Sunday, April 29, 2007

Why can't I sleep?

I'll tell you why, it's a beautiful day. The sun is shining, the birds are chirping and I am going in to work for my 3rd twelve out of four straight twelve hour shifts in a row. I want to sleep, but spring is beckoning me out of my bedroom window, glowing through my room darkening blinds. New life is on the horizon, and I am at the helm.

Last night I learned how to cover my butt so to speak. I was in the back, all by myself with a lady who was a grand multiparous (G6,P5) precipatous deliverer of babies. Being that I work in what is know as a teaching hospital, we have residents in various levels of training. This one particular resident was a family practice resident, which means that she does obstetrics for fun and not as a specialty. It is not her primary discipline, she provides a potpourri of services to her clients. Anywho, my patient was 6 centimeters dilated, 90 percent effaced and at a -1 station. She was huffing, puffing and used to having babies with no anesthesia. The family practice resident and attending came by to get her checked in and left me to manage her labor. As always I told them not to go to far because I had a feeling that this lady was gonna go really fast.

I received the patient at 8:50 pm. At around 9:25 pm that she felt like she had to have a bowel movement. I told her absolutely not and I explained that she could very well deliver the baby while it was still encapsulated in the bag of waters. Fishing a baby out of the toilet is not my idea of a good time. I explained that I would rather her poop in the bedpan and clean up the mess. She wasn't exactly pleased with the idea, but went along as she realized I was not going to give her any other option. As a precautionary measure I had the family practice resident and attending paged to assess her pressure because I just knew this lady was going to deliver any minute. At 9:30pm her water broke. At 9:35 the resident showed up she only had enough time to get sterile gloves on and say the patient was completely dilated. I covered my patient who was sitting in a pool of amniotic fluid and poop with a sheet and began to assemble supplies.

The patient was involuntarily pushing and I could not remove the soiled linen. I ran to the intercom and called for any attending physician and our charge nurse to come to my room for the delivery. Before I could hang up the phone good the baby's head was out. I swear, the attending peeked around the corner, saw that it was family practice and turned around and left. My charge nurse never showed up.

My delivery resident doctor said something cute like, "I've never done this before." I was thinking "Oh shit, I don't really know what to tell you to do. But hey, I have seen it done a million times. Here goes." I pulled the delivery cart over to the bedside. We placed the baby on the Mom's abdomen. She clamped and cut the cord. I told her to do some fundal massage and wait for the placenta to loosen. In the meantime I took the baby over to the warmer and worked on him. He was stable which freed me up to do other things.

She was kind of holding the cut end of the remaining umbilical cord and when she felt the placenta loosen she had the patient push it out. I started the pitocin to clamp down the uterus. I was doing like 5 things at once, pushing medication, doing apgars, assessing baby and mom when finally the charge nurse and attending came around the corner. Everything was already done. Then about ten minutes after all that, the family practice attending came. For a moment, I finally felt like a real nurse. I handled that delivery like a seasoned professional nurse. Or at least I thought.

The attending had a problem with my performance at the bedside. She felt that I should have called her sooner. I don't know how I could have done that, but she failed to realize that I was in the room when she told the resident that saw the patient involuntarily pushing on the EFM at the nurses station and decided not to come in to help. She must not have noticed that I saw her shoes under the curtain and her head peeking in to see what we were doing while we were getting the baby delivered. I imagine that this is going to turn into another episode in the nurse manager's office. But I don't care because I am a NurseDiva dammit! Oh yes, I'm still that bitch and I haven't forgot how to get nasty when I need to. Wish me luck!

DiVa...gettin' down and dirty when she needs to!

1 comment:

Anonymous said...

because I finished my OB class, I was able to decipher everything you wrote. Good for you Diva.