Phone Triage

You just never know what kind of phone calls you are going to get in the middle of the night. I don't know what it is, but something about the time between midnight and 3:00 am brings out the most intelligent questions. My guess is that people go to bed and lie awake just thinking about something that has been bugging them all day, pregnancy related, and then decide to call L&D. Or they want to mess with us. Either way, I've gotten some strange ones, like the grandma to be who called because her daughter who was 13 weeks pregnant was trying to poop, but couldn't finish the job. Her question was how to get the turd that was half-way out, all the way out of her anus. This past weekend was full of odd phone calls and while not as bizarre as the poop call, here are some of the gems I fielded:

"Um, yeah, I just found out I'm pregnant and I have a question for you. I just had sex earlier tonight and I was wondering if I could get pregnant with another baby while I'm pregnant with this one? I would shoot myself if I got knocked up with twins!"

"Can a chick have anal sex if she's pregnant?" Call was made by a man

"I accidently put nipple cream on my hemorrhoids. Is that ok?"

labwork and sono and doc appointments, Oh My!

Its been a busy couple weeks for us. As I mentioned, we have had some issues with Caleb and his weight. It started I guess about 3 weeks ago. He started spitting up after eating, more like projectile vomiting large amounts after most of his feedings. He never acted sick, always had a good appetite, kept having wet and dirty diapers, etc. Nothing seemed too off. I didn't think too much about it, figured he wasn't burping good, and this was something I did as a baby. It gets to be close to 2 weeks I guess, and over a weekend (our furnace was out at the time, but that's another story) Husband mentioned that Caleb had been pretty fussy, not wanting to sleep. Come Tuesday am, he mentions he was making odd noises when he was breathing, like he was sighing after each breath but it only lasted a couple minutes. I went to feed him at daycare after I got off work that morning, and he seemed to be his usual self, he did vomit all over me but seemed fairly happy. When I picked him up that afternoon, he seemed pretty sleepy. He usually gets very excited to see me but he went right back to sleep after I loaded him up in the car seat. My mommy-intuition kicked in and I decided that I would take him to the after hours clinic, just to make sure he didn't have something like RSV. I get there and the first thing they do is weigh him - only 11lbs 8 oz. I immediately start to panic because I swore that was what he weighed at 4 months. The NP saw him, said he had an ear infection, but lungs were good but the real issue became his weight. The next day, we went to Hospital for a pyloric sonogram to rule out pyloric stenosis. Caleb hated it, but it was fine. He also had some blood drawn and a urine sample done. All the labs were fine except his albumin was low. So that bought us a trip to the Children's Hospital in Bigger City for a sweat test to rule out cystic fibrosis. Now even though I knew it was impossible for him to have it since I am not a carrier, I still was a bit anxious about it. It of course came back negative. By now, it's Friday and he had stopped vomiting. We've started solids and try to supplement with a bottle of formula a day. But in true style of my children, he refuses the formula, will take bmilk out of a bottle just fine, and doesn't really like the solids. I would just supplement with bmilk, but I don't really have enough stored. I'm down to six 5 oz bottles in the freezer. I took him back for a weight check on Wednesday and in a week, he was up to 11lb 10 oz. I actually think he gained more because the initial weight of 11-8 was in a diaper, and this one was without. But the fact that he's 6 months and still hasn't doubled his birth weight and is gaining so slowly is concerning. We saw a pediatric GI doc yesterday and she was actually very encouraging. She said a 2oz weight gain in a week was great. She also thinks he may have reflux, which could explain why he hates solids like he does, so we now have zantac for the little guy. She also thinks that this whole thing stemmed from the ear infection/virus he had, and he dropped weight from the vomiting. The low albumin she said wasn't really a good indication for his current nutritional level, so she wanted to have a pre albumin done, along with repeat CMP and urinalysis. She was very pro-breastfeeding and wants me to try to get him to take 6 oz at a feeding (a no go so far) and if I don't have enough bmilk to supplement, she wants us to give a high fat formula (which I still need to pick up from the pharmacy) and try to get about 4 oz of that in him a day. We will have weight checks every week for 4 weeks and we'll follow up with her then. If he doesn't put on much weight, then she'll give us the high calorie version of this formula. But she was fairly confident he'd be fine. I did have my moment on my way to work last night because the diagnoses for him are GERD and Failure to Thrive. I remember learning about failure to thrive in nursing school and the way they presented it, it made it sound like the parents were doing something wrong. That isn't the case, but there's a sense of dread over that diagnosis. Plus it just makes me sad that once again my body is "failing" me and not providing for him like I want to, and should be able to. And even though I know that really isn't the case, all you mommies out there know what I mean - no matter what, there is still that part of all of us as moms that makes us feel guilty. So last night on my way to work, I let myself cry about the whole failure to thrive diagnosis. But, he is a happy boy, meeting his milestones like he should and hopefully we can plump him up.

And as a bonus, here's my cute little bubs:

Let's talk about Stress, baby

I never plan on being so neglectful...it just happens.

But in my defense, it's been crazy. Almost 2 weeks ago, our furnace stopped working and it took 5 days to get it straightened out. It was fixed last Tuesday and let me tell you, 50 degrees is WAY too cold in the house! At the same time the furnace man came, I was at the doctor's office with Caleb, just to be sure he was fine because he'd been throwing up after eating. Still pooping and peeing no problem, eating regulary, happy and content, but not sleeping as well at night. And he wasn't spitting up, but projectile-almost-emptying-his-stomach throwing up. He hadn't been too fussy and was still happy, so it was about 2 weeks this went on. I decided last Tuesday to take him in because Husband said he had a short period of time where it seemed like he was struggling with breathing - sounded to me from Husbands description that he was grunting, like a newborn who's lungs aren't quite mature and they start to tire. Caleb seemed fine in the a.m. when I fed him before going home to bed, but he wasn't his usual self when I picked him up. Mother's intuition said to take him in, just in case he's got RSV since my Fabulous new insurance refused to pay for the Synagis vaccines he was getting to prevent it. I really thought it'd be a pat on the shoulder, and an "He's just fine Mommy, quit worrying" kind of appointment since he wasn't really acting too sick. Nope. At almost 6 months, he's only 11lb 8 oz - the same as he was at his 4 month appt. That made Mommy completely freak out and bought us a pyloric sonogram, blood work and a urine sample. I also now know how they do a sweat test. And we get to see a pediatric GI doctor in a week. Yep, it's been, shall we say, a wee bit stressful here. I'd update more, but my bed is calling me after a long stressful night at work that included one true emergency.

Mass Chaos

Time is apparently getting away from me...I don't think I've ever been such a slacker about posting! Work has continued to be chaotic. We are short staffed, we have mandatory call, and even with the call schedule, we are still short staffed. One night a couple weeks ago, we had 3 labor nurses on...and started the night with just a couple laboring patients. Then the gates opened and everyone, and I mean everyone, came in in transition! I think we had 6 admissions, all wither 7 or 8 cm. About the time I was unplugging the bed to take one of my patients to the OR for a c-section for failure to progress, another mom came in, 33 weeks, complete and breech. So mine got bumped and we had to rush to get her prepped. By the end of the am, no one really had assigned patients - we just went to each room, doing what needed to be done. "Ok, she needs an IV, this woman is waiting for an epidural, this room needs an exam to check for dilation. It was unsafe, but the charge nurse on that night did everything she could to get us help. But no one answers their phone at night, except one day shift nurse who came to help, but we needed about 2 more nurses with what we had going on. I can't remember the total number of admissions/deliveries/patients that night, but it was unsafe patient loads. At one point, the anesthesiologist that was doing the c-sections/epidurals we had going on was just standing at the desk, waiting for them to get our second OR up for my c/s that was bumped for the breech 33 weeker, and it was getting crazy, with patients needing things right now. So I handed him the lidocaine I had pulled for an IV start in one room and said "Here, help me, start her IV in room 6". He said "You can't get it?", to which I said "Well, I have to go into room 3 because she is going to deliver right now, and that patient needs her IV and wants an epidural, plus my patient who was bumped needs to go to the OR once they get it ready. If I could clone myself to do it, I would, and I don't think you want to go be the labor nurse & nursery nurse for the patient who is delivering. Please help". So he did. Patient delivered, baby was skin to skin with mom (love it! we're trying to do that more and more), give quick report to a post-partum nurse who was back to help with the recoveries, and out the door I go to help with the epidural for the patient I sent anesthesia to see to start her IV on. Epidural in, charge nurse comes in to monitor patient for 20 minutes after the epiural and I head back to the OR with my patient. It was crazy. The house supervisor had come up and was trying to help, but unless you work in OB, there's not much you can do but start IV's, and answer call lights. If one more thing would have come in, I think we all would have crapped. But we survived the night, patients delivered healthy babies, they didn't have great nursing care, but we really did the best we could do and tried our best not to look too harried! All my charting from midnight on was done after passing off to the dayshift...I didn't get home and to bed until about 10am. We need more nurses, but no one seems to be able to pull any out of their arse. Hopefully management will figure something out, but unless we get some experienced labor nurses in and fast, I have a feeling this will continue. February is statistically a SLOW month for us, has been the slowest since I worked there, so who knows what the rest of the year will bring!

Quote of the day

Said by a scrub tech when she explained why she decided to get a nursing degree instead of a business degree:

"I decided to go ahead and do nursing because I can make more money as a nurse than I can if I get a business degree and go work for Big Insurance Co. in town."

All us nurses who were in hearing range stopped, looked at her, and then laughed hysterically to ourselves. Money isn't the reason any of my coworkers or I went into nursing, it was for patient care. If we were looking for a big salary as an RN, we'd be sorely disappointed.