June 27, 2009

Two Extremes

This past week, I took care of a mom laboring with her 2nd baby. Her husband was one of the those guys who was constantly cracking jokes, sometimes a little inappropriate, but the patient didn't care. That was apparently how he was all the time. They were both incredibly excited and you could tell by just walking into the room. She was ready for delivery and I stepped out to call the doctor in. Dad followed me out of the room, but didn't go back in after I'd made my call. I wondered where in the world did he go so close to delivery. Five minutes later, he comes walking in the room, dressed in our blue disposable scrubs we give dads for c/s, complete with hat, mask, and wet hands held up in the traditional scrubbed position. I thought everyone in the room was going to wet there pants and I worried the patient would laugh her baby out before doc could get there. I suppose some people wouldn't have found the humor in it, but it was pretty darn funny. He had asked one of the scrub techs if she could help him out so he could pull this little prank. Because he was dressed in scrubs, when the doc got there, she asked him if he wanted to deliver his baby. This wasn't anything he expected, but he was able to help catch his son. It was pretty cool. This guy who was a cut-up all night was now speechless, teary eyed and in awe of his wife.
Then I had another dad that wasn't quite as enjoyable. This couple came in and they just had something about them that made you uncomfortable. Just in the things they said, the way they acted, it just wasn't pleasant. Anyway, mom had come in after SROM at 33 weeks, and she was a repeat c/s. I had noticed she had been seen in our department before and that she had a birth plan. I asked if they had a copy, but she said they hadn't gotten a chance to write it down because they thought they had more time. So I ask them to tell me what they would have included in the plan. The dad immediately says "Save mom before the baby". Mom then says "They already know to do that" and then she turns to me, gives one of those quick, snotty smirks. And that was all. That's right. Their entire birth plan was save mom before our daughter. Now I would understand if she was like 22 weeks, and her blood pressures were out of control and she could die if she wasn't delivered, or something along those lines. But this was a 33 week mom with no other pregnancy or health issues, other than being preterm. She was going back for surgery in 45 minutes and the doc was already there, and there wasn't anything that could happen at that point where it would be a matter of having to choose one over the other. I realize they might not have understood that, but really, most times at that point in a pregnancy, the mom wants all measures to save her baby. I really tried not to be judgemental but I couldn't stop myself from saying "so I see you've really bonded with this baby." To that, they both just shrugged their shoulders and continued on and it just really wasn't a big deal to them. I had hoped that after they saw the baby, they would bond more, but not the case. They saw her briefly, dad declined going back to the nursery with the baby (dad usually accompanies baby and the ped and nursery RN back to the nursery while they finish up surgery) and they really weren't interested in seeing the baby in recovery or even the first few hours after she was out of recovery. And it wasn't because she was in pain, or not doing well. She had a pain rating of zero. And conversation in the room wasn't about the baby. They rarely mentioned her. I sent through a consult to social services because it just wasn't normal. I just can't help but thing that here is a couple who had a child that they don't really seem interested in and there are many couples out there who would do anything for a child. It just doesn't seem fair. Thankfully, most parents are over the moon over their children. But, those images of this couple are overshadowed at the sight of the other dad, donned in full scrub attire, walking into the labor room. It was too bad they didn't have a video camera rolling!

June 23, 2009

Battle at the 18 month old doctor visit

This a.m. I took Isaiah to his 18 month check-up. As everyone can imagine, doctor's visits with toddlers are not something that be ranked in the top 1000 things to do for fun. Somehow, I forgot how much fun it is to try and occupy a toddler in the office when all he wants to do it climb on the stool, table, pull the sheet off the table, etc. I think people who work with kids decide that they want some entertainment during the day. So they have you check-in with your toddler in tow. While they take their sweet time checking you in, you are trying to fill out the same paper about health history that you filled out the last 5 visit with all three of your kids. In the meantime, your toddler has discovered the potted plants by the window and is trying to eat the leaves. You figure "hey, if they're at a docs office, surely they aren't poisonous, and at least he's not trying to escape down the hallway, which is not barricaded with armed guards and leads straight to the lobby of the large clinic". That is of course when your little Houdini reads your mind and darts right down that hallway before the lady at the desk is done checking you in. You run after him and finally occupy him with the fish tank they have on display. Thankfully, your wait is short in the waiting room, but now you wrestle with your toddler to let the office nurse get his temp, head circumference, weight, length and temperature. It is a draw. You have start to develop a couple bruises from the kicking feet and you pull strands of your hair from your toddlers fist, but the meausrements are done, so it's a tie. You then wait for eternity (well, 5 minutes) for the doc to come in and do her thing. She is good and works well with kids, but there is still some restraining involved and we all know how much toddlers LOVE being restrained. Then comes time for shots. You find that you are up to date...but, he needs a finger stick for hemoglobin levels. The doc leaves and the nurse comes back to draw blood. Of course, your little one knows he's going to be restrained again and that the woman in scrubs is going to do something he won't like. So the tantrum begins. You suffer a black eye, but she gets the drop of blood she needs. Then, she realizes that she got him a little too good because his finger won't stop bleeding. Instead of giving the mother the gauze to hold on his finger, she restrains his arm and finger so as not to get blood on the mom or his blanket. Now you are sweating and finally say through clenched teeth "give me the damn gauze". She obliges and gives you a band-aid but firmly reminds you, the one who lives with this little person that puts everything in his mouth, to take the band-aid off before you put him in the car seat so he won't choke. Right. I never would have thought about that. No problem there because your toddler pulls the band-aid off and throws it in your face. She then tells you as your child is throwing the biggest fit you have ever seen to "Wait here while we get your results". WTF?!?! So you wait, and he throws himself all over the room and you are helpless to do anything. Finally after waiting so long you are sure Jesus has returned, you step out of the room and ask if you can call back and get the results because your darling angel has pulled his pants off and thrown his diaper on the ground. She then murmurs something you don't understand and the nurse comes back and tells you the results are normal and that you can leave. You walk out with your screaming child and hope he doesn't scare all the other toddlers in the waiting room. This is where your toddler claims victory in the battle at the doctor's office. Anyway, Isaiah is healthy. He had been on the low end weight-wise and his head was measuring 95% at 15 months. As I expected, it was probably a poor measure (I can't imagine how that could happen with a toddler) and his head circ is 75%, weight 45% and height 50%. So he's growing and doing well. Me on the other hand needs to take some ibuprofen and ice my wounds :)

June 22, 2009

Time flies

Wow, it's been over a week since my last post. Things have been kinda busy, at home and at work. This past weekend at work was kinda crazy. Saturday night was pretty slow. I was in charge, we only had a few patients on postpartum and besides one delivery at 11pm, labor only had a couple people come in for labor checks. That is until 6:15 a.m. I get a call that we have a 30 weeker in ER. Most of the time, the pretermers don't need much more than some terbutaline, IV fluids or antibiotics for a UTI. Not the case that morning. When she rounded the corner in the wheelchair, she had a contraction and made that grunty-I'm-pushing noise. Immediately she was checked and oh, crap, she's completely dilated wita huge bulging bag of water you could see pushing into her vagina. We dont' have a NICU and we try to ship people out to a hospital that does have one if they are less than 34 weeks. But this wasn't an option. We did manage to get the doctor there for delivery because somehow, her water didn't break on it's own. Once the doc and pediatrician were there, the OB broke her water, that baby's head came down and with one push, she pushed that baby out with so much force, the OB caught the baby like a football! It's just amazing how powerful the uterus is together with mom's pushing. The baby did remarkably well for being early. After it was stabilize, it was transferred to a high level facility and was doing quite well. Yesterday morning, I had a change of shift c-section after pushing with a mom for 2 hours. Baby just wasn't coming down and all, but she gave it everything she had. She pushed in a variety of positions, used the towel to play tug of war to help with pushing, birthing bar, squatting, everything. He just wasn't going to fit and never got any lower than maybe a 0 station. So we go back to the OR and because she had pushed so hard for 2 hours, his head was wedged down against her pelvis and I ended up having to push up on his head from under the drapes to the doc could get him out. There is nothing like pushing up on a baby's head and feeling the doctors hand touch yours as the pull the baby out. It gave me a chill. You may think "well, if you had to go under the drape and push up through the vagina, surely he would have fit eventually". Really, he was never coming out that way. You could see his scalp molding on his head from where it was trying to fit, but he didn't have a cone head. I know that may not make sense but basically his skull bones never started shifting to maneuver the birth canal. And he was a big baby for a small woman. Anyway, after it was all done, mom, dad and baby were absolutely thrilled with their baby and he latched on and nursed right away in the recovery room. It was change of shift, so I passed her off to the dayshift, and spent the next 1 1/2 charting.

June 13, 2009

Goal #1 reached

This morning, I ran my first 5K race in 10 years. I finished 31st overall (men and women) although I don't know how many actually ran. It wasn't a big race, but I think I was in the middle somewhere. At mile 2, I was wondering what the hell I was thinking, but after I finished, I started thinking about where I could run another race in a few weeks. It was kinda like labor, I forgot how much it sucked after it was over :) Anyway, I'm not a fast runner, my time was 29:58 I believe, which is not fast, but I finished, I wasn't last and I'll be doing another some time soon! It feels good to reach running goal one. Now it's off to work to take care of some business.

June 10, 2009

One of Those Days

I knew today was going to be one of those days that just sucks when first thing this morning, I step barefoot in cat puke. Yep. Not a good start to the day. Not only did I step in puke then, but after cleaning up the breakfast mess, I step in something and slip in the kitchen. I pull a muscle in my back trying to keep from falling. And what was it that I stepped in? You guessed it, more cat puke. So before 9a.m., I'm already grumpy because, really, how disgusting is that? And that d*mn cat pukes every single day. All the little things that happen everyday and are no big deal have gotten under my skin. Like why does Isaiah have to throw his food all over the dining room? And yes, I've tried every thing possible to get him to quit. Not only do I have to clean him up, but clean his mess he's thrown all over the room. And everyday, Clara somehow manages to spill her drink. Isaiah also decided that after he pooped, he would take his diaper off before I could get to him. So I'm in the kitchen doing dishes and I turn around to see my darling 17 month old son run by the doorway in naked from the waist down. I prayed it was just a wet diaper he took off, but of course, no. I was lucky this time because he dropped it on the hardwood and not one of my rugs, and it all stayed in the diaper somehow. I like things clean. I really try to keep the house picked up. I especially like a clean bathroom. There are few things better than walking into my nice, clean bathroom that smells like bleach. But, alas, just a few hours and there is pee on the base of the toilet, on the seat, shaving cream and bits of facial hair lining the sink, along with toothpaste, and the counter is covered with bottles, a razor, etc. My laundry is also piled high, possibly from numerous outfit changes due to Isaiah's messy meals, and I find wet clothes in the washer that dear Husband promised me he would put in the dryer for me. So, I'm washing them yet again because they smell. My attempts at cleanliness are thwarted by 3 sets of small hands, a bulimic cat and one husband. I also need to find motivation to get the rest of the wallpaper off the walls in the living room and toy room. After Isaiah had ripped a bunch of the red wallpaper off in the dining room, I stripped all of it off, and I plan on painting with some kind of textured paint. I hadn't intended on doing the same in all 3 rooms with the wallpaper, but Jacob and Clara saw me stripping it and decided to help and ripped some off in the toy room. Luckily, it's not floor to ceiling wallpaper. It's just up to a chair rail, and it comes off pretty easy. It's just extra work I don't really want to do, but it will be worth it in the end. In an effort to put myself into a better mood, I decide to step on the scale. I know that seems absurd to think weighing myself would boost my spirits, but over the last month, I've been eating better and I've been running 3-5 miles just about everyday, except Sundays. I'm even running my first 5K race on Saturday. Last time I ran one was probably 1999. So I figure I have to have lost a little bit. Nope. In fact it was up 2 lbs! WTF?! Yeah, yeah, muscle weighs more than fat, but I've been at this for awhile and I should be at point where I'm shedding some extra weight. And to top it all off, I have to go to work tonight, and I'm on call tomorrow night. I do love my job, but it is work, and sometimes you just don't wanna. But it is only an 8 hour shift and they go by really fast after working 12's. Maybe I'll run instead of taking my usual nap before an 8 hour shift. Or maybe not.

June 3, 2009

Zero To Full In No Time At All

The funny thing about OB is that you can go from a quiet, empty unit to crazy busy and full in just a few hours time. That's how it was this weekend. Saturday night, it was slow. We only had I think 3 patients on post-partum and no one back in labor. Sunday, however was a different story. We started out quiet and slow like we did on Sat., but by midnight, I had called 2 people in. It just seemed like everytime we turned around, ER was calling with yet another patient. By morning, we had filled all but on of our rooms with 3 labor patients, 2 pretermers and a patient who delivered a 15 weeker in the ER. And as we walked out, they were wheeling 2 more moms in. So I knew Monday would be crazy, and crazy it was. We started out with all but 1 room full, and that room would be for the midnight induction. I was going to admit the induction and I had to move my delivered mom out because we would need the room at some point. I go in, get mom up to the bathroom, moved to her room, situated, reported to the new RN and I started finishing up my charting. Right as I'm about to head back to labor,that patient starts hemorrhaging. A lot. It turned into a huge, long ordeal to get her bleeding under control and make sure she was stable. Every time we'd massage her uterus, huge clots came out, followed by very heavy flow. After manually removing a ton of clots, fundal massage, Methergine, pitocin, fluid, cytotec and 2 fresh 16 gauge IV sites she was stable. That was one of a few instances where I was really starting to worry. So, it's now 1:30 and my induction patient has been waiting since midnight. Get her admitted, pitocin going, it's all good. We have all the rooms full because another patient was admitted while I was dealing with the hemorrhage. I sit down to chart and, yep, another patient on her way up, 4th baby, history of a 2 hour labor with her last. We don't have a labor room, so she gets admitted to our monitoring area where we only have recliners. She's 3 cm, 100% effaced and then the FHR takes a dive to the 80's and isn't coming back up. Here I am, no IV supplies, no oxygen and a recliner that is difficult to reposition a patient on her side. So we run down the hallway to the C/S recovery room, Iv started, O2, and FHR back up. She labors, decides she wants to see what it's like with an epidural because she had her first 3 without pain relief, so she gets one placed and finally, we have a labor room. We move yet again. And right before shift change, she delivers. Thankfully, the mom and dad didnt mind changing scenery and actually thought it was funny. And it was a nice delivery. While I was busy with my own patients, we had delivered 4, replaced those moms with other labor patients, had a mom being prepped for a repeat c/s, and we had 3 moms in our monitoring area, laboring, waiting for rooms. I guess you could call that job security ;)

June 2, 2009

I hate my uterus

*Warning - whining ahead, and way too much personal info*

I just want to say right now, I hate my uterus. Okay, so on the whole, I think that the uterus is one of the most powerful, amazing organs in the body. No other organ can expand to the size of a watermelon and then shrink back down to the size of a small fruit, or house a growing fetus, contract strong enough to deliver a baby, etc. But right now, I hate mine. Yeah, yeah, it grew 3 babies, and delivered them, and really has behaved and doesn't give me more serious problems. I also have gone 26 months since my last period, thanks to my bcp and breastfeeding. But, Aunt Flow has returned...for the second time in 2 weeks. I woke up the morning of Husband's grandmother's funeral and found she returned. And then exactly 2 weeks later, she has come back to visit, yet again. If it were only that, it would be fine, but, oh no, she returned witha bad attitude: bad cramps, unbelievable bloating, mood swings and, quite honestly, heavier bleeding than I had before I had children. I was pretty lucky. My periods were pretty light, very little cramping, no bloating and I really didn't get too cranky. But, with each of the kids, they seem to be worse. Oh well. The timing really was impeccable because the last 2 shifts I worked were hell on earth, and that's when it all started. Nothing like finally being able to empty my bladder the size of a 2-liter of Coke only to find that, crap, not again so soon. But, those hell shifts are a post for another day. Right now, I'm wallowing in self-pity, I know it's ridiculous, but I'm gonna do it anyway. I hear my Lush bath and glass of wine calling me.