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.