July 30, 2008

Who wouldn't want to be me?

Last year when I took a weekend night shift position, I knew that some weekend, there would be a Sunday that my husband would have to work and no one would be available to watch the kids. Therefore, I would have to stay up Sunday and try to function on a nap and then go into work at 7pm Sunday night. That's after being up all day Saturday, getting a short nap Sat. afternoon, working 12 hours, then staying up all day Sunday with only a nap, working for 12 hours, driving home, then getting to sleep. That would be suicide if it ever happened. We've been lucky so far. This weekend, our luck ran out. Well, my luck, really. Husband has to work Sunday, no getting out of it, and none of our usual babysitters are available for a multitude of reasons. With the weekend option position I work, I can't just have someone work for me, plus, a Saturday night is very difficult to trade anyway. And, I really can't just call in sick. My only hope is that I can sign the "flex list", hope I'm at the top of the list and that it's slow enough I get put on call Saturday night. That kills the paycheck, but I also have to be able to function. Really, I realize I just can't stay awake that long because I can't put my patients at risk. It seems dire now and I'm completely freaking out, but I'm hoping we'll get something worked out by the weekend. I'm already running on a low tank of sleep. This could be very bad. Cross your fingers for me!

July 29, 2008

Sprinkler park fun

When I was pregnant with Jacob, I had this idea of how motherhood would be: full of activities, going to the park, playing in the pool, learning activities and just fun all day long. Yeah, there would be stressful times, but really, I figured it would be easy. Three kids later, I can tell you it's not like that. They bicker, fight, disobey, and I have a long list of household duties that have to be done everyday. We do do activities and fun things, its just not the idyllic constant fun I had in my mind. Today was one of those days where it was like I had imagined it would be. After a war of the wills, kids vs. mommy (mommy won), I took them to one of the sprinkler park after nap time. I was worried it would be stressful trying to keep an eye on them, but it was a ton of fun. We went to a new one and while the sprinkler park part was smaller than the one I went to last year, they had the biggest playground set I've ever seen. And it was on this really spongy, bouncy mat type thing, to help cushion the kids if they fall. Last year, Clara was scared of the water. After about 30 minutes, she got into it. Jacob loved it from the start and they had some small water spouts that Isaiah loved. It was fun just watching them run around, play in the water and just enjoy the hot summer day. I wish I had taken a camera. It was a ton of fun. Afterwards, we got dried off, they ate supper without a fight and without messing around, hallelujah, and we went to get ice cream at this small ice cream stand that has the best ice cream around. Since it went so well, I'm more willing now to take them back on a regular basis, and to try doing other fun things.

July 25, 2008

The return of the aura

I knew it was coming. I was due. The migraine and aura has returned. This past week I've been pretty stressed and I haven't gotten a lot of sleep. Yup, that combo is my trigger. This morning, I was awakened by my husband at 5:30 a.m. I had fallen asleep in the rocking chair last night, trying to get Isaiah to sleep and stay asleep. Even though I must have gotten some sleep, it wasn't good sleep, and my neck is still pretty sore. He's got a cold and I think that was what the problem was, but it sucked. I, of course, went to bed, knowing that Jacob would be up in an hour and Isaiah would probably be hungry soon, although I'm not sure exactly what time he had nursed last. This is TMI, but kinda funny: he must have latched on to the side of my breast because there is a small little hickey on the side of the arreola. Like I said, TMI. I have no memory of that, and I'm surprised because I'm sure it didn't feel good. I was that tired. But, anyway, I had a migraine this afternoon. Well, an aura with a headache. The kids were screaming, Jacob bit Clara out of nowhere, something he's never done, and that's when I noticed the blind spot. I had hoped, that I was just so frustrated I was seeing stars, but no, the electric zigzag appeared along with an annoying headache. It's been 2 months since my last one, I think, and I was hoping I wouldn't have any more. I work tonight and this weekend so I'm really hoping it goes away before I leave for work.

July 24, 2008

Disorganized and Disorderly

Back before I had kids, I was a very organized person. In college when my roommate and I would drive an hour to visit our boyfriends (now husbands) at another college, we both would have lists of what we planned to wear, down to the shoes, socks and jewelry. I had lists of what homework, studying, events needed to get done. And I did this everyday. I lived by my planner. I was never late to meetings, never forgot to do anything. Even after college, I was like this. I continued to have lists, and my apartment/house was clean, not spotless, but clean. Bills were organized and I was never behind on anything. I felt like I had a handle on everything. Not the case anymore. Yeah, I expected to lose some of that control after the kids came along. And I felt like I was doing okay keeping track of things. Boy was I wrong. Ever since I went back to work the end of February, I've realized that I'm utterly disorganized. Twice now I thought I worked one day to find out that I had the wrong date written down. Let me tell you, that's a good way to make you feel intelligent! One was the worst case scenario where I thought I worked a Thursday, was actually scheduled for Wednesday. So I go to bed Wednesday, and show up for work Thursday. Completely missed my shift Wednesday. That was a very proud moment! My house is a disaster, I can't keep up with household chores, I've forgotten to send in a bill here and there, and just keeping track of all the appointments and work schedule has proven to be a daunting task. I need to do something to get back on top of things. I haven't had a planner for the last 2 years. The calendar isn't in a very visible spot. So I will be moving the calendar, and I'm going to buy a planner. One I'll actually use. With Jacob getting ready to start school, I need to be more organized. I can't be forgetting meetings,activities, my work schedule etc. I think the stress of 3 kids 5 and under, an old house that needs work that can't all be done at once due to finances, me wanting it done like yesterday, lack of sleep and trying to please everyone is wearing on me.

July 21, 2008

Just a great delivery

This a.m., there have been some nasty storms rolling through. Cool looking clouds, but very ominous. Luckily so far they've not amounted to much. Last week, I actually felt like a labor nurse. I had a patient who was being induced that had a back surgery when she was a kid and had rods placed. When she got to the point she wanted an epidural, she found out that she couldn't get one due to the risk involved with placing an epidural with the type of rods she had. So, she's 4-5 cm, first baby, very uncomfortable and getting ready to labor and deliver without an epidural, like she had hoped. Plus, she was on pitocin and our policy requires continuous monitoring while on pitocin, so I couldn't get her in the tub. But, she did awesome. I worked with her, got dad involved, she used the ball, the rocking chair, did the labor dance while holding her husband, we did counter pressure and massage and she did it. And I found I was having fun, and I felt like I was actually a support to her, instead of just being and interventionist. Something I noticed was the difference in her behavior when she thought she could get an epidural and after. She actually acted more uncomfortable, and moaned more getting to 4-5 cm than she did after she found out she could not have an epidural. It's almost like when you know there is no relief except delivery, moms handle the pain better and are in more control than when they know they can always bail and have anesthesia. Not that I blame them, I myself went for the epidural. After it was all over and she was holding her baby (skin to skin, no less) you could tell she felt like The Woman. If I had to wager a guess, I would say that when she's laboring with her next baby, she'll go sans anesthesia. It was a nice delivery in the middle of chaos going on all around the unit. But, that's a whole other long story I won't delve into this post.

July 17, 2008

Product Warning Labels

You know all those warning labels on products that seem sometimes a little ridiculous? Or warnings that maybe makes sense to warn people and give them directions on what to do if they, say, ingest too much shampoo, but you wonder "how do you do that?" Toilet bowl cleaner, for instance, has a warning on it and directions on what to do if you get it in your eyes. It basically tells you to run water slowly over your open eye for 15-20 minutes, call poison control and/or call your physician for further treatment. The thought of holding my eye open under running water doesn't sound like a lot of fun. I always wondered how in the world could you get toilet bowl cleaner in your eyes? Well, yesterday while I was scrubbing toilets with toilet bowl cleaner, a very small drop of water splashed up into my right eye. Man, did it burn like fire. So I rinsed my eye, although not by running tap water directly into my eye, and flushed it with saline on and off for several hours. In case your wondering how it feels to get toilet cleaner in your eyes, its kind of like someone rubbing salt directly onto your eyeball. My eye burned for several minutes, and the rinsing did stop the burning. I then had a minor headache for a couple hours after that, and my eye felt like there was something in it, like an eyelash. Flushing with saline helped with that. That eye is now completely bloodshot. Today it feels fine, I can still see, but I look like hell. My left eye is all bloodshot because I ruptured blood vessels in it from my vomiting session over the weekend. Now the right eye matches, thanks to toilet bowl cleaner and my ability to splash toilet water 3 feet in the air and have a drop land in my eye. This really has been a fantastic week for me. I'm sure purty lookin' right now. It looks like I've been up for a week smoking and drinking. And I have to work tonight. Fabulous.

July 16, 2008

Hazards of Nursing

When you decide to become a nurse, you know that you are probably going to have to deal with bodily fluids. Vomit, feces, urine, saliva, snot, blood, amniotic fluid, breast milk, etc. None of them are very pleasant but you learn to deal with it as part of the job. Now I do well with bodily fluids. I've been doused with amniotic fluid. I've been peed on while a mom was pushing. One night, I massaged a fundus on this woman who was bleeding a bit more than she should after delivery and several large clots came out with a quiet "plop plop plop". After they were out, her bleeding stopped but I had blood in my hair. I hit the shower that night. When I worked critical care, I had to dig out an impaction in this guys rectum, which once it was dislodged, the brown flood gates opened everywhere, if you know what I mean. He said he was eternally grateful. I also had a guy getting go-litely for a procedure the next day. He was pooping so much, he just sat on the commode, because towards the end of it, its just liquid. Well, he had gone so much, the commode bucket fell to the floor, spilling hours worth of poop on the floor. While working as a CNA in a nursing home, a nice lady with Alzheimer's was found in her room, with her poop smeared all over her and the room. Sad as it was, she was happy as a clam and we got her and her room clean after about an hour. All of those were so very nasty, but I dealt with it. Respiratory secretions get me, though. When I had to empty out emesis basins full of COPDers sputum, it would seriously make me gag. If I would have ever gotten any on me, I really think I would have vomited. Deep suctioning and trachs grossed me out way too much. That was a hint I didn't belong in the ICU. Vomit usually does people in, but I do pretty well. I've seen plenty of vomit, between work and my kids. That is as long as it doesn't get on me. Work was busy so I agreed when they called and asked if I would work. No problem, I'll work for 4 hours. One of the patients called out and asked for her nurse. I didn't see her nurse, so I went in to see what I could do for her. Teamwork. I walk in her room, she's sitting up, with no sign of what is about to come up. I get to her bedside, she says "I feel a bit naus - BLLEECCHH". All. Over. Me. I'm not talking a small amount of vomit. I mean a stomach-full worth of chunky, smelly nastiness. It got in my pockets, into my shoes, my socks, down the front of my scrubs and on my bra. She showed no sign, NO SIGN, that she was going to puke all over me. We have strategically placed pans close to the bed for this reason. Labor can make you vomit. I just didn't have any warning and no time. It wasn't her fault and she felt horrible. But I almost vomited myself. As I'm standing there in shock at the amount of vomit on me, her nurse walks in, sees me turning paler by the second and the patient apologizing all over. And she starts laughing. Because she knew it could have been her. I did manage to get wiped up enough I could go to our lounge without leaving a trail, change and clean up and shower quickly before putting on clean scrubs. Ah, The hazards of working as a nurse!

July 14, 2008

A Weekend from Hell

This weekend kinda sucked the big one. Saturday, I started feeling a bit queasy after an afternoon nap. Nothing too bad, just enough to annoy you and make you lose your appetite. It reminded me of that constant nausea of early pregnancy, and no, I'm not pregnant. So I took a zofran, left over from when I was pregnant and went to work. About 9:30pm, I started feeling worse. At about 10pm, while I was standing in a patient room taking her vitals, I realized that if I stood up much more, I was going to vomit. So I darted out, made it to the bathroom and did so vomit. I hoped maybe it would go away, but no. I left work, barely made it home in the upright position without vomiting. I made a beeline to the bathroom and got there just in time. I proceeded to heave until about 4a.m. It was the worst case of dry heaving/vomiting I've ever had. There were times it wouldn't stop and I needed to breathe but my body wouldn't let me. I even have ruptured blood vessels in my eyes from all the pressure. Too much info, I know. But by yesterday evening, I decided I could work. I didn't go in until 11p.m. When I got there and started changing into my scrubs, I realized that in my haste leaving the night before, I had worn my work shoes home and hadn't brought them back. I wore sandals in both nights. And forgot my socks. Not appropriate. Luckily a couple co-workers bailed me out with shoes and socks. Good thing because I ended up in the c/s room with a patient I'd taken care of last weekend. I was dog tired this a.m., but had to take Jacob for his kindergarten physical. At 9:20 a.m. We weren't seen until 10:15. Jacob is doing okay weight-wise, but is a little short, so we have to take him back in 6 months. Kinda surprised because husband and I are tall. At the end to the appointment, he received two vaccines, and he did really well; he didn't even cry! Then she listens to his heart/lungs, and she listens longer than normal to his heart. Because I work with her, I know somethings up. She heard a murmur. He's scheduled for an echo next Tuesday. She reassured me that its probably benign, but feels we should check it out because she didn't hear it before. I wouldn't be quite so surprised if it had been Clara because she's the one who was delivered early for heart problems. Jacob has always been fine. Nothing can prepare you for hearing something might be wrong with your child, even though right now I don't really know if there is something wrong or not. Just the chance there could be is scary. So now 2 out of our 3 kids will have seen a cardiologist. I know, it could be worse, but it still sucks. So even though I should be in bed considering how tired I was, I'm not. I'm too keyed up with worry about something I have no control over. And I have a whole week to worry about it, and then another week more waiting for the results. I just pray it really is nothing.

July 12, 2008

My 200th post

Wow, this is my 200th post. That means that there have been 200 times that I thought to myself "My ideas are so interesting and important that I should write them out and share them with the world"! And when I look back at those posts, it's interesting to see what I was doing. Anyway, I wanted to make an important announcement: I have found The One. Yep. I finally found someone who knew what I wanted, even if I wasn't exactly sure myself. That's right, I have found a hair stylist, finally. When I was a kid and in H.S. and even college, I just went to the woman who did my mom's hair. She even did my hair for my wedding. My mom followed her from a department store salon to a couple other salons for the last 30 years. That's what I want. But, she's an hour away and I really wanted to find someone close to home. It's funny how hair is such an important thing to most people. No one wants a bad cut and people hold onto their hair like a security blanket, even though it will grow back. I'm no exception, although I'm much better than I used to be. My dream would be to let Nick Arojo from What Not to Wear style my hair. I'm addicted to that show, and I'd let my hair grow for a year if I knew at the end he would do my hair. But, I don't live in New York, don't dress bad enough for that show and won't be paying hundreds of dollars for a hair cut, so I had to find someone close to home. I've tried various places, had great hair cuts, but I never found someone who I felt I should go back to. So I'd just go to a department store salon and take whoever was open. Which is how I found the one. I said I needed a cut and style, and tried to explain what I had in mind. My only requirement is I wanted to be able to get it back in a quick ponytail for running and for going back to the OR at work. She said "I know what you want. I'm going to bring your sexy back. You can go back to mommy tomorrow." And I think maybe she did. For the first time in my life, I love my hair. It looks so healthy and shiny. The style is perfect, it's not the typical mommy do, it will go into a short ponytail, and I don't look silly if I don't have time/don't feel like completely doing my hair. So I'm quite happy. And I now have a stylist.

July 9, 2008

How inductions usually go on the unit I work on

*Not intended as medical advice. I'm really a 16 year old boy pretending to be an RN. :) *

As much as I have mixed feelings about scheduled inductions, and c-sections, they are pretty easy patients to admit. With an induction, they aren't laboring and uncomfortable yet so they can answer questions easier. There are several ways to induce labor, so I'll focus on what we do here with an induction using pitocin. This is the most common way it's done here. Usually, a pitocin induction goes something like this: at midnight, they arrive and after getting them acquainted with the room, I run through this database, full of questions that may not make any sense as to why I need to know, but I still have to ask. I joke with some patients that a labor nurse is the nosiest person you'll meet. We have to know your health history, any medications, herbal supplements you are taking, whether you have a birth plan, whether you have a car seat and have all the resources available to you. We have to make sure that if you have kids, that you actually have custody of them and that they weren't taken away from you. Even if you don't tell us, we'll eventually find out, just like if you are using drugs. Just own up to it, make it easier on us all. I also have to know if you have an advanced directive (living will or power of attorney for healthcare) We dont anticipate we'll really need it, but we are legally resposible for having it on the chart if you have one. And I think everyone should have one. I'll ask about your diet, if you feel safe at home, ask what you have with you and if you have any spiritual/cultural needs. After all of that, I'll do an assessment, which involves a cervical exam. In a perfect world, your cervix is favorable, or soft, thin and dilated. (If it isn't, I wish we could call the doc and either postpone the induction if its elective, or use a cervical ripening agent, like cervidil or cytotec. If I got to decide, it would be cervidil, but anyway... )I'll then start and IV for fluids, antibiotics if they are needed and for the pitocin, as this is the drug of choice for inductions at my hospital. Through the night, we don't expect that you'll make much (if any) change in your cervix. The goal is to get you contracting and ready for when the doc comes in in the a.m. to break your water, usually at about 7:30am. Some of the doctors may not do this if your cervix isn't ready, so they aren't setting the patient up for a c-section because their body wasn't ready to be induced, but with a medical induction, delivery is inevitable that day, regardless. And no, they don't come in at midnight to do this, at least not here. So I'll be in and out of your room every 15-30 minutes to increase the pitocin slowly, until you are having contractions 2-3 minutes apart. Then I'll only increase if they start to space out. It may be longer in between increases if the baby doesn't look especially happy. When a patient can get an epidural depends on the doc. With most, they are okay with it at anytime during the inductions as long as you are having regular contractions and are actually in pain. After your water is broken, things pick up pretty quickly. Contractions are more intense, you start to change your cervix and you are usually in good labor within an hour. Remember, I'm only generalizing here. Contractions on pitocin versus natural labor are more intense and closer together. That makes it more difficult for the mothers wanting to do it without pain medication, but it can be done. The stronger, more frequent contractions also increase the risk that the baby won't tolerate it. So, once you're on pitocin, we have to have continuous monitoring. That doesn't mean you can't move around, get up on the ball or in the rocking chair, you're just limited on how far the monitor cables can reach. Maybe at other hospitals, you can get up and move, I only know what we do here. Sometime in the hopefully near future, we'll have telemetry, so we can let patients walk in the hall and still have the baby on the monitor. I wish we used more methods of inducing more often, like using cervidil, or using a foley bulb. Some docs do use cytotec and cervidil, but none of them uses the foley bulb. I went to a conference and the midwife speaking. said he likes that the best. Speaking of conferences, I got info on a conference that I really want to go to. It's on emotionally charged issues in OB, like stillbirth, infant loss, the effects of that on the parents and children, postpartum depression, preterm labor and high risk pregnancies and how all of that affects the patient and the family. It sounds very interesting and worthwhile. So we'll see if work will pay for it.

July 5, 2008

More pics of my kids

The last couple days were actually not too bad with the in-laws. Here are some pics of the kids. For some reason, the dates were off on their camera.

Here's Isaiah, with his multitude of toys

Jacob and Clara "grilling"

One of the town police officers was driving by and saw the kids riding their bikes. Jacob gets excited anytime he sees an emergency vehicle. The guy saw how Jacob got excited so he came back to talk to them. He let them check out his car and posed for a couple pictures. It made their day.

July 3, 2008


In the midst of the frustration last night, I did have probably what I'll call my favorite/nicest delivery so far in my career. My patient, first time mom, was completely dilated when I came on. She was comfortable with her epidural and since she wasn't feeling any pressure/urge to push, and her baby was still kind of high, I let her labor down, or let her uterus push her baby farther into the pelvis, instead of having her start pushing right away. After about 45 minutes, the baby had descended nicely and we started pushing. The parents were a nice young couple, married only for a short time before they decided they wanted a family. It was a nice soothing environment, no loud shouts of "You can do it! Push harder, harder, harder, come on..." That's just not my style, yelling at the perineum. Nice, positive encouragement, without yelling worked well for her. She did push for about 1 1/2 hours. But when the baby was being delivered, she looked down, saw her baby and said "oh my gosh, our baby" and once her daughter was placed on her abdomen, she looked at that baby with tears in her eyes and then she looked at her husband and there was just something in their faces as they looked at each other and looked at their daughter. It was really touching. And the dad was just so gentle and nervous to hold her. The delivery also went very smoothely on our part, all of us working as a team like a well-oiled machine. Mom got to have her baby in her arms until she was ready for weight/measurements, and the communication was excellent. The scrub tech took those one-chance pictures of dad cutting the cord and she caught that moment when mom and dad looked at each other, in awe of what they created. And I can't explain in words how beautiful those first moments were. There are moments like these in all deliveries but it seemed different this time. It's no surprise to those who know me, because I cry all the time, but I had tears in my eyes. So while I whine and complain a lot, really those irratating times aren't the majority, and I'm not some jaded, frustrated labor RN. It's moments like these that make me love what I do. Hope everyone has a Happy 4th of July!

Caution: Very Negative Venting Ahead

So I had a not so good night. Started out with bickering on the home front, then while getting gas for $4.11 per gallon on my way to work a short burst of pouring rain soaked me. Then driving a car that desperately needs new wiper blades is annoying in the rain, which luckily only lasted a short while. Then after arriving at work, I find I have the keys to the van that my husband has to drive to work tomorrow. Kinda hard if I have the keys. So I hope that it's slow and I can leave early, but no, it is insanely busy. Luckily a co-worker on the prior shift lives 2 blocks from my house happened to be working and dropped them off for me. Oh, and tonight my out-laws are coming to stay for a few days. I've been having a grand 'ole time. So bear with me...

Please, dear doctor, when you send in your patient for an induction for edema (aka elective, but by calling it "medical" it ensures that you induction won't be bumped until later) can they actually have edema? And 2 patients in 1 week being medically induced for edema who, ironically had less swelling that their non-pregnant nurse did (yes, I still need support hose)? How odd. Oh, and an accurate cervical dilation would be nice. It's rather difficult to check someone who's baby isn't even engaged in the pelvis yet, and it's her first baby. You told her she was 2.5 cm/80% and at a 0 station, locked and loaded for delivery. Imagine her surprise when after 2 other nurses try to reach her cervix and are unsuccessful, I pull my entire forearm out of her vagina trying to reach her cervix and announce "1 cm, still pretty thick, maybe 50% and -2 station". That made for a difficult explanation. Because I am only a nurse, I wonder who they will believe. I guess I really don't know what I'm doing. Although 1cm and almost 3cm are pretty easy to distinguish. The patient did say that you told her we might have to postpone the induction if she wasn't dilated enough. 2.5 and 80%, should be good for induction so that makes me think you knew her cervix wasn't favorable for induction. Not only that, but at only 38.1 weeks, and with a cervix like that, you're setting her up to fail. Induce if you must, but can we try a cervical ripening agent before pitocin? And maybe not break her water so when she doesn't progress she doesn't end up with a c-section, made possible by inducing,seemingly unnecessarily, an unfavorable cervix?
And to my dear co-worker, thanks for letting me know that my diabetic patient is taking her own insulin. Insulin and blood sugars aren't any big deal. Although it is absolutely against hospital policy to allow patients to take their own supply, unless it is unavailable in the hospital pharmacy, go ahead, and let it be a surprise to me. I like surprises like that. I like going in the room to be told "I gave myself 4 units of regular and 20 of novolin". Nowhere are there orders for this. But, that's okay. We don't need doctors orders.

*Disclaimer: Sorry, I had to get all of that off of my chest, and I did create this blog as my place to vent. I do not have a problem with doctors, nor do I feel I am superior to them. I also love my co-workers, and I realize I'm not the perfect nurse. I also feel that a diabetics routine is screwed up when they are in the hospital and that as long as they are controlled, it would be better to let them do their usual routine.

July 1, 2008

The verdict is in...

Not guilty, by reason of insanity. That's the verdict for the girl I went to college with that was charged with involuntary manslaughter of her 10 month old daughter. I thought about posting the link to the story, but I feel somehow I'd be a horrible person for doing so. She has to undergo a psychological exam to determine if she needs to be involuntarily admitted for psychiatric help. And she's 31 weeks pregnant currently. Sigh.