It's amazing how much energy the hospital can suck out of me. Even though I'm still under a strict 'no touch' order until I get properly credentialed in the hospital, I felt like I worked for my money yesterday. And woke up today, feeling the worse for the wear, struggling to open my eyes and leave my cozy bed.
I spent the day battling our terrible computer system and filling out admission paper work in triage. I think I broke the record for the longest time ever taken to fill out an h and p (history and physical) - 5 hours. Perhaps I cheated in the breaking of this record, because the computer froze and my first version was lost entirely... By the end of the day, however, I felt like I had some sort of grasp on the many quirks and minimal perks of this system. The system has the ironic name of 'Sunrise' - which it is anything but. I would more appropriately title it "Darkness."
As the evening progressed into the later hours of night - the hospital got stranger and the cases got more interesting. I saw things that I had only read about in school. (Side note: this attitude always makes me feel conflicted, as it is a direct using of someone else's misfortune. I always want to preface stories like this with the fact that even though I learned from it it would obviously be better if it had never happened in the first place. The women I will write about probably had one of the worst days of their lives yesterday and I am happy only that I could be of minimal comfort). The interesting first case to walk through the triage door was a woman at 39 weeks pregnant who had been assaulted by her husband. I had presented on domestic violence during school and what to do - but in all honesty - a case like this had never confrunted me so directly. As I was leaving last night the husband showed up, started screeming, and created a mini-Maurie Pauvich episode on the floor. It was scary and sad and eye opening.
The second moments of chaos came slightly after. A woman who was 10 days post partum after a c-section came in complaining of "I don't feel well." Then she seized. And seized. And seized. My non-touching order allowed me to take her sobbing friend out of the triage room and explain to her everything that was going on - from afar - then chat her up about her own new baby, and how good of a friend she was for taking her bestie here. After the hanging of mag, and the giving of oxygen and the overhead paging of anesthesia and more chaos on the floor - she seized again. While no longer pregnant, this woman had an obstetrical emmergency that we all fear most.
I biked home late last night, images running through my mind, thinking "Wow. it's not just stuff you read about. Shit like that really can hit the fan." My experience in this job will inevitabley teach me so much about my field. It already has. I wonder what I will learn about tomorrow...
Thursday, August 20, 2009
Saturday, August 15, 2009
That's more like it...
I almost cried during a birth today - which I haven't done in a long time. It wasn't actually during the birth itself, but during the labor.
The patient was a young woman, in labor with her first baby, and accompanied by her boyfriend and her boyfriends family (mom, and two sisters). Her family was - well, we didn't know - the mom-in-almost-law gave the universal sign for "I have no idea - and don't ask..." with a shrug of her shoulders, a shake of her head, and a gentle roll of her eyes. She had dilated rather quickly, but things had slowed way down while pushing. She had been pushing for almost three hours - which- by any standards, especially my new medical institution, is a rather long time. We didn't think the baby was very big, the position seemed fine, and she was pushing with strength. Her family-in-almost-law was lovely and doting, and things should have been moving more quickly than they were. The docs were knocking on the door - both literally and figuratively - wanting to know what was going on - and starting to use the evil c-word when talking about the plan.
I was at a loss for what to do - we had changed positions, and used all the tricks up my fledgling sleeves. However, the midwife whom I'm shadowing today was almost eerily tuned into the woman's feelings. After a long hard push, the patient started weeping. Not a frantic 'this hurts like hell' feeling - but a deep, mournful cry or sadness. The midwife put her face close to the patients and stroked her hair. "I know this is hard," she said. "You want your own mom to be here with you. His family is wonderful - but you want your own mama now." The laboring woman's tears increased, and we encouraged her to cry as she needed to. She held her boyfriend's head, and cried, and grabbed the hand of her future mother-in-law - and cried. And they cried. And that's when I almost cried.
Voila. In about 30 minutes, she pushed out a screaming baby boy. It wasn't a shoulder or a body part dystocia. It was emotional dystocia. And she let it out. And it worked.
The patient was a young woman, in labor with her first baby, and accompanied by her boyfriend and her boyfriends family (mom, and two sisters). Her family was - well, we didn't know - the mom-in-almost-law gave the universal sign for "I have no idea - and don't ask..." with a shrug of her shoulders, a shake of her head, and a gentle roll of her eyes. She had dilated rather quickly, but things had slowed way down while pushing. She had been pushing for almost three hours - which- by any standards, especially my new medical institution, is a rather long time. We didn't think the baby was very big, the position seemed fine, and she was pushing with strength. Her family-in-almost-law was lovely and doting, and things should have been moving more quickly than they were. The docs were knocking on the door - both literally and figuratively - wanting to know what was going on - and starting to use the evil c-word when talking about the plan.
I was at a loss for what to do - we had changed positions, and used all the tricks up my fledgling sleeves. However, the midwife whom I'm shadowing today was almost eerily tuned into the woman's feelings. After a long hard push, the patient started weeping. Not a frantic 'this hurts like hell' feeling - but a deep, mournful cry or sadness. The midwife put her face close to the patients and stroked her hair. "I know this is hard," she said. "You want your own mom to be here with you. His family is wonderful - but you want your own mama now." The laboring woman's tears increased, and we encouraged her to cry as she needed to. She held her boyfriend's head, and cried, and grabbed the hand of her future mother-in-law - and cried. And they cried. And that's when I almost cried.
Voila. In about 30 minutes, she pushed out a screaming baby boy. It wasn't a shoulder or a body part dystocia. It was emotional dystocia. And she let it out. And it worked.
Thursday, August 13, 2009
And.... we're back
After a year long-hiatus, I'm back to the bloggesphere. Perhaps inspired by a huge transition and a new job, or requests from disappointed family and friends to start writing again, or perhaps because I missed public reflection on my career choice.
In short... since I posted last - I've graduated from a master's program in nurse-midwifery, passed my boards, applied for and accepted a job as a midwife at a large public teaching hospital in an inner city, visited Costa Rica and Israel, eaten lots of felafel balls and musli, and settled into an apartment with my fiance which feels like home.
Yesterday was my first true-day at work. I am only allowed to observe, as I am not yet privileged at the hospital. What a different place from the small, touchy-feely hospital where I did my training. There are no tubs, and only one doppler for intermittent auscultation (vs. continuous monitoring... the not-evidence-based-standard), which certainly speaks to the lack of it's use and there are no tubs in any of the rooms. There is a contraption, hidden in a closet, called an aqua doula - a portable tub which requires about 10 different small metal pieces to hook it up to be filled in by a sink (!!). Um, yeah, you guessed it. No one uses it.
Perhaps auspiciously, however, the first birth I witnessed there was a precipitous totally unmediated birth by a 19 year old woman. She was in control, in rip-roaring labor, and ready to give birth when she arrived. I learned, in watching her birth, that as new as I am, I have my own style, and was surprised by some of the hand techniques of those around me. I found myself, although rendered to the side of the bed to observe only, desperately wanting to touch and jump in hands first. It was not the birth that I would have conducted exactly, but it didn't matter. I was reminded, that even with 1 clueless but curious male medical student, one nervous ER intern catching, one experienced midwife, one inexperienced observing midwife, one nervous boyfriend, and two nurses at change-of-shift, birth is beautiful.
In short... since I posted last - I've graduated from a master's program in nurse-midwifery, passed my boards, applied for and accepted a job as a midwife at a large public teaching hospital in an inner city, visited Costa Rica and Israel, eaten lots of felafel balls and musli, and settled into an apartment with my fiance which feels like home.
Yesterday was my first true-day at work. I am only allowed to observe, as I am not yet privileged at the hospital. What a different place from the small, touchy-feely hospital where I did my training. There are no tubs, and only one doppler for intermittent auscultation (vs. continuous monitoring... the not-evidence-based-standard), which certainly speaks to the lack of it's use and there are no tubs in any of the rooms. There is a contraption, hidden in a closet, called an aqua doula - a portable tub which requires about 10 different small metal pieces to hook it up to be filled in by a sink (!!). Um, yeah, you guessed it. No one uses it.
Perhaps auspiciously, however, the first birth I witnessed there was a precipitous totally unmediated birth by a 19 year old woman. She was in control, in rip-roaring labor, and ready to give birth when she arrived. I learned, in watching her birth, that as new as I am, I have my own style, and was surprised by some of the hand techniques of those around me. I found myself, although rendered to the side of the bed to observe only, desperately wanting to touch and jump in hands first. It was not the birth that I would have conducted exactly, but it didn't matter. I was reminded, that even with 1 clueless but curious male medical student, one nervous ER intern catching, one experienced midwife, one inexperienced observing midwife, one nervous boyfriend, and two nurses at change-of-shift, birth is beautiful.
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