December 31, 2008

Hope you all have a safe and Happy New year!

December 23, 2008

A Little Faith before Christmas

I got to thinking about the number of times in my career that I've had a True emergency: meaning someone is on the brink of death. Yeah, I've had many moms who've been laboring and baby takes a dive, or a cord prolapse. Those are also emergencies, but I guess I mean emergency to the extreme. Emergencies when after it's all said and done, I realize my hands and legs are shaking. Anyway, I've had it happen 3 times with patients of mine. And I realized there are similarities. First mom, had labored and been pushing for awhile and the baby just wasn't going to fit. Doc called to do a c/s at 0600. So, we had her ready and were just waiting for 0600. It was going to be a nice, controlled delivery. The assisting doc was there and waiting and the primary doc and anesthesiologist were changing. We were just getting ready to go in and take out the internal monitors when I noticed that hearttones were taking a dive...down to the 30's. They were down in the 30's for a couple minutes, (can't remember exactly how long) when we decided enough is enough and had her back in the OR and delivered very quickly. Second one was a mom who had lost one baby at term and came in because she hadn't felt the baby move. Got her on the monitor and found the baby's heartrate to be 80's with decels. Got her delivered 20 minutes from the time I turned the monitors on. Then there was yesterday. Baby was already gone, but mom needed delivered NOW. Doesn't seem like too many similarities in their cases. Here's what was the same: all three were at change of shift so there was plenty of staff. The first mom was already prepped for c/s, c/s room already open, docs were there so delivery was within minutes. Second mom, there was a doctor there who just got done delivering another patient AND the anesthesiologist just happened to walk to the labor desk to see if he had anything. All of this at the exact moment we needed a surgeon and anesthesia. Third mom from yesterday, her MD was there because he had a 0700 c/s and had been in to see her and another patient he had. The anesthesiologist just happened to already be in the parking lot. If she had come in in the same condition 2 hours earlier, we wouldn't have had docs there to deliver and care for her...she probably would have bled to death. See where I'm going? When we needed people the most, they just happened to be available. Yeah, yeah, call it luck. I'm a firm believer that God had a hand in it. He provided us with the necessary tools/people. All three at shift change so plenty of hands, all three with doctors who "just happened to be there because.." so there wasn't a wait to deliver. And those are just patients I took care of. Another nurse and I realized out of all the True emergencies we could remember, this was always the case. Now I can't explain why bad things happen. I'm not supposed to know His plan. And you could say "Why did He even let this happen in the first place". I don't know the answer to that. But I do know this: He was watching out for these women. Maybe when bad things happen, He helps make the tools available to make the best out of the situation. Yeah, he took mom#3's baby with him, but she was very close to going with Him herself had much more time passed. And maybe that family will be closer than they were before. I don't really know. I really didn't need proof because I see the miracle of life everyday, in my own children and in witnessing birth and watching families get to know their babies. But for me, even after yesterday's horrible delivery, I can see He was there. And I believe. Hope you all have a Merry Christmas.

December 22, 2008

Maybe I should retire now

I think I just finished the worst shift I have had in my entire nursing career. Yep, yep, I'm certain. Worst Shift Ever. The first 11.5 hours were fine. It all went to hell shortly after 6 a.m.What's funny is I had a feeling something bad would happen. I realized it had been a while since we had a IUFD, and what with Christmas around the corner, we were due. Last year on the same day, I remember one of my co-workers coming in my room (I was post-op c/s) and told me they were delivering a 23 weeker. Ironic. Anyway, a delivery of a stillborn sucks, but when it's a crash situation and mom's life is the one we're rushing to save, it sucks more. Everything happened so fast there wasn't time to process until it was all over. This part of the job never gets easier. People have often said "You must love that you get to rock and hold the babies all night". If only that were all it was. Here's a simple plea: don't use drugs while you are pregnant.Cocaine can cause your placenta to detach itself from your uterine wall. This is BAD if you haven't just delivered your baby. The outcome is not good. Please, for the sake of your baby and yourself. Just don't.

December 17, 2008

Already one year

Tomorrow, my baby will be 1 year old. One Year. Wow, time has really flown by. I know it's cliche' but I look at him and wonder how this past year went by so quickly. Just like when I was pregnant with him, I wanted time to go a bit slower, knowing he is the last. But, just like the pregnancy, it still flew by. And I'm a little sad. I miss the days when he was a newborn and would curl up on my chest. I miss swaddling him. I'll miss the nursing sessions, although I'd be happy to forgo the middle of the night feedings. Nope, still doesn't sleep through the night. Ever. It's very frustrating and I realize it's partly our fault. I fell asleep in bed nursing him as a newborn. I sit and hold him until I'm ready for bed because someday, he won't let me hold him. We could let him cry it out, and make him sleep in the crib. I could stop nursing him at night to get him back to sleep, but I'm so tired, it's easier to give in. Bad, yes, but someday, I'll wake up in bed without the baby and realize that Isaiah is no longer a baby and long for those days. But right now sleeping kinda sucks. Even with that, I do think that both Husband and I enjoyed him more during his first year than we did with the other two. Not because we loved them less, but because we were more experienced parents, weren't as nervous and we knew that this stage only happens once and doesn't last. Sure, we had a hell of a lot more fights/arguments this past year than ever and there were times I worried about our marriage. But, rest assured, we're just fine, if not better than we were before Isaiah was born. And man, how he's changed! He's a walking maniac and today he tried to run. He's into everything, dances to music, and still likes to give High-fives. Since he's started walking a couple weeks ago, he's not a cuddly as he was before, but at night he still likes his mama time. Yep, still breastfeeding. He only nurses before naps and bed now. Right now, I have no plans to wean him. I always said I'd try for 2 years, but with Clara I weaned her at 19 months. It was too much for me when she started asking for it. But with Isaiah, I'm trying to hold on to all those baby moments so we'll see how long we go. Out of all 3 of the kids, he's the best eater. He doesn't have any interest in those toddler meals if there is real food around. He's eaten everything from mashed potatoes to prime rib. He'll also be the first to actually make a mess with his cake tomorrow. Jacob was sick with hand-foot-and-mouth on his first, and Clara was just too dainty at the time, although now you'd never guess that. We're not doing anything big, just having family down. I've been adamant that even though his birthday is only 5 days before Christmas, he'll still always have his own day. The in-laws wanted to do to Christmas tomorrow to save them a trip, but it's not going to happen. They're down for the weekend so we'll do it Sunday morning. Yeah, yeah, I know he's only 1 year, but if his birthday was in April, he'd have his own day. It's not his fault he was born in December, or fair. Man, I look at him and just can't believe that one year ago, I was getting ready for bed, trying to sleep before I went in to have him. Even with all the trials and tribulations, it's been a good year. As I type, he's bouncing up and down by the baby gate, squealing with delight as I make faces at him. Such a cute little booger.



One year ago today: 38.3 weeks pregnant, the farthest I ever carried, even with Preterm laborThe cute little booger today, with his toys

playing with daddy
Showing off his walking skills

December 16, 2008

A Whole Lot of Birthing Goin' On

Ask and ye shall receive, I guess. This weekend was hopping with labor patients. Started the weekend out with a 27 weeker, contracting, twins, 4th and 5th babies. Got magnesium started and it didn't touch the contractions on bit. So, got steroids on board, antibiotics, Level III hospital accepted transfer and got her out the door to a hospital with a NICU. Usually they give us updates on patients that we transfer to them, but I hadn't heard anything as of last night. Then I had 2 patients over the weekend that did not look at all like they were in labor. One was only contracting every 15 minutes, 1st baby and she wasn't uncomfortable. Just felt a bit crampy. Dilatation?: 7cm. She didn't make any fuss at all until she was crowning, but who wouldn't? The other patient came in, same thing, thought she might want an epidural, but never got uncomfortable enough to want one until her water broke at 10 cm. But, by then, she was feeling pushy and delivered her baby quickly, without tearing. She said "That wasn't so bad. It kinda burned and sucked as his head was coming out, but I feel great now". Amazing women. I also ended up in the c-section room for a nice controlled delivery, got another mom ready for a c-section. It was her first babe and he was breech. She couldn't have a spinal for health reasons so she had to have general anesthesia. She was absolutely scared to death of the surgery, of being put to sleep and most of all becoming a mother. She cried on and off until delivery. And if you know me, I am a complete mush and can cry at nothing, so it was all I could do to keep from crying with her. So I tried reassuring her that it was okay to be emotional. I also told her about my emotional-ness and how I cried after Isaiah was born. Not as I saw him, but as I waiting for him to be given back to me while I was in recovery. It was an odd time to cry and I didn't even know why I was crying because I knew he was fine. Anyway, I tried to relate to her and I think it helped her a little. Last night I went to talk to her and she was doing just fine enjoying her new baby. In between all of that, I also admitted several labor checks, took care of an induction, started 2 IV's for people who had been stuck numerous times (and I rock, I got it in!). As busy as it was, it was great to feel like a labor nurse again.

December 13, 2008

Labor Frustrations

I realize that lately I haven't had any good birth stories to tell. I looked back, feeling nostalgic and read some of my posts from last year and I realized that I worked back in labor a heck of a lot more then than I do now. And that frustrates me. Probably 90% of the time I go to work, I'm usually charge nurse and if I'm not charge, then I'm working post-partum. One of the other nurses I work with has been a labor nurse for many years, and prefers labor as well. I figure she's paid her dues, so she always works back there and I go to post-partum and will be the next nurse to go back if labor picks up. Don't get me wrong, I do like working with moms and babies and helping with the transition. But everyone has a preference of where they want to work. Mine is labor. I miss working with the mama's through their labor. I miss supporting them however they decide to labor. I miss witnessing those moment of absolute wonder on the new parents faces as they finally meet their baby for the first time. The one good thing about being charge, is I do get to do "baby care" at delivery. I think being labor trained, I tend to step back, and let mom enjoy her baby. The full assessment can wait. I figure if the baby is crying and pinking up, those no need to do all that jazz. But, again, I'd much rather be the one coaching mom. It was a full moon last night I believe so maybe it will be busy.

December 9, 2008

Lazy

I'm feeling very lazy today. I think its the weather. It's cold, dark and raining (for now, it will turn to freezing rain/snow later). Here are the things I should/could be doing:

* half a dozen loads of laundry, no exaggeration there
* clean the bathrooms
* dishes
* clean kitchen
* vacuum
* dust
* clean the litter box (yuck)
* Figure out what to make for supper
* go through the kids clothes and pull out clothes that are too small
* the same in my closet
* get groceries
* finish my Christmas shopping. I'm so far behind
* make appointment for my annual exam that I'm due for this month
* buy a preggo test, not because I think I'm pregnant, but because when I do go for my annual exam and they ask when my last period was, and I tell them haven't had one since the baby, they'll look at me like I'm crazy if I don't tell them that I did check before coming in. Even though I'm still nursing and on the mini-pill. It just makes it easier. Loving that the old girl hasn't come back around yet, by the way!!

But, I think I'll just be lazy. I think I'll just play with Isaiah and let him crawl all over me. I'll play catch with him. I'll just watch Clara take care of her babies. I'll let her "do my hair and make it pretty". I'll just read Jacob a book and play Candy Land. Maybe I'll even play play-doh or cars with them. Yeah, the dishes and laundry and toilets will be there waiting for me tomorrow.

December 8, 2008

Consolidation Negotiations

The hospital I work with has been in talks with a large healthcare system in regards to a possible "consolidation". What that means for me, I've yet to figure out. Will it bring positive change, or negative. My dad worked for many years for a company and when a larger foreign company obtained them, they shut the plant down. Now I know the situation is different with a hospital. They aren't looking to shut us down. Since the surprise announcement in the paper a few weeks ago, I will say that the administrators are trying to keep us informed. (or leading us to believe they are keeping us informed) There was a question/answer session, and 3 e-mail updates have been sent out. I'm trying to remain positive. Maybe we'll all see an increase in our base rates, and maybe better health insurance. There have also been some "interesting" decisions made on the unit I won't get into, but maybe we'll see people running things that make better choices. Something else that has come about since this announcement is in regards to the new building they were planning to build. They planned this new mother-baby unity with LDRP's, higher level nursery, new critical care area. The blueprints are taped up in our report room, construction to add parking is almost complete and they even set up a model of how the rooms will be. Most of us who will be working in the new unit are somewhat concerned with the layout and some of the design. For example, the hallways are the length of a football field with a LDRP at the opposite end of the OR. So, we could have a emergency situation in that room, need to run a patient in a bed 100m to the OR, trying to avoid running over families, etc. Anyway, back to my point: those plans are on hold. They are blaming the economy, and I believe it, but I also think it may have been affected a bit by these talks. I don't know, we'll have to wait and see what happens. If it goes forward, we'll be merged by the middle of next year.

December 2, 2008

A good weekend overall, despite the snow

This weekend at work really was a pretty good weekend. Busy, but I have to say, overall, everything was pretty manageable. Saturday night, we started out S-L-O-W. It was my first night back after 11 days off (yes!) and I'll admit, I was still lazy. But, around midnight, I admitted a patient for basically stomach flu. After getting her settled, doc called, it was about 1:30 and I decided "I think I'll eat something and then go pump". And I kid you not, as I leaned over to grab my bag, ER called with another patient. I was getting out of my funk, but I was still being a bit selfish. Patient came around the corner and I recognized her from the last time she had been in. This poor woman had a horrible pregnancy history. It consisted of a early 2nd trimester loss due to an incompetent cervix, miscarriage, shirodkar cerclage placement after successful IVF. That pregnancy delivered at 30 weeks by c-section under general anesthesia because of a placental abruption, and this pregnancy was also IVF, twins and she had been on bedrest most of the time. She came in because her water broke at 35 weeks. We headed back to the c/s room, and had a nice delivery, twins did fabulous and mom was thrilled to finally have a good delivery. Doing her delivery got me out of my vacation funk and things were much better. Then Sunday, we had a man getting an IV infusion who would be done by 10pm. (Our peds unit is part of us and that also included outpatient infusion) He started having issues with his congestive heart failure (CHF) and the CVCU didn't want to take him because they were short. House supervisor and patient placement coordinator were being difficult it this. Hello, we're peds/OB nurses, not heart nurses. I can't say "Sorry, we don't have enough nurses so that labor patient you have for us will have to deliver down in ER or go to Oncology". No, it's just not an option. So, after a long battle, I got him off our unit so he could get the quality of care he deserved. CHF is out of our area of expertise. And the doc had meant for him to be on CVCU overnight, not an outpatient infusion patient. So he should have never come to us. It's dumb, but I felt like "The Man" by being stubborn and insisting he be where he would get good care. Sometimes being assertive is difficult for me. Then, there were 6 IV starts I got that slid in beautifully that no one else could get, or on patients who said they're always stuck over and over for IV's. And a patient who was close to a panic attack because she was scheduled for a c/s and was scared sh*tliss that I manage to calm.
Only really bad thing this weekend was the snow. Yep, first snow of the year and you know what that means: lots of ignoramuses who drive too fast. Coming home yesterday, I was behind a couple cars driving a reasonable speed, which for as bad as the roads were was 30mph. I take a divided highway through the country home. It is 2 lanes going in each direction, with a fairly wide ditch in between. Some moron driving an SUV, who forgot that it was blowing snow over a sheet of ice, comes barreling up on the left to pass. As he gets to the left of me in my little light Lancer, he loses control of the back wheels and spins backwards and into the ditch dividing the interstate. I almost needed my brown pants. If he would have spun the other way, he would have hit me, which would have sent me into a spin and probably into the car in front or behind me and then it could have been really, really bad. I thought he was going to flip but thankfully he didn't. I drove white knuckled, praying to God to get me home safe. Best news: its supposed to rain tomorrow and turn to freezing rain and snow Wednesday. I picked up an extra shift Wednesday. Can you tell I'm excited?!

December 1, 2008

5 Years

Five years ago in the early morning hours, my BIL and SIL brought their first child into the world. There was crying, tears, and the flash of a camera. But the crying was not of a newborn making her arrival known. The tears that fell from everyone's eyes were not tears of joy. The crying, the tears came because a perfect full term baby girl with a flash of dark hair was brought into the world, stillborn. Today I took some time to think about my BIL and SIL andto remember my niece who would never run with her cousins, or color on walls. But, even though today brings sadness, there is also hope. Someday, they may have another child, but as my SIL said today, that child will be blessed. He or she will have her big sister watching out for them. Their own guardian angel. Today, we remember little angel Mirabel Ozara, born December 1, 2003.

November 26, 2008

Happy Thanksgiving

This a.m., I was quite surprised to read the headline of our newspaper. It was a story about how the hospital I work at is planning a merge with a big city hospital. I was taken aback. I hadn't heard anything about it. I work for the darn place and I have to find out about a possible merger by reading the daily paper. This weekend when I work, I'll have to find out exactly what's going on.

Tonight, we are all making a 2 hour trip to visit my in-laws for Thanksgiving. We had originally planned on going tomorrow and driving back, but somehow, we've been talked into spending the night tonight and leaving tomorrow. It's just such a hassle to visit overnight with them. First, there is the obvious lack of restraint when it comes to alcohol. Then there's the issue where all 5 of us will sleep. Neither my BIL/SIL or husbands parents have enough room, really. We're all going to cram into my BIL/SIL small 2 bedroom house. Should be interesting. I'm also kind of a traditionalist when it comes to Thanksgiving: I want Turkey, noodles, mashed potatoes, etc. My FIL decided to do prime rib this year. Not that I don't enjoy good beef, it's just not turkey. It seems so petty to be slightly irritated, but sometimes, I can't help it. I have to pack 5 overnight bags (Husband is capable, but apparently can't seem to do it himself), make sure we have the pack and play for Isaiah, plenty of diapers, wipes, outfits for all 3 kids, extras for Isaiah and Clara just in case she wets the bed, bottles/sippy cups, bibs, baby food, toys, bedding, pillows, air mattresses, and, oh yeah, the kids. I don't know how people do it for longer trips by air. I'm sure we'll have a good time once we're there. The prime rib will be excellent, and my MIL will be closely monitored. And the best part is: My house won't be destroyed!

On a different note, Isaiah may be getting the hang of sleeping most of the night. Two nights ago, he slept all night! I woke up a bit worried because he's not done that before. It was that irrational feeling that I think all mothers get when you wake up and realize the baby is still asleep. I was just afraid to go in a find him not sleeping, but, well, you know. He obviously was fine, and I knew deep down he was. But it was so uncharacteristic of him. Last night he slept until 5 a.m., which is still pretty good. We'll see how long it lasts. I also had to break out a bigger car seat for him today. He's just too big for the infant care seat, so I installed the next step up, still rear facing, but holds bigger babies. It was a bit sad taking out the infant care seat. I've turned into such a sentimental sap when it comes to all things revolving my children growing. I really do have a lot to be thankful for. Happy Thanksgiving!

November 24, 2008

Wow, 30 years

I survived the weekend and the whole turning 30 thing. It still seems a bit strange to think I'm really 30 years old. The years have really gone by way too quickly, especially since the kids were born. Time flies when you're having fun, I guess! We had a little get together on Saturday and it was actually a lot of fun. It was the first time we really tried to have a little party, so I was worried it would be a little bit lame, but I think everyone had a good time. We all hung out here, and then went down the street (only 1 1/2 blocks) to the local bar and had some drinks. I realized the next morning that I am in fact 30, not 21. I'll not be having any adult beverages for quite awhile. I also finally have joined the rest of world and I am now a proud owner of an ipod. Only problem: our frickin computer is too old and slow that I can't use it right now. I'm sure this computer is going to crash very soon. I mean, we bought this thing in 2002. So, really, it's time. I'm hoping that it will last until after Christmas, because with buying gifts, it just isn't in the budget right now. So maybe we'll hit an after Christmas sale. We'll see how it goes.

November 20, 2008

T-3 and counting...

This week, I've been doing some crazy cleaning around the house. My 30th birthday is fast approaching on Sunday and we're having a little party Saturday. Nothing huge, but we're planning on having some adult beverages, some non-alcoholic beverages as well, and some food. I thought about inviting people from work, because I work with some cool people and partly because most of them have this idea of me as Susie Homemaker with the 3 kids. I swear they think I put on the apron strings, bake cookies, can veggies, and do art projects all day, holler at kids for listening to music that's too loud, and go to bed at 8:30pm. Okay, so I might go to bed at 8:30 given the chance. Not that there's anything wrong with being Susie Homemaker, but that's so no tme. I still know how to have a good time, I just don't have the opportunity. I thought that if co-workers came, I could put an end to that belief, but I decided that I end up hearing stuff like "Oh my God, I cant believe you did.." and so on. Plus, if they see me that way, then really its okay. The people I'm close to at work, unfortunately have to work this weekend. So it won't be a huge thing. But, still I've been cleaning like a mad woman. I've scoured the bathroom, cleaned all the upstairs bedrooms from top to bottom, I'll have all my laundry done by Saturday, and I plan to dust, mop, vacuum, and put all the clutter that seems to reproduce in my house into a box and stash it in the basement until the weekend is over. Oh, and I'll have to get all the kids toys organized and put away. My mom and dad are being brave and are taking all 3 kids overnight so we can party and not have to worry about them underfoot. God help them. I really hope Isaiah sleeps. My mom even came up yesterday to keep an eye on the kids so I could really get down and dirty to clean the house. I just finished up cleaning our computer room/back porch and I came to a realization that I should have known was coming...all the cleaning a week before people are over, worrying about making sure everything goes okay, worrying about what people think about my house...I realize I know someone else like that. Someone who hounded us a week ahead of time to clean the house, who was constantly picking up, and I'd roll my eyes and wonder why the fuss. Who might you ask? My Mom. I have officially turned into my mother.

November 19, 2008

Ahh, I feel like a labor nurse again.

Monday night I actually felt like a labor nurse again. It was nice. I've been spending so much time filling in as charge nurse when I work or on postpartum, that it seems like lately my labors/deliveries are few and far between. Some days I wonder what it would be like to work in a bigger hospital where you work in one area. Monday, I admitted this mama, first baby, and she was one of those who aren't quite sure if they want an epidural. She was 6 cm on admission. She told me she will probably want one eventually, but was okay at that point. She was doing fine sitting in the bed, closing her eyes and breathing and relaxing with each contraction. She seemed so relaxed you couldn't tell she was in labor. Things started progressing, and she got to that point where a lot of women get when they don't have an epidural: she started saying "I can't do it". But she was. Checked her, she was 9cm with a bulging bag of water. Just knowing she had made great progress in an hours time seemed to help. I then helped her onto the birthing ball, and showed her husband how to do counter pressure around her lower back and hips, which seemed to help. When it came time for delivery, she did great, did what her body told her to do and delivered a healthy baby, with just a tiny little abrasion on the vaginal wall. After it was over and she was holding her baby, she was so happy she had decided against the epidural. It's so satisfying to feel like you're supporting moms while in labor, whether they get and epidural or not.

November 17, 2008

What a long week

Wow, what a busy week it's been. Here's a rundown:
Sunday night, I'm in charge and I realized the night would suck when I was cursed at by a father on the phone. His teenage daughter had come in for a few issues with her pregnancy and he was ticked I wouldn't break HIPPA laws. I'm not quite sure why he couldn't just talk to his daughter, but whatever.Every other work he said was f-this, and f-that. He said "She's a F-ing minor", I then had to explain to him that even though he was her father and that she was a minor, that she was an emancipated minor and had control over her healthcare. As you can imagine, he didn't like that, and told me I better have that F-in G-damn law at the desk waiting for him when he came in. He never came in, but the night never improved.
Went to work Monday night, Husband calls to tell me our van tire is flat at 6:30 a.m. Tuesday a.m., and that he's at home. He needs me to leave work so he can change the tire and get to work because he can't do that with the kids around. Ends up I don't get to sleep Tuesday a.m. Isaiah starts puking and pooping. He started feeling better Thursday. I felt off all day Thursday. My stomach hurt a bit right above my naval and if I'd eat very much, I started feeling nauseated. The pain was like a hunger pang. I ignored it until right before I left to go into work (an extra shift I had hoped to get out of). I ate some rice and shortly after vomited. And it was bloody. Shit, that's not good. But, I go to work anyway, a bit worried, but figure I'll be fine. I get my pay stub and realize work shorted my 10 hours of pay, plus 2 hours of pay for our ed-day. Then at 1. a.m., Husband calls to warn me that Jacob and Clara are puking and pooping. Luckily, I'm able to go home because here's yet another day I will have been up all night and no sleep during the day. Clara was sleeping when I got home, but poor Jacob had it bad. About 5 a.m, I start puking and yep, it's still a bit bloody. Not like a lot of blood, but definatly blood mixed in. That continues, and I end up calling the office just to try and get an appointment and they tell me I need to go to ER. I never even considered that, and I thought it a bit premature, but whatever. My mom comes up to take me, Husband comes home from work to watch the kids and I go in. I REALLY didn't want to go because it takes sooooo long for anything in the ER if you aren't dying. I feel like absolute crap. I spend 4 hour in ER, and they never pay attention to my chief complaint of vomiting blood, they're more concerned about my abdominal pain. Here I am, trying not to dry heave, on the really comfy cot (so not) and they're offering pain meds. How 'bout an anti-emetic? They start and IV and I realize as a RN, I'm a BAD patient. They didn't use lidocaine, but I was okay with that. I recognize the nursing student from work, so it comes out that I am a RN. I try to avoid that so people dont assume I know things. But, now it's out there. So the nursing student tries my IV, and I have great veins, but she misses, hits a nerve and I swear I was about ready to come off the bed. I go ahead and let her try again, but make a suggestion as to a great vein to use. This one goes in great. They were going to draw some blood work, but instead of drawing it off the IV angiocath, they start the IV and stick me again for the labs. I wanted to make a suggestion, but a huge wave of nausea came over me. They finally give me some zofran, which doesn't work and I wait. And wait. And wait. Finally, doc comes in says labs are fine, asks about my pain, again. I then finally say my pain isnt that bad, what about the blood? He says it's benign, probably a broken blood vessel and says I can go. Then I wait 45 minutes for the RN to discharge me. She hands me my papers and prescriptions and says I can go. They prescribe me pepcid, but never said why. It wasn't until I talked with Dr. Sister that I find out I probably have either a peptic ulcer, or gastritis. Makes sense. It was probably brought on by stress, the antibiotics I'm finishing up for the mastitis, plus the ibuprofen I was taking around the clock until the antibiotics started working, on top of the massive amounts of caffeine I drink. So, I have to see my doc. This week has not been fun. And in a week, I'll be 30. But, looking back, on the day I turned 29, I started having preterm labor at 34 weeks with Isaiah, I've had a not fun c-section, poor sleep, at least 2 bouts of stomach flu, mastitis, and gastritis/ulcer. Maybe I'm ready to say good-bye to 29.

November 9, 2008

A new nursing experience

So far in my journey as a mother, I have nursed (and continue to nurse) for a total of 38 months. And will probably nurse for another 10 months or more, and probably to the dismay of a lot of family who think I should have weaned already or expect I will at 12 months. I have been proud to say I nursed my kids with very little trouble. All three kids seemed to come out and knew how to breastfeed, latched on without difficulty and things went well with milk supply. (except when my freezer crapped out) Well, lately, Isaiah has been making me very sore again . He has 4 teeth, 2 on top and 2 on bottom and as he nurses, he's kind of raking his teeth against my nipple. He doesn't always do it, but he's done it enough that my nipples are sore like a new mom and they are peeling. Probably too much info, but oh well. He also bit me a couple weeks ago, and I'll tell you what, I yelped like a banshee, scared the crap out of Isaiah and he looked at me, quivered his lip and started to cry right along with me. He thankfully hasn't done that since, but the whole point is his teeth have been a little problematic lately. Never had that with the other two and I nursed them with almost a full mouth of teeth. Friday, I noticed that my right breast was achy from time to time, which I thought was odd. Then right before I went to bed, I noticed a firm, sore spot on the right side of right breast and thought, "Hmm, hope that's not anything to be concerned about". It wasn't a clogged duct, because I had one of those when Isaiah was just a couple weeks old. So I went to bed. I woke up a couple hours later, freezing cold. I layered 2 more blankets on top of my already heavy comforter, and continued to shiver. It took me awhile to realize that I was chilling from a fever, and not just cold. I had noticed that my boob hurt like hell, and so I stumbled downstairs to take my temp and find tylenol or ibuprofen. Temp: 102 and of course, I can't find anything but childrens and baby tylenol. I realized then I had mastitis. The whole side of my breast was red, hot, inflammed and very sore. It hurt just to touch it. And I was achy from the fever, disoriented and dizzy. By the time I got upstairs, I was so dizzy that I ended up vomiting. I was feeling great! Thankfully, in the a.m. I was able to call and get an antibiotic to help clear it up and today it already feels a ton better. We figured that with Isaiah raking his teeth across me, the skin got a break in it and bacteria traveled its way up the breast into the milk duct. Nursing for those few hours was quite painful, but the full feeling was worse. Thankfully, the last several feedings, he hasn't been raking his teeth across the nipple, so I think maybe my breast will heal now, because it looks battered. I know a lot of women end up with this multiple times while breastfeeding, and boy does it suck. It was hard for me to put a sore boob as the cause of the flu-like feeling I had. So, I send my ultimate sympathies to all those who have suffered from mastitis. Ah, the joys of motherhood!

November 4, 2008

GO VOTE!!

Happy election day! Tonight I will have news on, watching as the polls come in. Yeah, I'm a dork, but this is a very important election. Everyone, exercise your right to vote. This is one of our ultimate freedoms. Make your voice heard. And don't think "I'm only 1 vote, it won't matter". It does, and it will.



GO VOTE!!!

November 3, 2008

Allergies

Since I've been a nurse, I've had to ask patients about allergies to medication, latex, and any other allergies they may have. And I've heard quite a few. Some are legitimate, like to penicillin after they had an anaphylactic reaction. Other are not. I think sometimes people misunderstand an expected side effect and an allergy. I also take for granted that because I work in health care, I understand it better than a lot of people. And while I understand health care, I admit that I know jack squat about business, insurance and technical computer stuff. But, anyway, morphine is a drug people commonly think they are allergic to. I've had several people say they are allergic to morphine because they got a little itchy. I know how much itching from morphine sucks because I had a very bad case of it after my c-sections, but that is a side effect, not an allergy. Awhile back, I had a patient tell me they were allergic to pitocin, a medication used to cause contractions and to induce/augment labor. Her reaction to the med? She had said that she was given pitocin when she was induced with her last baby, and it made her crampy. Well, yes, it will do that, and that is what we want. But my favorite allergy, I heard this weekend. We had a mom going back for a c-section. As happens in c-sections, mom was given oxygen by a face mask. Mom started telling the anesthesiologist that she was allergic to oxygen. He politely said that she could not be allergic to oxygen, as she needed that to breathe and it is in the air around her, but she was adamant. He suggested maybe it was the mask or the tubing. Nope, it was the oxygen. He kept trying to explain how that couldn't be possible, but she remained firm. She did continue to get the O2 and had no ill effects.

November 1, 2008

Diaper Duty

There are some things that come with parenting that aren't so pleasant. One being poop. Especially baby poop. We all know that changing poopy diapers is part of raising a child. And anyone who's ever changed a diaper knows how smelly and colorful that poop can be. You start with the green-black tarry meconium of a newborn, then you get the yellow-brown seedy poop of the breastmilk poop. And once you start solid food, look out, you're about to see some color. Feed baby green beans or peas = green poop. Carrots, sweet potatoes = orange poop. For a real color palate, feed baby green beans at lunch and then carrots for dinner and you'll get that half & half poop. And we all know corn goes right through. So I've changed many a diaper over the last 5 years between 3 children and working in OB. I didn't think anything in a diaper would gross me out. Until today. Imagine my surprise when while changing Isaiah I see this. (warning: it is gross)













Keep going











Free Photo of an Asian Multicolored Lady Beetle (Harmonia axyridis). Click Here to Get Free Images at Clipart Guide.com

There was not one, but two mixed in the poo. I really thought I was going to vomit. These little beetles emit a nasty stink when you pick them up. They have been rampant this fall and are all over the place. You can vacuum all you want, but they seem to multiply. A good freeze get them, but the weather has been warm and beautiful. I hope to God that they found their way into his diaper externally, but considering he puts EVERYTHING in his mouth and even though I am relentlessly vacuuming, I still pull things out of his mouth, my guess is he found them and thought that "sure, why not, it's on the floor so it belongs in my mouth, right?". Since they weren't, ahem, digested, maybe there's hope, but how the heck could they have gotten in there?!? Well, if he did eat them, maybe in some parts of the world they are good protein.

PS: Jessica, love your blog, consider adding me to your invite list?

October 28, 2008

Thanks for the supportive comments. I'm feeling more confident we'll be fine. I guess no one said that marriage was easy. And since I keep an anonymous blog, I don't feel guilty about venting. Venting here keeps me from crossing the line when we talk later. No one I know reads my blog. Well, my sister does but that's it. Husband knows I keep it, knows the URL and could read at anytime. Nothing written is anything that I wouldn't say in our conversations. Some things I probably shouldn't,like the whole testicle thing, but nonetheless. As with any stories about work, I make things up, change facts, etc. Our issues could be anyone's issues. And I don't think Husband is a bad man. Not what I'm saying at all. And I'm not completely innocent in this either. If you know me, you'd know how hard-headed and stubborn I am. Husband said once that he found the only woman in the world more stubborn than he is. When you have to stubborn people who both think they are right, you get trouble. I also figured out a way to relieve stress at work: Saying no. That's something I have a hard time with. That in itself won't solve everything, but it's a start. Sometimes its hard to focus on all the good things instead of the bad. We have 23 beautiful, healthy children, good jobs that have flexibility, our own home and supportive family. I know it won't be a quick fix, but we'll work on it. Hopefully we can have a good chat once the kids our asleep and we'll put a new foot forward.
Changing the subject, I just paid $2.39 for gas! Odd how that seems like such a good deal, but just a few short months ago, I paid $4.39 for gas. I remember when I first started driving that gas was $.99 per gallon. Granted, that was a few years ago. And after 9-11, I walked more than a mile home because "I wasn't going to pay $1.99 for a gallon of gas". Seems so funny now. Speaking of that, in a few short weeks, I will be leaving the 20's and will be 30 years old. I remember when I thought that was so old, grown up and mature. What's funny is I feel no different than I did 5 years ago. Is that a good thing? If not, oh well.
Isaiah is also very close to walking. He has been standing for short periods of time the last few weeks, and now he is bouncing up and down and even lifted each foot once. He didn't go anywhere, but he's getting better at balance. Once he masters that, it' all over and he'll be running in no time. I guess I need to exercise anyway! On another positive note, our wheelchair ramp may be coming down this weekend. I am beyond excited. I've slipped and fallen on my butt many times: while pregnant, carrying Isaiah. The darn thing is so slick when it's wet. Plus, it's an eyesore, the kids could get hurt falling off of it and have in the past, and we don't need it. I will be glad to see it gone.

On the Rocks

I've been debating on whether or not I should talk about this here. But I decided it might help me feel better about it. I remember when we met with the pastor before we were married. He said "If you are having problems, keep them to yourself. The rest of the world should see you as the God-fearing, loving husband and wife." Basically, put on a show. Well, that just isn't working for my life right now. So, here goes. Yesterday morning, one of the dayshift charge nurses asked me when I was going to go back to school? I gave a little laugh. I remember when I really thought that I'd be able to get back to school and get my masters degree. If you've read my blog since the beginning, you may remember I had that in my profile. I wasn't always sure what I'd get it in, but I do have several options since I hold degrees in both nursing and biology. My coworker thought I should go to midwifery school. While I love labor and birth, I don't think I'd like the responsibility of being a midwife. Plus, the state I live in is not midwife-friendly. Or I could do women's health. Or kinesiology. Or exercise physiology. Or something completely different. But that's not really the main problem. It would be support from my husband That's really the kicker. That really got me thinking about the state of our union. I don't think my marriage would last if I added school into the mix. We're already on shaky ground right now. I work my butt off, work night shift and weekends to make the maximum amount of money with the least amount of time at work and most at home with the kids. I am exhausted all the time. I had to reevaluate my definition of tired since the birth of Isaiah. But everyone knows that's part of it. And in a year or two, I'll look back and long for those days when Isaiah was such a little love bug when he's coloring on my walls and terrorizing the cats. But, every weekend, there is a fight between Husband and I because he has to do what I do all week long: take care of the kids and house without my help and get up with the baby at night. To hear him talk, you'd think he was trying to hold the earth up on his shoulders while changing a diaper. Too bad he forgets I do it all week. Only difference is he has them alone at night. And he doesn't do the housework I do, or cook on the weekends. It's all just frustrating me right now. Things are stressful and I can't talk to him because he says things like "it was your choice to work nights and weekends", "go to dayshift" or "Well, think how bad it is for me". Um, okay, when was the last time you were awake, for 27-28 hours straight? I do that EVERY SATURDAY NIGHT. I can't just go to dayshift, even if I wanted to. I computed the difference in my pay if I did days instead of weekends and I would make less than half of what I make now. Not an option. Days would be a more normal life, but I don't think it would resolve any of the problems we're having. I also pay bills, buy groceries, do all steps of laundry, dust, sweep, mop, call people for house repairs, take care of the cats and those pesky fleas we had, litter box, bathrooms, and keeping track of what clothes the kids need, doctors and dentist appointments, birth control and breastfeeding. Oh, and most of Jacob's school stuff. He does work more hours than me so I don't mind doing more. But his list includes garbage, kitchen at times, and yard work (which doesn't always get done). All I want is for him to appreciate what I do without making me feel guilty. And to buck up, let his testicles descend and deal with the kids and lack of sleep for each 36 hour period he has to deal with it every week. I know we're both feeling under-appreciated and that's probably most of the problem. But it's wearing on me, you know? There are all sorts of other issues. His job is stressful, I'm frustrated with work as well, trying to make sure we do everything we should for Jacob's school and giving Clara enough time so she doesn't feel left out. We're just in a tough spot right now.

October 25, 2008

Evening in Charge

Earlier this week, I agreed to work 3-11 shift and be in charge. I had called to let them know that if they needed another nurse, since they had 3 RN's off on maternity leave, that I was available. I ended up agreeing to work for the nurse scheduled to be in charge. It was an agreement that afterwards, I sat there wondering, "what did I just do?". Evening shift, especially on Fridays, tends to be a bit chaotic. Post partum is full of moms and babies, due in part to all the scheduled inductions and c-sections. The book is usually full of inductions/c/s on Fridays because docs want to deliver their patients before the weekend and patients want to deliver before the weekend when their doc will deliver them, instead of the on-call docs. Now I've worked some busy night shifts. And I do work the back half of 3-11 every weekend. So I kinda know what to expect. And boy, was is busy. Luckily, I had plenty of staff. We started the shift with a c/s for failure to progress. After that c/s was done, another patient was taken back for repetitive late decels. As that mom is being taken into the recovery room, our last labor patient was pushing. 10 minutes or so later, heart tones start to get crappy, so it was decided that the doc would try forceps to get the kid out, but we needed to open for a c-section, just in case. You can see where this is going, right? Forceps are donned, heart tones look like crap, and I'm just hoping this baby comes out and that we don't end up with a shoulder dystocia. One pull with the forceps, baby decides "no way", heart rate dives to the 40's and we go a-running back for our 3rd c-section of the night. Our first c/s patient is wheeled out of recovery just in time to replace her with our 3rd mom. All 3 of these deliveries happened before 5:30 pm. Finally, it settled down, and after these moms were moved out to post-partum, labor would be empty. Moms get taken out, and wouldn't you know it, but ER calls letting us know we have a 30 week mom, ruptured on her way up. She is evaluated, and she is indeed ruptured. Her doc comes in, we get her transferred out to a higher level facility to care for her preterm baby. By now it's 7pm, and pediatrics gets their 2nd admission of the shift and they need another nurse. Done. Post-partum patients are pretty needy, due to having so many post-op day/ delivery day moms. I did manage to get staffing for night shift done and get most of my paperwork done by 0030. I crawled into bed at 1:30 a.m, after feeding Isaiah. I swear he sensed my presence as I walked up the stairs. Man, I was worn out. I'm not sure how those regular 3-11 charge Rn's do it all the time. The busy patient care was no problem. I've been staff nurse on many a night where it's a revolving door of pregnant women coming in. But it was a struggle being in charge, trying to keep a handle on everything back in labor, making sure we have baby care for deliveries and that the nursery is covered, maintaining post-partum with their new deliveries and discharges AND pediatrics/infusion admits/discharges and then doing staffing for the next shift. And I get to turn around and work all weekend. Hopefully I can get in a nap.


October 20, 2008

Why I'm a bit stressed right now

1. Just because I have RN after my name instead of MD of course makes me an idiot. I deserve no respect. And because I work night shift, I obviously don't know my ass from a hole in the ground.

2. No, it is my fault that I do not have a prenatal record on your patient. Yes, I've looked in every location, and it is not here. And yes, I am in fact saying that your office staff didn't send the record over even though she's been seen over the last 40 weeks. I do not work in your office, and I work night shift so I don't receive the prenatals from the office, as offices aren't open at 2a.m. so not my fault. But go ahead, ream my ass for it. Really, it's okay.

3. Nothing happens on night shift. Patients just sleep. And weekends, man, they are really slow, so lets pull staff off weekends and schedule them during the week. We need just bare bones staffing on weekend nights because people don't deliver overnight and certainly not on the weekend nights. Really. So when someone breaks the "Rules" and, oh, goes into labor on a weekend night 'gasp', don't give me crap for staying late charting when I had 2 active labor patients , one 9cm without an epidural, the other 4cm and is wanting her epidural, AND I have to hold the hand of a new RN who is on her own but shouldn't be. And all this at once. Oh, and to see how talented at multi-tasking I can be, I'll also be charge RN. So, no, staffing was a bit heavy for your shift (What a problem to have) because I did not have time to do anything but make sure that there was enough staff, and, yes, I'll get my charting done to your satisfaction. Excuse me for putting patient care ahead of charting.


As you can tell, I had a very stressful night last night. I'm really hoping tonight is better. On a lighter note, here are a couple cute pics:

Can you believe Isaiah is 10 months old today!?!?

Isaiah, standing on his head.

The picture is a bit dark, but they are in fact feeding babies. Jacob said "Boys feed babies with bottles, but girls feed babies with their boobs" !

October 18, 2008

More random tidbits

Finally, I think we may be winning the battle against the fleas. After much $ spent, the cats are flea free and I'm not noticing fleas anymore. I'm keeping my fingers crossed. If they do reemerge, Terminix will be visiting us again, and again until they are gone. But, for now, I'm optimistic.

After only 1 quarter complete in kindergarten, Jacob is reading! Granted, it is only sentences and words like "I am Sam. This is Dan. Dan and Sam. Dan and Dad" but he's is reading. His handwriting is also improving and his pictures he draws for us are becoming more obvious as to what it is. Clara is also learning more of her letters and seems wants to do all the things Jacob is doing. It's just too bad she has to wait 2 years before she can go. She is again wanting to wear earrings and I'm again torn on whether or not to get her ears pierced. Part of me says, why not? But the other part says she is too young to take care of them and she doesn't understand what is involved. So I'll probably wait. Isaiah is almost 10 months old. I can hardly believe it. This week I taught him how to give High Fives. It's pretty darn cute. He's also decided to hell with pureed baby food. He likes the graduate foods and he really likes regular food. Finally, I may have a good eater!

October 15, 2008

Time to unwind

After a couple of crazy, hectic weeks here in the Lochia household, things are quieting down. I think, anyway. Work this weekend was hectic, with me being in charge more often than I'd like. I swear our regular nightshift charge nurses never work anymore. My husband thinks I should be flattered that they put me in charge so often, but it's a hassle. Not worth the extra $1 an hour, I'll tell you that much! Plus, I'd rather take care of labor patient instead of worrying about staffing, etc. But, this weekend we had two co-workers deliver. Nice vag deliveries and healthy moms and babies. And 2 more nurses who have been trying for quite some time found out they are pregnant. There are so many people pregnant at work right now, it's crazy. Luckily they are all spread out due date wise, otherwise we'd be in trouble. Right now there are 6 that I know of!
I also decided that I was done screwing with trying to rid my house of fleas that I called in the big boys at Termi.nix to fix the problem. They had the best deal and will continue to come out, for free, to make sure the darn things don't come back. Well, I guess it's not free, but it's covered under the initial fee we paid. So he came and sprayed and I haven't noticed one yet. And I've been looking. He said to give it a week, and call him if we see even one. He is now my hero! My poor kitties are shut in our garage, which is good sized, for a couple days until I can get them treated again. I have to get the stuff today and I want to give it 24 hours to make sure it's in their system to kill any fleas on them. They're going to be so mad at me. But, I've got moist cat food, which they don't get except as a treat, that I'm giving them once a day, and Husband went out this a.m. before work to give them attention and I'll do the same later. My cat is still pouting, but she'll be happier once she's flea free.
This weekend Toyland opens at Fa.rm & Fl.eet this Saturday. I discovered this a couple years ago and they have the best deals on toys, especially if you can drag yourself out of bed at 6a.m. They have quite a variety on toys, and good deals of Christmas decorations, wrapping paper and cards. I'm going to try to make it, although I'm SO not a morning person.

October 13, 2008

Pregnancy and Infant Loss Remembrance Day

Wednesday, October 15 is the pregnancy and infant loss remembrance day. I just wanted to take a moment to remember all the families that love and have lost babies. It's a pain I wish no one had to endure. Each year at this time, I remember all the patients that have had such a loss. I remember my niece Mirabel. A child so loved, so wanted and anticipated. So many plans were made for this little girl and my son. I remember the joy of hearing my SIL was in labor, the anticipation that finally she would give birth and our children would grow up together and play together. Man, I remember the anxiousness I felt walking into her labor room, and then...the sadness. Seeing my big, tough BIL break down in tears, the fetal monitor without a fetal heartrate tracing, the tears in the nurse's eye when she realized we didn't know yet, and the words my SIL said "She didn't make it". I remember sitting with her, holding her hand, talking to her the duration of her labor. I remember the 4-5 hours of pushing on and off, wondering how long they would let her go on. And I remember seeing this perfect little baby being born, waiting for a cry that would never come. Feeling the tears burning my eyes as my BIL falls into the chair, burying his head in his hands. Hearing my SIL's voice, hoping against all hope, asking a desperate, quiet question "Is she breathing" and the doctor's no nonsense reply "No". I remember the nurse asking them if they wanted to hold her, which they were not ready yet, but in the end would hold her for 12 hours. I remember that same nurse handing me pictures of Mirabel, which I turned over and handed to my BIL, and having him turn to me and sob on my shoulders. I remember how after all of those hours, I left that delivery room, trying to hold myself together, walking to the waiting room, telling everyone she delivered and then running the bathroom and screaming, crying, yelling at God and the world, how could this happen? I remember not being strong enough to go back into that labor room to see and hold my niece with the rest of the family. I instead remember clutching my 5 month old Jacob and crying, thankful I had my son, but angry my SIL couldn't have her daughter. Oh my God, the hurt, the heartache and pain and it wasn't even MY child. I remember the funeral, and each December 1st since. All I know is the pain I felt, I can't even imagine what it is like as the parents. So here is in remembrance of all the babies who have gone on before their parents. You are much loved. You are not forgotten.


What Makes A Mother

I thought of you and closed my eyes and prayed to God today.
I asked what makes a Mother and I know I heard him say,
"A Mother has a baby this we know is true,
But God, can you be a Mother when your baby's not with you? "
“ Yes, you can ” He replied with confidence in His voice
“ I give many women babies; when they leave is not their choice.
Some I send for a lifetime and others for a day.
And some I send to feel your womb but there's no need to stay. ”
"I just don ’ t understand this, God I want my baby here."
He took a breath and cleared His throat and then I saw a tear.
"I wish I could show you what your child is doing today.
If you could see your child smile with other children and say
"We go to earth and learn our lessons of love and life and fear.
My Mommy loved me oh so much I got to come straight here.
I feel so lucky to have a Mom who had so much love for me
I learned my lesson very quickly. My Mommy set me free.
I miss my Mommy oh so much but I visit her each day.
When she goes to sleep, on her pillow's where I lay.
I stroke her hair and kiss her cheek and whisper in her ear
"Mommy don ’ t be sad today, I ’ m your baby and I ’ m Here".
"So you see my dear sweet one your children are OK.
Your baby is here in My home and this where he'll stay.
He'll wait for you with me until your lesson is through
And on the day that you come home he'll be at the gates for you.
So now you see what makes a Mother - it's the feeling in your heart.
It's the love you had so much of right from the very start."

Author Unknown


October 12, 2008

The birth plan

I'm all about a natural birth. It is a natural, beautiful process that when left alone, usually, goes great. Labor progresses, a baby is born, cries and we have a happy family. But something that can strike a nerve with many people is a birth plan. No, I'm not opposed to a birth plan at all, and neither are the nurses I work with. I actually think it's a very good idea to think about how you want to labor and deliver, and to visualize that labor. Do you want intermittent monitoring, do you want to use the tub for labor and/or delivering? Do you want pain meds?, etc. I am a firm believer for intermittent monitoring, ambulating in labor, using the tub to help ease the pain of contractions, allowing mom to hold her baby skin to skin immediately after birth and breastfeeding exclusively for 6 months. I think continuous monitoring leads to more interventions that cascade down to an operative birth, whether that be forceps, vacuum, or c-section. And research says it does not lead to better birth outcomes, it just increases incidence of operative births. But, here are just a few things I think you should consider when writing your birth plan. We are all working in OB because we love childbirth and when you have a great experience, we have a great experience. First, be open to letting things happen that will lead to a safe delivery. Sometimes, interventions are necessary, and no nurse I work with would intervene just for fun. Second don't just print one off the internet. Most of the things I've seen on those we don't do anyway, like enemas and pubic shaving. And at least where I work, no baby is given formula or a pacifier unless the parents request it. We are all for helping you get the best start to breastfeeding. But if you are breastfeeding, and you send your baby to the nursery to sleep but won't let us give it a paci, and it screams, we have to bring you're baby back to you to feed it. If you don't want pain medication, etc, then stay home until you absolutely have to come in. That way you are in active labor, if not in transition and it will be only a matter of time before you deliver after arrival. Probably most importantly, TALK TO YOUR DOCTOR!!!! I can't say this enough. I'm perfectly fine with no IV, drinking fluids, and ambulating and using different birth positions other than lithotomy, but if your doctor hears about all this for the first time when I call them at 3:00 a.m., they won't be happy and I can't guarantee that they will agree with your plan. Which when this happens, all involved will be unhappy. I am your biggest advocate and will do everything I can to ensure that you have the birth experience that you want. One thing to keep in mind is I am not the one who decides whether or not things are done or not. I get orders from your physician. We also do not like doing bloodwork and IV's and tests on your baby. We don't enjoy causing a baby pain and discomfort. We do these things to ensure the health of your baby and under the direction of the physician. I'm a little testy right now, I guess. I have a house infested with fleas, those damn yellow and black lady bugs and I've spent a lot of money to rid my home of these pests, to no avail. Several people I work with have the same problem right now. And work was a wee bit stressful. We had a couple who came in with an extensive birth plan that they hadn't discussed with their doctor. Biggest problem: they wouldn't let us do ANYTHING. No vag exams during the course of her 2 day labor, no doppling of heart tones at all, no newborn resuscitation of their blue, floppy, baby. I guess it was ugly in the delivery room for quite awhile. No vaccines, no tests at all, no assessments, and that baby never left their sight. And they treated everyone who came in contact with them like we were out to cause harm to them and their baby. Fine, you don't want interventions, but if you won't let us do anything, why deliver at the hospital? The state I'm in sucks because there are NO birth clinics and it is very midwife unfriendly, especially midwives who do home deliveries. There aren't too many done, but there is a midwife that will do homebirth around here. They were obviously miserable the entire time they were there and wanted to be at home. We were miserable because nothing we did could make them happy. Again, I'm not anti-birth plan, and I'm all for an all natural birth, and keeping your baby with you. I'm so hoping tonight will be less stressful.

October 7, 2008

I'm Free for a Few Hours

Since I didn't work last night and the kids were scheduled to go to daycare anyway, I decided to take them and use today to get some stuff done. I only feel a little guilty, but we have to pay for the day whether they are there or not. Plus, I slept like crap because of this cold I have. I just couldn't quit coughing. I've coughed so much, all the muscles in my torso are sore and I swear I strained a muscle in my stomach. So I need a nap. And Clara would be upset because she wants to go play with her friends. And I had thawed out 2 bottle of breastmilk for Isaiah, and I didn't want them to go to waste. So I took them. Every once in a while, a mom's just gotta have a day to herself, whether to relax, or to get things. done. I'm cleaning and plan on either bombing for bugs one more time today, or I might do that tomorrow. We'll see. I've gotten a lot done already. I've cleaned every room on the mail lever from top to bottom, except the kitchen, cleaned the basement, which was nasty and took an hour. I haven't mopped, but I'll do that after the bug bomb. And I finally got my letter to Isaiah written. I know it's not a new idea, but I decided to do this after Jacob was born when I was planning my SIL baby shower. I had passed out cards for everyone to write a letter to her unborn baby, with the idea that she could open a card on every birthday and see how excited everyone was before she was born. Unfortunately, she was stillborn, but her parents have those cards and notes as memories. So I decided that should something happen to me before my children are grown, and even if I live to be 100, I wanted them to have a glimpse of what their mom was like as a new mom. I just hadn't gotten the time until today, but I have typed up all I want to say. Now I just have to write it all. I want it to be in my own handwriting, for a more personal touch. After I get that done, I have a card I'll put the letter in and seal it in an envelope and put it in his baby box. I haven't decided when I'll give the kids these letters I've written for them (Jacob and Clara also have one), but since they are still young and can't read yet, I figure I have some time to decide. So I'm enjoying my free day, even though I'm cleaning. Right now, though, I think I'll eat some lunch, uninterrupted, take a bath, uninterrupted and then take a nap before I pick Jacob up from school and Clara and Isaiah from daycare.


October 6, 2008

Babies, babies, everywhere

I got my wish this weekend, and it was busy enough I got a few nice deliveries/labors in. Saturday wasn't real busy, but I admitted someone for a labor check at about 5a.m., but she wasn't in labor yet so she went home. She came back in last night, in good labor. She was 41+ weeks, which we don't see too much of because the docs her do quite a few inductions. She didn't really have a great contraction pattern, but she was making change in her cervix. Luckily, the doc on call isn't one to mess with something that works, so I didn't have to start pitocin. We just let her labor, and she was 8 cm when I left this a.m. About 5a.m. this a.m., we had 2 moms come in within 20 minutes of each other, ready to deliver. The first went to the bathroom down in ER, and they had to beg her to come out because she kept saying "I have to poop". Um, lets get you up to L&D to make sure you don't deliver your baby in the toilet. Sure enough, she was complete with the head right there by the time she got to us. She was in great control, doc made it (barely) and she had a beautiful baby boy. Twenty minutes, I'm in my labor patients room, attending to a mild decel. I come out after awhile to find that someone had come in by ambulance and was moaning in the next room. I head in there and another nurse and I assess this girl, multip, 7 cm, water broken, and she had a history of fast labor. Not too much later, she delivers. As this is going on, our morning c-section is waiting to be admitted. Now this might not seem like too much commotion, but there were only 2 of us working labor to start with. Luckily, another labor nurse was able to come from postpartum to help. Our poor scrub tech, who was also the secretary, couldn't keep up with getting things orders, assisting with the deliveries, getting the a.m. section room set up, etc. (A sore spot with us because people who don't work nights seem to think we don't need a secretary AND a scrub tech. It's a bunch of bull) But, we did manage to get the patients taken care of. I also had a nice delivery with a very young mom of 15. Her family was very supportive, and she had been in and out frequently with preterm labor. She manage to get to 37 weeks. She labor and delivered quickly and was very happy to see her baby. Another young mom, 16, was coming in for a c-section due to a breech baby. She also had a very supportive family and the baby's dad was over in Iraq. While both of these moms were very positive about having a baby sooner than they would have planned and were set up with all the resources they would need, you still worry about them. How will they deal with a newborn and all the issues of being a teenager? I just remember how immature I was at that age. But, sometimes these young moms handle the baby better than some moms who are older and married. I just hope these 2 moms do continue on with school and go to college like they both said they would like to do. Good luck to them.

Crap, crap, crap. Work just called and put me on call. Normally, I wouldn't mind, but I missed last Monday night of work because Isaiah was sick, so that's 16 hours I'll be missing this next check. Oh well, I am sick myself, and maybe they'll call me in at some point tonight. That's the bad/good thing about a working in a hospital. If they aren't busy, they flex staffing down to save money. What other jobs are you not guaranteed your hours? While it's nice to get a night off here and there, it also sucks if you want/need those hours.


October 4, 2008

Random Tidbits

This week has been a long one. So much has been going on, and so little sleep, that instead of making coherent post, I'll just hit the highlights.

* I'm finding myself more interested in politics as of late, and I'm sure I'm not the only one. The economy, bailout plan, etc., has gotten my attention and so I've been following the news more. I even watched both the presidential and VP debates. I know I should have been more interested before, but I wasn't. I knew who I want to be the next president based on just skimming the surface of his ideals, but after researching, I'm finding I'm hoping even more that he is elected. I won't get into my choice for the next president, as this isn't a political blog, but I'll be following election coverage this November with high hopes.

* Had noticed the charge for daycare (that comes out of my paycheck) was higher now that Jacob isn't going than it was before. They had increased their rates, as they do every September, but it didn't go up that much. Checked with daycare, and they'd been charging us for Jacob for the last month. This last paycheck was nice without that charge.

* Was in charge Sunday night at work, and staffing dayshift was a pain in my butt. We were dead slow, and we have to staff pediatrics/infusion/outpatient procedures. As far as I knew, our pediatric nurses could hang antibiotics on adult patients. Apparently not, as I flexed off the infusion nurses, thinking the peds nurses could do this. They threw a fit. Good God, people, doesn't it just go through the IV? Seriously.

* In the a.m.s after work, I go and feed Isaiah at daycare before going home. I knew he had a little cold over the weekend, but I wasn't prepared for how pitiful he looked Monday a.m. The poor little guy looked so sad and miserable. I took his temp, and he had a fever. So I took him home, hoping that I could get some sleep in. Alas, sleep didn't happen. I was supposed to work Monday night, but after working all night Sunday, being awake all day Monday, there was no way I could work Monday night.

* Sleep was sporadic all week long. Baby was up more than he was as a newborn: every 1-2 hours, tops. We're all a bit tired.

* Isaiah had a temp on and off all week. Finally took him in Friday afternoon. Verdict: pink eye and an ear infection. Had noticed that morning my eye was crusty and Clara's eyes were pink. So full round of eye drops for all three of us.

* Jacob had his first field trip to a local cheese farm and pumpkin patch. Packed a good lunch for him, put it in his backpack, dropped him off at the sitters where he catches the bus. Pick him up after the doctors appointments and found out that another mom said the kindergartners didn't need their backpack, so he left it at the sitters...with his lunch inside. Thankfully someone gave him a sandwich and a drink that day so he didn't starve. A bit irritated because I look like I just didn't pack him a lunch. Oh well. I'm probably more worried about it than I should be.

* Woke up this a.m. with a raging migraine, a cough and very little voice. Fabulous, because I work the next 3 nights. Migraine is thankfully gone, but I sound like a 85 year old woman who chain smoked her whole life. I encourage my children to share, but I'd rather not share colds.

Hopefully this weekend is a good one. I'm hoping for middle of the road busy nights. I'd like to have a couple deliveries and not have to be charge RN.


September 30, 2008

Complete previa

Every once in awhile in L&D, you have a patient come in that makes you nervous. This weekend, we had someone come in with a complete previa, and had had some bleeding a couple times at home over that last 12 hours or so. She never bled while she was at the hospital, but the on call doc ordered a sonogram to see what was going on. She was 37 weeks and some change, and they had done an amniocentesis to check lung maturity at her last doctors visit, and the lungs were immature. So they cancelled the c/s they had planned and were planning on checking maturity again in a week. Anyway, she's hanging out, and now I come on at change of shift. Both me and the prior shift nurse get to talking about the tentative plan to let her go home if the sono was fine. We were both a bit nervous and wanted to at least observe her overnight. Things can get ugly very quickly with a complete previa (placenta completely covering the cervix), and she had bled a couple times at home and was now having contractions every 3-5 minutes. Since I was the one coming on shift, I wanted to at least have IV access if she was staying because the last thing I wanted to do was have her bleed majorly, have the baby take a dive and not have IV access. Quite honestly, I was hoping they'd call for a c/s because if something did happen at 2:00 a.m., there wouldn't be an OB or anesthesiologist in house, which could make an ugly situation uglier. But, at the same time, things could be just fine. The prior nurse and I decided to give the patients doc a call, just to let her know she was here. And, much to our relief, she decided delivery would be the best bet, instead of waiting until something happened. With a previa, you never know how much blood loss you'll have. If the placenta is on the backside of the uterus, you are usually okay, but if it's in the front, where they make the incision, you can have a hemorrhage on your hands. I've seen where they've actually had to cut through the placenta to deliver the baby. Boy was that messy and scary. We started two IV sites, with 16 gauge hoses, just so if she did start to hemorrhage, we'd have to huge lines to run blood and fluids in quickly. We had 2 units on the unit and ready for use. Thankfully, the c/s went off without a hitch, the placenta was posterior and the blood loss was typical for a c/s. The baby did fine. She was breathing a little fast and was grunty working to breath, but never did need oxygen and by morning was going out to mom. I'm not usually a huge hurry-up-and-intervene-when-things-are-stable, but in this case, me and the prior nurse just had a "feeling" something would happen in the middle of the night. Now I've not been a nurse long enough to go by my instincts alone, but I think you get those feelings of foreboding for a reason. Ahh, just another day in the life of a labor nurse.

September 25, 2008

The war has begun

After one hell of an afternoon/evening/night, I am now waiting to see if all of my efforts did one bit of good in getting rid of fleas. It's overwhelming because 1.) it only takes 1 flea to reinfest, 2.) a female flea can lay up to 50 eggs 3.) the eggs are difficult to kill. I set off 3 bombs in the house, 1 on each level. They are supposed to kill the eggs, which is one of the biggest problems with fleas. I am vacuuming like a mad woman to pick up any eggs that didn't die. I also put some drops on the cats, let them stay in the garage overnight. The medicine is suppose to kill the fleas in 24 hours. I worry that because they are still alive and on the cats that somehow they will survive and take over my house again. Ugh. In preparation, I had to bag up all the kids toys (4 bags plus 3 toy boxes and 2 bins), all the baby's stuff, strip our beds and wash all bedding and blankets and rugs, turn off the pilot light to the water heater, and remove everything off my kitchen counters. After staying out of the house for 3 hours, I mopped the floors, vacuumed, wiped down the kitchen counters, dining room table, crib, and reorganized the kids toys. We decided to leave the stuffed animals in bags for awhile to make sure any fleas would starve and die. And to add to the fun, I didn't get to bed until 12:30 a.m. because Isaiah was fussing and husband decided to go to bed. Not really fair, but okay. But, then he was extra fussy and I really got 2-3 hours of sleep. And then this a.m., it took forever to relight the pilot light on the water heater so I could shower. It shouldn't have been so hard. To top it off, I work tonight, and am on call from 7-11 before my shift. I'm sure I'll be called in because I'm wiped out. I've got my last load of rugs in the dryer now, I have to rewash Clara's bedding because she peed in it at naptime (I swear she hates clean sheets because this is the only time she does this). The last thing I need to do is clean up the basement because, man, are there dead bugs everywhere. It's really disgusting. But, typing out all the things I've done in the last 24 hours makes me feel like Wonder Woman. And Wonder Woman needs a nap!

September 24, 2008

I am declaring War

I'm taking a mental break right now from clearing out my house. My indoor cats, INDOOR cats, are infested, covered in fleas. I am just sick over this. I'm in the process of removing all the kids toys, washing all things washable in preparation to bomb the house tonight. It's quite a daunting task. Thankfully one of my friends works at a vet clinic and is getting me some good stuff for the cats and the house. We didn't notice it until the cats were covered, and this morning, I noticed one on Clara and one on Isaiah. Everyone has their "thing" that absolutely grosses them out, like public bathrooms, outhouses, etc. Mine is apparently the thought of having fleas in my house. So, after my freak out, break down, I am recovering and waging war on these pesky little bugs. I will prevail.

September 22, 2008

Abdominal Cerclage

Last night, I took care of a patient that had an abdominal cerclage placed when she was 14 weeks. This was the first time I'd ever heard of such a thing. I obviously know about the usual cerclage, but this was different. If I understood right, it can be place before conception or afterwards. And it is permanent so she'll have to have a c-section. She'd had 2 second trimester losses, an incompetent cervix and a failed cerclage previously, so she went to a large university hospital to have an abdominal cerclage placed. Now she's 35 weeks, so apparently it works. Anyone else know much about these? I'd like to ask one of the docs about it or research it a bit, but I didn't have the time last night. It sounded like it's fairly new, and the patient said the doc who placed it said it seems to work much better at maintaining a pregnancy when there has been evidence that prior pregnancies were lost only due to cervical incompetence. I'm guessing it's a newer thing? But, like I said, I'd not heard of it. None of us working had. My imagination dreamed up this image of the doc making the incision, taking this big honkin' rope and just tying it around the lower part of the uterus, above the cervix, kinda like tying up a garbage bag. I've got a vivid imagination, but actually it sounds like that's sort of what they're doing. I'm curious to learn more.

On a side note, I remember my first patient who delivered before viability at 21 weeks. I bet I'll always remember how that night went, her doc, her name and he little son's name. She has since gone on to have another baby and she came in last night for a labor check with her 3rd baby at 38 weeks. I had bonded with them when she was hospitalized on bedrest. She had been 3 cm at her 20 week sono, and so she spent about a week or so on strict bedrest to try to get her to viability. I was just off orientation and pregnanct with Clara but not showing much through scrubs. She hadn't been contracting, denied any pain at all. She called at one point because she felt wet. Her water had broke. Her doc said to just watch her, because there wasn't much we could do. She told me she needed to have a BM, and I was filled with dread, worrying that it really wasn't stool she was feeling. So, I gave her the bedpan. She hit her call light within a minute or two and the look on her face gave it away: she was delivering. He was born alive, perfect, but not ready to be out of the womb. At first, she didn't want to see him. It was shock I think, but when she realized he was still alive and that she could keep him warm and next to her as he passed, she decided she did want to hold her son. She and her husband had about 2 hours with him. I saw her the next a.m. and they showed me pictures. We all had a cry together. I had typed up this beautiful poem I found on thick paper and had it laminated, which she still carries in her purse, which she showed me last night. I remember when she had her second son 2 years later. And it's was again great to see her pregnant and due anytime.

September 19, 2008

Postpartum

It seems I'm in a dry spell of good labor/delivery stories. Hopefully this weekend will be busy enough I can get in a couple deliveries. I'm more in my element I think, when I'm working labor than when I'm on postpartum. And on most nights, I would rather be working labor. Last night, though, I felt like I was in the right place that night. She had had a c-section with her 3rd baby at 35 weeks because he was measuring small for his gestational age and his amniotic fluid level was critically low. He came out screaming, small, and had the cord wrapped around his neck 3 times and a true knot. He's one lucky little boy. But, his lungs weren't mature, so he was on oxygen and working a bit to breathe. About 1:00 a.m., om was getting miserable: she was itchy beyond belief (something I really empathize with) was hurting and in need of pericare, plus anxious about her baby. So after about 1 1/2 hours, I get her itching under control, got an order for toradol (love that pain med), got her cleaned up and tucked into bed. She had been too uncomfortable and wiped out to actually get up out of bed for pericare. Part of it I think was earlier she had gotten up very soon after surgery and it was catching up with her. Her husband had gone home to be with their younger kids, so I spent a good deal of time talking with her. Anyway, she finally agreed that she needed to rest and decided to go to sleep. About 45minutes later, he baby is wearing out from working so hard to breathe and after a chest x-ray, we see he has a pneumothorax. So he needed to be transferred to a higher level facility. That of course sent mom over the edge and she spent a good 2 hours in the nursery with her son. It's amazing the strength mothers get when their children need them. We gave her time with her son, answered all her questions the best we could and she finally relaxed as much as possible in the moment. She even joked that her son would be able to say he got to fly in a helicopter as a newborn. He'll be fine after a couple days and she was very thankful just that we took the time to sit with her until her husband could find a sitter for their 2 other kids. Makes you realize that sometimes all it takes is a little time to make a difference to someone.