Saturday, October 24, 2009

12 Out Of 14

Just finished up working 12 shifts in 14 nights...not something that I would recommend doing again for a long time to me or anyone else. That's a lot of work in a not-very-long amount of time!! We have been so busy that the norm anymore is to have no empty room and have to put the elective inductions on hold just because we don't have anywhere to put them!!

I could have easily worked both of the nights that I didn't if I had wanted to...but I just couldn't knowing that the first time it would have been 9 nights in a row and the second time would have been after I had stayed over from night shift 'till noon the next day and couldn't force myself to go back at 1900 that night. everyone else seeing a big increase in baby #'s for October?! Our thing is too it's not just "babies" it's pre-term stuff and antepartums filling up the board! A complete previa at somewhere around 30wks...that's gonna hold a bed for as long as possible, kidney stones take a bed for a couple days, all this H1N1 stuff floating around...never a dull moment!

We were even having babies in the hallway this week!! One night the phone rang about 1940 and I picked it up. I hear "This is the ED, we're bringing you a patient in active labor and we need the laborist to meet us in the room." They say that all the time and lots of times the patient ends up being like 10wks pregnant or something. So I asked when her EDC was, who her doctor was, etc. The freaking-out-lady on the other end says "No, no, no! Listen to me, we need the laborist down here." I asked if the patient was delivering and the lady said "yes" and hung up the phone! So someone when to go grab our laborist who was in the middle of surgery and I flew over to the ED with a precip pack and asked the nurses where the delivering lady was. They said "oh, they just took her upstairs." Hold it...I thought she was delivering and they needed the laborist stat...

I met the laborist, the gurney with a grunting patient on it, and an ED tech in the hallway on the way to L&D. The patient kept saying "I need to push..." and when we rolled through the door of the room we heard the screaming under the sheets. Sure enough...welcome to the world baby! Mom was a grandmultip and baby's UDS came back positive :( Sad story, but sure added some excitement to our evening...we were simply counting our blessings that the baby didn't come out in the elevator on the way up from the ED! The ED told us they looked under the sheets and didn't see a baby so they thought they should bring her up to us.

For as much as I've worked, I don't even really feel like I've had that many babies! I had 4 this week...and I thought that was impressive!

1st one was a primip who acted about 10 years younger than she really was. If your mom is talking baby talk to you...are your really ready to have your own baby?! She was unblocked because "you know epidurals paralyze you...". When I first checked her I could have sworn she was complete, so called the doc, put her up in stirrups and pushed twice....then when she finally let me really feel...nope, she was more like 8. So out of stirrups and to her side. Thank goodness by the time the doc got there she was more like a rim that slid back pretty easily. The delivery was a little chaotic, she pulled her IV out twice while we were pushing, wouldn't listen to the doctor, wouldn't push...but baby finally (somehow) came out and screamed right along with mom. Healthy mom, healthy baby, and mom could walk to the bathroom on her own...fine with me!!

Another fun baby that same night, mom came in and did great, got her epidural about 7cm, doctor was there and AROM'd her and she pushed about 30 minutes. Thankfully it happened to be a little slower moment in the shift and before mom got her block for about 2hrs I got to pretty much sit in the room with her and coach her through it. The dad asked me afterwards "do you always get to sit in the room with the patients like that? That is so cool!" I wish I DID have the chance to do that with everyone!!

My last night of my stretch was the best one, even though even before I got to work that night I had decided in my head that I was quite done with work for a few days and was not too excited about going back. When I walked in the door they told me that I was going to need to take care of a recovery who wasn't moved because "she hadn't eaten yet." Her recovery was over, but since she was still working on her dinner tray they hadn't gotten her up to the bathroom yet. I'll be honest...the recovery/up to the bathroom/moving process is my least favorite thing about L&D. soon as day shift left I went in, got her up to the bathroom and moved her. Now why couldn't have have been done before I got there? I don't understand.

So after moving my recovery the patients keep on rolling in. Took a non-contracting SROM back to her room and got her settled, just as my cervidil showed up. Loved both couples!! Cervidil was a couple so excited about getting to have their first baby. Dad was just finishing up his residency and it was so nice to have someone in the room who knew how to help if I needed it! An extra set of hands when I was starting the IV, he knew how to silence an IV pump...but was so non-threatening about it. Other couple was their 2nd baby and had lots of family in the room all night.

I don't know where they ordered the batch of cervidil that we had that night...but it was doubly potent for both of them! I put it in and both of them took off! About 5min after I put the cervidil in the "scheduled" cervidil she was contracting every 1-2". I got both of them epidurals before midnight and ended up pulling both cervidils and both labored on their own. An hour after I pulled the scheduled cervidil she was still contracting every minute and I ended up terbing her. I NEVER terb cervidils!!! I figured the doc would be ticked in the morning. My SROM girl delivered right at shift change and I handed her off to a day shift nurse right after baby came out. I went in to say goodbye to my other patient and just for curiosity sake I checked her. She was 7! How to do you get to 7 after I terb you for hyperstim!!!

I begged to stay and deliver her and somehow it got approved, so I got to stay! When the doctor came around about 0745 she was almost complete..and delivered within an hour!! I was so excited and it was a great delivery. Both mom and dad said Thank You over and over for staying over my shift for the delivery. That makes it even better. Great ending to a LOT of work! Isn't that the way it was supposed to be?!

Babies today: 2f2m
Babies total: 65M/80F = 145
Vag:49M/60F = 109
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

Wednesday, October 14, 2009

Still Here...

Promise I haven't fallen off the face of the earth! More like into the crater of work! Even though it's the middle of October we're still busting at the seams and somehow managing to survive and laugh about it.

Several fun babies lately...all girls, go figure!!

There were moments that I felt like and idiot, a bad nurse and almost shed a few tears on the job...but then I look back on that night and think of all the things I learned and all the things I did that I didn't know I new how to do! I learned all about doing a D&C in our OB OR's...something I'd never done. How to do a sterile vag prep (I've talked to 1 nurse on the floor who'd ever had to do that...). I learned that I could put a scalp lead on someone who was 1/60/posterior when I had heart tones in the 50's (even the doctor was impressed at that!)...and I learned that I could stand up to a doctor and get what I needed for a patient. I also learned that I have some of the BEST co-workers ever. They're always there when I need them, they always are willing to help me out and I love them!! We just got 2 new nurses coming off orientation on day shift and they said they've already noticed a big difference between days and nights and how supportive night shift is of one another and how it's a team approach instead of everyone nurse for herself. I like that :)

I almost got to catch a baby the other night, I was all excited! But the doctor was in the lounge so I made sure she made it. You gotta love those multips who push once and all of a sudden the baby's crowning :)

Babies today: 4f
Babies total: 63M/78F = 141
Vag:47M/58F = 105
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m