July 9, 2007
Another busy night
Another glorioius weekend shift at work. Saturday was pretty busy, but man did the 12 hours go by quickly! I started out working on Mother-baby and was called back to admit a patient who was 23 weeks, no prenatal care, and cramping. Assessed her, found out she was not cramping but coughing. Just goes to show you how fast ER is at getting pregnant women off their unit. "Oh, you're pregnant, you must have some cramping...great, up to OB you go. I had just about finished triaging her when another nurse called me out of the room. We had another patient that they decided I should also admit come in. She had been transferred from a small town hospital that doesn't have maternity services. She was in active labor with her 2nd kid, no prenatal care and 6 cm according to the speculum exam the MD there had done. We were quite surprised she didn't deliver in the ambulance. Anyway, i'm a little peeved because I hadn't called the doc on admit #1 and there was no reason this other nurse could have done the new one. So I check her cervix, expecting to be close to delivery, but no, she is 8 cm and I don't feel head, I feel scrotum. Crap, crap, crap. The nurse who rode over with the patient asked if she was in position for delivery, and I said, well, in position for a c-section as the baby is breech. Then, finally the patient says, "Yeah, I didn't figure he had flipped". First, that's important info that she should have given the first hospital. Second, and most importantly, the MD who examined her should have been able to tell that she was not vertex (head down) as it was very obvious. And to top off all things, she stated she saw Dr. T when in fact she saw Dr. D. After 39 weeks, usually you know your MD. So off to caesar we go, baby born, dad didn't make it in time. He comes strolling in 20 minutes after we've been in recovery and asks "So you getting ready to have the baby". Oh, he was wasted, and the reason he missed it was because the police who went to his house couldn't wake him up. So we talked about time, weight and all the birth stuff. I sent him to the nursery to see his son. He comes back, after our conversation about how he missed the birth and says to his girlfriend "So you had him not long after I got here, huh". I thought she was going to come off that bed and strangle him, even with dead numb legs. All in all, the patient was very sweet and the baby was beautiful. So I get her settled on mother-baby, decide to sit down and chart and get a call that a 24 weeker, 10th baby, is coming in bleeding by ambulance. She arrives, has blood caked all the way down her legs, and is only 22. 3 weeks. No active bleeding at that point. She had bled like this a week ago and they found she had a hematoma behind her placenta. Her and her pregnant 14 yo daughter were laughing, talking about how they hoped he was coming today, how he just wanted to be born, etc. The dad of this baby also kept leaving and coming back, smelling strangely like he'd been smoking some pot in the car. Finally, I had to tell them that we would do all we could to keep her pregnant, that this was serious, and that if he was born today that he would not have a chance. Man, I felt like the grim reeper, but I had to let them know the seriousness of the situation. The tone did change and they were no longer worried about their 4a.m card game they left and were more appropriate. We got her stabilized and safety helicoptered to a hospital with a NICU at 7:00. I would have kicked my husbands backside had he acted like any one of the dads that were with the 3 patients I took care of. At least they did come in, which is more that some. I was able to finish about 7 hours of charting on three patients by 8:00. What I wouldn't give fore a nice, normal labor and vaginal delivery and a night where I can actually chart at least half of what I need to chart before the end of my shift.