Don't Panic!

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.

Surgical Weight Loss

Weight loss surgery is something that, not only as nurses, we are hearing more and more about. While the lapband surgery is currently being deemed the most safe, I am curious as to the long term results of any such surgery. However, if you are interested in surgical weight loss woodlands, and are in the Houston, Texas area you may find information at this link.

Floating

A real, hard-core Labor and Delivery Nurse's ultimate horror is working in any other department other than Labor and Delivery. Somehow, whether we like it or not, as an L&D Nurse, our job becomes part of us and we become part of our jobs. Our personalities are formed and developped through our jobs. Our humor is created and twisted and our cynicism is grown into healthy adulthood. So this weekend when I was assigned to float to Postpartum, I felt like I was being killed.

Nobody likes to float. Especially me. I hate working Postpartum. I hate handing out silly little pills that anyone can take over the counter. I hate stocking peripads and underwear. I hate talking about nipples and bottoms and pooping and peeing. I hate the crazy hormones and the tears. And mostly I hate sitting there wondering why everyone else is running around and I'm done everything I know to do...

So I finish off the day mentally exhausted. Wondering if I did anything right... wondering what I missed... cursing the day I became a nurse.

Pretty Funny Ad

I think we've all heard every one of these lines! And by the way, you'll never guess who this ad is for:

Risk Factors

I've got to be honest. I write this blog without any consideration of other people's feelings. There is no filter. It's just a cathartic expulsion of my thoughts and feelings after a day at work. I make no secret that I've done this for a long time and am unforgivingly sarcastic and jaded. So please do not take offense at my ramblings!

I should add that although I am admittedly rediculously callus at times, I am not immune to the joy of the birth experience to the families I care for. Nor am I unaware of the daily miracles that I witness. I may even squeeze out a tear now and then. So if you do read my blog, take it all with a grain of salt... or maybe a couple of jugs of it.

Alexis - I actually agree with your point of avoiding multiple surgeries, especially if you are wanting to continue to have children. Good and valid point. However, since there is no risk-free pregnancy or birth, I'm just not a fan of adding risk, no matter what the percentage is.

Pinky - Thanks for visiting my blog and leaving comments. Like any true L&D nurse, I have plenty of opionions but I would not be so unprofessional as to allow them to interfere with my patient's care. I have no problem, actually, caring for a VBAC. There's just always the question in the back of my mind: If you saw someone die following a VBAC, would you still be doing this?

I imagine the fear of risk can be quite limiting as you become more and more experienced. My patient the other day is a great example: I saw her walking down the hall and groaned inside. She was clearly over 35 by a generous distance and all of the risk factors were flying through my head. I'm in that age range myself, and am only too aware of the dreaded AMA (Advanced Maternal Age) classification.

She slowly walked up to the desk, bent over, holding her belly. Please tell me you're not the induction. Please tell me you're just here to visit someone... No such luck. "I'm here for an induction," she tells the secretary. Oh joy!

From the beginning, I was anticipating a disaster. The patient was excessively tearful and nervous. A fast-flowing IV caused her to cry because her arm felt cold. She was clutching her abdomen so fiercely with each movement I thought she was in active labor, yet she denied having any contractions. She wanted an epidural even before the induction began, and it seemed like a great idea if not to simply alleviate her anxiety. I might have been aggressive with the pitocin following that epidural; to my shock and utmost delight she delivered in the space of one hour without a single complication.

She turned down the offer to teach the rest of our laboring Moms how to do it...