7 Wasn't Enough...

I was so thankful to have a day off yesterday! I knew how crazy it had been, so I took brownies up to work last night about 2100. The board looked beautiful!! Couple green names and 2 ROL's. Why can't I work on nights like that!?!

So I dropped the brownies off and on my way out the door I made a funny comment about "now I don't want my phone to ring tonight because I've already driven over here once tonight!" I should have kept my mouth shut...!

Sure enough, about 0245 my phone rings. When I'm in a dead sleep I don't really think about what I'm doing and I just grab the phone and answer it. Sure enough "we need help! People just keep walking in!" Ok...I'm on my way. I couldn't say no after what I'd said earlier, and after the week we'd had, I know what it's like when nobody will come in to help. Only as I was getting ready to walk out the door did I realize that it was torrentially pouring buckets outside...no wonder the flood gates had opened at work (pun fully intended...).

When I got there I took one of the nurses SROM girls. After looking closely at the board I don't think it was quite as desperate as it had sounded on the phone, but I'm guessing it had all hit at once and when people keep walking in, there's no telling when they're going to stop walking in! So I checked on my girl, I actually used to work with her at the hospital day care before I went to nursing school. That was cool. She was ruptured and contracting, but hadn't really changed much from the office per the nurse who had admitted her. She didn't want any pain meds quite yet, so I let her rest for awhile. The doctor had given pit orders but I decided that since she WAS contracting, I would give her an hour or two to see if she did it on her own.

Baby looked great, and finally about 0530 the patient said she was getting more uncomfortable and wondered what she was dilated. So I checked her and something just wasn't quite right. I couldn't really find a cervix, and couldn't feel any suture lines, it was just all kinds of funk. So I had the original nurse check her and she didn't know what it was either...but she was definitely more than the 2cm she was when she came in. So we grabbed the ultrasound and then had the laborist come verify presentation, sure enough, it was a butt. You would have never know from where we were picking up heart tones, but then mom mentioned that "I have been feeling the baby kick me down low." Hmmm...well, no vag delivery for you! So we called the doc, Mom was about 5-6cm, and we took her back for a C/S. Baby was born just before 0700, little girl, perfect, adorable and sure enough...butt first!

So...8 deliveries in 1 week, I caught a baby, I checked (and almost pitted) a breech baby, I did a crazy, messed up C/S with a bakri balloon, rectal cytotec on the table and general anesthesia, I got along good with the docs, and I got 1 day off before I do another 3 in a row! Ah..the life of a labor nurse :)

Babies today: 1f
Babies total: 54M/60F = 114
Vag:42M/45F = 87
C/S: 12M15F = 27
Babies 'caught' = 2f0.5m

Thursday

By Thursday night I was seriously dragging. We had all gotten our butts kicked all week long, and you could tell all us nurses were getting near the end of our strings...

I took my patient back for a C/S about 1910 after her being a cervidil the night before and then on pit all day and having made NO change. That and the fact that every time she rolled or changed position baby would have a nice 5-6min decel. A C/S was definitely the best decision for her and her baby. She was a young mom, first baby, and she was giving the baby up for adoption after 24hrs.

Got her all ready and back to the section we go. That's where things started spiraling out of control. We had a great anes team on that night, and usually it takes all of about 10 mins to get the spinal in and the patient comfy. So we started working in the back, since we didn't really want to move mom and cause another decel anes tried to put the block in while Mom was laying on her side. This is nothing new for them, and it's usually no problem. Well the CRNA tried...and tried...and tried...and tried...about 30 minutes of trying. The patient started getting a little uncooperative and stressed out about the block as time went by. We finally called the anes doc to come and he tried a couple times on her side, and then said we had to sit her up. So we sat her up and he got it in, then the patient started freaking out that she couldn't breathe. She said it was only on one side and even though she was satting 100% on room air she started getting out of control. They waited long enough for me to get the foley in and prep her and then they slept her. At that point, I knew I was getting in over my head in things I'd never done before. So...let's just keep the ball rolling!

It's amazing how fast people start to move when the mom's actually slept instead of with just the block. That's impressive! So baby came out fine, but then of course it couldn't just be all said and done with...the uterus wouldn't firm up, it stayed soft and "soggy". So...1 dose of methergine IM. Still boggy. So let's try something else. 800mcg cytotec...rectally...on the table...by me. Seriously? This is not a skill I learned in nursing school OR during orientation! Anyone tried to shove 8 little pills up a rectum while the patent's strapped down on a narrow OR table on her back? Without breaking sterile technique during an operation? MORE than a little difficult. Add in the fact that this patient isn't the smallest patient I've ever taken care of either. Seriously...

Too bad her uterus still didn't clamp down...so let's try some hemobate...nope...more methergine...nothing. So when all else fails, pull out the bakri balloon. This is a balloon that actually goes into the uterus vaginally and is filled with fluid to completely fill the uterus and put pressure on it so it stops bleeding. Never done one of these either. So let's list the NEW things that BirthdayNurse got to do during ONE c/s:
1. General Anesthetic
2. Rectal cytotec on the table
3. Bakri balloon
4. Hemobate intrauterine

That's too many new things to learn in one night!!! So 2hrs after we got in the OR, we left the OR. I'd never recovered a patient with general anesthetic, or a bakri balloon, or one who was as out of control as this girl was after general anesthesia, so I very willingly handed off my recovery to a different nurse and took her patient back for a C/S.

Thank goodness the 2nd section went according to how it was supposed to, other than her begin 29wks with PPROM, but baby was great for 29wks, mom did fantastic, and I got a chance during recovery to finish charting on BOTH patients! After moving my recovery I finished up another recovery for another nurse who was going home, meanwhile people kept on walking in the door...

After finishing up the last recovery, I went back out to labor land and picked up someones blocked/comfy/tucked-in labor patient who turned out to be the same girl I had sent home the morning before after she slept all night off vistaril. I was happy she came back in labor.

I took another multip ROL who was actually ruptured but only about 3cm. She wanted a block too, so I got her comfy, charted and sat down for about the 1st time all night. It was about 6, so I went in to check my ruptured girl one more time before I started some pit on her and low and behold she was about 8cm with a nice bulging bag. The doctor was sitting out at the desk and when I told her she said "well, let's rupture her and then I'll deliver her before I leave." Ok...whatever you say! So AROM, drag in some delivery equipment and have a baby at 0635!

Another 3 baby shift...and my 1st boy of the week! I was seriously starting to wonder if there was something in the water to get all these girls! And 2 of them have had the same name, and 2 of the other's have rhymed!

Babies so far this week...7. I think I'm done for the week!!!

Babies today: 2f/1m
Babies total: 54M/59F = 113
Vag:42M/45F = 87
C/S: 12M14F = 26
Babies 'caught' = 2f0.5m

Wednesday

After Tuesday night I was already tired and it was only my 2nd shift! The fact that I picked up an extra 6hrs Monday night really threw me off, and I couldn't even tell you what day it was!

Wednesday I took a patient that followed me in the door for a rule out labor (ROL). I ruled her out after an hour, made her mad that I was sending her home, and tried to explain that I couldn't "force" her to leave but that I really thought she'd be more comfortable not in our beds and not being able to drink, eat or smoke her cigarettes. She finally decided to leave.

Then I took another ROL, got her in a bed, then got a page that somehow it was my turn to take ANOTHER patient. Ok...so I ran for about an hour and a half, the on-call doctor for the 1st patient decided that since she lived an hour away she should stay and would "probably go into labor during the night." I got her settled, gave her 50mg of vistaril to help her sleep (same sleepy effect of benadryl) and she slept the rest of the night. Hmmm...maybe not real labor?

2nd ROL went home, and I finally sat down to chart on BOTH patients. All fine and good, got everything caught up, I was good to go! Then another ROL walked in, of course it's my turn. She was definitely in labor and wanted a block so IV, block, check her and she was pretty near complete. Her doc came in, we had a great delivery! All right then! This was another doc who isn't always known for being super friendly but she came and sat at the desk with all us nurses and chatted for a while waiting for her other patient across the hall to deliver. I really like it when the docs sit out with us and socialize and just share in good old conversation. It breaks a lot of the the doctor/nurse walls down and makes everyone seem a little more human.

Right at shift change the same ROL that I had sent home 12 hours before came back and her cervix had changed, so she got to stay this time. You could tell she wasn't very happy, but in my mind, she got to go home for 12 hours, she got to eat and she got to smoke the cigarettes she wanted. She couldn't have done any of that if she had stayed. I'd say she was better off at home.

Total deliveries for the week so far...4

Babies today: 1f

Babies total: 53M/57F = 110

Vag:41M/45F = 86

C/S: 12M12F = 24

Babies 'caught' = 2f0.5m

Tuesday

I could sum up this last week in 1 word: CRAZY!! But...to be fair, I'll post about each day. Since it's Saturday now (and this recaps Monday through Friday) I may be minus a few details...but all my numbers are correct!

Monday night started the ball rolling. I took report on a very nice patient from one of the day shift nurses. The patient was a multip already in labor, already had an epidural and was comfortable. So it was the waiting game on her. She labored very nicely.

About 1930 I took a triage who came in contracting, it was her 4th baby. She was in great control, but was ready for an epidural ASAP, so I got her blocked, comfy and then sat down to chart. Meanwhile, my 1st patient was starting to have a few variables, so I went to check her and she was complete. I set her up and we only pushed a few time, called the doc in and had a very nice delivery! I came out of her delivery, stuck my head in to check on my 2nd patient and she mentioned she was feeling a little bit of pressure. Sure enough, she was complete. So I somehow managed to hand off my 1/2 way done recovery to another nurse and went to my other delivery. She pushed about 2 times, we called the doc and had another great delivery. I check the times and it was 1hr and 5min apart from my 1st delivery. Nice work for before midnight :)

The doctor for my 2nd delivery can more often than not be a little difficult to get along with, even though I've never had any troubles with her at all. We had a great delivery, she was very chatty, happy and sociable the whole time. When I came out to the desk afterwards, one of the other nurses said "whatever you did to get on her good side, don't get off of it!" I don't know what I did either...

As I was sitting down to chart my admission database on my 2nd delivery patient (who said that admission stuff has to be done BEFORE the baby comes out?!), I head a blood curdling scream from a room and any labor nurse knows the sound of "the baby's coming" scream and that was for sure it. I dashed into the room, threw the cover off the delivery cart and sure enough under the sheets there was a head full of dark hair crowning up nicely. The actual nurse was standing at the bedside holding the sheets up looking slightly panicked (I don't blame her!) I grabbed the top pair of gloves off the delivery cart, reached down and caught the baby just before the laborist walked in. Baby went to mom's tummy, cord clamped and cut and I let the doctor take over. Hey, a TOTAL step up from the last baby I caught...at least I had on gloves, and I didn't get anything on my scrubs! It was a slightly awkward angle to catch a baby since I was standing behind mom, but whatever works I guess...

What a way to start a week. All girls! And chalk another baby up that I've caught :) I'll take one of those ANY day!! Counting the 2 babies I had + the one I caught we had 322 babies in June! That's alot!

Babies today: 3f
Babies total: 53M/56F = 109
Vag:41M/44F = 82
C/S: 12M12F = 24
Babies 'caught' = 2f0.5m

Friday Night

Probably should talk about Friday night before I talk about the craziness of last night!

Friday night...I walked into a girl who was unblocked and on pit but who really hadn't changed all day. I walked down with the day shift nurse to check her right before shift change...she was 8. (Still unblocked). Got the room all set up, gave her a few more contractions...checked her again...she was 9.5...few more contractions, complete. Please let the doc get here! I didn't put her in stirrups 'till I had the doc present and accounted for and I was sure I was gonna catch the baby...but I didn't. Nice delivery, she was so proud of herself for going un-blocked, and with good reason! I love it when they think they're only 2 and then realize that they're like 8 or 9 or complete. It's amazing how well they stay in control that way vs. knowing that they're getting closer and closer. I wonder if it really is a mind game!!

So I hung out with my postpartum cuplet (since I've been trained now...hahaha!). Did the whole breastfeeding thing, etc, etc. Then about 430 I got a R/O labor/SROM who was indeed in labor and SROM'd. I got her block, comfly, did my charting and checked her about 0630 and she was complete! Got the doc there, pushed 1 and a half times and had a baby at 0658...handed off the recovery to the day shift nurse and left the unit at 0710. That's how I like it! Get the fun of bonding with the patient, do the delivery, sign the chart and walk out. I think every delivery should be that way :)

So...3 shifts this week...5 babies...all vag...what a week! Reminds me why I love my job (most of the time!)

Babies today: 2m

Babies total: 53M/53F = 106

Vag:41M/41F = 82

C/S: 12M12F = 24

Babies 'caught' = 1f1/2m

Babies Anyone?

Needless to say, it's been beyond crazy at work. I somehow managed to slip by on-call for part of my shift Friday night, I couldn't believe it! Then the calls started coming...

Saturday night...sorry I have a wedding Sunday morning!
Sunday... the manager of the entire Women's & Children's department called...twice!...sorry, I've got a bridesmaid dress on and I'm getting ready to march down the aisle!
Monday...just got off a mower after 5 hrs in 100 degree heat.
Tuesday... I was scheduled to work, and sure enough it was crazy. Somehow we've only had like 3 or 4 nurses scheduled every night, to cover an completely full board. We had more nurses there on time and a half pay than we did straight pay Tuesday night! I delivered a girl on mag about 2100, and as I walk out of that delivery with pressures of 160's/100's I get a page that there's a cervidil coming that I need to take. Since when is an unstable mag patient not 1-to-1? Whatever works I guess...
Wednesday...crazy again! I had one laboring patient and triage. Isn't that my favorite hat to wear? But it turned out not so bad. The labor patient I got at shift change was an SROM from early in the day who hadn't really gotten into any kind of labor pattern, and was stuck at about 2cm. I got report on her, got a quick triage about 1930 and had her gone before an hour was up. Then as I'm wrapping up the traige charting...in walks in another rule out SROM...who was very SROM'd. So I got her started, got both patients blocked, got my first patient an IUPC and a AROM of her forbag and attempted to tuck them both in to sleep.

About the time I started trying to chart my every 15minute heart tones on both patients since 1900, my 2nd SROM girl started having variables, so I went in to check her and flip her. She was almost complete...so I called the doc. That was my first mistake....I guess I thought going from 3-9.5 in an hour was impressive so I thought I should update the doctor. I guess I should have waited until she was complete and ready to deliver! The doctor came in and was upset that we weren't pushing yet! Um...first baby, she wasn't even quite complete. All I really wanted was for her to come and sleep and be there for delivery. Heck, she didn't even have to come yet! I just wanted her to know that we went from 3-9.5 in an hour! So the doc set my room up, rush, rush, rush, stood in there and pushed with us for an hour! I felt like a retard, totally useless, there were several implications made that maybe I wasn't the best nurse and that I clearly didn't know how to do my job. I felt like I had never done a delivery before! That will teach me to call before I should...

Half way through pushing with that patient, my other patient had several impressive variables so another nurse went in to check her and she was 7-8. Nice! So I finished my first delivery, checked my other girl, she was complete, tried to give report to a M/B nurse about my first patient so I could go push with my second but couldn't ever find the M/B nurse so I was an hour into my recovery before I could actually focus on my patient who was complete. Then my doc calls and says he's across town getting ready to head into surgery and he'll be another 45min-1hr before he's there. Ok...

Long story short, everything went great, she had a fantastic delivery. I had never done a delivery with that particular doctor and I loved him! He was great! Great bedside manner, very personable, calm, cool, collected. He knew his stuff and was great at explaining everything to the patient. He came up to me afterwards and said thank you for all my help, that I did a great job and that he wishes more of his patients came to our hospital. Total opposite experience from 1st delivery!

I haven't done 2 vag deliveries in one shift in a long time. I didn't realize until after I was leaving that I hadn't really sat down all night except to chart and that I was a little hungry! Oh well, the price I pay for loving my job and getting 2 babies in one shift! One of each none the less. It was kinda cool, neither couple knew the sex of their baby before delivery, so after the first one was a girl I told the second couple that they needed to have a boy so that I could have one of each on my shift, and they did!

2 shifts so far this week...3 babies, not bad!!

Babies today: 1f...1f/1m
Babies total: 51M/53F = 104
Vag:39M/41F = 80
C/S: 12M12F = 24
Babies 'caught' = 1f1/2m

Awaiting Sweet Sleep...

Last night will get blogged about AFTER I have not been up for 22 1/2 hrs and when I am in a better mood...

1st of 2 IAR

So because of a fetal monitoring class this week that's required (even though we're not getting paid for it...) my schedule got all mixed up. Instead of working Sun/Mon/Tues and then having my long stretch off, I work Sun/Mon, class all day Wed/Thurs, then work Friday night. Then they "had" to switch my schedule next week because someone else had to change nights so I'm working like Tue/Wed/Fri. It makes no sense to me, and I can't say that it's all working out just how I want it, but I'm sure I'll survive somehow. It will be nice only working 2 IAR this week for a change instead of 3!! Looking @ the positive :)

I started out the shift tonight with a postpartum mag patient...plus the baby. So even though they still say that I need to orient to M/B, they feel free to assign me a M/B patient before I've been over there. Maybe now they won't feel the need to float me over there since they can just assign me a M/B team over on labor now! Whatever...it wasn't that big of a deal. Mag is mag, and a baby is a baby. He ate/pooped/wet for me, so I guess I did OK with him!

When it started to get a little busier they finally called in the M/B nurse they had at home on call (they had me take the mag girl instead) and she came in and took my PP mag, I took a SROM and got her delivered, then took another ROL who I ruled in pretty quick and had her blocked and comfy and a good 4cm by the time day shift got there! So it all worked out pretty nice. Now off to sleep before tonight gets here. Who knows what adventures it will hold... :D

Babies today: 1m

Babies total: 50M/51F = 101

Vag:38M/39F = 77

C/S: 12M12F = 24

Babies 'caught' = 1f1/2m

Boards Re-Visted

It's been an interesting week...it was 1year ago (not by exact dates, but the 2nd Wednesday in June) that I took my nursing boards for the first time. That is one day I will never forget. 3hrs, 270 maximum number of questions, left the test in tears.

It was 1 year ago (again, 2nd Friday in June) that I found out that I didn't pass boards the 1st time around. THAT is for sure a feeling I'll never forget. Seeing that big FAIL next to my name and that horrible sinking feeling in my stomach. I was the girl nobody ever expected to have any kind of problems with boards...and I was the one out of the class who failed. I felt like I was NEVER going to be a nurse, that maybe this wasn't what I was supposed to do, that all my years of work and dreaming had come to just that...work and dreaming without ever achieving my goals. I never felt as worthless, stupid and ashamed in my life.

The next 45 days were the toughest ever, and I'm still not sure how I ever got through them! Well, actually, I do know. It was because of the awesome L&D nurses, especially J, who encouraged me and helped me see that I still WAS going to be a good nurse, and that even the best nurses sometimes have to try again. It was a rough but valuable lesson, and one I am SO thankful that I'll never have to attempt to re-learn. If I never see/hear/think about the word NCLEX again that will be OK with me!

So I made a better memory this year...I had my 100th baby AND I bought my first (NEW) car! That's a better way to remember the 2nd Friday in June :D

Baby #100!

Another 2 crazy nights to finish out the week...Wednesday night was another attempt to float me to M/B...that lasted about long enough for me to finish my C/S recovery. Then I took a cervidil, another triage or two, then got a SROM that I got started and ready for dayshift. Pretty good night overall. Loved my cervidil couple, and the SROM couple was pretty hilarious.

Thursday night was another night in the zoo. I got to take my cervidil couple back from Wednesday just as she was complete, so we had a baby by about 2000. She did so good, but had had a LONG day on a LOT of pitocin to get the active labor going, so she bled after delivery. Some methergine and 800mcg of cytotec later and she was OK. I always love to finish those cervidil deliveries, especially if they do it without being cut. I get the start process and the finish process too!

An hour into the recovery I claimed the triage crown again and started my 1st of about 4 more triages. One in, one out, one in, one out. Trying to get my 3rd triage of the night out about 0415 when another nurse catches me in the hall and tells me that I have just acquired the new SROM that just walked in and is a repeat section. Oh, and she's 35 weeks. Soooo...thanks to a LOT of help from my amazing nurse team we got her ready and had a nice C/S about 0500, rolled into recovery @ 0630 and had all my paperwork and computer charting done! I was super impressed with me and all the help I got from everyone else. I couldn't have done it without them. I did realize in the middle of the section that I hadn't sat down long enough to even pee all shift...but it DID make the shift go fast.

My C/S baby was baby #100 since starting as an "Real Nurse" last August. I took a second and thought about that in the OR...I can't believe that I have done that many deliveries in less than a year. Granted, that includes all my orientation babies, but still...that's pretty darn good for a 1st year new grad! It makes me feel like I've accomplished a lot in the last several months. It makes all the rough nights definitely worth it!

I said something in the OR about it being my 100th delivery and the doc laughed and said something about seeing if I was as motivated and enthusiastic in 10 years or so. I've had lots of the older nurses smile and pat me on the head when they hear I keep track of all my deliveries, but when I've been doing this for 10 or 15 years and someone asks me how many babies I've delivered, I want to be able to tell them!! I've kept track this far, why stop now?

Babies today: 1m/1f
Babies total: 49M/51F = 100
Vag:37M/39F = 76
C/S: 12M12F = 24
Babies 'caught' = 1f1/2m

Another Day

First of 3, after 1 off...gotta love the extra on the paycheck, right? When I showed up for work, I had 2 recoveries...and then I hear the wonderful news that the new plan to cover all the short staffing is...to float more labor nurses to postpartum!!! Now isn't that just a way to solve all our problems? So all us new nurses get to be the first ones "cross-trained" to mom/baby. I will do it, because I have to, but let me just say this:

#1 I became a LABOR nurse
#2 The biggest downfall of a delivery is the 2hr recovery period
#3 Since I do those 2hr recoveries...isn't that postpartum?
#4 Why is it L&D's job to cover the short staffing of Mom/Baby?

Ok, I'm done complaining :)

So, as I'm walking over to PP after moving my recoveries I'm hard-core praying for a triage. And one shows up! :) ROL who was scheduled for an AM induction, her cervix didn't change in an hr and a half, but then she had 2 nice little variables so I tucked her in for the night.

Then as I'm tucking her in I got the sweetest couple down the hallway. Mom was going all natural for the second time around, she did great! I felt bad for her that she didn't get her doctor, but she was a rockstar. Very vocal, but hey, if that's what it takes that's what it takes!!

She bled a little in recovery so I kept her for an extra hour or so. Meanwhile I got another 37wk triage. Put the baby on the monitor and it was flat with a heart rate in the 210's! Just a little high. Mom had a fever, so after we got that calmed down, gave some tylenol and some antibiotics she was looking much better when I left.

I got the C/S ready for this morning too. 6 patients in a night...that will teach them to float me to mom/baby! Well...at least until my next shift. I'm afraid I'd rather just do it then to worry and stress about it every time I come in. So I'll bite the bullet and push on some fundus' for 12 hrs...

Babies today: 1f
Babies total: 48M/50F = 98
Vag:36M/39F = 75
C/S: 12M11F = 23
Babies 'caught' = 1f1/2m

Dreading the Next 2 Weeks

They called me to work extra tonight in the middle of the afternoon...I told them that I am NOT super nurse and I can't work 8 nights in a row! Sigh...

The rest of the weekend was as crazy as Thursday night, only with less staff. We all ran our butts off! I had really nice deliveries both nights, so that was at least worth it. My girl on Friday night pushed 2 1/2 times...I'm glad the doctor came as soon as I paged her or she would have missed it!! Baby came out with a nuchal and was a little floppy, but pinked up pretty quick once he got moving.

Saturday night was just one of those nights that I got the triage crown and as soon as I would send someone home another would walk in the door. I did 7 admission data bases (the ump-teen screen computer form we have to fill out for everyone)...that is TOO many! I did get a nice delivery out of the night, so that was good. I felt sorry for Mom, it was her 2nd baby, she precipted with her 1st baby, and almost did with this one...thank goodness for nice strong BOW! She walked in 8cm, with that bulging bag and was in total control .We all flew, got an IV in, bolused her, she wanted a block, called the doc, etc. I knew as soon as that bag broke we'd have a baby, but it stayed in tact. When the doctor checked her she said the same thing and gave Mom the choice of trying to get an epidural or going ahead, doing an AROM and just having a baby. Mom thought about it and decided she wanted the block .We talked with anesthesia and we all decided that it would be best to do a spinal that would work faster and longer. Well...I don't think anything is going to give you much relief at 8cm, and even after the spinal was in she didn't get any relief. She decided to go ahead and AROM and we had a baby in about 3 pushes, but I still felt bad for Mom. She wanted that epidural so bad! She said afterwards "I guess my kids just don't want me to have drugs!" We told her to just come hang out at the hospital when she was about 8 1/2 months pregnant and then we'd get her a block!

The doctor who did her delivery is very pregnant (it was her last on-call shift before her induction) and I really thought she was going to pass out in the delivery. When Mom pushed it was the most "excrement" that I've ever seen during a delivery. It doesn't usually bother me, but the doctor got kind white and I wasn't sure she was going to make it...but she did!

They called me in last night to work extra. It was a mess...no empty rooms again. I sent one triage home, then got another one that was a repeat C/S scheduled for later this week. She was contracting every 10-15 minutes and talking through them very easily. She was off the bed when I checked her and was very upset that she hadn't changed her cervix in an hour. She didn't understand why the doctor wouldn't come in and do the C/S now when she was having contractions that hurt when if it had been Thursday morning and she hadn't been having contractions she would have the baby anyway. We went round and round, I gave her some vistaril and tried to give her a fluid bolus, but after missing an IV on a thrashing hand she decided to just go home and "suffer through contractions" since we weren't going to do anything else and left in tears. I hope her contractions stopped...and I'm sure my name is now down for a NOT THIS NURSE request for her c/s later this week...

I left about 4am, after it had sort of calmed down...but then I guess it got crazy again. One nurse last night did a C/S on 33wk twins while I was there and then I guess got a set of 27wk twins after I left that they did an emergency section on about shift change as another one was precipting in the bed. I told her 4 babies in one night wasn't too shabby...!

Slept most of the day today since last night messed me up and I hadn't had much sleep before that. Now it's 2am and I can't sleep, and I have to work the next 3 nights. Surprise, surprise. These next 2 weeks are totally messed up schedule wise because of the fetal monitoring class I have to take. Add a wedding and a bachelorette party in the mix that I'm in charge of and I think I might not be sleeping much for the next several weeks!!!

Babies today: 2m
Babies total: 48M/49F = 97
Vag:36M/38F = 74
C/S: 12M11F = 23
Babies 'caught' = 1f1/2m

I'm BACK...

Seems like I haven't worked/blogged in a VERY long time! But don't fear...the craziness has still be going on, I guess I've just been avoiding it...until last night. I turned down 2 extra shifts in my "8 days off (which was really 7 this time around...)" for 2 different but very valid reasons. I realized when I went car shopping yesterday that maybe a few extra shifts in the near future would be a GOOD thing and I need to stop coming up with excuses like "I'm tired" or "I'm busy", etc...reality bites!

Anyway, as I'm halfway to work yesterday (after an hour and a half nap after the car deal...) I get a call from the day charge nurse..."Sorry it's 1815, but we're putting you on call!" Seriously? Here I am thinking that I need extra shifts and I can't even work my regular ones anymore? I was JUST on-call, and I'm half-way to work already! But what can you do...so I drove to the gym (just a different building on the hospital campus) instead of work and ran a few miles, lifted some weights...on about mile 4.5 my phone rang "Well...a twin mom just walked in who's 6-7 so I think we'll need you. Well, only 1 nurse has said we need help so far...Well, I'm not sure if we'll need you LaborNure wise, but I know I don't have NICU help..." Before the conversation could go deeper I said I'd take a shower and come in. Meanwhile thinking "#1 I'm not going to be of any use if they need NICU help, I do mom's not babies (especially 35 week twin babies!) and #2 if I get there and they don't need me, I'm going to be ticked!"

When I walked in I got ticked, but for a different reason. The board looked horrible, there were no where near enough nurses, I didn't even have anything to do with the twins who walked in, I got someone's recovery (why...I'm not sure) and a random ante from someone else. The recovery...ok, no big deal. The ante...a little bigger deal: she's been there for an hour an a half, the baby wasn't on the monitor (she was "too big and hard to trace"...) there was NO paper work or computer work done on her, the doctor hadn't been called, pretty much she'd gotten on a gown and sat in a bed...for an hour and a half!!!! THAT made me a little upset.

So I went down, flipped her on her side and found the baby, got the scoop of why she was there, called the doctor, got orders, helped 3 other people get up to the BR/roll to the OR/very random things, started her IV, tried to get my recovery moved, got told that I was the next one up for triage and that there was a term ROL here in a room for me, put moving my recovery on hold, triaged the ROL, got her situated, gave report on her to someone else, moved my recovery, came back found out the traige had gone from 3cm to 9cm in about 45 minutes, found out my ante was feeling better, did ALL my charting, sat down to breathe...

Round 2 of the night included: helping with the unblocked delivery of my "ROL", sending my ante home after 2L of fluid, setting up delivery packs for day shift, taking over on 2 other antes so a different nurse could go home, taking a ROL at 0530 and then ALMOST getting to catch a baby when mom precip'd in the bed (7min on the monitor, 2 contractions, in PERFECT control, with her 2 y/o standing wide eyed in the corner). I was a little bummed about that one, it was total group effort and when we pulled the covers back and saw the head crowning I grabbed the gloves off the delivery table and was ready to catch the baby, had my hands on the head when the laborist walked into the room. 30 seconds from baby catch #2! :( Maybe next time. At least I had gloves on this time! I have learned that 7mins on the monitor 2 contractions and exactly 1 hr from waking up to contractions to delivery is how I want to have MY babies!!!

Topped off the shift with giving report to a VERY grouchy day nurse who was NOT happy about getting antes and somehow it was my fault...go figure.


Moral of the story (in my personal head, but what do I know?):
#1: don't put nurses on call just because you can pull the strings to make it "ok" for the moment (cuz when it hits the fan it hits fast and nurses don't just magically appear when you need them)
#2: It's easier to have an extra nurse and send them home than to not have enough nurses and wait for them to come in
#3: When you're calling nurses in, don't just stick patients in a room and wait for the called-in nurse to take care of them. They're still patients in the 30mins before the called-in nurse gets there...treat them as such! What if my ante had had a nasty/cuttable strip in the hour and a half she was there before I got her? "Someone's coming" is not a reason not to take care of them before that "someone" gets there! Paperwork/orders/computer work goes with it...getting dumped on when you walk in the door is NOT a way to make friends...
#4: No rooms is a good reason not to move patients from L&D to post partum...not being willing to call a nurse to take them is NOT a good reason. We wouldn't tell a laboring mom "sorry, we have no nurse for you" us labor nurses would suck it up and take her and we'd start at the top of the list and start calling...all the postpartum nurses doesn't help us in that situation, so why do extra labor nurses get to "fill in" and take postpartum patients instead of calling in mom/baby nurses? Somehow that doesn't seem to balance out...
#5: The UP side to a DOWN night is that you can always look to starting with a clean slate the next night (or two...)
#6: I did get a workout in before work which was an added bonus, and I got to go in for time and a half when I got called back in :) Car payments here I come!!

Ready For Some Time Off

Don't know why, but it seems like I have been working ALOT lately! And the sad thing is...I really haven't been! I haven't done the 6 or 7 IAR thing for a long time, just my 3's with 2 off in the middle. But this is my last set of 3 before my "long stretch" and maybe that's why I'm tired. This week kinda messed me up too with the holiday. I didn't get to work my Sun/Mon/Tues, instead it was Mon/Tues/Wed...so I've been behind a day all week!

After my rough week last week I've been a little over anxious/nervous every time I come to work too. I didn't get my first baby 'till Wed, and that was a C/S that wasn't supposed to happen but baby only tolerated the cervidil for about 5 hrs before it got grouchy. I've done cervidils the rest of the week, I guess I had a recovery one night too, but no babies. :( Sadness for me!

I'm super glad that I get a few days off now, I need some time to sleep and exercise some, that's fallen by the wayside too many times the last few weeks. My bike wreck injuries are slowly healing and I'm not grossing my patients out anymore :) Horray!

So Much Better

So much better night at work last night...I had no nightmares today while I was sleeping! I must say, I love the nurses that I worked with. I guess I was more shaken up about the whole run-in with the doc and the crappy strip from Wednesday night, plus the 30wk SROM from Tuesday night than I thought. I had at least 3 nurses come up to me last night and tell me that I was a great nurse, that it just takes time to get the docs to trust you, and that the particular doctor didn't have a nurse there who hadn't had a run-in with her at least once. The couple nurses that had looked at my strip said they wouldn't have done anything different than I did, and that I did all the right things. That almost made me cry all over again! When I'd left Thursday morning I really felt like the worst nurse ever and that I had totally missed something super important and that I put my patient into real danger. But after all these nurses who have 10+ years of experience were saying the same thing...I didn't feel so bad!

I had a couple cervidils last night, dealt with a little drama/out-of-control pain issues...then finally gave some stadol which must have been pretty strong 'cuz Mom went from moaning and screaming with her contractions to sleeping for 6 hrs. Stadol must be a miracle drug! (or maybe once she didn't think about her contractions any more she just slept). Either way...no babies, but no doctors mad at me either :) Off for a few days now, going to enjoy the graduation weekend at my brother's school and I'm back Monday. Happy long-weekend to everyone1

Another Night...Another Lesson

Ok...so Tuesday night I learned that I should stand up to doctors when I want something or think something should be done for my patient. Last night I learned that it's probably better to call the doctors TOO often than not enough...and to go with my gut feeling instead of listening to what other people are "suggesting" even if they may have tons more experience and their opinions make you feel better about the situation at the time.

My strip turned to @(#^ last night, and after one run-in with the doc earlier in the evening I wasn't too excited about calling her back and asking for her to come back in to assess it. I had one nurse saying "ya...maybe you should call" and another nurse who has worked there WAY longer than any of the rest of us saying "no...it doesn't look that bad. If it was bad you'd be doing something about it not just sitting here watching it." Ok...so I didn't call 'till the patient was almost complete, then the doc came in and I got the very "subtle" feeling that she wasn't too happy with me, and we ended up in the OR.

The baby came out fine, Mom was great, but I get the feeling that I'm just going down the list of doctors and one by one losing their trust...not that I ever really had it in the first place. It's so hard being new and trying to figure out all the doctors. It's worse than a soap opera because everyone likes things done just a little different...and you know you're gonna do it wrong. I think the one thing that I want most as a nurse is to have the doctors hear your name or hear your voice on the phone and have the credibility for them to listen to what you're saying. For the first thing that flashes through their minds NOT to be : "why is she taking care of my patient? I hope she doesn't totally screw it up" or "can I really believe what she's saying?" or to have them worried about their patient because they know I'm the nurse. I've never once had a doctor tell me "hey, that was a good call" or "thank you for calling me when you did" or "you made the right decision" instead it's "why didn't you call sooner" or "why are you calling me now?" or "why hasn't this been already done?" or "why did you do that?"

On our way back to the OR this morning, and hearing the doctor talking to the other doctor assisting her saying "did you see the strip? why didn't she call? this never should have happened." I totally, 100% understood why one of the new nurses to OB just quit. I totally understood...

Babies today: 1m
Babies total: 46M/48F = 94
Vag:34M/38F = 72
C/S: 12M10F = 22
Babies 'caught' = 1f1/2m

Breaking Patients

So after getting sent home @ 0200 on Monday night, I got the dreaded 'you're on call" phone call @ 1745 last night. I was seriously on my way out to my car...bother. So I sat around after having slept all day, kept texting one of the nurses at work who assured me that everything was nice and quiet and under control. So finally about 0115 I sent one more text saying I was going to bed. My phone rang exactly 10 minutes later "we need you!" Ok...here I come.

I loved my patient that I had, she was 30+1 weeks and had just SROM'd. Absolutely nothing was done for her when I got there other than a sterile spec by the laborist to confirm rupture and that she was closed. Ok...so IV, antibiotics, one dose of beta, tuck her in. She was "cramping" every 5-10 minutes she said but didn't say they were any more intense than a menstrual cramp. I finally called the doc about 0430 just to let him know that she was still contracting every 5" or so and if he wanted me to do anything about it. He said "no, just watch her and call her primary OB @ 0645 with an update." Ok, wrote those orders and watched.

Her baby looked amazing, and the patient even got a little sleep. Then about 0630 I went in to check on her and she said the last few contractions had gotten worse, she puked on me (that's way too many patients that have puked on me in the last few shifts!) and said she felt some pressure. So I checked her...she was 4/100/-1. So the primary OB got called a little earlier than 0645 and he wasn't too happy that she hadn't been mag'd already. So we got the mag bolus in, I gave report to day shift and she delivered while I was walking out the front door. The doctor got there, and last I heard baby was doing good. My heart was pounding most of the morning though. That was a little intense for the end of shift! The patient was AMAZING and handled everything perfectly.

I can't help but wonder if there was something I should have done differently though, if I should have pushed the Mag issue with the on-call doctor and laborist a little harder or what. All the nurses at work said I did everything I was supposed to do and that it was more between the docs than me. But my heart goes out to the patient who all of a sudden has a 30wk baby she wasn't expecting. Sigh...drama, drama, drama.

Birthday Twin!

So Monday was my birthday, and I wasn't originally supposed to work. But then I switched a shift with another nurse so she could do something with her daughter...so I ended up working. I know nobody likes to work on their birthday, but I thought it was kinda fun! I had put in the request book that I did want a labor patient, because if I was gonna work my birthday, then I didn't want antes or postpartum!

The worst part of the deal was that I only got one night off (Sunday night) between my 2 sets of 3 IAR, so that was kind a bummer. But tonight was good!

I did get my birthday twin, a nice couple, a good delivery. She delivered right around 2100 and had a little girl! Yay! It's kinda weird to think that not-all-that-many years ago that was my mom and dad looking at their first baby and not sure exactly what hit them...then here that baby is helping another mom and dad do the same thing! That's pretty cool :)

It turned out that we had 3 back-to-back-to-back deliveries all within about an hour of each other...so I really got about 3 birthday twins! We all moved our patients over and went from 6 nurses down to 4, then when there were 3 of us sitting around with no patients someone else had to leave. It was my turn by dates and for once nobody else wanted to leave. Most of the time people are jumping at the chance to go home early, but not tonight I guess! So I had to leave about 0215. I didn't really want to go, 'cuz I'm back the next two nights and if I was already there for 7+ hours there was no point in leaving. Bother...

My very cool family brought up treats to the floor about 2200, I was way surprised! It's my brother's finals week at school so he and mom are pretty tied up, and I knew I had to work so took a nap today so it wasn't really any different than any other day, even though it was my birthday. But then I got a fun surprise at work with the food, so I was excited. I'm pretty lucky (and so are all the nurses who work with me!) to have such cool parents!! Maybe I'll make working my birthday a habit!

Babies today: 1f
Babies total: 45M/48F = 93
Vag:34M/38F = 72
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Done With The Weekend

This weekend has been CRAZY. Not "no end of patients" crazy, just steady and "nobody goes home" weekend! After the 33wkr came in with no heart tones on Friday night, things just snowballed.

I feel like I've gotten SUPER lucky though. I've had AMAZING patients and AMAZING delivereis EVERY NIGHT!! Makes up for that week of all antes and NO babies! Anyway...I'm pooped!

Friday night I got a totally cool patient, she's a nurse at one of the children's hospitals in town. I feel an extra bond when the patient is a nurse too, even if they don't know the first thing about labor. I think there is something to be said for having the common ground of just working in a hopsital. They know what it's like to get tied up with doctors, they know what it's like when things have to change or don't go EXACTLY as planned, they've learned what it's like to go with the flow. Even if you're not a nurse, you still understand the environment and how things work. She had a beautiful delivery, she was 6+ feet tall, dad was like 6'6", baby was big too, but looking at mom you would never know! Baby had a nuchal X2 and her poor little face was SO bruised! Worst bruising I've seen in a very long time. After baby got weighed, Mom realized that she weighed the same, was the same length and also had a nuchal when she was born. Talk about "like mother like daughter". They were so greatful for a baby that they'd been trying hard for, and were happy with how everything went. Yay!

Last night, another early delivery in the shift, less than an hour of pushing, another >8# baby, amazing family, funny as everything. I love patients who make me laugh and will say anything they're thinking. Dad kept asking when he was going to get to put on the gown and mask and hat (gotta love those 80's birthing class videos...updates anyone?!). So I finally gave him one of C/S hats and masks. He decided that after he put the hat on he looked more like a food service worker than a doctor, so he didn't wear them for delivery. It was so cute. He wanted to cut the cord so bad, and when the doctor started to clamp it Dad yelled "I'm supposed to do that!!" We laughed and said that the doctor had to clamp the cord first, then handed him the scissors and let him cut the cord. He apologized for getting so excited and I said I was glad that he said something instead of missing out on the opportunity he wanted...but it was pretty funny.

After delivery/recovery I did one triage that I sent home, and then got a 26wkr with pyelo that I bolused, gave some antibiotics and tucked into bed. Then about 0400 the "bus" rolled in and I got a labor patient who was dying with uc's, sat down in bed, started a contraction and promptly said "I'm going to puke." I grabbed a bucket and ALMOST got it to her, which she missed and all over my hand it went. Remind me to ALWAYS wear gloves when I'm anywhere near a patient because who knows when they're going to spew. It was gross. I'm patting her back and telling her she's doing great all the while gagging with every heave. I don't do puke.

Her 6y/o step son had come to the hospital with them and was sitting on the couch wrapped up in his pj's and a Thomas the Train blanket and I figured we'd have either tears or another pile of puke in the corner but after she was done and I was dumping the contents of the bucket he was like "Dad, is that throw up?!" Leave it to a 6 year old.

After I threw in an IV and got some zofran on board I promptly walked back to the OR and told the doc that I had a patient of hers who needed a block. I felt bad later, I don't even think I asked, I said "she's been here 15 minutes, she's 3/100/-2, she's puked on me and I'm waiting on labs for a block." She kinda said..."uh...ok, go ahead." I guess I'm more assertive than I thought!

She did change her cervix and was 5 with a bulging bag and was laughing watching her contractions on her monitor and not feeling a thing. I totally was wishing that she'd come in at like 2000 instead of 0400 so I could have done her delivery. Oh well...

I can only hope I get 3 more deliveries this week too! I switched a shift with someone so I'm working on my birthday and I requested a labor patient. If I'm gonna work my birthday then I at least want a birthday twin!

Babies today: 1f1m
Babies total: 45M/47F = 92
Vag:34M/37F = 71
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Hard To Go Back

So after my little "bike accident" on Monday...I've turned down more extra shifts at work than I EVER have. Mark this one down for the record books...I didn't even step foot inside the hospital since I left last Wednesday morning 'till I went back for some simulation drills this Wednesday night! That's over 7 whole days...gotta be a record for me!!! I'm sad about all that extra that I missed :(

I felt super guilty and stayed for 2 hrs after the sim drills to do a C/S recovery Wednesday night and counted it my extra shift for my week off. And then did a full 12hr shift Thursday night. Things haven't slowed down...that's for sure!

I did have a nice delivery, first one in a while after having antes all week last week. I went in early for a nurse so she could leave @ 1730...it's amazing how just an extra hour or two at work can make the shift seem never ending. After the delivery I took a cervidil, then another cervidil, then handed them off, then took one back, then did a triage that I sent home. Ah...the staffing matrix...

I'm still sore after my date with the pavement this week, and all the docs are mad at me for not going and getting the "full workup" after it happened...but one wrote me an RX for some stuff to keep the scabs soft so they look nasty, but at least they're not cracking and splitting open when I sit down or bend my arm. The bruises are turning nice colors :)

I got a Facebook message from a friend telling me that one of their relatives was a cervidil that night, and would I please take care of her. What a compliment! She took right off the cervidil too, I got her blocked and she delivered pretty early after I left. Yay for her!!

Babies today: 1m
Babies total: 44M/46F = 90
Vag:33M/36F = 69
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Bike Crash

Ok...one more story from my "non-work related life."



Beautiful day today, so I decided to go for a bike ride instead of the running I was planning to do. There's a great trail just down the road that's about 24-miles round trip from end to end, so I thought it would be a great day to ride it. Set out, it's beautiful! About 5 miles into the ride there's a small hill on the trail that got wiped out in a flood a few years ago and they've never totally finished it, it's still gravel and torn up trail pieces. It's normally no big deal, but today my tire caught on it "just so."


I skidded to a stop on my elbows and knees and the first thought I had was "it's gonna be a sore ride home from here." I've whipped out numerous times before (running, rollerblading, etc.) and I usually pick myself up and head back, 'cuz how else am I supposed to get there? Anyway, as soon as I got up everything hurt, especially my L elbow. My first hope is "I really hope my elbow's not broken...I gotta go back to work on Thursday!" A very nice older couple about 50ft ahead of me had heard me crash and they turned around to make sure I was OK. I told them "I'm fine!" at the same time thinking "Ok, maybe I'll just have my dad come and get me..." I whipped my phone out of my shirt (I had no other pockets...where else was I supposed to put it?!), walked my bike over to the edge of the trail and called my dad.



I got out "Dad, can you come pick me up at X access point on the trail..." and that was about all I clearly remember. I remember bits and pieces...the couple helping me sit down; my dad saying "where are you again?"; feeling really dizzy; not being able to focus; feeling my head go side to side; thinking "Come on BirthdayNurse, just open your eyes and focus!"; thinking my knees really hurt and hearing my phone ring again but not knowing how to answer it; the woman asking me my Dad's phone number and having to think really, really hard about what it was, and then not even being sure that I said it out loud.



The couple called 9-1-1, even though I kept saying I didn't need it. About 5-7minutes (from what they told me) I finally snapped back into it and was OK. About that time my dad and sister got there...along with 2 cop cars, a fire truck, an ambulance and the park rangers. They checked me out, cleaned up my road rash, had me sign a HIPPA form (first time I've been the signee of one of those...) found out I was a nurse, asked me if I wanted to go to the ER (I said absolutely not) and said thank goodness I was wearing a helmet!



Next time I'm gonna do it up good and deserve an ambulance ride! Good thing I don't have to go to work 'till Thursday, I'm best friends with the Advil bottle at this point. I had forgotten how many nerves are effected scraping off that top layer of skin!!






Top "owie" on my L knee








L elbow/forearm
(this is the one that's obnoxious!)

























R wrist













Both arms

Week's Worth of Work

Things I realized this week:

1) I hadn't had antes in a long time
2) I had antes twice this week and that was enough for a long time
3) Antes are all just little time bombs ready to explode...and I'm always afraid that they're going to explode on my shift!
4) If they don't explode...antes are boring after the first couple hours
5) I went all week with no babies...that made me sad and only slightly grouchy on my last night
6) I actually am going a WHOLE WEEK without working extra (because I was out of town the nights I wasn't working...)
7) I have GREAT job security...

And Another Night...

12hrs Monday night, 12 hrs Tuesday night, 13.5hrs Wednesday night, got a call and went in @ 0430 on Friday morning, then got another call last night and went in from 2300 to 0400. Part of 5 shifts in 1 week! I took tonight off before I start my 3 IAR tomorrow.

When I got there last night they re-evaluated the board and kinda figured that they hadn't needed me as desperately as they thought they did, several of the patients ended up going home, and they did some re-assignments. If we get called in, we get paid for at least 2 hrs, so I figured I'd sit for 2 hrs and then go home. I helped move a patient or two, did some random stuff and was just about to leave when one of the doctors came down from the lounge and said he had a patient coming in who thought her water broke. He said that her own doctor was coming on call at 0700, so to just tuck her in and wait for the morning. So I said I'd hang out, get her started, then leave.

Story short, she delivered an hour and a half after walking in. 3rd baby, SROM'd, unblocked (delivered all 3 kids without one!), it was great! She came in 5-6cm which was what she'd been for the last week or so and said her contractions started after her water broke. Funny how labor happens when it's supposed to!! I think I finally got her admission paperwork done about 45minutes after she delivered.

I felt bad for her after the delivery. The delivery was flawless, she pushed maybe 3 full times, no tearing. The on-call doctor made some off-handed jokes, and then said "maybe next time you should try an epidural...just for the heck of it! Haha..." and he left. She asked me later, "did I do something wrong? Was I a bad pusher? Was it a bad delivery? Why should I have gotten an epidural?" No, no, no! She was a rockstar! She did everything perfect! I was so ticked at the doctor for what he said! Why would you tell anyone who just pushed out a baby without any meds (she didn't even want nausea meds!) that they should try a block "just for the heck of it"? Come on, now! Made me mad...

Came home and tucked myself into bed at about a quarter to 5 this morning and slept great! Enjoying my one night off...and starting all over tomorrow!

Babies today: 1f
Babies total: 43M/46F = 89
Vag:32M/36F = 68
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Finished!

For an un-usual 3IAR (Mon/Tues/Weds nights), this week's been pretty good! They called me 2 minutes before my alarm went off yesterday "can you come in early?!" it always scares me when DAY shift is calling for help, because seriously, if they have 10 or 12 nurses there already, how do they expect a night staff of 5 MAYBE 6 to handle it? And yet we always do...anyway, that's besides the point.

So after getting ready and across town in rush hour traffic, I finally clocked in about 1800. As I was walking in, I met the couple I had triaged the night before and ruled OUT of labor, in the lobby. Guess the UC's came back! Nobody was expecting them, so I jumped at the chance to take them again. They were really sweet and I had been sad to send them home yesterday morning anyway.

She was a good change from that morning, and I had her admitted, AROM'd (per doc), comfy with a block and all my paperwork done by 1930! Everyone else on night shift was just getting started!! My girl did AMAZING and we had a baby by 2200. Not bad for being 3/100 when she came in and a first baby! Great delivery too. It was quite the waterfall when the head came out, amniotic fluid was shooting up and over the legs, but nobody got wet! Made a nice puddle on the floor though...ha!

Waited on a patient that was called in for like 5 hours...never came. So I finished my recovery, sat for a while, did a traige, was walking her out the door and met another one coming in. The 2nd one was one of the presentations (crying, huffing/puffing, screaming, out of control) that has all the nurses running into the room to catch a baby. Throw on a glove, lay her down on the bed...can't find a cervix anywhere...oh wait, maybe I can feel it...WAY back there.
"Sit on your fists..."
ALMOST can reach it...just a little further...there it is! MAYBE I can get a finger in it...and it reaches half way down my finger.
"Honey...you're a tight one...and maybe 40-50%...yes I know your contractions hurt...how long have you been contracting?"
"Your first contraction was 15 minutes ago? Well let's see what a few more do, maybe your cervix will change."
2 hrs later, among many inappropriate comments from the 15 people in the room (including a friend who I had taken care of during labor...who abrupted 30minutes after my shift ended...), poor girls cervix was still the same and as long as nobody reminded her she was having a contraction she would talk and laugh through them. But as soon as somebody said "ok, breathe through this one, it looks big!", there were tears and labored breathing. I think sometimes "support people" need to be reminded of the meaning of "support." I really felt bad for the poor girl! She was sweet as could be, and I don't think she was convinced she was in labor, I think everyone else freaked out and convinced her she was dying. There were some not-so-very nice comments as she was leaving...

Not back 'till Sunday! Ready to enjoy a nice, rainy, muggy weekend with grass about 5 inches long that's way too wet to mow...

Babies today: 1f
Babies total: 43M/45F = 88
Vag:32M/35F = 67
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

HELLP

Seriously, I have had some sick patients lately! My PIH friend from early yesterday morning that I thought we should deliver ASAP...platelets dropped to 50, livers into the 800's, never got past 2cm. :( Section in the afternoon, then I got to take care of her last night. She felt so much better after she got delivered and her baby is ADORABLE!!!

6hrs postpartum I got a couple quarter sized clots out, increased her main line with some pit in it and hoped they'd go away. Then 45min later, I got a fist sized clot out. 800mcg of rectal cytotec fixed that...no more bleeding!!! Glad we got the bleeding stopped while we could, her platelets were 40 at midnight. Sheesh!

She was a tough IV stick b/c of all her swelling, and so they had put in a 2nd IV in before surgery yesterday. We could use it to draw labs off of...oh my goodness. I think all mag patients should have an extra IV to draw labs off of. It was AMAZING! No searching for a vein, no digging, no extra needles...just pulling off blood into a syringe and then transferring to the vac-containers. I'll do that ANY day!

I'm going on a baby dry-streak again. Time to fix that!!

Night #1

Night #1 after having 5 wonderful nights off (except one night I went in @ 0300 so a nurse could leave early for her vacation)! Nice little recovery...nice little cervidil who actually slept...I swear mine NEVER sleep!....and a "nice" little PIH gal who came in at 0415. Severe Right Upper Quad rent pain/brisk reflexes/Liver enzymes of 400+ and 300+ ("normal" is <30)/3+ class="blsp-spelling-error" id="SPELLING_ERROR_3">mag'd her and then pitted her. Wonder what time she'll get cut? They were the sweetest couple, I would take them back tonight...

Party for 3

Ok, hold the phone...last night...there were THREE nurses on L&D...ALL NIGHT LONG!!! I was a little nervous about it, combined, the 3 of us have about 4 years of experience, two of us are '08 grads, the other an '07 grad. Not that we're not capable nurses...but I know there's lots of stuff I've NEVER done, and if some train wreck walked in we'd be in deep meconium! But...the night was great!

I sent a triage home, there were 3 antes, I took a SROM, there was a cervidil, then after my delivery we had 2 ROL's walk in and then we had the 0730 C/S to get ready, but together we got it done! We were all pretty proud of ourselves. We had 4 nurses at home on call, so that made us feel a lot better, but we didn't' need them! When we were leaving this morning I kept looking around wondering where all the night shift people were...and then remembered that there were only 3 of us!

My delivery last night was a little crazy, she was a multip, SROM, started some pit, got a block, the doc came in when the patient was about 7cm and then hung out in the break room. When the patient was about 9cm and feeling "pushy", the doctor got a call that she'd just had a patient walk in compete and +2 station at a different hospital. What to do? Does she leave my patient and rush and TRY to make the other delivery (that she probably won't make...) and end up probably missing both deliveries, or does she stay with my patient and just tell them to deal with the other patient since she won't make it anyways?

She decided to dash to the other hospital, which ended up being OK. I guess the other patient really wasn't complete, she was only 7cm with a bulging bag, then when her water broke the nurse didn't check her again, thinking she would just be complete. So the doctor made the delivery, which in her words was "poop filled" and then headed back to my hospital. We had our laborist (24-hr in-house OB doc) sitting at the desk ready to catch my baby. I figured it wouldn't take too long, but my gal was 9.5 cm with a lip for a good 45 minutes, with the kid sky high in the pelvis. So we just kinda stood around and waited. She was finally complete about the time her doc got back. So yeah for the doc who made BOTH deliveries, and who told me afterwards that my delivery was 100X smoother than the other one :)

After work I ran from the hospital to the school my mom works at. It's only 5.5 miles, but it has the worst hills EVER!!! I did it in under 44minutes though, after 3 12-hour shifts...

When I woke up this afternoon I was/am exhausted, can't wait to turn out the lights, go to bed and not go back to work 'till Monday!!

Babies today: 1m
Babies total: 43M/44F = 87
Vag:32M/34F = 66
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Quiet Night

I probably just jinxed myself...but last night was so PEACEFUL!!! We had a nurse on call, and probably could have had more if we had really wanted to. We had 2 deliveries, 2 cervidils, 3 ante's and a few random triages that were in and out...and 5 nurses! I had ONE (1) (uno) cervidil all night...when was the last time that happened! It was WONDERFUL!!! Ah...for once I'm not "scared" about going back tonight!

A bunch of us nurses were all talking about different charity or not-so-charity running events that are going around in the area this year, and I think we're going to try to get a group of us together and do some of them. I don't by any means call myself a "runner" but I go out and try to do 4-6 miles a couple times a week. I used to do 5+ miles 6+ times a week in college, but once "life" started, not so much any more. There are several 5k or 10k runs going on that look fun and I would never have guessed that some many of the nurses run. So who knows, maybe it will inspire me to get up off my lazy butt and start really running again.

After all the talk about it at work last night, I thought maybe I should at least go get a little wind after I got home this morning. I knew if I didn't do it as I walked in the door it wouldn't happen 'till a different day. I was planning on 3 miles, and it turned into 6.2. Oh well, it didn't hurt me any I guess.

Gonna go switch the laundry, go to bed, get up and go to my brother's baseball game, then back to work for the 3rd party in a row! Horray...I think :)

One Party Down...Two To Go

When I walked into work I had a brief moment of celebration as to how nice the board looked! NO MAG!! a couple antes, a couple postpartum's, a couple of early recoveries...it was beautiful. Then when I left this morning...no empty rooms. That's what we did last night!

I admitted 5 patients last night, ended up handing a couple of them off because I can't handle 3 active labor patients at the same time all being admitted within an hour of each other. Sorry...

I started off with a post-partum bleeding, family practice delivery who needed suprapubic pressure, but was intact? I don't think so...when we finally got the laborist in and spec'd her they found a bunch of placental fragments and she used 3 sutures to fix labial tears. Reason #283 why I recommend going to an OB for obstetrical cases...

Handed her off when I got 2 ROL's at the same time. Both ended up staying, and of course I balanced them so that I didn't sit down all night. My goodness...I got the one a block, she was comfy, got the other one a block, was 5 and then complete about 10 minutes later and feeling rectal pressure, turned her to her side to wait for the doctor...for 20 minutes. I knew if I turned her we'd have a baby. As I'm holding Mom's legs together listening to my variables down to the 70's with every contraction I hear someone else walk into a room down the hall, then a nurse call out "she's complete and +2". Sorry, I was a little tied up at the moment, so I think some other nurses took care of that one. My doctor walked in and was like "what's going on?" I rolled Mom to her back, he went to check her and you could just see the head crown up. So he's fumbling to get gowned and gloved, thank goodness I had some gloves on, I'm trying to get the foley out, but figure I better at least grab the head while it's sliding on out with a contraction. He's like "it's ok...I got it..." um, not so much, I was holding the head as he's finishing with the gloves. The bed never did get taken apart, nursery made it after the kid was already up on the abdomen with the cord cut...the doc delivered the placenta and walked out in all of 4 minutes...leaving me with a HUGE mess (in the bed of course) to clean up. Oh well, it was quite the smooth delivery I guess. I was a little bummed because if he had waited another 2 or 3 minutes I would have gotten to catch the baby... :(

I start recovery #1 and then go check my other patient...she's 7 with a BBOW, I figured she was going to blow a kid out any second. She was almost complete when I left, thankfully she and her baby behaved during the chaotic night.

About 0530 everything hit the fan, we had 4 or 5 new patients walk in, I took one who was 5cm and then got in the tub and was 7cm, then was almost complete and unblocked as I was leaving. Ah, the craziness of it all.

It doesn't sound so bad, but it was just constant all night, at least for me. Next time, it's someone else's turn! I'm too worn out for it to only have been my 1st night...

Babies today: 1m
Babies total: 42M/44F = 86
Vag:31M/34F = 65
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Thursday Night

So it's technically Sunday morning...and this blog is technically about Thursday night. I've been too busy enjoying my whole TWO NIGHTS off (last) week that it hasn't gotten written 'till now...and the Internet connection has been kinda shaky.

Anyway, the craziness continues at work...it was jus a SMALL cluster on Thursday night, ok, so it was kinda a crummy night all the way around. Walked in and the assignment didn't look too bad other than the fact that there were no empty rooms, not enough nurses...and it stayed that way all night.

The atmosphere was kinda set by the fact that they had just found out that afternoon that one of our extended-stay twin mom's had lost one of her babies. She'd been admitted for several weeks and they kept talking about sending her home but just hadn't ever done it. They'd been doing NST's every 8 hours and after a great NST Wednesday night...the NST on Thursday morning had only one heartbeat. It was really, really sad. This poor mom was a G6P2, had had several stillborns before...it made all of us sick. She was only 33 weeks, so they weren't going to induce her, but she wanted to be in labor so bad. I don't blame her! I'd want my healthy baby outside and with me NOW after something like that. The nurse I talked to yesterday morning said that she went into labor and delivered early yesterday and the alive baby was doing great.

So after that small shock to everyone Thursday night, things went from bad to worse. We had a 31wkr break through mag and deliver, we had a set of vaginal twins who turned into a section after baby B flipped breech, in the middle of the twin section a 29wkr broke through her mag and was 4cm with a cord presentation, the carge nurse went ahead and called in all 3 cervidils who were scheduled even though we had no rooms for them, then they got frustrated when they had to wait in the lobby, our footling breech IUGR twins who were scheduled for a section Friday morning SROM'd...and the doctor decided that they could just wait a couple hours until their section...needless to say we were all ready to go home Friday morning!

This last week has been CRAZY! The poor NICU is overflowing with 23 kids (their usual max is 18), they're starting to have to ship kids to the children's hospital in town just because we don't have room. Labor's overflowing, and it's nothing "normal" it's all crazy stuff that's going on!

I've been counting small favors...like the last 2 nights off!

2 Babies, More Mag, 1 More Night

So after my melt-down post yesterday...I had a mag gal who had been cervidil'd X2, pit all day yesterday and was 5. Then she was complete at 1915 and we had a baby by 2030! Yea! But then again, the baby was only 4#3, so I would HOPE it didn't take too long to push out! Seriously though, more mag? I think at last count (after starting someone else last night) we have 5 patients on mag. That's insane!

Our manager was in helping us 'till 0300 this morning and we had a little chat about an antepartum unit...and those of us from last night NEVER having to work it! Sure, a load of easy ante's is kinda nice every once in a while, but all these pre-terms, mags, etc are too much! I was talking to J on the way home this morning after we called a rapid response on her delivery from last night and she mentioned how nothing was every "low-risk" anymore. Every delivery has some complication or the mom is some kind of sick. Must be something in the water...

So after I got my mag patient all settled down I got a ROL (because I happend to be the only nurse standing at the desk when she walked in) that I got started...and ended up keeping. I've given up waiting for someone to tell me that it's my turn to take a patient. Someone has to take a patient when she walks in, and I seem to be the one standing there most often, so I might as well do it. I feel so bad when these patients walk in and everyone's saying why they shouldn't be the next one up for triage.

So getting her started, still trying to recover my post-partum mag, and trying to beat the computer before it went down for 3 hours for updates...I was scrambling just a little bit. The IA finally said "can someone please help her get her patient started so she can chart?!" Thank goodness for the IA standing up for me! Then everyone was great and helped get an IV, etc, etc.

She delivered unblocked for me at 0630 this morning. G5P4, straight OP, >8#...and intact! Go her! Honestly this is the first un-blocked delivery that I think I've ever done "on my own." I almost caught the kid too, there's not stopping those unblocked mom's from pushing once their complete! The doc just happened to be at the desk watching the strip and walked in just at the right time! Thank goodness...I didn't need that at 0630!

So now it's too bed, then back for yet another playtime in Magland. Sheesh!!

Babies today: 2f
Babies total: 41M/44F = 85
Vag:30M/34F = 64
C/S: 11M10F = 21
Babies 'caught' = 1f

More Of The Same

I'm still tired of antes, mag, preemie's, twins, etc. I got another transfer from out of town who was 4cm/100% and 30wks. Their NICU was full so they sent her to us...our NICU is full (after our 29wk PPROM delivered) and if she deliverers we'll have to ship her baby to the children's hospital. So start some mag, listen to her complain about her foley all night. I would have taken out her foley, but not after the 1st hospital gave her 5L of fluid in 6hrs. Not sure that mag was a good idea after 5L of fluid either...but whatever, her lung sounds stayed clear!

I'm ready for a nice, normal, one-on-one labor patient! No more of this "green" mess! And this was only my 1st scheduled night of 3 this week. I'm regretting going in extra on Monday!

Preemie Land

Seriously, I think we're running a special on pre-mature deliveries at work...plus a special on twins. I think we've had more <37week deliveries and twins (most of the twins being <37weeks) in the last couple weeks than I can remember in a long time! All these 29 week ruptures or pre-term labors or PIH gals. Yikes!

I was just thinking yesterday that I was actually gonna go a whole week without working any extra shifts. That was until my phone rang about 2000 last night. I think my message was something like..."you can have double time, triple time...and free coffee!" There were no empty rooms at one point, a C/S going on, vag twins, 4 extra nurses, 2 or 3 mag patients, my 29week twins contracting and 3cm, and 2 more SROM's on the way...it was a mess!

I wasn't too thrilled on hanging out all night, 'cuz tonight is when my 3IAR (in a row) starts and I'm sure it's gonna be crazy. Miraculously, I think after a couple deliveries, handing over early recoveries, etc they were able to get all the "extra" nurses out of there by about 0200. I left at 0145, made a McDonalds run for everyone still there, and then got home about 0230. Good thing I took a nap yesterday afternoon!

I slept for a couple hours, got stuff cleaned up at my "house sitting house" let the dog out and headed to my OWN BED! I get to enjoy it for a nap today, tomorrow and Thursday, then I'm "babysitting" for the weekend, then work 3 more IRA, then maybe I can relax on my 8-days off. I'd LOVE to get the lawn mowed sometime in the near future before it's 3 feet long, but the way the weather and my days off have lined up, I'm not sure that's gonna happen!

Half A Shift

So I love the nurses that I work with :) One of the other nurses offered to split the shift with me last night so that I could hang out with my little brother and go to California Pizza Kitchen (AMAZING!) and a quick comedy show (actually pretty funny!), then I headed into work at midnight. Even though it was only half a shift, I still wasn't sure it was ever gonna end...I was tired!

No babies :( but I did get the "gold star" for the LONGEST rule out labor...she came in at 2000 and I walked her out the door at 0635 this morning! She wanted to be in labor, her doctor wanted her to be in labor, but after 10 hours...still no real cervical change and miraculously a little Nubian let her sleep. So after a little nap, she went home.

I got a SROM started and all lined up for day shift and did lots of charting. I was READY to go home at 0700. I felt really bad, we had a 29wk gal come in with PPROM (preterm premature rupture of membranes). Start some steroids and start the clock. She'll be hanging out a while...hopefully! I think NICU is a little tight, they don't want a 29 week baby if they can help it!

It was cold and rained all day, I think it's supposed to supposed to do that every single day that I'm off this week, but you know it's supposed to be nice and sunny Tuesday/Wednesday/Thursday! Go figure!