"seriously, so blessed!"

There is a hilarious blog that I occasionally read to brighten my mood... it's an exaggerated look at the life and times of a Utah housewife.  You really have no idea how RIGHT ON it is.  I die sometimes reading it... die laughing that is.  Here is a short clip:

I wish we could all be IRL besties you guys, bc seriously LOVE YOU, and if we were real life besties I would split a rio with a bunch of you and refill your diet any day, THEN hit the gateway for soooo many darling clothes that just SCREAM "us!!!" so loud we could NOT resIST and then whoopsies, overspend a smidge, end up hidding them from our hubbies until the credit card thingie comes, and then if JJWT or your hubby get's mad, we will cry and seriously bawl and then remind them of that one time they hurt our feelings real bad and then zinnnnng, the whole thing gets turned around on him and he'll end up apologizing his brains out and then I'll say, look, babenugget, I know you don't get it, I just need some girl time...

AND THEN WE JUST DO IT ALL OVER AGAIN!

LOVE my life!

 hahahahahaha.  Makes me grateful to live in Utah, just because of the pure entertainment value.

But now on to MY updates... I must admit, I am SERIOUSLY so blessed.  Great family, great friends, great boyfriend, great dog, great home, great job.....  YES, it has finally happened -- I have secured my first job as a nurse!  Not at all what I had expected, but it is turning out to be an incredibly pleasant surprise.  A friend down in Provo gave my information to a new office looking for RNs, and while I was driving back up to Salt Lake from Los Angeles (for another job interview) I received a phone call from the director of the center asking if I would come in for an interview the following day.  A couple meetings later, and after a few trial days of working in the office,
I am now the Nurse Care Coordinator for the Spine Center of Excellence in Provo.  The office has not yet opened, so this time is strictly dedicated to designing and organizing the most efficient and effective way to run our center.  We will be working in conjunction with the Utah Neurological Clinic and the 3 neurosurgeons there, who are well-known in the medical community.  Currently, the clinic has a 6-month backlog of patients waiting to see the doctors for diagnosis and treatment recommendations for pain related to the spine.  Records show that 80% of Americans will suffer back pain at some point in their lives, creating a large market for neurosurgeons specializing in this field... but with only 3,000 total neurosurgeons in the country, most are overwhelmed and understaffed to handle the demand.  Many patients wait months to be seen, and during that time, they are not treating the problem which can lead to worsening conditions and more severe symptoms.  Spine pain is not to be taken lightly, as it can lead to complete disability without proper care.  Many problems, however, can be treated with alternative non-surgical specialists (physical therapists, physiatrists, neurologists, radiologists, or pain management) and prolonging the diagnosis only delays the start of the appropriate course of treatment.  My primary responsibility will be to direct the patient pre-screening process through an online system, and then act as the connection between the patient and the physician before a first appointment is needed.  It's much more of an administrative nursing position than direct patient-care (as seen in a hospital) but I see great potential in the SCE's ability to provide quality patient care in a different way, touching the lives of many people and (hopefully) improving their overall quality of life.  I know it's going to be a bit of an unknown at first, as I am the first (and only) nurse working on this project at the center, but I am confident that once I get started and see how the system functions I will be able to make appropriate changes for things to operate more smoothly.  I have yet to meet the surgeons, but I have been scheduled to shadow their clinic days on Monday and Tuesday, and hopefully I will have the opportunity to watch some surgeries in the OR on Wednesday.  I know that this exposure will help to give more background on the patients' needs so that I will be able to better serve them.  My past experience at UCLA in athletic training is definitely coming in handy, but I know that I have much to review to feel more comfortable discussing conditions and treatment recommendations with these patients.  I'm quite surprised at how much I'm enjoying this aspect of nursing... I'd never considered the business or administrative side, but my personal strengths are very compatible with the job I've been asked to do, and I'm excited to see where this will take me (and what I'll learn along the way)!  On top of it, I really enjoy the office environment and the people I work with, so I am incredibly grateful for this opportunity.  I know there were many applicants for this position (they actually wanted to hire 2 nurses, but my boss has decided to wait and see if I am able to manage on my own for now) so I am extremely motivated to prove that I deserve this position and that I can handle the responsibility I have been entrusted with.  I'll be excited to share more as the weeks proceed, especially once we are up and running (hopefully) in a month.  The one downside is that I do have to commute about 30-45 minutes down to Provo (and it's PROVO... enemy territory...) but I can't complain about having weekends and holidays OFF!  How often does that happen in health care?!  And as a new graduate nurse... seriously. SO. blessed :)

I know the last post I made was while I was patiently waiting with Brenn for the arrival of her daughter, Blake, but my time in California was cut short when I heard back about a potential position at a hospital and I needed to return for an interview (which, as you may have figured, did not work out but of course everything happens for a reason...).  As of today, Brenn has not yet delivered her baby, putting her at almost 2 weeks of a very prolonged labor... my thoughts and prayers are with her during this difficult time of waiting.  Thankfully Blake is doing just fine -- I guess she is stubbornly refusing to take her place in the world... wish someone would tell her that her family is anxiously awaiting her arrival, and she will be one of the most loved little girls with two amazing parents completely prepared to care for her every need.  Her mom is aware that her "Auntie Lola" is ready to spoil her... I can't wait to meet the newest little Fergie :)

Hard to believe the holidays are right around the corner... but this is my absolute favorite time of year, especially because of the spirit that accompanies this special change in season.  I'm looking forward to having family in town next week for Thanksgiving, and for the early snowstorm we are expecting this weekend...!  I do love Utah snow, especially up in the mountains -- Snowbird opened today, and it's only a matter of time before Park City will be ready... Can't wait to strap on my board and cruise down through the fresh pow.  Oh how I missed being 20 minutes from the greatest snow on earth...!  And I'll definitely be making up for missing last year with my season pass this year... need I say more?  Okay, maybe :) seriously so BLESSED... blessed to live here in Salt Lake, and even more blessed that the Lord has provided me with an abundance of knowledge and opportunities to serve the people of this community.  Never saw this one coming, but that is the story of my life these days!  Guess I'll just continue to put my faith and trust in His plan for me, wherever that may lead me.........

Fall, Winter -- Summer?!

I had every intention of writing a new entry last week while I was enjoying the fall weather in Salt Lake City, watching the treetops change to beautiful shades of crimson and gold, and then covering our backyard in a yellow blanket of leaves... it was such a relaxing and enjoyable time.  I love the change of seasons, especially fall -- it's my favorite time of year.  Then, out of nowhere, it decided to SNOW.  Really?! In October?? A surprise "blizzard" created a VERY early winter wonderland, and it caught me completely off-guard.  Thankfully the snow melted over the next couple days, but regardless, I had plans to drive to Las Vegas for Halloween weekend with my boyfriend (yes, you did read that correctly) for his friend's wedding -- at the Little White Chapel no less -- and then on to California to help with Brenn's labor/delivery, so I knew I was going to escape the cold (at least for a week or so).

SO, currently I am enjoying the typical California fall weather -- 95 degrees at the BEACH. Whaat?!? That is definitely not normal.  But I'm not going to lie... I'm loving this last little bit of summer weather before I head back up to the truly winter weather in Utah.  But this trip is not exactly a vacation that I am able to "enjoy"... I'm sitting with Brenn after a short walk down the strand, who has now been in labor for 48 hours.  Poor thing... we're all so excited to meet little Blake, who is apparently completely content staying warm and cozy right where she is.  We head back to the hospital in a little while to see if she's made any further progress... bottom line, we are in need of some serious prayers everyone!  And in the spirit of Thanksgiving (it is November after all) I just want to say how grateful I am for the testimony and knowledge I have that everything happens for a reason -- whether it be this prolonged labor or the fact that I don't yet have a job to return to in Utah -- the Lord has a plan.  There are no mistakes or coincidences, only blessings that have not yet been revealed to us.  And with that, I'll be back to update in the next couple days, once there is something to update on... :)

breathe. just breathe.

It's Monday morning, and so begins yet another week as a member of the Day Club... I've been asking myself lately what I am meant to learn from this period of unemployment -- patience? gratitude? selflessness? For a person who truly enjoys being busy and having a regular schedule, this has REALLY been a struggle for me... my roommates say they're jealous, but I would trade this freedom for work in a heartbeat!  Thankfully having Charlie around has kept me occupied, but I worry that when I do start working, he is going to go through a serious period of separation anxiety.... he is SO spoiled right now!!  But I guess I should appreciate this time when I have "nothing" to do... and I'm trying to take advantage.  Like planning a spontaneous trip to NYC this week... one of my favorite places in the world, and definitely a great place to celebrate becoming a nurse :)

Unfortunately, the job hunt is proving to be much more difficult than I had ever anticipated... with the economy in a slump, hospitals have lost a lot of money, and are unable to hire "new graduate" nurses (like myself) because it is too expensive to train us.  It has been getting better over the last couple weeks, as I have noticed more job postings that "strongly prefer" rather than "require" previous hospital experience, but I have applied to 40+ jobs and I'm still waiting for some sort of response... I haven't given up hope though -- the Lord guided me here for some reason, and I have faith that something will present itself when the time is right.

In the meantime, I have been keeping busy by strengthening my resume -- I became a certified Phlebotomist (hoping to find a temporary job, but apparently I'm OVERqualified for those positions) and am currently taking an online Medical Spanish course.  I had intended to take a course to become a certified Doula (or Labor Support person) but I had conflicting appointments and was unable to attend.  I did get the course syllabus though, and I have been reading through it to keep my mind focused on nursing-related topics in the Labor & Delivery field... especially because in just a few short weeks, my dearest friend Brenn Ferguson will be giving birth to her first child (a daughter, Blake Marie) and I will be present for this special time in her life.  I feel so honored, and I am so grateful that I will be able to share this experience with her and her family.  I have complete faith in her, and know that she is going to be an amazing mother!!

The fall leaves are beginning to fall here in Salt Lake... quite late, actually, but I'm not complaining.  I enjoyed having an extra month of summer weather!  But I've pulled out my coats and sweaters, and I am happy to make this seasonal transition.  I'm planning to get my pass to Park City sometime in the next week... SO excited to be close to the mountains again!!  I only had a couple days on the slopes last winter, so I intend to take full advantage of my proximity to the BEST SNOW ON EARTH.  At least here we can make use of snow... I know I won't miss the snowmageddon days in Balmer last winter!  haha.  Well, I'm off to tackle another day of unemployment -- gotta keep busy in order to stay sane!  I'll be back next week with updates from my adventures in the city... until then, take care all!

Laura Newman, RN

 IT'S OFFICIAL!  

I found out this morning that I PASSED THE NCLEX (aka my nursing board exam)!!  I'm still in shock.  I might have to wait until this afternoon to write a more lengthy note because my head is spinning.... this is just so surreal.  I'm actually a NURSE!!!!!!!  Next step: find a job....

But for now, I'm relishing in the fact that I never have to take that horrid exam EVER. AGAIN.    SO, I'm going to go celebrate... Lululemon is opening their newest store in Salt Lake today (coincidence? hmmm...) and I'm going to treat myself to a little something special :)  And yoga this afternoon, of course.... despite the cloud-filled sky, I feel like it's going to be a BEAUTIFUL day!!!

aaaaaaaand.. I'M BACK!

Yes, it has been quite a long hiatus from my last post... but I was enjoying a much-needed "vacation" in California for the past month, and for some reason, R&R did not include pulling out my computer to update my blog.  But now that I have FINALLY returned to Salt Lake... I decided it's about time to share a few little details about my life as of late...

First and foremost, I need to bring attention to the fact that there has been a recent addition to "my" family......

.... meet CHARLIE!  I adopted him from an animal shelter in LA last week, and he is the perfect dog for me.  He is a 2-year-old Miniature Pinscher, and has been the greatest "best friend" I could ask for.  Such a great little personality, and I have had so much fun getting to know him!  He's been an outdoor dog, so I'm working on discipline and training, but thankfully he is house-broken.... no accidents in the house (yet.... *knock on wood*).  He's been my little shadow, but I'm slowly working on the socialization process and getting him used to being at home alone, in order to reduce his separation anxiety.  It's been an incredible learning experience for me, and I'm grateful for this opportunity to include the needs of another in my daily plans.  For so long I have only had to worry about my schedule and needs, and this is a completely new experience for me, and definitely one that I need to get used to!  He's very active, so I'm excited to explore the neighborhood with him on walks and, eventually, hikes in the canyons.  I've been looking forward to the day that I would have my own dog, and it was well-worth the long wait! :)

Aside from that exciting news, I am still studying and preparing to take the NCLEX (nursing boards) sometime within the next month.  The longer I sit and stare at my books, the more anxious I get, but I'm hoping (and praying) that this time studying will pay off.  Not that I have any job to rush off to... unfortunately I have been met with many dead-ends and "wait and see" responses, so I'm still on the hunt.  I don't want to let up my desire to work in maternal/newborn health care to find a position on a med/surg unit, so I'm going to find part-time work in a non-nursing related job until I find an opening somewhere.  I have faith that something will open up if I patiently wait.  In the midst of this search, however, I have made a very big decision: I plan to enter graduate school in June of next year!  Well, that is if I am accepted.  I know what I want to do, and I feel confident in my knowledge and skills to begin the road to my master's degree without spending another year working before I do so.  Besides, if I wait, who knows what life will throw at me, and will I really be able to start in a couple years?  I'd rather just start the program now and get it all over with, graduate, and be "Dr. NEWMAN" -- yes, it is a doctoral program.... so I will have my Doctorate in Nurse Practitioning (DNP) and I will be a Certified Nurse Midwife (CNM) after the 3-year program.  Meaning... I will graduate and FINALLY be done with school at the ripe YOUNG age of 30.... :)  haha.  I can't even believe it.... me?  30?!  But I know it is the best option for me, and I'm excited to get started!!  I have a meeting with the program director next week, so I'm crossing my fingers that things go well before I begin the application process.  As much as I try to plan, my life has proven to be quite unpredictable... so I've learned to roll with it, and I'm ready for this new direction my life has taken.  Trust in the Lord... that's all I have to do, and I know that it will all work out as planned :)

Without sharing all the "boring" details of my trip to California, I will say that I am SO grateful to be back on the West Coast!  I definitely belong out here, and I am so happy to be so "close" to my family and friends.  It was so great to see everyone and enjoy time basking in the sun on the beach....  but now I feel that I have been re-charged and given the extra boost I needed to kick-start my life here in Salt Lake.  So here goes nothing.......!!

HOME AT LAST!

It's Monday morning... I'm sitting in the comfort of MY bed at HOME here in Sugarhouse after a great weekend with my 3 new roommates (Aubree, Lori, and Amy).  We celebrated the Pioneer's holiday by throwing a housewarming party (complete with a delicious S'mores bar) and we were grateful for the many friends and family that showed up to visit. 

Because I feel somewhat disconnected from my life as a nursing student, finally able to sit back and ENJOY summer, I'm going to refrain from providing excessive details of the final weeks in Denver... looking back at my time at UCH in the Women's Care Center, I really feel grateful for the opportunity I had to learn and grow with the diverse range of experiences I was exposed to while there.  It was a challenge, but it solidified my desire to pursue work in this field -- I know without a doubt that I have been called to be a Midwife.  But I'm still trying to process the past 14 months -- did it all really happen?  Did I move 2,000 miles away from family and friends?  Did I survive the rigors of one of the most prestigious, competitive, and intensely accelerated nursing programs in the country?  Did I actually GRADUATE from JOHNS HOPKINS UNIVERSITY with my third BS this past Friday?!?!  I think I've really outdone myself this time... to the point of not believing it could all be possible.  But once my diploma arrives in the mail, it will really hit me -- I DID IT.  I am now an NURSE!  Well, unlicensed, but still... I've worked so hard to get to this point, and I am SO excited to finally start this career that I've waited so long for.  I just have to get past my NCLEX (board exam) at the end of August....

As of now, I have plans(/hopes) to work as a nurse for the next year, and by next fall, I'm hoping to work on my application to the University of Utah's graduate nursing program -- dual degree as a Certified Nurse Midwife (CNM) and a Women's Health Nurse Practictioner (DNP).  We'll see what this next year holds in store for me, but whatever is thrown my way, I know I'll be ready for it....  I have a quote on my nightstand that reminds me:

"Believe in yourself and all that you are.  Know that there is something inside you that is greater than any obstacle." - Christian D. Larson

And for family/friends who are in Southern California, I'm coming "HOME" this Thursday -- can't wait to see you all!  The Pacific Ocean is calling my name....

While you were sleeping...

Darkness has enveloped the city of Denver, and for most people that indicates time to prepare for sleep.  Well… my body isn’t quite sure what to make of ‘time’ anymore, especially the meaning of daylight hours.  I worked last night, and I remember watching the sun rise and light up the unit, which was the signal that our shift was nearing its end and I was almost free to go home.  Rather than preparing for a new day to begin, I was reflecting on the night’s adventures and processing all that had happened – I still cannot believe all the chaos we dealt with!  Although I’ve had some crazy nights over the past couple weeks (I’ll share some highlights later), nothing quite compared to the madness of last night.  And I feel it’s only fair to share my experience with you…

07/12/10 @ 1715 (5:15 pm for those not familiar with the 24-hour clock): I roll out of bed after a 3-hour nap hoping that I’ve had enough rest to carry me through the night (my FRS natural energy drink helps a bit too).  I throw on my work attire - navy blue scrubs - and gather my supplies (and my brain) for one of the few remaining shifts I have on the WCC unit here in Denver...

1750: Driving on the freeway to the hospital, I get caught in rush hour traffic – people heading HOME after a long day at work.  To think that my night had only just begun…

1820: Walking on to the unit, I take one look at the board to find 4 out of our 5 birthing rooms occupied, with 2 patients in active labor (meaning they are past 4 cm dilation).  The rest of our inpatient rooms (14 antepartum/postpartum and 1 PACU) were nearly full, and we had 2 patients in triage (with 5 triage rooms available).  I knew then it was going to be busy, but I had no idea what the night would turn into…

1845: I get my patient assignment, and find out that we are slightly short-staffed, so I will be managing this labor patient mostly on my own (!!) with Miriam, checking in occasionally to see if I am managing okay.  I learned that my patient was G3/P2, meaning this was her third pregnancy and that she had 2 additional children (one who wanted to be at the hospital with her mom and dad).  I was not too worried – ‘multips’ (as we call those women who have had 2 or more pregnancies/deliveries) usually know their bodies well enough to tell us when they are ready, and know how to push (one of the primary factors that affects the delivery process, and usually the most difficult thing for women to figure out how to do).  We anticipate that once these patients 'go', they are able to deliver a baby smoothly and quickly.  Yes, we were treating my patient for severe pre-eclampsia, but nothing else stood out as being a major factor for a complicated delivery (we deal with pre-eclamptics quite often, and it is serious, but we are well-equipped to manage these patients).  The best treatment for these patients is delivery, so it’s common to induce/augment the labor process if the contraction pattern is not regular enough to cause any change in the cervix.  We received the order from the doctor to start Pitocin (the synthetic form of the natural labor-inducing hormone) and turned the IV drip on at 1 mU/hour (the smallest dose possible).  I will say, I am NOT a fan of Pit… yes, there are situations that it is more-or-less necessary (as with my patient) but many physicians/hospitals exploit the ‘benefits’ of Pit – namely, that they can schedule deliveries.  If a doctor wants to deliver a baby faster, they’ll turn up the Pit.  Well, that’s all fine and dandy – unless you consider the stress it puts on the baby.  Every time the uterus contracts, pressure is put on both the baby and the placenta, which decreases the amount of blood/oxygen flowing to the baby.  If the contractions occur too frequently (hypertonicity) and baby isn’t getting enough oxygen, the fetal heart rate (FHR) drops… and when the monotonous sound of the rapid heartbeat emitted from the monitor slows from 130 to 80, it sets off alarms in our heads to react.  This doesn’t always happen with Pit, but it is definitely a ‘common’ adverse effect that we must be prepared to deal with.  So, we started my patient on Pit, and watched her progress from the central monitors in the nurses’ station.   

1950: A nurse calls an L&D ‘code’ for an antepartum patient, who was pregnant with twins at only 30 weeks.  Her twins had been diagnosed with “Twin-to-Twin Transfusion,” meaning one infant was receiving more of the placenta’s blood supply than the other (a high risk for infant mortality).  She was also a Jehovah’s Witness, so refused any transfusions during her pregnancy to promote development in the smaller twin.  The ‘code’ was called for the smaller baby, when the FHR dropped to the 60s – and stayed there.  The doctors rushed in, checked the ultrasound tracing, and confirmed that the baby was not getting enough oxygen = CRASH C/S.  The team raced back to the OR for delivery, and en route, our charge nurse nearly ruptures her Achilles’ tendon – no joke.  I guess in her efforts to push the bed back to the OR, she turned too quickly around a corner and heard a dreaded ‘POP’ and then found herself in the ER for the next couple hours (after the C/S of course).  What a trooper… especially when she came back up and wheeled around in her classy hospital wheelchair in order to manage the floor. 

2000: I return to my patient’s room to do her hourly ‘Mag check’ (an IV med she’s on for the pre-eclampsia) and my preceptor insists that I turn up the Pitocin.  “We want to deliver this baby!” she says… and I understand that delivery is important for women with Pre-E, but she’s not showing any major concerning signs of the diagnosis. I know my preceptor is slightly more aggressive with Pitocin titration, so I expressed my desire to hold off a little while longer, but I work under her license… so we turned up the Pit by 2 mU/hr. 

2115: One of the laboring patients feels the urge to push… some of the staff returning from the OR dash into the room to deliver baby #3 for the evening, leaving the nursing station virtually empty.  I wandered into the room to see if any help was needed, and one of the nurses asks me to check in on a patient next door who is paging.  I walk in to deal with Cinderella’s stepmother and two stepsisters – a teenage ‘primip’ (1^st pregnancy) lounging on the labor bed, expecting to be waited on hand-and-foot while she is in ‘labor’ – I’m sorry darling, a cervix that is “cl/thk/H” (closed – thick – high) is NOT considered labor, regardless of your seemingly-regular contractions – asks me to clean up a spot of blood on the base of the bed.  Okay, I understand in normal circumstances this would be something I would take slightly more seriously (it should have been cleaned better) but in comparison to the events taking place just 30 feet away, I almost wanted to hand her a paper towel to clean it up herself.  But of course the Cinderella inside me smiled, grabbed a Cavi-Wipe (hospital-grade Clorox wipe) and cleaned up the small reminder of a previous delivery.  Apparently, the rest of the night she paged every 5 minutes because she felt as though HER needs (including ice water, which is accessible to family members) were priority #1. 

2130: I return to my patient’s room to check in on her progress (our new intern, now in her 3^rd week of her residency program) comes with me to do another cervical exam.  “Great news – she’s complete!  Her bag is bulging, and we should probably AROM her so we can have this baby.”  Artificially rupture her membranes?  I understand this does speed up the process, in most situations… but is it really necessary?  My preceptor and I are both on the same page.  But in this hierarchical chain of command, the doctor’s decision trumps our intuition, even if she is only in her 3^rd week of her residency (meaning that she just graduated to receive her MD less than a couple months ago).  The attending physician approves, and soon enough, the patient is one step closer to having her baby.  Miriam and I stay close to monitor baby, and the pushing begins.   Because the patient has her epidural, she can’t feel her contractions, so we have to ‘coach’ her as she pushes to ensure that she pushes with the contractions, and that she’s focusing her efforts on the right area (which she can’t feel).  I understand that comfort is ideal, but this is LABOR! It is not meant to be cushy and relaxing… even if the anesthesiologists market their services to offer that experience.

2220: After nearly 30 minutes of pushing with little progress, unusual for a gravida 3 patient, the repetitive sound of baby’s heart beat disappears from the monitor.  I jump in to move the monitor and throw a pulse-ox on the patient’s finger to distinguish mom’s heart rate from baby’s, and find that the situation is much worse than we expected – mom’s heart rate has jumped to 120, and baby’s has dropped to the mid 80s-low 90s.  NO BUENO.  Delivery needs to happen, and it needs to happen NOW.  Lucky for us, the chief is close by – even though this is his FIRST NIGHT working at our hospital (he had just completed his residency in Ohio) he scrubs in to help our attending and intern.  “FORCEPS!” He yells.  One of the nurses races down the hall to grab the sterile ‘birthing spoons’ used to help deliver baby’s head in such emergent situations.  Just 20 minutes later, a healthy baby girl is born screaming her little head off – it was almost as if she was laughing, like she had played some practical joke on us to scare us all into thinking she was tanking.  Her APGARs of 9 and 9 are indicative of a healthy baby, and the NICU team (who are always present for forceps-assisted deliveries) chuckle as they swaddle this ‘perfect’ little infant.

0015: We get a call that a patient is being flown in from Boulder, with complaints of regular contractions and bleeding – and she’s only at 27 weeks.  We prepare the room, alert NICU, and wait for her arrival.

0045: A patient checks in, and we look at her numbers – G10/P0905.  Yes, she’s on her 10^th pregnancy, but all 9 previous babies were born pre-term (before 34 weeks) and only 5 survived.  Patients with 6+ pregnancies are considered ‘grand multips’ and we definitely worry about precipitate delivery (labor onset à delivery less than 3 hours) with these unique patients.  She’s at 28 weeks, however, and that means yet ANOTHER preterm infant.  She rattles off her complex OB history (including 6 cesareans), and we all look at each other stunned that our shift is only ½ over… and wonder if this is the rain starting to pour…

0100: I return to my patient’s room for her routine Mag check, and notice that her blood pressures are spiking upwards of 170s/100s – a BAD sign for any patient, but especially for those with the diagnosis of pre-eclampsia.  I get the information to the doctor, and she orders a stat dose of Labetelol to be given IV.  My preceptor returns with me and we administer the med, and I complete my assessment.  Thankfully, she doesn’t have any other complaints or worrisome signs/symptoms, so we watch the monitors closely and see her BP return to her baseline, offering reassurance that we avoided a possible eclamptic seizure. 

0130: A patient returns from a 2-hour ‘walk’ (we send patients to walk through the hospital if they are in earlier stages of labor and don’t want to admit them just yet) and is vomiting at the front desk.  The triage nurse brings her back to one of the rooms, and has her lie down… just a few minutes later, we hear her shout “I can see baby’s head!  We are delivering in Triage C!”  As if we haven’t had enough exercise running through the halls of our unit this evening, we rush to help.  The triage rooms are quite small, so only a handful of people can actually fit, so we wait outside for instruction.  Shortly thereafter, screams are heard (not from baby) indicating that the patient is very close to delivery.  I can only imagine what the other triage patients were thinking… but it’s the reality of the situation they’re all in, and I’m sure many of them contemplated the idea of an epidural at that moment. 

0220:  Triage C baby is doing well, and we look to the board to see all of our triage rooms full, with 2 patients in very active stages of labor.  Our crippled charge nurse calls upstairs to the ‘Birth Center’ (the low-risk labor & delivery unit) to see if they can take some of our less-complicated patients.  They are short-staffed as well, but we are able to send 2 of our patients up for their deliveries. 

0245:  We learn that the transfer patient from Boulder is not going to deliver… yes, she did rupture, and yes, she is at risk for pre-term delivery, but thankfully her baby has decided to stay inside for a little while longer.  Despite all the medical interventions we can implement, in the end, nature does take over – mom’s body is the best (and only) determining factor that can predict what will happen.

0400: I return to check on my patient, finally resting comfortably in the peace and quiet of her postpartum room with her 5-hour-old infant in the basonette at her bedside, and her husband and 7-year-old daughter asleep on the couch, and offer a small prayer of thanks that this little Hispanic family was so patient with me as I did my best to care for them throughout the frenzy of the night.

0430: The chaos finally subsided (I didn’t even mention the incidents with a couple of the postpartum patients who were being managed for hemorrhages they had suffered during their deliveries the day before).  We gathered together in the nurse’s station to process and debrief the events of the previous 10 hours.  We finally found time to laugh at our charge nurse, who had attempted to hobble in to Triage C on crutches to help with the delivery, and listened as the nurse caring for stepsister A joked about some of her ridiculous demands throughout shift.  With another 2 hours to go, we all PRAYED that nothing else would disturb this rare silence… (thankfully for us, our prayers were answered)

0630: I returned to my patient’s room before I left the floor to offer my ‘best wishes’ and ‘congratulations’, and her sincere response of “Gracias” made (most) memories of the night dissolve… oh, wait, did I mention she only spoke Spanish? HA. But in all seriousness, despite crazy nights like these, I am SO grateful for this position that I have been called to – I have the unique opportunity to be a part of this momentous occasion in each of these patients’ lives.  It might be just another night of work to me… but I constantly remind myself of one of my favorite quotes:

“To the world you may be just one person, but to one person, you just may be the world.”