runs to a kiddo's soccer game or picks up their kids from dance class. Everytime I do it, I curse myself for ripping myself off a day off. And everytime I swear I'll never do it again. Yet, here again, I find myself picking up part of a shift.

Even the partial shift today was a reason to come home and have a stiff drink. My patients were fine. But everyone else's were certifiably crazy! It began as soon as I sat down for report. A blood-curdling scream comes from the end of the hall, followed by a string of coarse language and curse words. I jump up, asking WTF?! Nobody else moves. Turns out this Freak-Fest down the hallway has been carrying on all day like this, despite having an epidural so intense that she cannot move. This time it was because the Nurse was removing a piece of tape from her arm. Glad I wasn't around for that delivery!

Next came a sweet looking, but very anxious young couple who's complaint was that the husband had fallen on the wife and they just wanted to make sure the baby was ok. I take them to a room and get her connected to the monitor. So tell me what happened. "Well my husband was standing on a chair, hanging some curtains and I saw he was going to fall so I crouched down on the floor to catch his head. When I caught his head my hand smashed against the edge of the door." So where was your tummy hit? "Oh, my tummy wasn't hit." Huh?!

Amateur Transplants: Absolutely Hilarious!