But I can’t get ahead of myself… I have to stay focused and on-task while I am here in Denver. It’s been a rough couple weeks, trying to balance my free-time during the day with sleep… night shifts, as much as I enjoy them, have really taken a toll on my body. I had gotten into a nice rhythm, but then I had 8 days off (because my preceptor had scheduled herself a week-long break) and so it really messed up my schedule. I took that time to help Meghan move up to her new home in the mountains… it was a long weekend – packing, driving, unpacking, organizing – but her new house is lovely and in a great little rustic mountain neighborhood near Winter Park. I’m planning a couple more trips up there to visit before I leave Denver. After returning to Denver, I moved into Meghan’s grandmother’s home (she has a nice little townhouse in an senior housing complex) and it’s been a delightful treat spending time with Dorothy (when I’m actually awake). She is a sharp 82-year-old, and she is gone most of the day for lunch dates, card games, and volunteering at one of the local hospitals. What a little spit-fire too… I swear she has more spunk than me! She is so sweet, and I appreciate her willingness to let me stay here for a few weeks.
As for my time in the hospital, nights are rarely quiet on our unit… we are the “high risk” L&D unit, but we also take care of “emergent” issues with pregnant women, so we deal with a wide spectrum of problems… including the middle-of-the-night spontaneous labors that result in precipitate deliveries. Exciting yes… definitely keeps me on my toes! I’ve worked another 4 nights (in a row, no less) since my last post, and I feel quite grateful to have seen a wide-variety of patients – it has made me much more comfortable and confident in my role and responsibility, and I feel much more prepared to work on a labor unit later this year. I’m hoping to have my own patient assignment at some point this week (I work tomorrow night and Thursday night), or at least have a little more independence from my preceptor in managing the patient care. We’ll see how that works out… I’m a little nervous, but I need to have this experience as a student before I enter the workplace as a licensed RN. I’ll keep you updated with how things go…
I’m sure you’re curious as to what has happened the past week, and I do have some stories to share! I’ll try to keep it brief…
Thursday Night
Miriam and I were assigned a 32 y/o patient, having her second child. In her first delivery experience, she pushed for 2.5 hours and the baby did not come down, so they had to do a C-section. This time, she was determined to have a delivery, and we have to monitor these patients closely to ensure that they don’t have a uterine rupture (tissues are weaker after they heal because of scar tissue). She was doing just fine, and baby was descending quite nicely with her contractions… then we finally reached the point for her to start pushing, and because of her epidural, she wasn’t feeling her contractions, and we had to coach her through each push. Well… baby was a bit impatient. As the doctors were gowning up for delivery, the little guy popped his head out for a very dramatic entrance! It caught us all off-guard, and the nurses had to scramble to help the doctors deliver the baby. Looking back at the whole situation, it was quite funny… in the moment, however, I had never been told what to do in that situation, soooo I was definitely in a bit of shock. But all was well – mom and baby were just fine. As we monitored her afterwards, however, we noticed her temperature spiking upwards of 103-104 degrees… so we had to start her on an antibiotic drip for chorioamnionitis (an infection). It’s not at all uncommon for that to happen, so we just continued to assess her regularly. Our next delivery happened in triage… a precipitate (labor à delivery happens in less than 3 hours) and thankfully mom and baby were happy and healthy, although mom was a bit “mad” at her new baby boy for coming so quickly… she didn’t have time for an epidural, and was not prepared for the pain that she unfortunately had to endure. But at least it was over quickly! There were a couple more patients in triage for observation, and I overheard that one 22 y/o patient had a BMI of 49… yes, 49. For those who are not aware, BMI for women should be below 26… above 30 is overweight, and above 35 is considered obese. 49? That is just a whole new degree of “morbidly obese” – with so many possible/probable complications... I didn’t have the opportunity to meet with her, but I hope the nurse who did gave her some educational information on the multiple risks associated with her health status – for both her and her baby. Scary.
Friday Night
Our patient was admitted to our unit because of her uncontrolled diabetes… she loves her carbs, and apparently doesn’t adequately correct with insulin. So she was put on an insulin drip while under our care, requiring us to check her blood sugar every hour and adjust her insulin accordingly. She was very sweet, and unfortunately, her labor process was much longer than she had hoped (her last child was delivered 11 years prior, so she was essentially a “primip” – first time NSVD, “normal spontaneous vaginal delivery”). We were not present for her actual delivery, but we did take care of her throughout the night. Thankfully having checks every hour kept me busy – that’s the only thing that helps keep me awake! I need to be walking around, engaged in some sort of task to keep my mind going. We helped out with two other patients in labor, and unfortunately one of those patients was at 24 weeks (the youngest gestational age that can be delivered and have a chance at survival) and had to have a stat c-section because her membranes ruptured and baby’s heart tones took a turn for the worse. Last I heard baby was alive and getting stronger, finding the will to live in the NICU. So tiny, so precious. What a special little spirit.
Saturday Night
Goodness… Saturday night was rough. It felt like nothing went “right” – each problem we had was made worse, and resulted in a crash c-sec. Our patient was a 16-year-old from Burma who spoke very little English, and unfortunately neither her husband (yes, husband) nor mother spoke any to help us out. So we had to use the interpreter phone service (we talk to the interpreter through one headset, then the interpreter communicates to the patient what we have said through another headset… makes a difficult situation even more complicated). She refused all pain medication, despite repeated “offers” from the doctors and anesthesiologist (which I was not happy with, to say the least). Her contractions were getting stronger, intensifying her pain dramatically, and she was not dilating quickly at all (hmmm… wonder why). So, at about 6 cm, she finally consented to an epidural. Well, we had to talk with her via the translator phone (which I was lucky enough to handle) and try to communicate how she had to sit for the epidural. She could not comprehend our directions… and on top of it, each contraction she had made her squirm, and another important piece to the placement of the epidural requires that the patient remain completely still (which is near-impossible for a teenage patient who has waited until she is in the later stages of labor to have this procedure done). The anesthesiologist tried… and tried… and tried… finally realizing that the girl had scoliosis (her spine was not straight) which probably explained why she couldn’t get into proper position. All in all, it took an hour and a half, and two doses of Fentanyl, to get her relaxed enough to place the epidural (a miracle, if you ask me). But… of course, nothing could go smoothly… just a few minutes later, her baby’s heart tones dropped to 60 (a VERY bad sign, considering that baby’s HR needs to be between 120-160) and we turned her back and forth to try to improve baby’s condition… nothing was working. We gave her the “antidote” for fentanyl, thinking that maybe the narcotic depressed baby’s nervous system to cause the drop in heart rate, and that med unfortunately did not cause any change in baby’s status. So… we rushed her back to the OR for a crash c-sec. I could see the terror in her eyes, so I made it my responsibility to stay with her and hold her hand (because she was conscious during the surgery) and offer some reassurances that she would be okay. Baby came out screaming just a mere 5 minutes after we rolled into the OR, getting APGAR scores of 8 and 9 (out of 10) – indicating that he was a very healthy boy. After the craziness of her labor/delivery, we spent time in the PACU while she recovered, and she and her mother were able to bond with the newest member of their family. It was quite a special time, and I was grateful for the opportunity I had to offer her comfort in what would be a very scary experience for an individual who was raised in a culture where babies are not normally delivered under such circumstances. I knew that I was there for her, and even though we were not able to communicate with words, the simple gestures of a comforting touch and a reassuring smile conveyed more than any words ever could have. Such a special moment… especially when I was able to hand her son to her to hold for the first time… have I mentioned recently how much I LOVE my job? Yes, there may be experiences and outcomes less than ideal, but the most important aspect of my position as nurse for these patients is to offer them support and care during these stressful times. On that same night, another patient delivered a baby with multiple congenital anomalies, and the baby was given only a few hours to live. I know that many of my experiences will not be “picture perfect” but I am grateful to be able to offer comfort to these families in any way that they may need. It is an awesome responsibility, and I know that the Lord will prepare me to handle these delicate situations, as difficult as they may be.
Sunday Night
Unfortunately, we had a VERY quiet night… Miriam and I took triage, but we only had a few patients check in, nothing too serious. Around 3ish, I started feeling quite nauseated and weak, and as much as I tried to stay active and engaged in my work, I was not feeling well enough to stick it out until 6:30… so I left a few hours early. Apparently my body was trying to tell me something – over the past couple days, I have slept almost 24 hours!! So… hopefully I’ll be recharged and ready for tomorrow night when I return… two more shifts this week, then it’s back to Salt Lake for the 4th! I can’t wait… white-water rafting on Saturday with the fam, it’s going to be GREAT fun. SO with all that said, I’ll leave you until next week… have a great holiday everyone!!
I slept a lot during the weekend too, but that's because I'm a lazy beast.
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