Birthday Nurse

I had the best patient today that I've had in a long time. It was a great way to come back to work after a few days off, and a good vacation in Branson. J and I were slotted for 2 inductions. One multip pit induction at 0700 and another cervidal from the night before. The board was crazy (what's new...) and there was no way we were gonna be able to handle both of them, so J took the cervidal and I took the induction. I was pretty proud of myself overall for the day, much better than the last epidsode I had at work. I love the doc that we had, and the couple was as nice as could be. Lots of fun, great at interacting with eachother and with me. They were wide open for anything and when baby was born at 1109 everyone was surprised! One of my favorite things is when the parents don't find out the sex of the baby. It makes it awkward calling the baby "it" all day long, but it's so fun to see the faces of Mom and Dad when they find out if it's a boy or a girl a...

I love reading other people's blogs, I think it's cool to be able to read what's going on in other people's lives and think that these stories are really happening...right now! I follow most of the blogs listed in my Blog Roll, and I just added a spot to show the people that follow my blog and read my stories! So, if you like reading about my adventures, let me know and add yourself to the "Follower's List"!

So yesterday was the first time I really wondered if I'm ever going to be a Labor nurse like the nurses that I look up to. I worked with N yesterday, ' cuz I needed an extra day. The patient I walked into at change of shift was about 1 1/2 hours into pushing, and trust me, that's the worst time to switch patients. The first thing you see of them is them up in stirrups and you're supposed to go over and introduce yourself? Right...I wasn't too convinced that this gal was gonna be a great pusher, and we pushed and pushed in this position and that position for another hour and a half. I wasn't seeing much progress and I think we were both getting a little frustrated and poor girl was getting tired. Then Dr. M walked in and somehow put his hands on the head and made it happen. I love Dr. M, he did the first delivery I ever saw and I've always just thought he was a good doc. N came into the delivery, but she scrubbed in to help Dr. M so I really was kinda doin...

I was really worried that Sunday was going to be like Saturday with not much action. I was half wrong. J and I got a really nice unblocked multip who had SROM'd at like 0130, and was not 5-6cm. She went really fast and we had a cute baby boy at 0805. She did so good, and had such good control. I want to be like that when I have a baby! I see the other side of it too, the people who try to do it naturally and have absolutely NO control and are all over the bed and saying lots of choice 4-letter words. Those patients grind on my last nerve and I wish it could be a nurses' order to get an epidural. As we were walking back from taking our first patient over to postpartum I was thinking it was gonna be a long rest of the day b/c there weren't any more patients for us to take. I went into the galley to get a cup of coffee and get a page that there's a patient at the end of the ramp needing a wheelchair. 30 minutes later we had another baby. That's my kind of delivery...

I think today was the first day since I've been a "Real Nurse" that I haven't had any babies :( That makes me sad! I got really close though, we left a girl almost complete and he delivered at 2006 (yes I called back to check on her about 2130...I'm a sucker!). It was the weekend, so pretty quiet. there were all of 3 nurses on today plus two orientees ...ha! J and I had 3 ante's and we sent them out the door and then got another triage with "vaginal pain" and sent her home in exactly an hour. We could have sent her home earlier, but it's protocol that they have to be o n the monitor for at least an hour, so we took that and no more. The doctor listened to what I told him about what her s/s and he said "well, nothing I can do about it. Send her home." Seriously, you're pregnant...you're gonna have a lot more "vaginal pain" pushing that baby out than you are right now... We had an 18yo prime walk in with SROM , thick mec...

So J threatened to take me off orientation today after 2 deliveries that I did pretty much on my own. I guess that's a good thing, but more than a little scary too. She said "you don't even need me anymore!" But that is so far from true. The moment I get put on my own something bad is gonna go down and then I'll be freaked out forever. Yesterday we had a leftover cervidil from the night before, and then she didn't change so we put in another cervidil "just stick it on your fingers and shove it up somewhere high" were my insertion instructions... haha ! Anyway, this primip gives up after 1 1/2 cervidils , so she ended up being a section. Jamie had started another induction in another room, so I was doing the cervidil pretty much on my own, but then I got another nurse to go back to the OR with me. So circulation and then a section recovery. I ended my day with a nice little R/O rupture that I ticked off when I told her that she wasn't rupture...

When I first started nursing I kinda thought that epidurals really weren't that big of a thing, and I always told myself in the back of my head that they were kinda the "easy" way out. My mom never had one with any of us 3 kids, and I figured that they were " ok " but you could really do the whole process without one...I'm starting to change my tune big time. After J and I got report on our cervidal from last night, we quickly did a precip delivery in another room at 0731, and then I promptly resumed care of the gal we originally had and t kinda stayed that way for the rest of the day. J had to leave at one, and came in a few times to help me out, like during the 7-minute decel after a hyperstim on 5mu/pit and when I couldn't find heart tones, but other than that, I did most of it! When we took over care, patient was 1/20/-3 and had "No epidural!" on her chart. Great...0645 is too early in the morning to see that. So when I started pit and...

I can think of fewer cooler things than watching a set of twins born vaginally...except for one of them being born vaginally breech. I got to see it today...and it was awesome! There's something out of this world about watching one baby be born...but two? And one coming out with it's butt first...that just doesn't happen! There were 14 people in the OR (where all twins are born, just in case we have to crash into a section): mom, dad, 2 nursery nurses, the Neonatal Nurse Pract ., 2 scrub techs, 2 nurses, 2 docs, a pre -med student, a CRNA and another nurse. Then the two babies. That's a big birthday party...in a not very big room! It was way cool though. Baby "A" had always been vertex. On the first scan this morning she was still head down, but "B" was almost transverse, but slightly breech with her butt down. Baby "A" came out in about 1/2 pushes and was way fine. Then "B" didn't flip around to easily. Her bag hadn't r...

I guess when you walk into work during a thunder storm that's been going on all night and see absolutely no green (ante) names on the board and every room has a red (labor) name...you know it's gonna be busy. And when you see that one of the room's has twins and there's another set of twins scheduled for a C/S you know you're gonna have lots of babies before the day shift goes home! I only got one of the 17 babies, but once again, I did it all by myself...almost. Even more than Friday. It was a VBAC which was the first of those I've done. It doesn't really change anything, except that you're m ore careful with how much Pit they get and you almost always get an IUPC so you don't hyper- stim . I got to FEEL a cervix change, from a very tight 2 to complete over a full day. Another multip who went fast at the end, but when she was till only about 5.5 at 1700, I was positive we weren't gonna meet the baby. But at 1751...here comes baby! I was po...

Friday was my day to work with my "other" nurse. I think it's been really good for me to have two main nurses that will let me work with them. J teaches me a ton every time I work with her, and then N makes me go out and do it on my own...and I ususally surprise myself with the confidence I come away with. Friday we had a carryover induction/cervidal from the night before. This was her second baby, and she was bound and determined she didn't need an epidural b/c she hadn't gotten one 18months ago with her first baby 'till she was 9cm, and by that time it didn't really help her. She was about 3 when I came on, and the doc came over and was denying any pain. Then the doc came over and broke her water...and then it started hurting. I figured it was gonna be a long day, especially after we started Pit and they weren't just "natural" contractions anymore. I figured I would be spending the bulk of the day in by her bed helping her through it. All t...

When I got to work on Tuesday I checked out how many babies we had at the hospital in the month of August...324! That's a lot of babies! Yesterday J and I did c/s...3 of them to be exact while the rest of the floor was completely full...maybe a good day to be in the back! When I left yesterday we'd had 13 babies just on day shift. Nurses get worn out after too many days like that! So I got to circulate my first c/s almost by myself...of course J was there, so I kinda got to do it on my own...right? I must say, my least favorite part of delivery is the cleaning the mom up afterwards, and it seems like there's lots of that with a c/s. You have to clean them up in the OR, and then again before they leave recovery. There's just lots of rolling and turning and wiping and it's just not my favorite thing to do. Oh well, we had some great families to work with. I like it when the patients are also nurses, because they are fun to talk to and they relate to what I'm doin...

Whenever I tell someone that I work in L&D they 8/10 say "Oh, you're a BABY nurse!" Wrong. I am not really a baby nurse, I am a "mommy" nurse. True, lots of what we do depend on the baby, and until the baby is actually "outside" we pay lots of attention to Baby, and we make lots of decisions dependent on Baby...but, in the long run, we are the nurses that take care of the MOMMY. Lucky for us, the hospital has found it beneficial to hire an entire set of nurses that specifically take care of Baby once it is in the big, bad outside world. Well when new L&D nurses start on the floor, the people in charge have decided that we should all spend a day working with the Admit nurses from the nursery to learn what to do if in fact one of the "baby nurses" doesn't make it to our delivery. My hospital is the only hospital that I have found that is cool enough, safe enough, smart enough, etc to require a NICU nurse to come to all deliveries...

So I got a little more taste today of what it was like to be "on my own." I felt pretty independent, with someone right there if I needed anything, but the nurse that I worked with (it was J's day off) was awesome about being there when I needed her, but otherwise saying "let me know if you need anything!" I did a PIH eval almost totally on my own, 2 recoveries really on my own, and I got to do a lot of a labor with minimal assistance. Well, probably more assistance than I realized, but I really did feel like it was "my" patient. I'm sure that in a few months I'll be wishing that I had someone to help me and check up on me, but right now, I'm kinda enjoying the somewhat-independence. All then nurses are great at encouraging me about everything, but N is great about saying "see, you know how to do this." "You know more than you think you do." I need to hear that, and hearing if from more than one person is what really s...

So I really am still here...just been so exhausted this is the first time I've taken time to sit down and think about everything that's happened. Last week we did more ante's...but after Wednesday...we're done with them! It all went crazy on Tuesday, when we walked in and ended up taking a 35.4 weeker over to the main OR to take out her appendix. She had this " excruciating " pain in her abdomen that wouldn't go away, and her WBC count was 21, so after a bunch of surgery consults we roller her, a big 'ole baby monitor cabinet and a c-section kit (just in case ) over to the main hospital for an open appy . Usually they can just do it laproscopicaly , but since she was more than 20 wks pregnant, they actually had to cut her open. So J and I had to sit over there for the entire hour case and watch the baby's heart rate. It was cool though, they didn't give her general anes because that wouldn't have been good for baby, so they just did ...

So Friday we got a little comic relief from my new favorite patient. We had 2 "custodial" ante patients who are in for the long haul, plus an induction who wasn't on the books, then a couple triage's later in the afternoon. Had an great vag delivery which kinda made up for the mess on Wednesday. The Mom and FOB from the fetal demise on Wednesday came over to see us before we left for the evening and brought over handwritten thank you cards. That really meant a lot to me. I didn't know what to say to them on Wednesday, but they were grateful for what I did. If I could do anything to make their loss just a little easier, and helped give them some memories of their baby boy, then I did what I needed to. Anyway, so this patient comes in because when she was at the office her doctor told her she was dilated to one and she was a scheduled for a repeat c/s ' cuz the baby was breech so she didn't want her to go into labor. Anyway, so we get her all settled ...

I've been thinking a lot about our fetal demise yesterday. This wasn't my first demise that I've helped with, but it's the first one that has been anywhere near term, and the first one that was actually considered alive at delivery and then died later. I guess the technical term is "expired" but that to me sounds like a gallon of milk being past it's expiration date. This is a baby, not a gallon of milk. When Mom and FOB walked in yesterday it just hits you "THIS ISN'T FAIR!" Mom was only 21, and her first baby and she looked so young and innocent, and yet so grown up and calm and collected. I know when she walked in she was still denying that her baby wasn't going to make it and she had this secret hope inside that everything was going to be ok . When we asked her the typical "why are you have a primary c/s" question, she didn't say it was because the baby was breech, or that the baby was going to die. She said "becaus...

I am way glad that I don't have to work tomorrow. After today, my head is spinning and I need some time to sit and think though everything that I learned and absorbed and experienced today. I told J today that I don't need anything else on orientation , because in the last 2 days, we have done everything. We did ante's and a vag delivery/recovery yesterday, we did a scheduled section today, and then we did a non-scheduled section for a fetal demise that totally just finished off my day today. I should have known that today was gonna be crazy. I thought J and I had gotten everything lined up to do ante's for a while so that was totally what I was expecting when I walked in, but no, we were scheduled for the 0900 c/s. That's cool too, I really don't HATE doing much of anything around there, I need practice at it all. So we got our little primip ready and as we're getting ready to walk back, the doc calls us from the main OR and says that his 0730 case got b...

So I knew even before I started orientation that there are 3 basic parts to being a labor nurse: antepartum patients, labor patients, and C/S. Of those three, I'll take anything that gets me at least 1 delivery on my shift, but I'd much rather have a labor patient all day and end with a vag delivery than do a scheduled C/S, and I'd rather do ANY of those than do antepartum patients. Not that it's the patients that I mind, but come on, if I wanted to do antepartums I'd work on MedSurg or something. It just doesn't seem any different to me than sitting around and doing NST's all day. Some nurses love it, and I give them 3903 props for that, because I don't have that kind of patience. I love labor because something's always going on, there's just enough adrenaline to keep the whole 12-hours interesting, most of the time. Anyways, so today was my first day with J and for some reason nobody remembered that, so she got 3 ante patients. Bummer.....

How uncreative of a title is that...but at the moment that's all I can think of, so I'm sticking with it. I don't know why I'm so exhausted, but I'm getting ready to lay down and take a nap that I've been thinking about all day. I think I may die when I actually have to work a 12 next week...maybe I should try getting some sleep the night before and see what happens. I worked with a different nurse since J wasn't there today, which was totally ok but I'm ready to work with J next week. I really enjoy working with N though, she says it like it is and she's great at making me feel like I'm the one taking care of the patient, not just standing in the shadows. I was more than a little bummed and worried about how the day was gonna go when things didn't start off too hot with 2 missed IV sticks. The first one was totally crazy and bled fine until I tried to draw labs, then it clotted or something and I couldn't even run the fluids though it. ...

***Forwarning...I tend to ramble when I type, so my feelings won't be hurt if you just skim the blog and read the interesting parts. Happy reading!*** To make a long story short...today marked the beginning of the rest of my life...the rest of my life that I've been waiting the last 22 years for. I guess I'm officially still on "orientation" until the end of tomorrow, but today was my first shift on the floor as an official NURSE! Not just a nurse, but a Labor & Delivery nurse...on the same floor of the same hospital where I was born. That's kinda a cool feeling. The nurses that have been there since before I was born don't like it when I mention to them that they could have been my mom's labor nurse, and now I'm coming back to work with them, but they let me hang around anyways :) I just graduated from nursing school this past May, and this has truly been the longest summer of my life. I didn't pass my state boards the first time I took th...