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.