Talkin' bout a bunch of shift work, a big old pile of shiftwork...

Lately, work has been pretty mundane. Routine labors, preterm patients, c-sections, inductions, and the like. The last few weekends have been pretty slow, but this last weekend was hopping. I had 2 labor patients, both laboring with their first. One was married, in her mid-twenties. The other was not married, and a fifteen year old sophomore in H.S. Both ended up with c-sections because their pelvis was too small. Guess which was the more mature patient? The 15 year old had a better all around attitude, a higher level of maturity and more realistic expectations than the older mom. I was pretty impressed. By Sunday morning, we left the dayshift with 6 active labor patients. By the time I came back in at 7pm, they had done 4 c-sections and 3 vag deliveries, with plenty of labor checks, UTI's and NST's. That's quite a bit for our size unit, and for a weekend. Sunday night wasn't too bad. I admitted an induction at midnight. One of the docs is notorious for doing inductions. He'll say they are medically necessary, but upon assessment, we can't figure out why. Suspected LGA in a multip. Or the pre-eclamptic mom with BP's of 110/50's on admission, no proteinuria, fine labs, nothing that would indicate pre-eclampsia or pregnancy induced hypertension. And when we look at her prenatal record, there isn't any indication of pre-eclampsia there either. One of my favorite reasons for induction? Edema. That was the reason for my induction last night. Too bad I had more edema in my ankles than what she had. (yeah, I need to buy support hose) The patient stated at her last visit, her doc told her he was scheduling her for induction Sunday night. Patient didn't request it, wasn't given a reason, and didn't question it. And on our orders, the reason for induction was edema. Just call it what it is, elective, and be done with it. This doc also seems to decide dilatation with what works for him. One of his inductions came in, I checked her, reached to her tonsils to find her cervix, and found her to be 2cm. On her prenatal record, the doc documented 3cm, 80%. When he came in to rupture membranes, he called her barely a 1cm. Huh? Just a week before he called her a 3, now she's 1cm? And I wonder why work can be stressful!

It must be hormones...

...because I'm feeling a bit sentimental today...

I'm thankful:

For the craziness of my in-laws because I appreciate my "normal", boring upbringing and family more.

For my parents, who are great role models and are always there when I need them.

That I have a sister I can tell everything to, and if I'm being stupid, she's not afraid to tell me, and vice versa.

That my college roommie talked me into driving an hour away from campus to party with her and her boyfriend, because that's when I met my husband.

For my husband, who puts up with my moodiness and still loves me. That he has turned into a great, loving father.

That I easily got pregnant, had normal, relatively uncomplicated pregnancies (with only minor bumps) that resulted in healthy babies.

That we had an "oops" pregnancy that gave me my daughter.

For my two scars left from childbirth - they are physical reminders of my journey to motherhood.

For my job - I get to witness one of the biggest days in a family's life and the miracle of birth. It also has the flexibility that allows me to be home with my family more than a typical M-F job.

That I was able to put aside my desire to run away and hold my then 6 month old son Jacob and pretend it wasn't happening, and stayed with my SIL who needed support for the 13 hours while she labored and delivered her 39 week stillborn daughter - that experience helped me help the families I take care of going through the same thing.

That I'm not afraid to cry with these patients.

That I get to watch Clara cover her babies and pat them to sleep, watch Jacob build his towers and tell me he's going to buy me a new car when he's a grown up, that I get to listen to Isaiah sing himself to sleep in my arms.

For the temper tantrums, the fights over eating dinner, diaper "blow-outs", night-time feedings, lack of sleep, and a messy, loud house - because one day, I will sleep uninterrupted, there won't be any tantrums and the house will be all too quiet and clean.

For random hugs and I love yous from Jacob and Clara, and the huge grin Isaiah gives me when I walk into the room.

Swingers

Back in high school and even college, I never would have guessed how some of my classmates would turn out. In the high school newspaper every spring, there would be a "Most likely to..." for the senior class. You can try to guess what people will turn out to be, but really, in H.S., you just never know. I can't remember what I was voted most likely to do, I think I was voted most likely to succeed, because I graduated #2 in my class. I was also the shy, quiet girl that never really dated, and actually had a friend tell me she didn't' think I'd ever get married. Yeah, she was a great friend. I wonder if she remembers telling me that, 3 kids and 6 years of marriage later. I would have never guess I'd be a labor nurse back then. I was a bit immature and sould have never believed I'd be comfortable doing pelvic exams, and all the things that go along with birth. I never would have guessed that a sorority sister would be on trial now for involuntary manslaughter of her daughter. I can now add a new surprise: I can now say a friend of mine is a swinger. We grilled out with a girl I went to H.S. with and her husband last night. She has always been a little on the wild side. She's had encounters with a girlfriend since she's been married and even had a 3-way with her husband and her former female boss. The first time she told me about making out with one of her girlfriends was the day after I came home from the hospital with Jacob. That was enough to stun me. But last night, she told me her and her husband have given each other permission to have relations with other people. Her choice was a 21 year old in their circle of friends. His choice was one of his wife's friends. She was actually out and her husband called and said "so and so is over, do I have permission?" To which she said, "I'll be home at 4a.m." And that was that. I guess if that works for them, then more power to them, but seriously, how can that be healthy for a relationship? I don't share well and kinda feel that you shouldn't do things like that when you're married. I guess I'm old fashioned. I told my husband that it was a good thing we weren't into swinging because I'd get the raw end of the deal because none of his friends strike my fancy.

On-call

Tonight, instead of working my usual Saturday night shift, I'm home on call. As a weekend-option person, they can't put me on call when the census is low unless I want it. I decided to take it because 1.) Husband had said the baby was fussy and 2) I need a break. After I got home tonight, I was telling husband about the bad dream I had during my nap today. After I was done he said "Man, you need a vacation, not a maternity leave like you've had, but some real time off". And he's right. Basically, all the things I worry about too much made their way into this dream. I come from a long line of worriers, so it comes naturally. Serious worries like money, work, as well as tiny things, like the fact my husband wants to cut down a big tree by our deck and I don't want him to wove together into one moster of a nightmare. Worst part of the dream basically was work related. Long story short: I dreamed my labor patient had a decel while I was gone, they took her back for a c/s without getting me out of the other room, she threw a PE and when they tried to intubate her, her head ripped open and she died. And all of this was my fault because I forgot to check her temp every 2 hours because her water had broken. Crazy, huh? And doesn't make a whole lot of sense. So an extra night away will do me some good. After that crazy stuff going on in my subconscious, I've decided I need to cut myself some slack, get more sleep, need to find a way to relieve stress and I need a vacation. Vacation is covered in August, when I took the weekend off before Jacob starts kindergarten. And I need to exercise more, whether I run or walk. Running was always my stress reliever in the past. My left knee has been achy during weather changes, so I may just stick to walking for now. That will help my stress. And I know I need to give myself a break and get more sleep, but those will be harder to accomplish. I'll get my groove back soon enough ;)

Feeling inadequate

Lately, I've been feeling like I'm not the nurse I used to be. I really feel like I forget to report off things, question my abilities, etc. The main reason I feel like this is I've done things I've not done before, and believe me, if I had, I would have known. For example, and this is actually the worst case of my forgetfulness, I admitted a patient for the RN working back in labor. She, unfortunately was trying to get a hold of the doc (for 2 hours) so I admitted a patient for her. I had her admitted, IV in, doc called, orders given, all that jazz. She was what we call a frequent flyer, so all her history was already in there. I'm pretty anal about making sure I cover all my bases, and I thought I had. Turned out I was wrong. An hour later, I go back to check on her and the nurse I passed her off to let me know I didn't tell her she was beta strep positive. I thought I could just die right there. After she said that, I remember seeing it highlighted on her prenatal record. I just didn't report it, or send orders down for the antibiotic. Luckily, it was her first baby, it had only been 1 hour, and she was treated 3 times before she delivered. But, still, I shouldn't have forgotten to tell that to her RN taking over. If that wasn't bad enough, Monday a.m., I had a labor patient who would have tubal ligation immediately after delivery. I can't remember if I told the dayshift nurse she was planning on getting the tubal. A couple years ago, I took report on a patient who delivered very quickly for me, but the evening RN didn't tell me she was a tubal. She actually didn't even have the mom sign the appropriate consent forms (something I did with my patient, and I even told anesthesia, something most people forget) and I remember being so incredibly pissed off because I ended up looking like a fool when the doc asked if the OR was ready. And then I asked "for what?". But, I think I may have forgotten to tell the a.m. RN. There have been a couple minor things as well that make me think I'm losing my touch. I'm known to be thorough, and a good RN. People look up to me, ask my opinion on things and even defer to me, waiting to see what I decide to do in an emergency. And, I've heard, the docs really think I know my stuff. But lately I'm not living up to that. I was even given a "bonus" for taking on a lot of responsibility long before I should have had to, and handling it a few years ago. Now I'm not saying I'm the worlds greatest nurse and that I never made mistakes before, but lately I'm slipping from the level I had been functioning. I'm so worried, I even had a bad dream about a RN I really look up to telling me I'm not doing as well as she thought and that I should really be working at a much higher level than I am, considering my experience. My stress/worry is spilling over into my sleep. Not good. I thought I was doing well with 3 kids and the lack of sleep and added stress, but I guess I'm not. No harm has been done, thank the Good Lord, but it's a lot of little things, and that bugs me. I'm actually really anal...I look over my work 3 times to make sure I'm not forgetting things, and I write down everything I want to tell the MD before I call. So this whole "missing things" is really bugging me. I guess I need to figure out a better system for myself to make sure I don't continue on this path.

Stinky poo

Man, did I forget how stinky baby poop is after starting solid foods! Nasty! And it's only going to get worse once we move on from cereal to baby food. I'd just been thinking "man, did we waste money on the diaper genie sitting upstairs in his bedroom." Now I remember why that was one of my first baby purchases last year.

(Almost) 6 Month Update

As Isaiah has gotten more mobile, things have gotten more interesting in our house. Gone are the days when I could leave him lying on the floor with his toys. Now if I leave for just a moment, he's halfway across the room. Not crawling, but doing a combo of rolling and scooting. I need to go to the store to buy all the baby proofing stuff we need. I should have done it earlier, but I think I was in denial that my baby is growing. So, I need to get outlet plugs, baby gates, toilet seat locks, fridge and oven locks, and we have to figure out something to keep him from messing with the pocket doors. He's also doing better sitting up on his own. He'll still topple over after a bit, partially because he catches a glimpse of Jacob or Clara and wants to see what they're getting into and falls over watching. It's kinda funny. We also started him on some rice cereal this week. It was a hard decision that I had to work up to since he's not *quite* 6 months. I know, I know, it's completely silly, but it's a thing with me. Part of it is, again, he's my last baby and I know how quickly this time goes by and before I know it, he'll be off to school, like Jacob. I just want to savor every baby moment I can. Anyway, he hated it the first time, but now he's actually eating it. We gave him some oatmeal yesterday and he like that so much more. Not that I blame him, that rice cereal looks like the stuff you use in grade school art class, where you dip newspaper in stuff and plaster it on a balloon, and it hardens. I can't think of what you call that, but anyway. So today (if I'm lucky) I'm going to clear off a spot in the cabinet for baby food. It's kinda exciting in a way. I always liked buying baby food, looking for new stuff to see if he'll like it. He's always had this thing he does when he nurses. His little hand will roam, and grab whatever he touches - hair, necklace, lips, nose, etc. Now he's decided to kick while nursing. I do the side lying position at night, and he kicks so much, and it hits my c/s scar and it makes it sore. I guess he's just an active little boy!

A whole lot of shaking going on

Only one word can describe last night: busy. It was one of those nights where the ER door was a revolving door. We just kept getting call after call from them. Only one was actually a labor patient. The rest we simple things that we treated, fixed the problem and sent them home. I just seemed that we would get the discharge order and before we could actually go through discharge teaching with that patient, that there was someone else on their way up. It wasn't anything so busy we couldn't keep up, it just never stopped.
Lately we've had quite the variety of "stuff". Lets see, we had a couple crash sections, one for a complete previa, one for unknown reasons, preterm labors, a fetal demise. We had 2 patients who had their original due dates moved up by 4 weeks in the third trimester (even though 1 had an ultrasound at 10 weeks; I could get on a soap box here, but I'll refrain). One (who I took care of memorial day weekend when she was with her old doc) should have been 34 weeks, but according to her new doctor, she was 38 weeks, irregardless that first trimester ultrasounds are accurate at establishing dates, not third trimester US, unless something has changed I don't know about. So, she delivered, and guess what? Her baby had trouble breathing and was shipped to a NICU, and is still there dealing with problems caused by a preterm birth. We also had a neonatal death. It was an expected death because the baby had anomalies not compatible with life. The family had other children who were present to meet the baby. It was heart wrenching from the start, but what really was heart wrenching was the siblings. When the pediatrician said the baby was gone, those siblings just wailed like children do. I could cry just thinking about it. Last night I had a first for me. I admitted someone for a UTI and was going through all the questions we ask everyone every time they come in. I asked her what her date of birth was. She kinda mumbled, and I thought I heard "January '86", so I clarified. Nope, January 1996. Now she looked young, but 12?!?!? A few years ago we did have a 12 year old deliver a month after her mother had another baby. But I didn't take care of her. I graduated from high school the year this patient was born. I'm no spring chicken, but I'm not that old. It sent my mind to thoughts of "Crap, Clara is almost 4 years old...only 8 more years until she could get pregnant". I wasn't even thinking about sex when I was 12. Times, they sure have changed.

This week the kids and I went to visit my sister at her new place. It's a 4 hour drive from here, so I was worried about how they would handle the car ride. I can hardly sit still for 4 hours, let alone kids. Plus, I worried they would destroy her apartment, clog her toilet, and re-decorate the walls. The ride up was a pain, but not as bad as I thought. We had to stop for potty breaks, once because Clara unfastened her seat belt and couldn't get it re-fastened, and there was a lot of whining. But it really wasn't too bad. They didn't even destroy her place, too much. They did break a fan, and her cat was traumatized I'm sure. But nothing major I don't think. Hell, the only carpet stain was from me. And I tried to clean it up before she noticed, but I was caught in the act. We went to the zoo, played outside and played at the park. It was a pretty successful trip, and encouraging for future trips. Isaiah is scooting around already and was all over, trying to chew on cords or really anything in his path. It just doesnt seem right that he's mobile now. Only bad thing was Isaiah didn't sleep the first night. And really, I'm not exaggerating. He wanted to nurse constantly. I do side lying at night and I end up with a mild twist in my back. He'd fall asleep, and I try to just realign my hips, he'd wake up and we'd start all over. But, oh well. He slept a bit better the next night.

Our 6th Wedding Anniversary

Yesterday, my husband and I celebrated our 6th wedding anniversary. Well, we had our anniversary, I worked Sat. night, slept all day Sunday and saw him for, oh, 2 hours before going back to work. And this afternoon, I'm going to visit my sister in her new place for 2 days. After 6 years of marriage and 3 kids, sometimes it's okay. We'll still be married next weekend. It seems like a lifetime ago that we were married. I guess it was in a way. We were young, in love, with no responsibilities but ourselves. Within these 6 years, we moved 3 times, bought our first house, bought 3 cars, and had 3 children. So you could say things have changed just a little since we were married. 6 years isn't that long in the grand scheme of things. But our relationship is much different now. For example, when we were first married, we'd call each other "Sugar" and "Hot Stuff". And I'd still get that tingle that runs through your body when we touched. Now I don't most of the time, but that's not a bad thing. Because I'm comfortable and accustomed to his hand on my waist, or in his arms. I'm also not so worried about what he think of my body. This man has seen me slender and in shape, large and 9 months pregnant, seen me push one baby out into the world and have 2 pulled out of my abdomen. The ultimate test: he's seen me in a hospital gown, walking to the bathroom postpartum, with my butt hanging out in lovely mesh underwear and a monster pad, blood dripping down my leg and colostrum wetting the front of my lovely hospital gown. I know, not a pretty picture, but he'll still look at me with a look in his eyes that lets me know he still thinks I'm "hot". We may bicker and fight. He may drive me bonkers at times. But the love we have has grown stronger and deeper since that beautiful Saturday, June 8 , 2002. Happy Anniversary (a day late) Hot Stuff!

Work and hospital addition

Work this weekend was pretty typical. Saturday, I took care of a mom laboring with her second baby. She was progressing nicely on her own, but not quick enough for her doctor. Even though she was 8 cm with bulging bag of water, he wanted me to start pitocin and said he'd be in to break her water. Okay, fine, I'll start pitocin. But it was needless, as she was completely dilated in 20 minutes. Doc arrives, breaks her water and we start pushing. Then the baby's heart rate took a dive and didn't come back up. So he had to use the vaccuum to get the kid out. Luckily the baby was low enough that a vaginal delivery was possible. If the baby hadn't been low in her pelvis, we would have had to go back for a c-section, and that would have added about 10 minutes that the baby's heart rate was low. He was blue and floppy when he was born, but with a little oxygen and stimulation, he came around. There was a tight cord around his neck and shoulder and when he came down the birth canal, it just was pulled too tight.

Today I decided that I should be a good employee and actually go to a staff meeting. I hadn't been to one for a long time. Plus it had been a couple months since we had one, so I went. And it lasted 3 freaking hours. All talk about stuff that could have been put in an email and sent to everyone, but instead I got paid to sit and listen to a bunch of BS. They did show us the new layout for the new unit. I'm starting to be more optimistic about the new unit. It will be a HUGE change once we get in there. We'll all have to change how we practice drastically. But, I think it will be good after we figure it out. The rooms are going to be large, and we'll have some LDRP rooms and some regular single patient rooms. It will only have one entry for the public and they have to be buzzed in at the reception desk. A few bad things: the unit will be huge, in the shape of a triangle, with 2 of the hallways being the length of a football field. The c-section rooms are at the base of the triangle and there will be LDRP rooms at the point of the triangle. What if we have an emergency in that room and have to run 100 meters to the OR, pushing a patient in a bed. Granted, that probably won't happen very often. But still. And the charge nurses will be running all over the unit during their shift. Even the manager said she is willing to place money on the idea that all the charge nurses will lose weight due to the increase walking. I guess a little exercise won't hurt any of us! So we'll see how long it actually takes to get it built and up and running. I think the timeline is by 2011? But they still have to finsih added decks onto on off the parking decks, tear the small one dow, and actually build the addition. Plus getting approval from the Health Dept., and all that. So maybe much later.