Year in Review

For multiple reasons, I'm glad to say good-bye to 2009. I'm ready to start fresh. Not that 2009 was horrible, but it will forever be the year that I had a miscarriage. It's wasn't all bad. i was able to take a trip to a large hospital supply company with a few other coworkers. There we looked at what our new LDRP's would look like and started working out the kinks. And it looks like we will be breaking ground in March 2010. The project had been on hold until the decision to merge with a large healthcare system came into play. We will have a new name come January 6th. I reached several goals. I breastfed Isaiah for 19 months. I started running again. My jump start to running began after my darling daughter looked at me and said "Mommy, it looks like there is a baby in your belly". And, at that time, there was not. So I started running and I ran 5 5K races and one 5-mile race. The majority of those races, I ran with an old H.S. friend and we reconnected after 10 years. Each race I ran, my times were better than the last and it made me feel great. However, in July, I found myself unexpectedly pregnant and Due march 19, and it happened at what was probably the lowest point in my relationship with Husband. No details, but we were not in a good place at the time. After the shock, we came to embrace this new adventure and worked through the difficulties we needed to get through. Then at the end of August, I started bleeding and was told that pregnancy was no longer viable. The next couple days I felt I was in the deepest depths of pain and loss, felt empty. I delivered the pregnancy in the toilet in the hospital toilet in same day surgery 2 days later. Proceeded with the D&C to be sure all tissue was out, hemorrhaged and went home to grieve. After the weekend, I returned to work, having to face the pain straight on because I work in OB and surrounded by pregnant coworkers, many due Feb-April. It was through those weeks of pregnancy and after the D&C that Husband and I worked through everything and we are stronger for it. Our relationship is the best its been and keeps getting better. Life goes on, and Jacob started 1st grade and is reading very well, and lost his second tooth. Isaiah is weaned and all memory of breastfeeding in his mind is gone. Clara continues to grow and is learning to write all her letters. I feel blessed everyday that I have these 3 kids. We also made the decision to have another child at some point. Next year, I'm looking forward to running again and even running a 5K race with my sister - something we've never done (yes, sis, I'm holding you to it!) Maybe if I can get motivated, I'll try for a half-marathon. Maybe next year will bring another pregnancy, one that will result in a live baby 40 weeks later. We turned another year older and all of us continue to have good health. Christmas came and again my children were spoiled rotten by Santa and family and overall, we had a great holiday. So I guess looking back, 2009 for all the bad spots, turned out alright after all. Here's to looking forward to 2010, hope it finds you all in good health and good fortune. Happy New Year!

Catch

That was what I did last night at work, I had to catch. Not once, but twice and it was cool as hell! Last night was exactly what I needed to rejuvenate my spirit. With everything going on in the hospital, all the alternative agendas and politics on the unit, a merger happening in a week, anesthesia change and the fact that we are slow, going to work wasn't such a great thing. Moral is low to say the least. But last night was fun. It started out like a pretty normal shift, but soon we got a call from the ER that they had a patient that is pregnant, in labor and just told her mom in the ER that she was pregnant, as they are working her up for abdominal pain. No prenatal care. So she gets up to us, and I decide I better check her. Yup, complete with bag of water bulging out of the vagina. I grab gloves and send someone to call the city call doc since she didn't have a doc. Then the heartrate dropped, and the bag of water broke with a huge gush of thick pea soup meconium. Very soon after, baby is crowning and head is out. No cord, but the shoulders just wouldn't come. We ended up having to do suprapubic pressure to get the shoulders out. Babe looked to be full term, did well transitioning to extra uterine life and will make an adoptive family very happy. The second baby happened just an hour later. This mom presented in labor, didn't look to be uncomfortable and said her water broke and she just started having pain about an hour ago. You guessed it, she was completely dilated and after 2 contractions, the baby was crowning. This baby delivered easily. It was just awesome. Both moms delivered in less than 10 minutes of arriving on the unit. Neither doc had a chance to make it because we don't have OB's in house. After last night, I'm feeling more and more that I should get back to school at some point. Both of the deliveries were pretty easy, (although there was some mild shoulder dystocia with the first), and I know that it won't always be that easy but man, was that fun!

Status: post m/c 4 months

This is a long one, sorry. I know that most people don't talk about miscarriage all that much, and I for one think it's a shame. It's usually not until someone has a miscarriage that people come out of the woodwork and say "Hey, I'm sorry. I had a m/c, too, so if you want to talk, I'm here". But after a month or so, people forget and move on, and it's expected that the mother does the same. I have mentioned that I was completely unprepared (I guess there isn't a way to prepare) for the whole experience of the m/c, both before, during and after. So once again, here are my feelings, 4 months out. Just this past Sunday at church, I had a moment I was unprepared for. It's been almost 4 months since the m/c. The kids were singing in church so I stayed up so I could go. After the service, the minister (who I took care of when she had her 2nd baby) came up to Husband and I and said "Mrs. S told me you guys had a loss a couple months ago. I just wanted to say I am sorry and that you are in my prayers". At that, my eyes welled up with tears and I couldn't stop them. I don't know what it is, but the first time I talk to someone about it, even after 4 months, I tear up. I could talk with my sister, coworkers, husband, etc. all about it, recount the entire story and be fine. But let someone I haven't seen say something, and I lose it. I was kinda surprised Mrs. S. even knew about it, but I guess in a small town, news travels. Anyway, at work I talked with a nurse who has 2 children and has had 3 miscarriages and had a stillborn at 22 weeks. She said that even years down the road, something will trigger her memory and tears will come. It was nice to know that others have the same thing happen, even years later. I realize after the next few months have passed, that things will get easier. I am feeling just fine, but as my pregnant coworkers are starting to show, it's gotten harder. Seeing my pregnant neighbor who is due the day after I was due was hard. I found out a coworker (who only works prn) is due the day after I was due. I knew she was pregnant, just didn't know how far she was. There are several nurses, like I mentioned in the past, due January through April. And I'm starting to see people with March due dates coming in at work. It's also the holidays and on Christmas day, Husbands b-day, I would have been exactly 28 weeks, another milestone I always held dear. And honestly, I really thought that I'd be pregnant by now. Yeah, yeah, I know, it's only been 4 months. We have 3 children, and there are people who have tried for years and don't have any. My body is still trying to figure out what the hell happened. My last 2 cycles were very long and I'm pretty sure were anovulatory. I cramp like there is no tomorrow with periods, and the last two months, I've had pregnancy symptoms a week leading up to AF. Its weird. So physically, it's apparent my body isn't ready. Logically, it would be better if it was later down the road. But emotionally, there is that part of me that keeps saying "get pregnant, you need a baby now, etc." I remember when I first found out I was pregnant, I thought if it was due March of 2011, that would be perfect. And that would still be perfect. I could run more races this summer, I'll have 2 kids in school, more time to save money, 3+ years between Isaiah and the new baby, and time to potty train him, plus we'd have birthdays spread out over the spring, summer, fall and winter. If I were to get pregnant now, we'd have 4 birthdays between July and December. Logically, I know it's better to wait. But every part of my heart disagrees with my mind. It's hard to tell your heart to wait. This is something most people don't understand. They say "I thought you guys didn't want 4 children. Since you lost #4, you can really decide if you want one or not" . Or if they hear someone ask me if we are going to have more, they'll answer for me "well, she's already got her hands full with 3". We have already decided what we want. We want another baby. Another child. It's hard to be honest about whats going on with us when we feel no one is on board with us. And we understand that people are just concerned. They want to make sure we aren't hoping for another because of the loss. But it's between Husband and I, and believe me, we've had many a long conversation about this. We aren't stupid, we wouldn't even consider bringing another child into our family if we weren't prepared. No, we don't know what it's like to have 4 children, but we have 3. I am a mother and a nurse. I can multitask like it's no one's business! Yes, we had a rough patch in our marriage after Isaiah, but we are in a different, better place now. If we had really been done, why didn't I have my tubes tied after Isaiah was born? They were in there anyway. Yes, I had planned on getting an IUD, but would we have really gone through with a vasectomy? The answer is I don't think we would have gone through with it. We would regret not having another child. Part of me feels that the m/c happened for a reason. Subconsciously, I think we always wanted another, and losing that child made us finally acknowledge that. I know I don't have to justify our decision to anyone and that's not what I'm doing here. It just feels good to be able to say it. So we find ourselves in a position we've never really been in: planning to actually try to conceive at some point. We always just let it happen before. Well, 2 of the four pregnancies were surprises. The other 2 came easy. Anyway, this is how I'm feeling, how we're doing, four months later.

Chrsitmas Letter #2

Hi y'all,

We sure all do hope this here Christmas letter finds y'all well and good. Everything is sure hunky-dory here in farm-town USA. Haven't heard much from you all over this last year, what with us being busy and stuff, so I thought I'd send out this here letter to bring you up to speed on our business.

Jacob, boy is he doing well. He got him his first buck this deer season! Daddy was sure proud of him! Well, he got his own deer when grandpappy hit it with his truck, but Jacob don't mind that none. So we's got all sorts of meat to last us this winter. Jacob's learning all sort of things in first grade. Why, just the other day I heard him say "Dang nabit" and the teacher sent a letter home saying he gave another student the "bird" and even knew what it meant! We are so proud!

Clara has been busy herself. She got into having her hair crimped and she doesn't look much different than Madonna in her early years! With the singing voice of hers, we think we may just see her on the TV some day. Boy, she was all into helping get that deer of Jacob's dressed this year. We figure she'll get her own one of these days. Again this year, we got all three of the youngin's their very own camo bib overalls and orange huntin' cap. Out of all three of 'um, she was the most excited about that get'up. She ain't hardly wanted to take it off even to sleep!

Isaiah, whoa boy, look out for that one! He's is one fiesty critter! There ain't nothing that boy can't climb or destroy! We think he's gonna be the one to climb the water tower when he's older and spray paint a love message to his woman! He's darn good at taking things apart. He pulled the Christmas tree over on the cat just this week! He spends most of the day running around with his Pamp.ers hangin' off his behind and a sippy cup of juice. I think he'd like a cup of our moonshine, but that'll have to wait a couple years!

Husband and I got lots of projects we be working on. He has 'bout 5 cars in the backyard. He says he's gonna rebuild me that T-bird I had back in school. So far, he has the frame for it, one black door, a red door and a engine from a '96 mustang. Says it might be awhile 'fore it's ready to take on the road, but I don't mind. He done bought me a new pair of bib overalls with a little pocket that's just the right size for my beer! He's done smokin' the cigarettes, and to help him quit, he bought him some Red.ma.n. Boy, nothing turns a woman on like her man holding a beer and spittin' into an empty can. For this Christmas, I done went out to the Wal-M.art and bought a pair of them red lacy underwears that I think I'll surprise Husband with this year. He sure does like the feel of the lace on his booty! As for the house projects, we done finished putting in new plumbing. We just ran a new line of PVC from the kitchen sink out through the backyard and it dumps into the sewer line out by the street. We also turned on our Christmas lights again this year. We forgot we left them up from the year before, so it was easy. Most of the strands work. There are a few dark spots where the line burned out, but that dont matter none, there's still lights out there!

Anyways, hope y'all have a wonderful Christmas, and hope to see you soon. We got ourselves a parking lot and we can hook up your power so we can just have our own little line of campers in the yard!

Christmas Letter #1

Dear Friends and Family,

This has been a wonderful year at the Lochia household. Time just seems to fly by and before I knew it, it was time again to send out the annual Christmas letter to let everyone know what we've been up to lately.

Jacob is in 1st grade this year and is loving every minute. The school is positive that he is a genius and that he will be eligible for Mensa within the next year. He is reading at the level of a college freshman and just last week solved an old algebra problem that math scholars had been unable to figure out. The teachers have wanted to move him up to high school so he could be challenged, but we want him to be able to socialize and experience grade school. Should he decide he wants to jump 10 grades, we'll be supportive. Who knows, we could have the next Doogie Houser on our hands! Because Jacob isn't being challenged in school, he's full of energy when he gets home. We decided to let him play flag football this fall to burn off some of that energy, and he has shown mad skills! We are sure that should he decide to wait on college until he's 18, that he may be able to get a football scholarship and play NFL.

Clara can't wait to go to kindergarten. She, too, is showing signs of genius as she is able to read at just about the same level as Jacob. We think she may have a career in singing because she walks around the house singing and if we didn't know it was our 5 year old daughter, we'd think it was a professional opera singer! She has a huge range and can really hit the high notes. Again, we don't want to push our kids too much, so we're taking cues from her as to what she wants to do. When we had family pictures taken this year, several people told us she could be a model and that we should take her to an agent to see what she could do. Maybe we'll pursue that after the holidays.

Isaiah is a wonderfully well-behaved 2 year old. Following in the footsteps of his older siblings, he is quite intelligent. He doesn't say too much, but he has his own language that only we understand. Its really quite remarkable that a child of ours has come up with his own language. We could be speaking Isaiahese instead of English in 20 years! We think he may be great at wrestling as he is able to tackle and take Daddy down to the floor! His charming good looks and personality may also make him a great actor, which we will check into when we book Clara's first modeling gig.

Husband is doing well. He recently got a promotion and is now the owner of a very popular deli-style chain restaurant franchise. The money has been nice. The corporate headquarters got together with a local university and decided to award him a honorary doctorate degree for his exceptional skills as a manager. We are very proud of him! With the influx of money, we plan to completely redo our old house after we contributed to several charities. The state has also classified our neighborhood is a Historic District, based primarily on our house. We have restored it so that it looks like it did when it was first built in the 1800's. With the increase flow of traffic from people sightseeing, we realize we may have to build another house to live in and give tours of this house! There are still some renovations that need to be done, but we're taking our time, as not to disturb the original structure.

As for me, things couldn't be better. I have been given privileges to work as a midwife, even though I haven't gone to school. I just have such natural ability that they decided it would be a waste for me to go to school. Even with such an honor, I have decided to continue to work as a RN because I love my patients and feel I should go to school to make sure there really isn't anything I don't already know. They need me. So far, I am soley responsible for saving the lives of 4 babies in distress! The hospital understands my decision, so they decided to give me a huge raise to entice me to stick around while I go back to school in the future. This past year, I ran 5 marathons and came pretty close to winning the Chic.ago marathon. Yes, I not only reached my lifelong goal of running a marathon, but I also surpassed any expectations on my performance. Next year, I think I'll scale back and run only 4 marathons - I want to give others a chance to win:) I've really enjoyed balancing work, running, the kids and their activities, all household chores, bills and parties. I love having a busy schedule, my immaculate house and getting my hair done once a week!

As you can see, we are all doing pretty well and keeping busy. We are sure there are more exciting things to come in the next coming year. Our hope is that our letter finds you almost as well as we are! Merry Christmas and Happy New Year! We have enclosed a few dozen pictures of us on our last vacation of the year for you to enjoy!

Holy Cow, 2 years!

Tomorrow, my baby boy will turn 2. Time sure does fly. I started this blog at the very beginning of my pregnancy with him and I kept a log of what I was feeling and what was going on with the entire pregnancy, birth and afterwards, of course intermixed with all the wild L&D tales. Sometimes I wondered as I would type up a post, "why am I publishing my life on-line? Should I really be this honest about life?" but now that I'm able to look back, I'm glad I did. I can see just how I was feeling at different parts of my life the last 2 (almost 3) years. The L&D stories are composites with some changes, as to protect privacy, but the rest is just me. I just can't believe it's been 2 years already. He's not a baby anymore. This morning, Isaiah crawled into bed with me and I thought to myself "Two years ago, I woke up on Dec 19, knowing that this was the last day I'd be the mother of only 2 children as Isaiah's birth was scheduled the next day at 7:15am. That night, I didn't sleep in anxious anticipation of meeting my new son. I remember worrying how I would manage 3 children, and although it hasn't always been easy, I wouldn't change it for the world! Happy Birthday tomorrow Baby Boy!


38+ week gestation, night before delivery


Sweet 7lb 15oz newborn Isaiah


Sweet, ornery, full of fun 2 year old Isaiah. Who could resist this handsome little man?!?

Concert

It's pretty easy to get wrapped up in trying to keep up with the amount of work that 3 kids, and two adults create. There is always a pile of dishes in the sink, bottomless laundry baskets, a sippy cup with rotten milk buried in a toy box, screaming, yelling, crying, tantrums, and just a general loudness in my home. Sometimes I forget to stop and just enjoy these kids as they are. Right now I am trying not to disturb Clara and Isaiah. They are both sitting in the recliner and Clara is singing Christmas songs to him. He is sitting quietly (amazing in itself) and is quite happy to listen to her renditions of Rudolf the Red-Nosed Reindeer, Away in a Manger and O Little Town of Bethlehem. She's been singing to him for the last 15 minutes, which if you have ever been around kids under 8, you know they have attention spans of usually 15 seconds, if they find something entertaining. While I know this little concert won't last much longer, it's been nice to listen to, a nice break to the sound of yelling and the dryer. Maybe the next song I'll see if they'll let me join in...

That's not what its for!

It's always good to continue to learn. Even after several years of working as a labor nurse, I am still learning new things, but there are very few things that could shock me...so I thought. Last weekend I had a patient in labor. It was her and her husband's first baby and they were very excited. She was progressing nicely, got an epidural and went to sleep for the rest of her labor. Since she was numb from the epidural, I placed a foley catheter to keep her bladder drained because she wouldn't be able to feel when her bladder was full. I noticed that the urethra seemed larger than normal, but everyone's anatomy is different so I didn't think too much about it. A couple hours pass and I decide it's time to recheck her cervix. I go to check her and find the foley has come out. The catheter was sitting between her legs with the bulb still inflated, and no sign of bleeding. I searched my mind for the possibilities. I know it was in the right place, because I had a bag full of urine. That foley bulb had 10cc of saline in it - it should not fall out. And if it was pulled out, there would be a fair amount of blood, but there wasn't any. I was dumbfounded. I check her and find her to be 9 cm, so I don't worry about it. She progresses and pushes well so I call the doc for delivery. Perfect delivery, healthy baby with great apgars and the parents are thrilled. Afterwards, I go out to the desk and the delivering doc explains to me that this patient had dilated her urethra for sex. Huh? Maybe I live under a rock, but I had never heard of this. I know people may have their urethra dilated by a doctor for medical purposes, but not for this reason! I wish I was making this up! I guess she has seen a few people, this patient included, that have managed to dilate their urethra enough so their husband/boyfriend/partner can penetrate the urethra during sex. It explains why a fully inflated foley just fell out. Apparently its quite pleasurable for the man, but these women are, as you can imagine, going into the office with raging UTI's and kidney infections. Ouch! WTH people? I can't imagine there being any pleasure in that. Are these men so small that the vagina just isn't enough? I thought just having a catheter put in before my 1st c-section was unpleasant, I can't even imagine something larger. They must find pleasure in pain. But what happens down the road when they are 50? They'll be wearing depends by age 35! I guess everyone is free to do what they please to their body, but damn. I was completely shocked, still am. But, next time I see a fully inflated foley lying in the bed, I'll have an explanation.

Addition: I had to know how common this is and from what I've found, it's not very common, but happens. Maybe this couple used other objects and not a penis, but regardless, why, ouch and yuck!

Watching a Friend Become a Mother

Awhile back, I had the opportunity to take care of a former coworker having her first baby. She was a great L&D nurse with the sweetest disposition, very caring, and never hesitated to advocate for her patients. She started about a year after I did and after a couple years, she went to work in my OB/GYN's office. She had mentioned about 2 years ago that she and her husband were going to start trying to get pregnant, so I've been waiting to see her roll through the doors pregnant and when I'd see her in the office, I'd look to see if she had a belly. She did finally come in. An induction was scheduled for PIH and she had requested that I be the nurse. It was what we call a staged induction: a cervical ripening agent was used to "ripen" the cervix and once the cervix was soft, then pitocin would be started to get things going. They arrived at midnight and I got the induction going...and it lasted all through the day and when I came back the next night, she was still there. Only 3 centimeters. The nurse handing off to me told me that there had been some late decelerations, but she said they had resolved so she had talked with the doc and the pitocin had been restarted. I looked at the strip, still saw lates, and wondered why on earth she had restarted the pit. So I go in and do all the things to try to get the baby to be happy, but it was to no avail. I called the OB, she called for a c/s and we head back to the OR. It seems most of the time when we go back for a c/s for a non-reassuring fetal heart rate pattern, the baby, thankfully, comes out with Apgars of 9 & 9, leaving you to wonder if it was really necessary. Not the case here. This baby did not tolerate labor and was worn out and came out pale, floppy and was not breathing, but after resuscitation, she came around and made her feelings about the whole process known! The pediatrician showed the patient her baby and she looked at my friend and told the pediatrician "That's her mother, let her mother hold her". And with that, the very young birth mother made a huge sacrifice and changed the life of my friend by making her a mother. My friend, who had to leave the OR for a second because it was too much to watch as they worked to get her child to come around and take that first breath, cried tears of joy and relief. Watching someone become a mother is always amazing, but when it's someone you know, it's even sweeter.

The birth mother makes what is probably the most difficult choice she'll ever make when she decides to give the baby up for adoption, its a choice that she will think of for the rest of her life. I can't imagine the grief that birth mothers feel as they hand their baby over to a couple who will provide the life she wants for her child, a life that she can't provide herself. This birth mother said that it was a difficult choice, but she was comforted by the fact that the adoptive parents would provide a life she couldn't at this time, and that this little girl would be surrounded by love. Thank you to all the birth mothers out there for giving couples who are unable to have a biological child, the opportunity to be parents. Thank you for being brave enough to decide not to terminate the pregnancy, but to nourish and carry the child, to labor and deliver, to bear the physical scars of childbirth as well as the emotional scars, in order to give that child the life you want for her. May God bless you.

6 Years

Wow, 6 years. It's been 6 years since my niece Mirabel was stillborn at 39+ weeks. It's amazing how quickly time has passed. She'd have been in kindergarten. I talked with my SIL tonight and she said she is comforted a bit because this Christmas, her daughter has a little cousin to take care of and play with. It is a nice thought if heaven is really like that. Two souls of innocent children, who left this world before they were even born, one left at full term, the other while it was still an embryo. Tonight, the family is remembering little Mirabel Ozara.

Here's a link to Mirabel's story.

Are you tired?

Dear well meaning coworkers,

It is not helpful nor is it ever nice to comment to me "Nurse Lochia, you look tired. Did you not sleep?" or "Are you not feeling well?". Trust me, hearing this every single weekend from the dayshift is old, but when evening shift starts saying it, it gets downright irritating. Yes, I am tired, I work 12 hour night shifts, I have 3 children, the youngest still will wake up in the middle of the night, and he thinks that 5:30am is an appropriate time to wake up for the day. I have a house, kids activities, so yes, I guess I am a bit tired. People, this is how I look. Thanks for the boost to the ole' self esteem. Grrrrr.

Thanks so much,
Nurse Lochia

Football?

When there are young children in your house, you just never know what they will do or what will come out of their mouths. This afternoon, Isaiah was sitting on my lap. Well, it's more like he's bouncing, jumping and climbing. I just happen to be sitting in the chair he's climbing on. I'm fairly certain he's long forgotten all the hours we sat in the recliner, while he happily nursed and fell asleep. He seems much too old for that now. He turns to face me, reaches out and grabs one of "The Ladies". I tell him "No, Isaiah, that's not nice". And his reply? "Football?" No, Isaiah, they are not footballs.

Viability

This is the week that, should my last pregnancy have continued, I would have hit 24 weeks, or viability. I'm not 100% sure this is the week, and I decided not to torture myself and look it up to see if I am correct. But I remember when I first found out I was pregnant, I looked at the wheel to see when I would hit 24 weeks, and I remember thinking it would be appropriate that the baby would be viable around Thanksgiving. A friend who had a miscarriage told me that over the course of what would have been her 40 weeks of pregnancy, there were dates that she'd been a little sad: 20 weeks when she would have had the sono that could determine sex, 28 weeks when she'd be entering the third trimester, 36 weeks when her OB said they wouldn't stop her labor, and the due date. I guess the 20 week mark didn't really stand out for me, but 24 weeks does. Maybe it's because I'm a L&D nurse, or maybe that doesn't really matter, but for me 24 weeks was always a milestone where I could relax a bit, breathe a sigh of relief. At twenty-four weeks, the fetus has a chance of surviving if born at this gestation, although the mortality rate is high, and the likelihood of long-term problems is even higher. Of course I always hoped to hit term, but somehow knowing I had gotten to this point was a relief. Today I've been thinking about what could have been. I looked at my belly pics when I was pregnant with Isaiah, so I know my approximate size. I'd be in maternity clothes, feeling fairly regular movement and overall feeling pretty good. I would have used the excuse "I'm eating for two" to indulge in just one more piece of pumpkin pie tomorrow. (Well, I'll probably go ahead and have that second piece anyway!) I'd be protecting my belly from ornery Isaiah, answering Jacob and Clara's questions about my expanding waist and the impending arrival of their new sibling in 16 weeks. I didn't shed any tears. I was just thinking, and remembering. This Thanksgiving, I will again give thanks for the 3 healthy, happy children I have here. I'll also give thanks for the opportunity to have carried my 4th baby for 11 weeks. Even through the tears, the heartache, I can see that in that small amount of time, that life that was there, a life that only I was physically aware of, changed our lives in more ways than I can count, many for the better. But for today, I am a little sad as we reach what would have been a huge milestone in my eyes.

Second Class Birth

There is a lot of discussion that happens about natural childbirth and sometimes these discussions get ugly in my opinion. Sometimes, just because of how strongly they feel about natural childbirth, VBAC and no pain meds, they come across as though women who have c-sections, for whatever reason, did not have a full-filling birth experience. There are times that I have even felt a bit jaded, like there is something wrong with me for getting an epidural with my first baby and for not being upset about my c-section...I had a repeat elective c-section, even though I had delivered vaginally before, I opted to not VBAC. There are times I wish I had made a different decision, but I really don't have a regret. But it was a good experience, and not a second class birth because I didn't go into labor and deliver with no interventions. I do agree, very strongly, that the national c-section rate is much higher than it should be and that women should be given more support when they decide they don't want interventions. There are too many elective inductions. Fetal monitoring should be intermittant with a healthy pregnancy so mom can move around in labor. VBAC's should be the norm instead of repeat c-section for numerous reasons. In most cases, they are safer for mom and baby, it isn't major abdominal surgery, etc. But just because a mom doesn't deliver au naturale, doesnt' mean she has had a second class birth. I bonded just fine with all 3 of my children, and have no different feelings for the child I pushed out into the world than I have for the two that my body continued to support while they were delivered through an abdominal incision. All three of my children were awesome breastfeeders. I am a firm believer that as a labor nurse, it is my duty to help the woman achieve the birth she wants. If she wants to labor without an epidural, I am there to support her. If she wants an epidural, I will support her. If she has chosen to have a repeat c-section, I will support her. In every way, shape and form that birth can be achieved, I will do what I can to make it the best experience it can be. It is awesome when a mom delivers without pain meds and she feels this sense of empowerment. It is a beautiful thing. But it doesn't always happen. One mom I took care of not too long ago, delivered her first baby without an epidural...and regretted it, said she'd never do it that way again. She did fabulous, and I hadn't a clue she felt this way, but she later admitted to me she would have asked for the epidural but her support people were anti-epidural and were very discouraging when she started thinking about it. She did not enjoy her birth, and it made me very sad to learn this. On the flip side, I've had moms who wanted an epidural as soon as they hit the door, wish they hadn't gotten one because they hated not being able to feel what was going on. I've seen a support person make a woman who has had a c-section feel like she took the easy way out. A c-section, my friends, is not the easy route. I guess I hadn't realized how very strongly I feel about this: there is no such thing as a second class birth. The mother has provided nutrition and the perfect environment for the baby to grow since conception, and that continues throughout labor and delivery. The baby is supported in the presence of pain medication, an epidural and throughout the c-section. If the mom knows her options, has been able to make an educated decision, is happy with her experience and the outcome is a healthy mom and baby, then that is what is important. The birth experience is important, and every birth, every baby is a miracle. Let's not make women feel their birth was anything less than spectacular, regardless of her method of delivery.

In a Funk

The last couple days I've been in a funk. I've wanted to be lazy but I am unable to indulge my fantasy of lying on the coach and napping. I am slowly coming out of it. I was on call last night from 7p - 11p, and I desperately wanted to be able to stay home. I had worked evening shift charge the night before to help out the usual charge nurse. So I worked Friday, on-call Saturday, worked Sunday night, Monday night and Tuesday evening. I just wanted to tuck the kids in and go to bed at a normal, decent time. Usually, they know by 2 hours before a shift if they need you or not, and they hadn't called me by 5:30, so I figured I was in the clear for awhile anyway. When you are on call, they could call at anytime during that call slot and you have to be there in 30 minutes. I knew I still might have to go in. At 5:40, they called "We need you to come in at 7". Rats. I moaned and groaned about having to work, wondering what type of assignment they'd give me. Evening shift is notorious for giving people coming in to help a less than pleasant load. But, I was assigned to care for a coworker, having her first baby. Early in her pregnancy, the sono had indicated there was some type of mass that was shifting her heart and lungs to the wrong side. Plans at that point were to deliver her at 34 weeks at a Hospital with a Level 3 NICU. But, at a follow-up sono at 33 weeks had shown that it had resolved and that the mass had completely disappeared. So last night she delivered a healthy little girl. It's funny watching an OB nurse on the other side of the monitor for the first time. This nurse rarely shows much emotion, but as her baby's head emerged, she reached down to touch the mass of hair and the tears started falling. Of course, that gets me crying. By the end, there wasn't a dry eye in the room. Not unusual when one of our own delivers. It was a beautiful delivery. So I had dreaded working but it turned out to be a nice shift, plus it's another 4 hours of call-in pay. It will make for a nice check for Christmas shopping. This a.m., I found myself not wanting to get up out of bed, drag the kids out in the cold rain to take Jacob to school. It was so nice and toasty warm under the blankets, and since I had worked until 11pm last night, I hadn't gotten to bed until after midnight. Obviously there wasn't any option other than to get my butt out of bed, but I grumbled all morning. I stopped at a pop machine (I have a diet cola addiction and try to limit myself by not buying a 12 pack and just getting one at the machine in the morning) and it gave me 2 for the price of one! Hey, sometimes it's the small things. I took the mail out of the box and found a Save the Date card for my old H.S friend's wedding. We reconnected this summer when we ran races together. I also received her bridal shower invitation and noticed it was on a Sunday afternoon. I thought "Well, I guess I can't go to that" until I realized I was scheduled to work Friday/Sunday that weekend, so I will be able to go. I also found a coupon booklet from the grocery store I shop at for $20 off a $200 purchase, on top of great coupons for items I routinely buy. Things are starting to look up and my motivation is coming back. I might just be able to get the 5 loads of laundry tackled today.

The Moment

A patient presents to L&D, full term with her second child. As she rounds the corner, you see she is sitting to one side, sweat above her lip - a telltale sign that she will deliver soon. She tells you she wants her epidural and she wants it now as she is getting into the bed. She has no intentions of delivering naturally. A quick exam reveals a huge bulging bag of water and no cervix left. No time for an epidural. With the next contraction, her water breaks and with the gush of fluid, the baby's head descends rapidly and is now visible through the labia. The mother becomes frantic at this intense pressure and burning sensation. With the calmness that this is an everyday event, one gloved hand supports the perineum and the other is ready to catch. "Look at me, look me in the eyes. Okay, your baby is coming and you can do this". With these gentle words, eyes lock, and the patient reaches within and finds control. As the mother involuntarily bears down, the baby's head emerges. Gentle support of the perineum and slow stretching allow the head to come without tearing. "Okay, now blow" and a quick finger sweep shows a loop of umbilical cord wrapped once, twice around the neck, which is easily reduced over the head. "Easy now, nice and easy" and the patient delivers her baby with a powerful contraction and an easy, controlled push. "It's a GIRL!" dad announces as their new daughter is placed on her mother's chest. At that moment, the OB, who had entered the room as the head had emerged makes her presence known. "Congratulations Mom and Dad" and to the L&D nurse who 'caught', a "well done, you look like you've been doing this for years". She had stood back, seeing all was well, knowing it would hinder more than help to jump in. The L&D nurse, who reads midwife memoirs, and loves all things related to birth, thinks to herself "That was awesome! And there wasn't any nervousness, because it was just a baby being born, and I was there just in case, but it was awesome!". Maybe, just maybe, it was that moment a calling was realized. A calling that may have to wait some years until after her family is complete and undergraduate debt repaid. But a calling that may have to be answered nonetheless. Perhaps in 10 years she'll answer that call at 3am to come now, the patient is ready, instead of being the one making that call. Who knows what the future may bring...

Another night in L&D

Last night wasn't too bad of a shift. I am pretty flexible and there are a couple weekends this schedule that I am working Friday/Sunday. Fridays tend to be pretty busy and Saturdays not quite so bad. Only problem is when I show up at 7p on Fridays, the evening charge has always forgotten that I was coming in, because the 12 hour shifts are usually on the weekends. Yeah, we work 8 hours during the week and most people work 12's on the weekends, some still do 8. It's a bit confusing at first. Anyway, I ended up orienting one of the new evening shift nurses. I think she'll be a pretty good labor nurse. It took me a bit to figure out where she was at, what her skills and comfort level was. I have a hard time sitting back and directing, instead of just doing. Our labor patient was one of those unfortunate moms who had the perfect birth in her mind: no epidural, no forceps, no episiotomy, no pitocin. minimal interventions, etc. Yet in the end, she had an elective induction (her choice) episiotomy, forcep delivery with an epidural, and thankfully, she was happy. Shortly after she delivered, another mom came in about 2215. She was a multip and said the contractions weren't too bad, but were getting closer. When I went in the room to introduce myself, I noticed she had the "look". Something about her face and the way she moved got me thinking she was much more active than she thought she was. She also indicated that this time she wanted an epidural. She had delivered in the tub her last 2 deliveries and wanted to enjoy labor. But, it wasn't to be as she was 9 cm with a huge bulging bag. I called the midwife to get her on her way, tried to get the tub full so she could at least deliver in the tub, but deep down I knew we'd never get it filled in time. Midwife arrived, the patient ruptured her membranes and out came baby boy. The couple had girls at home and the mom was sure it was another boy. Dad said he knew all along, and was right with their other children. Twenty minutes from the time she hit the door, she was holding her baby. I'm actually quite surprised the midwife made it, barely, but she got there. Afterwards, mom said "I was wondering why it hurt so much. I was thinking on our way in that it didn't hurt so much this early with the other kids. Now I know". Her total time in labor, from the time she noticed the first contraction? One hour and 45 minutes. Start to finish. Amazing.
After those 2 deliveries, we ended up and shut labor down, and no one came in the rest of the night. It always seems incredibly bizarre when we are able to do that. And after a slow night like that, we usually pay with a huge influx of patients the next night or two. That would be oaky right now. I'm on call tonight, and would love the extra 12 hours of call-in pay right before Christmas.

Loose Interpretation

As I mentioned before, there has been a lot of drama making its way around work, way more than I ever thought possible. I try to just stay away from it. I go to work, take care of the patients and stay neutral. That is until something starts that will affect me. I work weekend option, or the Baylor program. I work 50 out of 52 weekends a year, for time and 1/2, and get full time benefits. I opted to work one day during the week for 1 1/2 time for the extra cash and to help with the lack of staff on nightshift. I do not build PTO, because I get 2 weekends off and shouldn't need PTO. I am to be flexed down after the regular staff because my work week is Saturday and Sunday. I also do not have to be included in the holiday rotation because when holidays fall on the weekend, I just have to work them. We also work every Memorial Day and Labor Day. All of this is in the policy and has been like this for years. Well, turns out one of the other WEO girls that does the extra weekday was scheduled to work Thanksgiving. She argued and the director and charge nurses said they decided that WEO people needed to be included in the holiday rotation. So because we pick up an extra day, it's like they are going to punish us by scheduling us on holidays during the week. They also decided that the charge nurses should never be flexed down, and if it's very slow, then WEO would have to flex. You can bet that in 2 years when Christmas Eve, Christmas, New Years Eve and New Years day fall on the weekend, that they will make us work then, too. The charge nurses have way too much pull with the director and they just don't want to work their holidays. As with the flexing, our census has been low and people are getting flexed. Now because the holidays are coming, the charge nurses don't want to lose their hours, so let's screw the WEO people. And when it gets hectic, then they don't care and want to flex. It's all fine and dandy that we work weekends so they don't have to work but 1 weekend a month, and it'll be great in 2 years that the major holidays are covered by the WEO people. But this year, to benefit themselves, the rules are bent to accommodate them and screw us. Part of the problem is the loose interpretation of the policy. The policy clearly states that WEO are flexed LAST. So they can't change that part. There have been other things come up that we can't get a concrete answer to. And we've tried since January to get the director to come in and talk with us WEO girls and let us know exactly what the rules are, in black and white, not the gray BS. We've been unsuccessful at that. So, unless things change, we are going to the Director of Nursing with a grievance. Who knows how much good ti will do, but it's been long enough. And there is hospital across town that I heard is getting busier, and looking for a few L&D nurses. It would be the same doctors, same standing orders...I'm sure they'd love an experienced labor nurse/charge nurse who wants nightshift. We'll see what happens.

Stellan

For the last several months, I've been following Stellan's story. If you haven't read about him, he is a one year old little boy who was found to have SVT while in the womb. They were certain he would die before birth or shortly after. Miraculously, he was born healthy, but has been battling SVT that wasn't controlled in the usual fashion. Anyway, today after nearly dying, he underwent a risky surgery to ablate the accessary pathway that was causing his heart to beat dangerously fast. It was successful. Go read his story. God performs miracle everyday, many of these we are too blind to notice. This is truly an in-your-face miracle. People all over the world have been praying for this kiddo. After reading how the ablation was successful, I cried, and I don't even know the family or Stellan. God gave the physicians the wisdom to know what to do, guided their hands opened a door for them to take a risk and go for it, and it worked. God always knew the outcome. Against all odds, little Stellan is free of SVT. He still has hurdles, but so far, the biggest one has been beat. And if all goes well and Stellan lives a long happy life, just think how amazing it will be for him when he realizes how many people prayed for him. Praise God and continue to pray for Stellan's full recovery.

Back On-Line

Can I just say I forgot how much I like new computers? After using granny hp computer, bought back in January of 2002, this brand new puppy is nice. I've heard good things about Macs, but I've always been a PC kind of gal, plus all my files are for PC. So I'm happy. I'll be happier when we can get the approximately 1000 pictures off of the old computer. I was bad and lazy and never backed up all our pictures, dating back to our wedding. The problem with the old computer was something was downloaded that corrupted our audio and visual settings, so we couldn't retrieve any music or pictures, or see the graphics clearly. Husband has a friend who works on computers and he's certain he can clean up the infection, and get our files. Thank goodness. As for preventing future problems with certain FILs downloading inappropriate and infected material on the internet, we have solved that problem with parental controls and top notch virus protection. That's right. When they come down and he wants to use the computer, he will sign in under Guest and we have it set up so he can't access those sites. Seems like it a bit backwards, doesn't it? The kids blocking sites from the parent? Crazy.

Work had been like a soap opera, seriously. I never would have guessed that there could be so much drama going on in the whole hospital, and it's all political. There is just way too much to get into in detail. There are 2 anesthesia groups in town, and one has had reign over the majority of anesthesia services in the community. The other group is significantly smaller and only provides services to Hospital. Because we will become part of a larger healthcare system in January, talks led to the smaller group getting the contract and the other long reigning group did not. I wasn't privy to why or how it happened, but because of how it went, the larger group resigned from the staff. The majority of surgeons preferred the larger group and in retaliation and loyalty to the group, they are sending patients to the other hospital so they can use their preferred anesthesia group. The thing is is that it has been nothing but pleasant dealing with the smaller group. We didn't see them much, but man, they do great epidurals, are pleasant to deal with, and treat us like professionals, plus do great epidurals. This past week since this came about, we have seen a decrease in our census. We'll see if that continues or what happens. The bad thing is, OB anyway, the other hospital isn't equipped or staffed to care for the number of OB patients we do. We work together with their unit on standing orders and lately on the new OB hemorrhage code and standing orders, and they are just swamped and can't handle the sudden influx of patients. They have 1/4 of the staff we do, only 3 labor rooms and maybe 10 postpartum rooms. There are several other drama issues going on involving a multitude of things. It's like a bad spin-off of daytime television.

Computer Issues

So our ancient computer is finally on it's deathbed. We bought the thing back in January 2002 and it's been a wonderful tool, but it is now time to move on. It may be a bit before I have a more functional computer so my lack of blogging is just due to lack of a good computer. It has crashed and we believe the cause was my wonderful FIL. When they come down, he uses our computer to browse the internet, ie: porn. Based on the issues we've had come up, which happened very suddenly after this weekends visit, we figure he tried to view something that our computer in it's old age couldn't handle. On top of a couple other projects needing tending to (you know, small things like new main line plumbing under the house) it may be a week or 2 before we have a new computer.

Ranting and Raving

Dear Charge Nurses, when there are two nurses back in labor with 5 labors, and 2 outpatients, if there are 2 labor nurses on post-partum, please send at least one back to help, before a patient precips because she is moving quickly. We were stretched too thin. Your 2 labor nurses were in catching a baby while no one was out monitoring the other patients. It could have been ugly. Plus now you have two grumpy labor nurses who will repeatedly tell you "we told you we needed help". You are lucky we are experienced, work well together and know without having to ask what needs to be done. You got lucky this time. Let's not keep playing Russian roulette.

Dear elective inductions who don't give us a working phone number, we are very sorry you didn't get the message that you were being bumped because we don't have a labor room to put you in, or the staff to care for you. Yes, we know you were "scheduled" but shall you or I go tell that mom who is 8 cm with no epidural laboring in a triage chair that she needs to close her legs because you were "scheduled" and should get a labor room? These people are in labor, you are not. We'll reschedule you when we can.

Dear Physician of the Year in my book, thank you for seeing how nuts the unit was, and told your elective induction that she would have to go home after we made sure her baby looked great, and be scheduled later. You did this with no prompting from us nurses. We love you. Really, we do.

Dear Physicians, if you see that there are only 3 labor nurses for umpteen billion patients, please, we beg of you for our sake and especially for the patients sake, please do not break your 3 patients bags and order pitocin at 1am because you came for a delivery. And please come up with more creative diagnoses for medical inductions than swelling when my lower extremities are more swollen than your patient, or for PIH when her BP's are 90/50 and no other symptoms. If you were worried about PIH, how 'bout ordering extra labs? Oligohydramnios would be a good one. That I can't rule out without an US. Try that one, make me feel like you don't think I'm an idiot. Again, talk with some of your colleagues, take notes, treat the nurses like professionals, don't make a bad name for the majority.

Dear Mother of my labor patient, I just want to thank you for the comic relief this morning when after a cervical check you said "Why are you carrying on so much, did you do this when he was sticking his weenie in your stuff?" Patient laughed heartily and I about wet myself at your colorful remark. Thank you. I needed that.

And please, dear God, can you let this weekend be more manageable? I pray you send an experienced labor nurse, or 3, who wants to work nights to our hospital.

Infant and Pregnancy Loss Remembrance Day

Tonight at 7pm, we will be lighting a candle for our own loss this year. Since 2003, I've remembered my niece who was stillborn and thought about her on this day and the day of her birth. This year, sadly, I will be thinking of my own baby, lost at only 11 weeks, but loved just the same. We will never forget and are forever changed.

Good Times

This past week went by in a blur. It was so busy on the unit we could barely see straight. Thankfully the rush is over and this weekend was actually pretty slow, except for the rare triplet delivery at 35 weeks that went off beautifully. What was funny is her waters broke, yes waters, 6 hours before her scheduled c-section. Baby B's water broke first, and Baby A's water broke as she sat on the OR table for her spinal, C's was broken when they got to him after the other two were delivered. A great outcome, and a rare treat for us. I actually circulated for a triplet delivery 4 years ago, and because a labor patient came in 2 hours before her water broke, I didn't end up getting to do this one. I had been taking care of triplet mom up to that point, and if that one patient hadn't come in, it would have been me. It was good someone else got to have that experience. That pay period, I ended up with 25 hours of call-in pay, which will make for a sweet check.

On a different subject, I learned a valuable lesson this weekend: don't pick fights with a dresser and TV. Okay, so we live in a 100+ year old house. Over the years as the house settled, the floors developed a slight slant to them. Generally, the house will settled out and the floors everywhere, except our bedroom, dip ever so slightly down toward the outside of the house. If you put a marble on the floor, it will roll toward the outside walls. Not the case in the master bedroom. The wall that my long dresser is on actually dips ever so slightly toward the center of the house. Well, Friday night my in-laws were in town. My MIL was passed out in Clara's room, and my FIL was still up watching TV down in the living room, right below the master bedroom. It was about 11pm, and Husband was in bed and I was headed that way. I got upstairs and wanted a pair of pj pants to wear. My dresser, I'll admit is overstuffed with clothes, and Husband's sock/undies drawer is always open. The TV, my jewelry boxes, etc are on top of the dresser. I tried to open the drawer that my pants were in but to no avail, so I lean over, start pulling, and you guessed it, the dresser came crashing over on top of me and the TV hit me straight in the forehead. I think my FIL downstairs about wet himself. The kids and my MIL never stirred, though. I did have a pretty good sized knot on my forehead and a decent headache for the rest of Saturday. No worries that I have a subdural hematoma, or even a concussion. Just a little bit of embarrassment that my dresser and TV fell on me, but I now have motivation to clean out those damn drawers! Now if that was the only uncomfortable thing this weekend, it would have been enough. Sunday night at work, at about 10pm, I felt a twinge after I had finished peeing that I had only felt 2 other times my entire life. And I thought "Great, I think I'm brewing a UTI". I knew if it was truly a UTI, within the next 2-3 hours, I would know for sure, because the first 2 I had progressed rather rapidly from that first twinge. The first two UTI's I have had, started after not getting up to pee after, um, well, shall I say a bedroom rendezvous after a night of partying years ago. I learned my lesson and always, always get up afterwards. So I"m not sure what happened this time because sure enough, about midnight, I was peeing red, and when I say red, I mean red, and about ready to lose it from the urgency, pain and pressure. And I still had 7 hours left in my shift, and another 9 until the doc's office opened. I started downing cranberry juice and water, hoping to flush things out a bit. I had a labor patient who ended up delivering for me and I was so uncomfortable I did something I have seen other nurses do, but have never done myself: I asked that delivering doc to write me a script for an antibiotic. By this time, it is 6am, and I'm actually starting to feel like I could possibly spike a low temp if I don't get treated. I could have waited another 3 hours to call my docs office, but I was tired after a 12 hour shift, and it would be at least an hour after I called to get my script picked up. The doc was kind enough to do it and didn't seem to mind, but I still feel horrible. I really try not to take advantage of the fact that I work with doctors and have never asked for something like that. I've seen other nurses do it and the docs don't care. And in all honesty, if one of the other nurses hadn't said "Nurse Lochia, there's Dr. H" and got his attention, so he was waiting to see what I needed, I wouldn't have asked. And it wasn't like I was asking for pain meds, or sleep aides. It was for a UTI, and we see UTI's all the time and I'm sure he knows after the years of working with me that I wouldn't ask if I wasn't miserable. He gave me a script for Cipro, offered pyridium, but I said I'd just do cranberry juice, and I was able to take the first dose at 8:15 a.m. When I was crawling into bed, I had that feeling I usually get right before I spike a temp, like my skin is super sensitive. Hard to explain, but anyway, I've got drugs. I'm no longer peeing red, but that urgency and burning pressure at the end of the stream is still there. So I'm in for more fun and glasses upon glasses of cranberry juice for awhile.

Full Moon Brings 'Em Out!

Man, oh man was work busy this weekend. I am wicked tired and sore. My usual 2 12-hour shifts and 8-hour shift turned into 13- and 14 hour shifts. Not only long, but busy and hard. And I'm on-call Wednesday night and there was no sign of it slowing down. Lots of walking, turning patients with epidurals, moving beds to the OR, stooping over to help with breastfeeding, and just running from one thing to the next. At one point Sunday night, I had 4 active labor patients (thankfully only for about 1 1/2 hours), one having late decels, and one who was a repeat cesarean. I wished I could just squat, grunt, push and deliver a set of fully-trained labor-nurse triplets to help out! There was no time to eat, drink or pee. This a.m., I realized I hadn't peed since I went into work, and still didn't feel like I had to go. That's the kind of busy we were. Gotta love a full moon and storm. Oh, and Saturday night, we had a bomb code. That's right, we had a code called because of a bomb threat. I never wanted to hear that code called. I didn't actually hear it called because I was admitting active labor #3, and when my co-workers told me, I thought they were lying. Nope. For about 2 hours, we waited, as patients were still coming in (yeah, lets bump of the census before the bomb goes off) wondering when they'd call it clear or tell us to evacuate. We figured it was probably bogus, but you just don't know. It turned out to be bogus, but man, was scary.

Saturday morning, before the chaos of L&D, I ran another 5K, this one was to benefit St. Jude. Let me tell you, when I woke up at 5:00 a.m., in the dark, to 40 degree temps and mist, I wanted to crawl back under the covers and go to sleep. But, I had pre-registered, and I thought of all the kids that would never be able to run a race, and all the kids that someday might be able to thanks to the money raised. Even though my money was already there, I felt obligated to go run. Before the race, they had a fun kids race, 1/4 of a mile. I'm a huge crier, and man, did the tears fall watching these little kids run. Who knows if these kids were ever patients at St. Jude, but at that moment, in my eyes they were. So here I am, a 30 year old woman, crying because some kids are running. I'm sure I was a sight. But, then it was time for my race. It was cold, but thankfully it had stopped raining. I had my best time ever, 27:15, and felt great afterward. They had marked every 1/4 mile, which was nice because you knew how close you were, but at the same time, you knew how far you had to go. Apparently, I do great and feel awesome the first 1 3/4 mile, then I start to tire, and want to be closer. At mile 2 1/2, I'm done. My muscles are screaming "stop, stop! we're tired! we can't go one!", but there's only a bit more than a half mile left, so I keep going. And once I see the finish line and the time clock, I'm able to maybe kick it, like a 4 cylinder engine running on fumes, and finish strong. It is a test of endurance and strength, finishing a race, but afterwards, it feels great. Just knowing I can do it, is awesome. I'm not fast by any means. Serious runners finish in 19 minutes. I'm happy to not be last! I'm working on getting a co-worker who runs regularly to run a 5K race in 2 weeks here in town. I'm not sure I can better my time at this point in the year. It gets dark so early and so it's hard to get out and run. But, it sounds like it's a fun race to do, so I'm hoping to get her to run it with me.

It's Fall!

I just love this time of year. The temperatures are great, you can wear long or short sleeves, the colors of the leaves are fabulous, and of course, I LOVE the pumpkin patches and apple orchards. It's become a requirement with our family that we go to the apple orchard and local pumpkin patch at least once. On Tuesday, the weather was great and we decided to go. There is a little pumpkin farm not too far from us, and it had been just a little farm where you could buy pumpkins, pay on the honor system in a cash box, and they had a turkey and rabbits for the kids to look at. I had heard they had expanded their farm, and boy did they! They have an actual store now, a little village for the kids complete with mini-houses, hay bale tower, and more animals. It was a ton of fun.

Five weeks

Five weeks ago today, I went to bed after fretting all weekend that there was something wrong with the pregnancy, although I had no reason to think so. Five weeks ago, I woke up in the afternoon and was bleeding. Five weeks ago, my heart was crushed. It has only been 5 weeks, but at the same time, it seems like that was a lifetime ago. In a way it was. That day and the day I had my D&C and delivered the pregnancy in the bathroom did change me forever, probably in ways I don't even realize yet. There will always be a part of my heart that is broken, a part of me that realizes how much it hurts to lose a pregnancy. I understand that it doesn't matter if the pregnancy ended early, that you have hopes and dreams of what life would be like with that child. But, I'm really doing well. For the last week, I hadn't cried, and hadn't really been too sad. I really think working in OB forced me to grieve hard and fast, to figure out a way to get to a place emotionally so I can take care of pregnant women and new moms. Kinda like exposure therapy, I guess. This a.m., after a quiet, easy shift at work (couldn't believe it) I got home and out of the blue, I started crying, and I let the tears fall. I let myself grieve again for the baby I'll never hold on this earth. I did wonder what in the world brought on the tears, but I think that happens to everyone. After awhile, I decided to head to bed, and I noticed that AF had made her return. I was happy to see her for the first time in years, probably since I was a 12 year old, hoping to cross that bridge into womanhood. I am happy as that means my body is getting back to normal, although I know it could still be a couple cycles before it is regular again. I am sad as it reminded me that I should have been about 16 weeks. But now we have the green light to try again if we so desire. I'm happy for that. But the timing was impeccable. Exactly 5 weeks ago, I went to the bathroom and found blood, not expecting it. Exactly five weeks ago, I lost all hope for that pregnancy. Today, I have hope that I can have a successful pregnancy in the near future. Five weeks. Only God knows what the next 5 weeks will bring.

SVE

As a labor nurse, part of my job is to evaluate where a woman is at in labor, by determining if her contractions are the real deal, causing her cervix to dilate. In order to do this, I have to do a sterile vaginal exam, SVE, to see how far dilated she is, effacement, station and to make sure the presenting part is cephalic. I don't think any woman enjoys this part of the process. Sure, all that really matters is if the baby is crowning, but I do work in a hospital and when I call the doctor/midwife, they like to know where she is in the labor process. I do try to limit the number of SVE's that I do, especially if their water has broken, to minimize the risk of infection and the mother's discomfort. Most women tolerate this as part of the process. But, on occasion, I have run into some difficulty, like I did Friday night. I had a patient come in after her water broke. On her prenatal record, the doctor had noted that the patient was unable to tolerate any kind of SVE, and that she had recommended doing something to desensitize the area, since she would eventually go into labor and have to give birth. There was even discussion of delivery by c-section. So I knew what I was getting into. After going through the admission process, I get to where I need to check her cervix. She assumed the position but before I even touched her she moaned "oh, that hurts!" And no, she wasn't having a contraction. I tried a couple more times and if I even touched her, she grabbed my wrist and yelled that it hurt. She told me to go ahead, even if she yelled, but I just couldn't do it. I felt like I was molesting her. Not only that, she was tensing her muscles so tight, and would grab my wrist, so I couldn't physically perform the exam anyway. She is part of a large group of people in my community that belong to a culture that women must keep covered, marriages are arranged, the husband speaks for his wife and that the father's mother comes to live with them for several months after they have a baby. The wife's duty is to care for her husband and if you were to ask her, she would probably say that in her spare time, she likes to care for her husband. The only time the woman is in control and is catered to is when she is in labor. And they accept this as a way of life. Anyway, so I called the doctor and gave her report, and she said to get her an epidural (patient wanted one) and after she was comfortable, to check her cervix. She knew this was the only way she would tolerate the exam and labor. So that's what we did. She got an epidural, was comfortable, and I tried again. She was very kind and apologetic, but even after the epidural, I was unable to check her. I don't think she realized that she wouldn't be completely numb. I was able to feel that the baby's head was low, and I guessed she was probably somewhere between 7-10 cm, but that was just a guess. I'm fairly certain she was delivered by c-section. I have had two other patients that needed an epidural to have a SVE, and they were fine afterwards, and even delivered vaginally (they were also part of the same culture). I'm not quite sure how this mama got pregnant. This culture is known for the "scoop method". Where they don't actually do the deed, but that the mom scoops the "stuff" up there to get pregnant. I'm not sure she could even tolerate this. I'll have to find out tonight how she did and when she finally (and how) delivered.

I'm on , Top of the World....

Man, I have to admit I still love The Carpenters. Okay, sidetracked again. Just warning you, I'm going to "toot my own horn" for a change. I'll try not to be too obnoxious. I'm feeling pretty good. Here's why: I had my yearly evaluation and I got "exceeds expectations". Yep, that's right. I managed to attain one the most wanted but very rarely (if ever) achieved goals. I "exceed expectations". The director said that it is reserved for those nurses that are in the top 5% of the hospital staff with excellent clinical skill as well as interpersonal skills. Yes, I admit, I'm bragging here, but damn! Never in my wildest dreams did I think that I would be classified as that. She said "achieving expectations is an A+, just so you know how your coworkers, patients and the physicians perceive you as a nurse. And I see your name on cards, emails and in phone calls from patients who love you, all the time". With that kind of evaluation, that would entitle me to the highest possible raise you can get, which I've been assured people very rarely get. But, wait, oh crap, the hospital isn't doing merit raises this year...for the next year, we will ALL get a .75% raise IF the hospital meets budget and patient satisfaction goals. Figures. I guess it makes it easier to give that "exceeds expectations" when there's no benefit from it, other than a little ego stroking. We'll see if I still attain that at my next yearly evaluation when the merit raises resume.

Autism 5K

I am running another 5K race tomorrow morning. This race is raising money to benefit the local autism association. With the other races I've run, I was excited, nervous, but more than that, I knew I had to be aware of my body and know when to quit, so as not to stress the pregnancy. This race, I don't have to worry about that. I am excited, nervous, but running this race is bittersweet for me. The last race I ran, I had planned on it being the last race during the pregnancy, but after doing so well and feeling so great afterward, I had decided to run this race, since I hardly felt pregnant running it. Now I know why. But, now, I am free of constraints. I can push myself, feel the burn and see just what my body can do. My last race, I was 5th in my age group with a time of 28:22.7 and a pace of 9:09 per mile. I never claimed I was fast! But I held back that race. I don't have to this time. Plus, I have brand new running shoes, and let me tell ya, what a difference those puppies have made. The ones I ran in before I bought, well, actually my mom bought for me when I was in college 10+ years ago, they had little support, and the tread was gone. Bad, yes, I know, especially for an ex-physical therapy wannabe. The first time I ran in my new shoes, when I was just walking in them I felt like I was walking on spongy cushions. That's how bad my old shoes were, and I didn't really notice. I've rearranged and added to my running playlist, I'm motivating myself and I'm as ready as I can be for my first race after.

Follow Up Appointment

Yesterday afternoon, I met with Doc for my post-op appointment. I've been somewhat dreading this appointment for a few reasons. One, it was the first time I went into the OB/GYN office for something that wasn't happy. Two, I knew I was going to cry. And three, I was afraid that since I was going in at 4:00pm, that they would be behind schedule and I'd have to sit and wait forever. Thankfully that wasn't the case. They got me in right away. The med. asst starting talking, saying how sorry she was, etc., and that's when I started tearing up. I then had to walk down the hall past a pregnant couple sitting in the chairs waiting for bloodwork. I tried to hide my face because I didn't want them to see me with tears in my eyes. I'm not a graceful crier. Some people just have a few tears that sit in their eyes and their faces don't turn red. Not me. My face turns red, and my eyes get red and puffy. The room I was in, of course, had the sono machine and I thought "that would probably be a bad thing for most people to see after a D&C". It didn't' bother me because, well, I'm exposed to pregnant women and newborns. Doc came in, tears started falling again, but I'm sure she is used to that. I had made a list of questions because I was afraid that I would forget to ask one or two of them, but I managed to remember. I remember her telling me in the OR that I bled quite a bit, and that she had to give me pitocin, methergine and hemabate. I had wondered if that was fairly common. She said that a lot of times, people won't need anything. Sometimes people will need some pitocin, sometimes even methergine but she's never had to give someone hemabate. When she asked for it, the OR nurses didn't know what it was and had to go down to OB to get it. I'm just sooo happy I was a first for that. My fundus was contracting down like it should, but my lower uterine segment was being lazy. She didn't seem concerned about a future pregnancy, but I'm a bit worried that when I get pregnant again, and if I miscarry and need a D&C, that it will happen again. Or that I'll hemorrhage after delivery. But who knows. I could have asked, but I don't know if it was because there was dead tissue in my uterus for 3 weeks, because it was my 4th pregnancy, because I have scar tissue on the lower uterine segment from my c-sections, or just bad luck. I'm not going to worry about it at this point. I also asked about the sono report because the ER doc told me my body had absorbed the baby, but I delivered it in the bathroom before surgery. She read the report and it clearly stated that there was a baby, measuring 8w3d with no cardiac activity, so we couldn't figure out why they told me what they did. Hearing the gestation, I realized that it was about that day that I had started worrying again. Just more proof that a woman knows her body. I wasn't sure what this visit would entail, and I was glad there wasn't any kind of exam or anything, it was just basically a check to see how I was doing and to answer any questions I had. She reassured me that my running didn't cause it and there was no need to not run with a future pregnancy, that it was most likely a chromosomal problem. I knew that, but there's still that part of me that wondered if it might have affected it. She suggested waiting at least one cycle before we try again and to be sure I'm okay emotionally, which we plan to do. We'll see what time will bring.

Oh! What A Night, Early September here in 2009...

Wow. That's all I can say after last night's shift. Wow, were we busy. Honestly, I don't think we've run our butts off like that since I've started working as a nurse. Oh yeah, we've had busy nights, but not like that. We started off with 4 labor nurses and all 7 rooms full of laboring women, plus 2 new patients in triage. 2 patients were probably going to be heading to OR, one was 8 cm, and the others were in all stages of labor. One nurse had both c-sections, which were done back to back. My girl delivered shortly after midnight, just a few minutes before the first c/s was done. Our scrub tech was back in the OR, and the baby nurse was as well. So it was just me and the midwife. Not a problem, but it is a bit hectic being the labor nurse, scrub tech and nursery nurse. She delivers, and I take over another labor patient, who by the way has the worst attitude in the world. She had a scowl on her face the entire night. Not sure what the problem was, but I think she wanted a cigarette. I had to have a discussion with her and her family, who looked like they were straight out of the Kentucky backwoods, why they could not smoke a cigarette in her room. Hello, oxygen tanks, smoke-free campus and it's a freaking hospital! Anyway, the second c/s is heading back and one of the patients in triage is found to be in labor and a repeat c/s...so she's taken back shortly after the second patient is in recovery: It's now only 2:30! I finish up mom and baby and I move my delivered mom to post-partum, check on the other laboring moms, who thankfully had been medicated and had epidurals. Come back, handed another patient who is on Mag Sulfate for PIH and needs pitocin started because her labs were bad. Get that going, start pit on my grumpy mom because she hadn't made cervical change in 3 hours, place FECG because baby was hard to trace, get her epidural redosed, and change her peripads that were soaked with amniotic fluid. I then run and check on the other moms who were doing alright, but were starting to wonder when their nurse was coming back. I reassure them that we are monitoring them at the desk and that if something were amiss, we'd be in. So in case you lost count, one nurse is tied up in recovery, one is tied up in the OR, one is in the process of transferring her patient and that leaves me back in labor with 4 labor patients at this time. After transferring the first c/s recovery to PP, that nurse comes back and we think we can finally catch a break only to get a call from ER: one of the 7am inductions was down there in labor. We crossed our fingers that she wasn't too far, but a G4P3 we knew it was probably the real deal. And she was: she was a rim with a bulging bag of water. The third c/s moves to recovery, we get the doc here for the new patient and then all the sudden her baby's heartrate drops to the 40-50's. We're all wearing brown scrubs by this point because the head wasn't coming down well. Her doc said "we may need to head back for a c/s". I thought our poor scrub tech was going to die. About that time, the baby rotated and was delivered. We were all breathing a sigh of relief. Time? It's about 3:30, still about half the shift to go! We do alright running around, getting the 7:15 c/s ready, doing patient care, not documenting, but taking care of the patients until about 5:30. My patient on Mag for PIH starts having higher BP's, and my grumpy mom's baby isn't looking so hot. Call doc, got order to increase the Mag on PIH mommy, and I flip and give a bit of O2 to grumpy mommy which eventually gets the desired results. Finally, the clock says 6:00 and the day shift charge nurses are here, and we realize we're on the last lap. But its not over yet. Grumpy mommy calls and says she feels pushy and she's now 8cm. And about that time, another of the 7am induction patients comes in early. But, one of the dayshift charge nurses takes her and finally, finally it's shift change and we can pass off our patients and go back and document everything we did over the last 8 hours. We considered going out for drinks when we were done, but decided to do it another day. With all the running we did, we were tired, figured it would be hard to drive home anyway, and if we got pulled over for weaving just because we were tired, we'd end up doing a sobriety test if the cop smelled alcohol. I'd hate to explain that to Husband. I do have to say that the patients didn't get the best of care, it was probably barely adequate, but it was the best we could do. No harm was done, we answered the call lights, and we have a huge monitor so we all can keep an eye on the monitor strips. No one else would come in to help, they tried, but every patient was well and healthy when we left. This afternoon after that exhausting shift, I had my follow-up visit with Doc, but I think I'll leave that for another post.