Hope you all have a safe and Happy New year!

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.

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.

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

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.

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.

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.

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.

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?!

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.