Never Not a Nurse: A Big Last Day on the Labor and Delivery Floor

8:30 pm
“I want to write this paper like I want a hole in the head,” I told my patient while tidying her up after a long delivery. She knew I was supposed to leave the floor at 3:00 and write an essay, but chose to remain until she had the baby. I figured it was my last day on L&D, and possibly the last time I would ever help deliver a baby. I wasn’t going to miss out on that! “Thanks for staying with me!” she smiled as we both gazed at her precious little girl, learning to eat for the first time. It was just she and I alone in the room together for a brief moment.

I can’t describe what a rush it is to be the one to walk over to mom, holding her new baby - freshly scrubbed and bundled and make the introductions. She was being stitched up and dad was a little emotional, so I had to hold her up by mom’s face while they bonded and cooed. It is such an intimate moment and I was just happy to see the two of them fall in love, especially after our hard day.

I was really glad I stayed, but it had been a loooonnnnggg day. Up at 5:30 a.m. to meet my clinical instructor for breakfast to plan our day. It was just she and I for this rotation, which I thought was kind of neat. Who doesn’t like all the attention? It was very relaxed and she let me pick assignments of interest, trying to pack in every experience I could get into my last day.

7:30 am
I get to scrub in for an early morning C-section. Scrub in! While I had had my OR rotation previously, I had stood well away from the action, jockeying around the room hoping for a good line of site between me and the team of people working on the patient. But for this C-section, the surgeon gave me permission to be right by his side. Front row seats! I did a scrupulous 3 minute scrub and then my instructor busted me for tying my mask on, and I did another scrub. I entered the OR and the tech got me gowned and gloved. Then I pinched the nose of my mask on tighter so it wouldn’t fog up my glasses. Sterility broken. New pair of gloves and a glare from my instructor.

The tech marched me right up next to the resident who was assisting on the surgery. I stood right over the incision, and gazed into the abdomen as he teased away the layers between the outside world and the baby. I felt unsettled from having botched my sterility earlier, but somehow they still felt I deserved a piece of the action. They handed me a retractor! I was one of the people assisting! It was all very enthralling, but nothing was as heart-stoppingly cool as when they pulled that baby out and flopped it right in front of me, and her little hand curled around my finger while they coaxed her to take her first breath. Everything just stopped for me as I gazed at her hand around mine, wet and warm, willing her to breathe. I held my breath until she began to scream, and then I cheered her on. She was whisked away and I went back to observing the rest of the surgery, but that moment is now engraved on my heart.

9:00 am
We got into our next case, a vaginal delivery, and she was already pushing. We elected to do baby care, which I love. The doc catches the baby, gets him breathing, and passes him into our waiting arms. We take him to the corner and do all the newborn care. Because this guy arrived in record time, his lungs were a little junky. I got to assess him, perform interventions to help him breathe, and get him ready to meet his parents. All went well, and he joined his happy parents after a short time.

10:30 am
My instructor and I propped our feet up in the staff lounge and gazed at the clock in wonder. How could it be so early in the day? Not even lunch time and we had already worked on 2 cases. Felt like the day should be over. After a brief respite we selected our next one. Should be easy...a multip who had been induced at 6:00 am. The timing seemed right, maybe she’d deliver before the end of our clinical day? (We were both hoping to leave at 2:00).

The mom was so cool, just happily chatting away as we bustled around performing her care, reading her unremarkable tracings on the monitor. Everything looked great. I helped distract her from her mounting pain as we waited for the anesthesiologist, who was delayed on another case. She wanted that epidural just as soon as she could get it. I asked about her other child, about what she liked to do before she had kids. It was like we were old friends. She seemed happy for the distraction, because her husband was consumed in a magazine in the corner...seemingly mute.

11:50 am
Text message from friend: “I’m convinced I am dying. I wake up to tingling hands. Cancer probably…” Me: “Wrist cancer is usually lethal. But have you considered carpal tunnel, a bad pillow or a frozen neck from 2 years sitting at the computer getting your MBA?” Since I have started studying nursing, everyone has a question.

2:00 pm
My instructor and I look at each other and realize our patient is in no way going to deliver before we leave. She offers to let me stay. Realistically I should have left. I had to write a damned paper, and study for a drug exam all in the next 48 hours...but anyone who knows me knows I was going to stay. I am the queen of procrastination, and besides...how long could this baby take? I could be home before dinner.

4:00 pm
I enter a test of wills with an unborn baby. Me: “C’mon baby...it’s nice out here...don’t you want to meet your parents?” Baby: “Nah, its nice and cozy right where I am.” Mom is dilating at a glacial pace. I get stubborn and decide to dig in. I go get my notes to study in between care. We encourage mom to sleep.

4:30 pm
Text message from friend: “Could be carpal tunnel I guess but I have odd sensations also in my thighs. WebMD has 17 answers, but I ruled out stroke.” Oh geeze, she has paresthesia. I wince when she asks me for answers. Last time I told her a doc needed to look at a rapidly growing rash...she squeezed onion juice on it, an old home remedy with anti-inflammatory properties. Me: “Do not Google symptoms. You typically run low on iron, and you recently went vegetarian.” Her: “Yes! I was just thinking about how this feels like after I hemorrhaged after my son was born.”

6:30 pm
The nurse I have been working under is about to be done with her shift and still no baby. I’m going to be sad to see her go, because she has been teaching me other ways to chart, and is just willing to have me around and help. The next one might not be. Why won’t this baby come already? The word C-section is being thrown around at the nurse’s station, but we haven’t talked to the patient about it yet. She will be so bummed. I begin negotiating with the baby. Me: “Listen I have a paper to write. And your mom is getting pretty tired. How ‘bout joining us at the party?” Baby: “There are no papers to write where I am.” Me: “Touche.”

7:30 pm
The new nurse is on, and seems grudgingly willing to have me around, but now I have to do the work of proving my worth and earning her trust at this late hour. Dang. Still...I’m happy I stayed, because the mom had to deal with a shift change and I am now the only consistent face by her side. By now we have an amazing rapport and she is good-naturedly trying everything we suggest to move things along. Unfortunately baby seems to be getting sick of getting squeezed. The formerly unremarkable tracings are now remarkable...zig-zagging all over the place. It’s still recovering in between contractions, but I can see the team is getting tense. And so am I.

Over and over in our lectures we hear, empty the bladder...empty the BLADDER! It can impede progress! I suggest the patient try the bed-pan one more time, and suddenly I have earned my nurse’s respect. She launches into some bedside teaching with the patient about how this could be just the edge we need to get that baby down. We are so close! So she tells me to put her on the bedpan and leaves the room to empty her own bladder. It’s just me and the patient.

The head of the bed goes up. And the baby’s heart rate goes crazy. Then so does mine! In my calm voice I say, “You know, lets get you off that pan and onto your side.” But in my head I’m screaming NOW! Just as calmly, “Okay that side isn’t working, let’s try the other one.” And the heart rate just keeps dropping. I decide to plea with the baby: “This isn’t funny. Hold on kid.” At that instant the room is full of people.

It reminded me of a code. Organized chaos. Luckily this woman was a really good pusher. Dad seems to be so nervous and just wants to be out of the way. I’m on one leg and my nurse has the other. Six minutes later we had a baby. Thank God!

I stay until 9 to help with the after care and then drag myself home. No way I’m writing a paper tonight. I’m dead on my feet. I stagger down the hall to my room and am deciding whether to collapse on my bed in my clothes, or shower first.

9:15 pm
Text message from dorm friend: “Are you home?” Me: “Just got home from clinical, why?” Her: “Please come get me in the first floor bathroom.” Head tilt. I’m not even out of my clinical clothes. Feet killing me, I go down five flights of stairs to find this girl with her head between her knees, sweaty and pale. Oh shit! We talk about her symptoms, and after a while I coax her into the elevator, where she sinks to the floor. Note: NONE of us would willingly sit on this floor, it’s covered in all kinds of micro-filth from the hospital. I myself just took this same elevator wearing shoes that had tread through amniotic fluid and blood only an hour before. That’s how sick she was.

The doors open and she bolts like a gazelle to the nearest bathroom stall and heaves up everything inside her. Multiple times. Thank goodness. Maybe it was something she ate. I’ll get her into bed, go get changed and then check on her. She will probably sleep it off.

9:30 pm
I check on her and she is groaning. She asks me to get her back to the bathroom where she heaves even more stuff up. She is as thin as a ballerina. I didn’t believe she could hold that much. She is unwilling to leave the stall. First...I go get myself a chair and park outside checking text messages.

Text from friend: “Low iron must be it. I haven’t eaten red meat in months.” Me: “Oh honey, no good. Iron is not optional.” Sounds of retching from the stall. And now...violent diarrhea. Her: “Maybe there are veggies with iron.” Me: “Meat sources or pills best. Go get it checked.”

I am starting to get concerned about the loss of fluid and moans from the stall. She says she’s so cold. I can hear her teeth chattering. I get her bathrobe, her sweatshirt and her Uggs and bundle her up as she lays on the cold tile. Every minute or so she rises and its seems like more gallons pour out of her from both directions. She can’t keep down the water I give her and though I was wishing I had some Pedialyte, I realize she won’t be able to keep it down. I go get my watch. Start taking her pulse and her respirs. Both normal, but she’s breathing pretty shallow. She’s still so cold that I move from my chair and lay on the floor next to her, sharing my body heat.

9:45 pm
We have called her parents to come. I’ve told them to take her to the hospital. But they are 40 minutes away. She is now only answering some of my questions around a swollen tongue. She is white, with blue lips, black smudges under her sunken eyes and she is trembling uncontrollably, covered in sweat. Maybe it’s food poisoning, or maybe its a terrible virus, but either way it doesn’t matter because she is severely dehydrated and going bad fast. I enlist several students to try and help me move her to the basement where her parents will pick her up, but she is too weak to stand, and she needs the toilet every other minute. She begs me for an ambulance and I quickly concur. She needs fluids. Now. I call 911 while another student calls her parents to reroute them to the ER to meet us.

10:00 pm
The medics can’t move her. Not until they get a bag of fluid going and an IM injection of Zofran to keep her from retching on the way. Finally we get into the ambulance and I stare at her in amazement. Somehow she is even worse. She hardly answers any questions and she looks like death warmed over. I’m so grateful we called.

12:30 am
Finally home. By the time I saw her, she had enough fluid going that she was her normal pink color, and she was able to answer the Resident’s questions. Gastroenteritis, exacerbated by a session of hot yoga that afternoon that likely dehydrated her ahead of time.

Text from friend: “Any home kits to test iron?” Me: “Not to my knowledge. I’m not saying it’s low iron, but you describe a side effect that shows up when its really really low. You don’t know what is deficient. This matters. Tell the doc how you’ve been feeling and your health history...they’ll take it from there.”

I review the day. One C-section. One emergency vag delivery. Three sets of happy parents and healthy babies. And then the Black Plague when I got home. I’m praying I don’t get it! I know I can’t lay in my bed knowing every bug on me that could be plotting my demise, so I drag myself into the shower. No way I’m writing that paper. Heck, I’m not even going to class in the morning. I’m going on pure adrenalin and I’m exhausted in a way I’ve never felt before. Finally, I recognize what it is:

An incredibly long day of being a nurse.

Babies Large and Small

It was Saint Patrick's Day this weekend. I was told I needed to celebrate it the way the locals do which meant rising early (but not early enough for Keg 'n Eggs) and putting on my sarcastic green t-shirt to celebrate with this entire city...for the entire day. 

I'll need a full year to recover.

Sunday after dinner I went to atone for my sins by volunteering on the Pediatric unit as a baby cuddler. I was given a baby who is perfect in every way, except for having spent his whole life (1 month) trying to wean off drugs his mom took while he was in utero. I have rocked him before, but he was having an especially hard day. Despite my lingering hangover, and the million other things I should have been doing for school, I just couldn't put him down. The only time he stopped crying was when he was held, and he had been crying all weekend. His little voice was raw and he was just so tired. So I rocked him for eight hours, until 1:30 a.m. (The floor nurses love an insomniac-volunteer). Together we watched: NCIS, Friends, The Big Bang Theory, and the Downton Abbey marathon. He was just under 9 lbs, but after this long, my arms were frozen.

Drug babies have a number of symptoms besides having a hard time settling down, one of the strangest to observe is hypertonicity -- their little arms and legs are always very rigid and flexed -- even their necks (they can hold up their heads extremely early!) Changing their diapers is very weird because they are so strong, you can't really uncurl their legs to make things easier. It's like changing a plastic baby doll. I imagine this is one of the things that makes them so unhappy and tired. Imagine doing a sit-up...for weeks. 

I slept in on Monday morning and awoke to a text that my 5-hour afternoon class was canceled so I had the afternoon free. But my little guy from the night before was on my mind so after lunch I went back, meaning to hold him just until his next feed. Again...I couldn't put him down and delayed going to do my clinical pre-planning until later that evening. 

The next day (today) I was in the Neonatal ICU with a little preemie born 7 weeks early and about 4 lbs. Yikes! What a contrast to my little boyfriend from the night before who was so big (comparatively) and strong!! It was quite an adjustment just handling the preemie who was like a little Raggedy Andy doll. No head control to speak of. I felt like apologizing to him all the time...."Whoa there, sorry about that!...I suppose you'll be wanting to take your head with you while we feed you that bottle." Lord, I felt like I was going to break him! (The really tiny ones look just like baby birds.) Then you watch the NICU nurses just flopping them all around (skillfully, mind you) - but still it's a little hard to watch in the beginning. The thing is, these nurses have eagle eyes and keen senses. The conditions change so rapidly and sometimes so subtly! You can hardly hear the babies little kitten meows and the monitor alarms go off all the time. I am in awe.

Today I felt like I haven't had any nurse training at all. 

I fumbled all around. Like a newbie I tried to check the placement of my guy's NG tube by pushing the air through the syringe while listening to his abdomen...and it really would have helped if I took the cap off first! It's ok, another student shared that she put both her hands through one of the holes in the isolette, and her nurse reminded her there were two! While feeding, my clinical instructor tried to help me use one hand to pour the rest of his milk into a syringe (while holding baby in the other), which meant I got breast milk all down my arm. 

Later, I was feeding my patient and my rocking chair was facing away from his monitor...where I would have noticed his heart rate going down (a bradycardia), but my nurse got to us both in time to correct it. It didn't do anything for my confidence when I inquired more about it and as she tossed over her shoulder rather morbidly, "Oh that just means he was dying a little bit." 

My eyes got wide as saucers as I stared at this little 3-pounder napping happily in my hands...and I died a little bit! 

I suspect she loves torturing students. (She was actually an amazing teacher and helped me pick up on so many subtle symptoms and time-saving techniques.)

I'll have this patient again tomorrow and I'm really looking forward to it. I intend to fix all the mistakes I made from today...and probably make a bunch of new ones tomorrow. 

I Hate Babies...and Here's Why

This is my term for Family Nursing. I knew I'd have an easier time academically, which has proven true. I'm getting great scores on my exams. I also knew that I would hate the clinicals. Also true.

It's not so much that I hate them, but its a love-hate relationship. Probably best explained in some hightlights.

The babies:

Taking care of newborns, some only hours old, is really fun. I love their little pink bodies, how sleepy they are, and how much they need us. Its the families that I can't stand. (Not all of them, mind you.) One patient I had was a little girl who was perfect in every way. But in my morning assessment, her hands were starting to tremble. Just 4 hours later, her whole body was. Turns out her mother's urine had tested positive for drug use during delivery and this little girl was entering withdrawal. Of course mom acted shocked and couldn't see how it was possible. Maybe the test was wrong? Mixed up? The savvy nurses, who have had conversations like this a depressing number of times, didn't fall for it. "We have the cord blood, and it's being sent to the lab for confirmation. Whatever you have been on is going to show up, so you might as well tell us..." It went back and forth like that all day, trying to drag information out of the mom so that the proper treatment could be done. Wasting time, as the baby continued to spiral downward. And after she spends time in the NICU, and about 3 weeks being tapered off whatever drugs mom was on, this little girl will go home. With mom.

I grieve over that.

Another patient of mine had a trach. He was such a smiley little nugget, born way too early to a teen mom. (Her 2nd child). He was several months old but still needed the ventilator. His lungs may not be strong enough to breathe for himself for a very long time. I had never taken care of this kind of patient, and so was terrified to look down to see his face screwed up, red and crying...but it was completely silent! What a scary thing to watch! It made me never want to take my eyes off of him, because crying is how babies signal when something is wrong...but this little one could not be heard! Some day he will go home, with this mom who is still a child herself.

I am also a volunteer "Baby Cuddler" at my home hospital. An easy walk across the street for me, and the Pediatric floor is desperate for extra hands, especially at night. I have insomnia anyway so its no biggie for me. Win win. One night I was holding an angel baby, and the nurses informed me that he was 2 weeks old and nobody had ever been to see him. Not parents. Not grandparents. Of course...I had to stay for hours after that because I figured he was way behind on getting any human contact.

The worst one for me was this week. My little BUFA baby. (Baby Up for Adoption).

I went into the nursery in the morning and this little guy was being held at the nurse's station instead of just laying in his bed like the other newborns. He was about 6 hours old. I didn't know he had been surrendered by the mom at that time. All the nurses were naming him, since he didn't have one. Looking at his thick, dark hair sticking up in all directions...I contributed "Elvis." But they settled on Lucas. Since my own patient was rooming-in with mom, I decided to take care of all the babies in the nursery, and at times, he was the only one in there. Which was how I found out he was up for adoption.

For some reason this really bothered me. All the other babies were learning to breast feed. Moms and dads were counting their fingers and toes. They were wearing hand-knit caps instead of the hospital issued ones. Their little wrist bands matched the ones on their mommies. He was banded to the social worker. He just seemed all alone in the world and nobody was celebrating his arrival. (Yet).

So, at tremendous cost to my soul, I decided to be his surrogate mom for the day.

I fell in love with him instantly.

Any time I wasn't busy with my own patient, I held him. I would take him into the other room, away from the noisy nursery, where there was a rocking chair and give him attention. I counted his fingers and toes. I took off his cap and let him snuggle into my neck and feel skin-to-skin contact. Hear my heartbeat. I carted him around in one arm, and stood doing my homework at the counter with my other hand.

Then he was put in his bed and rolled next to the circumcision room (a place I chose not to enter) and I nearly had a fit. I was at war with myself. Part of me wanted to go in there with him so he wouldn't be alone...but I wasn't sure I could watch him go through it! (I made my brother take my son in when he was snipped!) I kept hovering near him by the door, finally venturing into the room because he started screaming when they strapped him down and I couldn't stand that. As soon as I put my hand on his little head and whispered to him...he fell asleep on the table. I stayed until the very last moment when the doc had the instruments in her hands.

Then I bolted.

What followed ripped my heart out. Apparently this doc took about four times as long completing his circumcision as she normally took. Right outside the door I rounded with the med students on a couple of other babies and tried to ignore his screams. I felt like I had an internal hemorrhage. To stay busy I got his bottle ready, intending to cram it in his little mouth the second he was done. It felt like hours later, but he was finally done and I whisked him out of his bassinet and back to the rocking chair. He sleepily guzzled the whole bottle.

When it was time for his newborn assessment, the pediatrician saw that he was being held, and knew that he was up for adoption. She said to her medical students, "We will save this one for last, because he is being held right now and he needs that more." I freaking love that woman. I felt exactly the same way. Together we combed over him, and I was a nervous nellie that he may have had some flaw that would impede his ability to be adopted right away. The doc smiled up at me and said he was perfect in every way. I agreed.

She had just completed her exam and was holding his naked little body face down after the spinal check when he proceeded to urinate like a sprinkler all over her, himself, and his whole bed. We all cracked up and she just handed him over to me, naked and wet, looking like a pink little baby bird. With one arm, I changed the whole bed as he fell asleep in the crook of my arm. Skin to skin.

That day I cried during clinicals for the first time in nursing school. Just rocking him and wondering how anyone could ever give him up, even knowing that it was better that he was going to new parents the very next day than staying with a mom who didn't want him. It just made me so sad that nobody was there for him on his first day in the world. Luckily I was alone with him in the rocking chair when it happened, so my lack of professionalism wasn't noticed.

But we rocked and I told him about his future. I prayed for his life and what it would turn out to be. I joked and told him he might grow up to be the next great hockey player. That his parents were definitely giving him a car for his 16th birthday and that he'd wear J Crew the rest of his life. But mostly I just wished for him to be surrounded by love for the rest of his life. And I'm believing that that is what happens to him. As I write this I know he is with new parents who have gone through so much just to get him. Who yearned for him. And this comforts me, even though I still miss him.

And that, friends, is why I don't want to take care of babies.

They freaking break my heart.