.: the way i see it :.: season of change...

It has truly shifted to fall here in Baltimore... green trees have given way to beautiful shades of amber, gold, and crimson dotting the surrounding mountains. I have loved driving the winding back roads of the Maryland country side just to take advantage of the natural beauty of this region. I feel so blessed.. I love seasons! Not sure how prepared I am for the winter that is sure to follow this mediocre fall weather, but it's coming whether or not I am ready for it! So I am trying to enjoy all that this season has to offer, including the start of the holiday season. Yesterday was Halloween, and it was (albeit rainy and cold) an enjoyable evening and celebration in Charm City (aka B-more). Amanda and I were able to make our way out to the cobblestone streets of Fells Point (my neighborhood) for the festivities last night, and it drew out quite the eclectic crowd! We mainly enjoyed the opportunity to people-watch, as there were plenty of costumes to gawk at.... people never cease to amaze me! I dressed up as a ladybug and Amanda as a bumble bee - we were quite the twosome, and were proud of how classy and cute our costumes turned out to be! My high heels were not the most favorable shoes for the cobblestone streets however... I was grateful that I didn't injure myself as a result of walking the streets - I'm positive that there was some unfortunate girl who woke up with an ankle swollen two sizes this morning. We called it an early night, after a very long week and I was very appreciative of the extra time to sleep - the only reason I like the end of Daylight Savings Time! Now I have early darkness to look forward too... it's only 5 pm as I am writing this, and it's already dark outside! Oh winter, how I loathe thee..... at least I have holidays to look forward to! Only a few more weeks and I'll be on a plane back to Utah for Thanksgiving... I can't wait!! Maybe get some snowboarding in if I'm lucky.... but until then, I have plenty to focus on and worry about with school, which has been keeping me very busy over the past couple weeks! I'm sure you're eager to hear about my recent adventures, so without any further adieu....

The past couple weeks have been quite the whirlwind, to say the least! I'm sure you're eager to hear about how my transition has been into the Labor & Delivery clinical... I really don't even know where to begin! We started our new rotation last Thursday, and I remember the feelings of anxiousness and nervousness as I walked onto the unit for the first time... I had been in Psych for 7 weeks, never seeing an IV stand or Foley catheter, so imagine my nervousness when our instructor informed us that we needed to be prepared for these skills when we were assigned patients on Friday! I was hoping that I would remember the steps and how to maintain a sterile field... just picturing opening up a catheter kit and then having my patient kick it off the bed in the middle of a contraction. Okay, so I knew that probably wouldn't happen, but I was still picturing the worst. The field of L&D seems so unknown to me, and I was unsure of how my presence in the room would affect the experience for the new mother and her family, and I felt a load of pressure on me! Our instructor gave us clear instructions on what to expect and how we needed to prepare in order to participate in nursing care of our laboring patients, and I was a tad bit overwhelmed. I think not having a clear understanding of the labor process really affected my outlook, so I made sure to study that night in order to better prepare for what was to come on Friday morning. Unfortunately... nothing in a book can adequately depict the environment that you're thrown into as a nurse for a laboring patient! So, as we walked into the unit on Friday, I was caught a bit off-guard as our instructor threw a few of us into our patient's rooms first thing! No orientation? No warm-up period? I got report on my patient - gravida 1, parity 0000 (her first pregnancy) who had gone into labor the day before and had an epidural started early that morning so she was resting comfortably. I walked into the darkened room and introduced myself... the girl was sleeping with her mother sitting at her side and the baby's father sleeping on the couch. I sat off to the side, quietly observing the monitors and the patterns of contractions and the fetal heart rate (FHR) on the print-out strip, trying to apply the material I had looked at the night before to the real-life scenario playing out right in front of me. For a while, I sat in pure awe - medical technology never ceases to amaze me. I could watch a computer monitor and follow the tracing of contractions and how it affected the baby's heart rate. Incredible. Such simple things... but it made me realize how grateful I am to live in a country where such technology is so standard. I spent the morning monitoring my patient and her baby, and was grateful that the nurse had time to share some insight into the foreign language of L&D. Thankfully (for me) my patient was progressing through her labor quite slowly, and so there weren't many changes to her status other than the constant progression of her cervical dilation and effacement. I was hoping for a delivery, but was a tad grateful that I had another week to better prepare myself for the delivery atmosphere. One of the girls in my group was able to participate in a delivery that day, and hearing about her experience gave me a better understanding of what to expect and how to be of assistance in that situation. However, as much as I read up and prepared for the scenario in which I would undoubtedly be witness to, nothing can prepare better than first-hand experience. With that said, I'm sure you can guess where this is going... :] This past Thursday, I was put into my patient's room, her third pregnancy and she was 6 cm dilated, 80% effaced. Her husband and mother were in the room, and I introduced myself and learned that they were an Orthodox Jewish family, which I was completely unfamiliar with, when it comes to traditional expectations. I tried to be as supportive as possible, but gave them their privacy to prepare for the arrival of their son/daughter - they had left it as a surprise! I stood outside at the nurse's station, monitoring the FHR and contraction pattern from the screens, and had the opportunity to observe the staff as they busied themselves about the unit. As I stood there, amidst the flurry of nurses and anesthesiologists and OB physicians, I started to picture myself in that environment - and I really felt a sense of belonging. I really enjoy the atmosphere of L&D, and the role that the nurse plays in the patient care, so much so that I am giving it serious consideration as a possible field to work in! Getting a master's degree and becoming a Certified Nurse Midwife... I could really enjoy that position and responsibility. I'm still keeping my eyes and options open, but that is one path I NEVER expected to consider pursuing. So I'll keep you updated on that! But back to my patient... unfortunately, my patient's husband was a bit on the over-involved side, and every time I came in the room he pressured me for information about ever flashing light and beeping monitor, wondering if there was anything wrong with his wife or the baby. I kept reassuring him that everything was progressing as it should and that there was no reason to be concerned, and he was grateful for that. I found out later that one of the physicians had told him that the baby should be delivered by 5 or 6 in the morning, and now it was closing in on 11, so he was worried that the labor was taking longer than it should. Thankfully my instructor was there to provide some reassurance and inform him that he had no reason to worry, that baby and mom were doing just fine. I was grateful for that! Because her labor was not progressing as they would like, the doctors started her on Pitocin and hoped that her contractions would develop into a more regular pattern (they were only 5-7 minutes apart, lasting 50-90 seconds) and decided to grab some food while I was waiting. I didn't have much time to wait... I heard that there was some commotion coming from my room, and I rushed back to my patient's side (literally - her husband was waiting outside) and helped her through the (relatively) quick delivery of her son! It was a "beautiful" experience... it all happened so quickly (she delivered about 20 minutes after she reached full dilation) and I was there, a part of the entire process. Her baby was delivered, 8 lbs 8 oz with a full head of hair and some mighty powerful lungs! He wouldn't stop wailing for about 45 minutes after he was delivered, and he made it very difficult for us to clean him up and administer his medications. But I did it - I gave my first shot and took his vitals and was able to do a quick assessment before handing him back over to mom. It was a rush - it took me a while to really process the entire experience, but I felt so grateful to have been a part of it. Words can't adequately describe the emotion and feeling of being present for the delivery of a new spirit into this world... I can't imagine what it will be like when I have children of my own! All in all, it was a fantastic first birthing experience, and I am really interested in the option of becoming a nurse midwife... we'll see how things go over the next few weeks! As for Friday, without going into a long, detailed description of my clinical day, I will say that the OB wing of the hospital is never boring... I spent the morning in the NICU, assisting with the care of the premature infants and those with congenital problems - I have definitely ruled that unit out! The little babies, as cute as they were, frighten me.. any little change in their status or care can have such dramatic effects on their health. It is a very quiet and controlled environment... I like the action of the L&D unit. Speaking of... as I was returning to the unit from the NICU, I was rushed into the first room to help care for a woman who had delivered her baby in the hallway after arriving on the ambulance! The paramedics stood by in a state of shock after what they had just witnessed, and I pushed through to help care for the baby. The doctors and nurses worked to treat the mom, and I focused on baby. Thankfully the little baby girl was healthy and happy - 8lbs 10oz! I guess she was just ready to see the world... couldn't wait until her due date in a couple weeks! Mom said it was her fourth child, and she had just started labor a few hours earlier. Wouldn't that be nice... one minute you're waking up for the day, next you're arriving at the hospital for the delivery of your daughter! It was an exciting mash of people in and out of the room, everything in order and treated as need be treated. I was able to give the baby girl her meds and assess her vitals before handing her back over to a somewhat disillusioned mom... I think she was still in a state of shock. haha. In the end, mom and baby were just fine, and I left them to rest after a very exhausting morning. What a couple days! Never a truly dull moment... even in the quiet, the constant FHR monitor sounds of the baby's heart beat remind you of what you're caring for, and it is a special role to play. We'll see how the coming weeks turn out... I feel lucky to have been a part of two deliveries, as some girls in my group haven't seen one yet! I'm hoping to be able to follow a patient to the OR for a C-section, but I don't know if that will happen... we haven't had a patient go into the OR yet during our clinical hours. I still have some time left though! It may be November, but we are only a couple weeks into our 6-week OB rotation (three of which will be spent in postpartum). I can only imagine what the coming weeks have in store for me...

Wow. This has been quite the entry! I guess I am just really excited about the experiences that I've had over the past couple weeks... I feel like I'm still processing what I was a part of. So much left to learn! I feel like I've only reached the tip of the iceberg... but I'm loving the progression and acquisition of knowledge. It is a fascinating environment, and I'm realizing more and more how much I enjoy being a part of a specialized focus, so I'm trying to learn more about this field and my available options and opportunities. I will make sure to keep you updated! But for now, I have to get back to my Pharm studying... test #3 this week, and then I have to write up my L&D care plan for my patient... it's going to be a LONG and busy week... but I can't begin to tell you how grateful I am that I am not dreading the work I will have to contribute! How pleasantly reassuring it is to find my niche, and discover my individuality and independence in this oftentimes overwhelming environment. I am just grateful that I have been blessed with a passion for this type of service, and look forward to my future... it won't be long now... 9 more months and I'll be an RN! And with that, I'll leave you until next time.. happy start of the holiday season to you all!!