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.

A few Pictures

Jacob has been playing football this fall. The flag football program is new this year as a part of the JFL, or Junior Football League. Once the kids are in 3rd grade, they play with full gear but for the little kids, they are doing flags, although they end up tackling each other anyway! They are the Sting, which goes along with the school mascot, the Hornet. So far they haven't really figured out a structure for the flag football. Some places they keep score, some dont. One game, they treated it like a H.S. game, obviously more for the fun of it than anything, but they announced the players, did play by play and ran the siren with a touchdown. It was cool and the kids loved it. It's fun to watch these little guys playing and the little girls cheerleading.

God bless those coaches and their patience! They manage to corral a group of 6 and 7 year olds and teach them to play football!

I got a flag!
Cool Cats

Husband watching Isaiah run all over the field

I'm sure there was some serious football discussion going on here
And the ball's in play

Right before this picture, they were all actually sitting nicely, until Isaiah started fussing, wanting to play with the camera. He was also kicking and got Clara, and Husband caught her mid-holler. Ah well, you just can't get 3 kids to cooperate for a picture very well!

I Made it Through the Rain..

Ah, just a little throw back to Barry Manilow. Mom loves Barry Manilow and Dr. Sis and I were subjected to his music growing up. We even went to a concert and we knew every. single. song., except for his new release. I do like Copacabana, (and Mandy, I Write the Songs, Could it be Magic, oops, did I just admit to that?!?) but I digress. This song title just seemed appropriate. I survived this weekend at work. It was hard, but I got through it. Saturday night was super busy. Between me and the other labor nurse working that night, we were responsible for 10 laboring patients in that 12 hour shift. I had my first vag delivery and c/s since going back. That seems to be the key for me, getting through the "firsts". The vaginal delivery was perfect. Nice couple, very excited about their first baby. Mom did great, only pushed for 15 minutes and had a beautiful baby. I did okay with that delivery, just a very quick moment that I thought tears could surface, but they didn't. What was hard was my c-section delivery. My coworkers thought it was strange that a c-section of all things would reduce me to a few tears. It was no surprise to me. All I could think about was "that should have been me in March". And to make matters worse, it was my doc's patient, so it would have been the exact scenario. It was a repeat c/s due to the onset of labor. So a simple, no rush deal, but my anxiety level was where it is at after I've done true crash sections. My hands were shaking, I was anxious, and simple things seemed more difficult than they needed to be. Here's what I mean: we put foleys in after the spinal, and my doc is one that will do it herself before she scrubs in. Sometimes when you fill the catheter bulb with the saline, if you aren't careful, it will shoot out all over the place and not go into the catheter bulb. That's what happened. So what I have done in the past is grab 2 saline flushes and use them. But there weren't any in the OR for some reason, and instead of thinking "just get some tap water in a bowl" because really, it doesn't matter what goes into the bulb, but I grabbed a vial of saline and a bottle opener, popped the top until I realized it was lidocaine and thought, "I can't use this", and then just opened some irrigation. Duh! And during the whole thing, I kept thinking "Nurse Lochia, what is your problem? You've circulated many, many c-sections. You could circulate in your sleep (not actually b/c I have to see to do the counts) Why are you so worked up?" Everyone seemed to understand, and afterwards, I let myself mourn a bit and let a few tears fall. The next one I think will be better. Each night this weekend (I also work Monday nights, so I consider that part of my weekend) was a bit easier. No tears actually fell Sunday or Monday night, they welled up a time or two, and I let myself cry a bit to and from work. So I'm really doing okay.
Running has been a very good thing for me, even before the miscarriage. Like I said, I plan on increasing my mileage, plan on doing the St Jude 5K race and I'm looking ahead to actually doing the St. Jude Run. It's held the first Saturday in August each year. I probably won't be doing it next year as I hope to be with child in August, but I do think this is my ultimate goal. I've seen the St. Jude runners going through in the past, and on top of the running aspect, it's raising money for a great organization. Runners don't actually run the entire way, but it's done in legs, I think. I don't know too much about it, yet. I had thought my ultimate goal would be doing the Chicago Marathon, but I think this is better. Doing something that I enjoy PLUS its for a great cause? Of course I'll sign up!

Slowly Going Forward

Tonight is my first full weekend back at work. I'm really hoping it is a bit better than Monday night. I think it will be. It's only been a bit more than a week, and things are slowly getting better. I still have moments, but not so many. I've checked out every resource people have suggested, and it's been very helpful just hearing from people who have gone through the same thing. The only thing no one has had is a negative urine pregnancy test before any of the pregnancy was passed like I did. Yesterday was a bit of a low day, and we had friends over to cook out. I just really wasn't in the mood to socialize, but it was fun anyway. The kids had a blast, getting to stay up later than they normally do and running around. We even got our little fire pit going and watched the fire for awhile. Not sure why that's fun, but it's relaxing and mesmerizing sitting around a fire.
Physically, I think things are pretty normal from what I've read about. I've been running again which feels good. Running has always been a way for me to relieve stress. I spotted for about 4 days post D&C, then nothing. I was really hoping that would be the end, but I started spotting again yesterday. It's quite obnoxious. I was also pretty crampy and felt like I do right before AF comes yesterday, but I know it's way too early for that. I am hoping that my cycles come back sooner rather than later, partially so I can feel normal again. I've read in many different places about how long you should wait after a m/c and D&C to try again, and I'm hoping my doc doesn't suggest waiting too long. I know it could be awhile before I even have a period again, but we are hoping to try again soon. I do plan on running more races and had hoped to go ahead and try to do a 10K, 15K or even a half marathon before it starts getting cold in November, but, of course, there aren't any that I can get to: they are all on Sundays. So, I may just try to increase my mileage on my own because once I get pregnant again (I'm being positive that our fertility hasn't been affected) I will not be running. I know that the running didn't have anything to do with it, but I just couldn't take the guilt if it happens again. I'll walk and do lower impact activities to stay in shape, and I'll just resume running afterwards. I know in the whole scheme of life, 3 months isn't a long time (it seems the recommended time to wait is either 1 cycle or 3 cycles) but right now it seems like a lifetime to wait.
Emotionally, it's still pretty hard at times. It's frequently on my mind, but it's getting better. I hadn't been able to actually eat a full meal until last night. Sleep is still a bit hard because when it's quiet, that's when my mind kicks into gear, but it didn't keep me up last night. I couldn't sleep because it was just that temperature where if you don't cover up, you are cold, but if you do then you wake up sweating. I've never had it to that degree, but I swear I'd be freezing and could cover up and then wake up in a cold sweat later. Niffer sent me this link. I actually have the book it's from. I tried to find the book last week because I remembered there was a touching story about "Spirit Babies" in there, but I couldn't find it or remember the story exactly. So I thought I'd repost the link so everyone can enjoy.

Pure Hell

Pure, and total Hell. That's the best way to describe having to go work in obstetrics with your pregnant coworkers a week after learning you miscarried. An hour before I even had to leave for work, I started having a sick feeling in my stomach, and it got worse as I parked in the parking deck. It was seriously the longest 8 hour shift I've ever worked. The funny thing is, though, is I found I was pretty OK taking care of my labor patients. Really, it was just working with my pregnant coworkers that killed me. I could hardly bring myself to even look at them. And I feel horrible about it, but I'm just so jealous and emotionally raw right now to be anything but selfish. I hope and pray that their pregnancies end up with them holding a live baby because they are great deserving women. And both of them had a bit if difficulty getting pregnant. One miscarried twice before this pregnancy and the other took 2 years. So I'm happy for them, but at the same time, it hurt to work with them. The schedule I had didn't show them working last night, but we were busy so they were called in. And of course, several people gave their regrets, which was nice but set me off crying every time. I know it will get better in time. One girl said after 2 months, it wasn't so horrible walking through the doors. I sure hope so, because right now I don't feel like I'm dealing so well. And I just keep thinking about all my coworkers who have miscarried over the years, and how I just didn't understand how much they hurt. Someone said that's the only "good" thing about a miscarriage, that you finally understand how much the loss, regardless of how early, affects you.