Tuesday, June 26, 2007

An exasperating week...

This past week I have had some kind of week at work. I had a patient with a blood sugar so low it was undetectable by glucometer (the patient was 10 weeks pregnant a type 1 diabetic and chronic hypertensive), a preemie delivery that went off without a hitch (The mom had severe pre-eclampsia and went into labor at 33 4/7 weeks delivering healthy baby that had a dubowitz score of 35-36 weeks gestation and a blood sugar of 4!) and a vacuum assisted vaginal delivery, (a 17 year old with + Human Papilloma Virus that I found out about on palpation, eww! Then her baby's heart rate took a dive into the 60's in transitional labor. Thank God we didn't have to do a c-section). It is so good to have some time off. My kids and I went to see Blades of Glory my first night off. I really should have put a bit more thought into movie choices before considering this film. There were a few scenes where I had to cover their little eyes. Most of the adult jokes were over their heads, besides all that it was hilarious!

Last night I had my first date with Jeff. Unfortunately, it did not happen. I don't know why, I am disappointed but I am not going to sweat it. I am sure my cousin put the kibosh on that because she wanted him, even though she has a boyfriend. I could care less. The electrician has seemed to change his tune, a little. He has planned a date for us on Saturday to go bike riding. I am refreshed to have a date that is something besides dinner and a movie. However, he seems very anxious to come to my house late at night. I think I can manage this guy; it will be good practice for the real thing and a lot of fun. I feel a little apprehensive, especially when he said he has never been married and has no children and he is at least 40-50 years old. We are only friends at this stage so I guess it doesn't really matter, but at the same time I feel like if I hadn't spent my time kissing frogs and worked more on my career I would be a better prospect. Despite all that I am still cute. What ever the universe has planned for me will happen in its own due time. I still have a lot of "housework" to do anyway.

Tonight is my last night off. I am planning on buying a new bed. The store is holding it for me until I can pick it up. Then I am going to move into the basement and get rid of my old bed. The new bed is a king size bed. I wonder if it will fit in my new room. Anywho, my plan is to give my daughter my room and my son will have his room to himself again. It should work out to give us all our own space, even though I predict that my kids will spend most of their time in my room. This should hold us over until I can get me stuff together for buying a new home. After the next week or so (working almost seven days in a row, including the holiday) I will have some time off. Until then I will make the best of my last day off provided that is doesn't rain.

DiVa...Into our lives a little rain must fall. But if it weren't for the rain, we wouldn't have rainbows!

Friday, June 22, 2007

Updates and such...

On dating...
Okay, so I called this guy that I met at the job. (The electrician) I was initially very excited and optimistic about what could be and when I talked to him I found out that he is a little bit arrogant and self absorbed. I probably won't be calling him again. Here's what happened. I decided to call him one night before I went to work and he didn't answer his phone. I thought "Whew!" when all of a sudden, my phone started ringing. It was him returning my call. Do I answer, or make him leave a message? I answered and he sounded like he was in the bathroom.


I said, "Hi, it's NurseDiVa. I met you a few mornings ago and you gave me one of your business cards." He says, "At the hospital?" I said yes. He said, "What floor?" I said, "Labor and Delivery...?" He says, "Oh, the baby floor." (Not sounding so good.) I said, "Yes..., the reason why I called was because if you are not seeing anyone, I though it might be nice if we got together for lunch or coffee or something. You seem like a really nice person with whom I'd like to be friends." He said something like, "I don't do coffee." I said, "Well what Do you do?" Basically he said he likes to work out at the gym and admire himself in the mirror, Oh and make money. *insert deep exasperating sigh....

After that conversation he wanted to come up to the job and meet me for lunch. (Hello, night shift?) He left two messages on my phone. I returned his call yesterday. I dont think he remembers me. I think he wants to see me before he makes any kind of plans because he wanted me to page him to our floor before the end of my shift. I bet there is a nurse on every floor that has one of his business cards/pager number and to be honest he didn't deny it when I made a joke to that effect. Whatever...

I met a nice guy at the drugstore yesterday. he had seen me at a party a month ago and I left before we had a chance to meet. His name is Jeff. I don't know much more about him. In all honesty, I thought that my cousin wanted to date him so I never gave it a second thought, but now that she is dating another guy I guess he is fair game. We exchanged numbers and someday I might call him too! That is if he doesn't call me first. I think I like calling first since I have tried it because I feel like it gives me a certain sense of control over the outcome. I don't know if I will be talking to the electrician again and if I do, we will be ONLY friends.

On the job...
Suddenly, it seems like everything has clicked and I finally know what I am doing. For real this time. I was wondering when it was going to happen. It has taken almost a year to get myself together. People have always said that it takes about a year to feel like you know what you are doing. I guess that is true. One of the hardest lessons that I think it has taken me to learn is not to sweat the small stuff. And believe me, about 90% of it is small stuff. Being on a first name basis with a doctor is not so awkward anymore.

I am not as afraid to express my opinion on the plan of care, or discuss aspects of the plan of care that I am uncomfortable with. It is becoming easier to ignore people with attitudes, accept mid-shift assignment changes and discern REAL emergencies from potential emergencies or things that just need to be watched. For the first time in a long time look forward to going to work. I have even learned who to ask for help and who not to ask, because believe me you cannot ask everyone for help. Some people will give you bad information and then pretend like they didn't advise you when it doesn't work out. Or they will report you to the nurse manager for being inept. I am glad that I stuck it out.

On family life...
The kids are making me crazy this summer. The house is a mess, there is no food and sleeping is nearly impossible. But we are working it out. My son is going through this independence phase. I have to get him in check now because he is approaching the unruly teenage years and I am the law. He did get up this morning and get himself ready for football conditioning. He made sure he ate a well balanced meal, got dressed, I must say I was impressed. My daughter is still my baby. She is getting taller and more independent. Soon, no one will need me for anything. But I still think it will be a while before I can trust them to get themselves ready for school unsupervised.

DiVa...counting her blessings and loving life at the moment!

Tuesday, June 19, 2007

Scrubbing with the enemy...

I was scrub nurse last night on a C-section and the doctors were not in a great mood. The first surgery started out as a crash turned non-emergent. As I understood it we were not in a hurry. In an emergency, we do not have to opportunity to perform what is known as a pre-operative count. In the pre-operative count we establish sort of a baseline inventory of equipment that we are starting with to perform surgery. Since the first surgery was not an emergency a count should have been performed, but the doctor grabbed instruments off of the field before they could be counted and started the surgery as if we were ancillary staff instead of licensed professionals who assist in making sure that the surgery is being performed safely. As a result, an x-ray had to be performed. Not a bad thing, but would not have been necessitated had the doctor given us an extra three minutes to finish the count. The x-ray came back unremarkable. Everything turned out fine.

The thing that probably pisses me off the most was that the circulating nurse tried to make it seem like it was all my fault. He decided counsel me on "how to be a better scrub nurse" in the middle of surgery in front of all of the surgeons. I told him right away that I am not accepting the blame for the count not being done. I think that instead of assigning blame or using that as an opportunity to "teach me" how to better scrub, we should have been defending each other because we BOTH made the MD aware of the fact that the count hadn't been done. How many times must I tell people that reprimanding me in the middle of surgery is unprofessional and plain old rude. After surgery, pull me aside and tell me what you want me to know. I am approachable.

The second C-section was with a doctor that wanted me to anticipate her needs and differentiate by tone of voice when she is talking to me and when she is talking to the resident. I couldn't do anything right for this doctor. I didn't fold the sponge properly or hand off the suture scissors quick enough and she in the middle of surgery decided to give me immediate feedback regarding my performance. I responded by saying that I was a new nurse with limited scrubbing opportunities and with practice, I will become better at anticipating her needs but in the meantime I need her to be patient and clear about her desires during surgery and I left it at that. She walked out of surgery with a major attitude. Most of my peers would have been bawling their eyes out but I think that these "experienced medical personnel" need to realize that at one point in time they were new and that medical school or nursing school is ineffective at teaching a person everything they need to know about being a doctor or nurse.

DiVa, Experience is the best teacher...

Friday, June 15, 2007

An interesting possible date

You know I have always kind of been against dating on the job, but this time the DiVa might have to make and exception. I met a really nice guy on the job. The first time I saw him, he was trying to be flirtatious and I was like "whatever" but now I am thinking about it and I am like "maybe". He is not a nurse, nor does he work on my floor. Oh, and he is not a cop which I have been told goes together with nurses like peanut butter and jelly.

He is an electrician, and he is a really handsome. Since it is late and I have to go soon, I will have to log in and tell you more later. In the meantime, any suggestions on what to do next?

DiVa...so bad at this dating thing!

Thursday, June 14, 2007

There's just one thing...

That I cannot seem to wrap my head around. When I find out or have a feeling that people have said something crappy about me or reported some fictitious occurrence that gets me in trouble at work, I cannot smile in their face and act like nothing has happened. I cannot be fake like that. I have always been one of those type of people that can't let someone hurt my feelings repeatedly. You have ONE chance to screw over The DiVa and unless you apologize to my satisfaction, (Or I realize that whatever happened is my fault), you are written off. That's how it has always been.

One night I talked to a senior nurse about what I was feeling and she shared that she feels the same way. But nursing isn't one of those professions where you can alienate people because you don't like them. If it is a code situation you need HELP and alot of it and you cannot pick and choose who comes to help. You may have a room full of your worst adversaries and you have to make it work. It has happened to me before and I know that they went back and reported that I am inept, but I was a brand new nurse to the world, I shouldn't be the expert yet. I am still getting adjusted to this nursing thing.

I know for a fact that I cannot Susan cuss me out in the presence of everyone and then the next day say "I love Susan, she makes the best coffee." I would be more like "F--- Susan, that B---- better be glad I didn't beat her A--!" That is definitely something I need to work on.

I am really pissed off at my cousin this week. I had Tuesday night off and I though that we would hang out and have a cocktail and enjoy the night. I gave her $11 to buy a bottle of our favorite alcoholic drink and told her I would be over by 8-8:30 to hang out. I should have known I couldn't trust her to do the right thing. I get there at 8:30 as promised and her driveway is full of cars. I get in the house she is passed out drunk with a house full of people who had been obviously partying at my expense. I was a little pissed because the bottle that she allegedly bought with my money was EMPTY and sitting on the table. I was cool, I said "Someone owes me $10", and left it at that. Her nephew dragged her drunken behind out of bed. She ignored me and said, "What is she gonna do, beat my ass?"

I am a professional. I don't need to beat anyone's ass. However, I do believe that I am due a bit more respect. It was my idea to hang out. I had brought a movie, I had a babysitter I planned to have a good time. How do I approach her now? This would be a perfect opportunity to learn how to resolve problems and move forward in relationships because all the time I have wasted being mad at my cousin about the stupid crap she pulled this week we could be working on having a more meaningful friendship not that it is too late to do that, but the stuff did happen on Tuesday. If only I could work out situations with the understanding that the offending action would never happen again.

DiVa, trying to learn how to better manage her relationships...

Wednesday, June 13, 2007

Beware of flying babies, a cautionary tale...

Have you ever seen a movie where a woman is having a baby and the baby comes flying out of a woman like a cannon ball or something and the doctor is standing right at the end of the bed and catches the baby like a football? This very thing happened a few weeks ago with a patient of mine. Here's the story.

It was a busy night in the delivery rooms and I already had one laboring patient, but she wasn't doing a whole lot so I was assigned an active laboring patient. She was a gravida 2 para 0 and she was 6/90/-2 on her exam. She was 31 weeks pregnant, which is viable (at our facility anything over 23 weeks is viable which I think is crazy but that is another post). The doctors told her that they believed that they could possibly stop her labor because recently we kept a lady at 5 centimeters with a bulging bag for almost two months in a reverse trendelenberg. Not common, but possible. The plan for this patient was to give her Indocin (a medication to stop labor). If that stopped labor good, but if not we were planning to have a baby. So I gave her the Indocin and the Nubain (pain medication that works at the neuromuscular junction to intercept pain impulses) and then the waiting game began.

Her family surrounded her bed and they held hands and prayed. They were pleading with God to stop the labor. It was very nice, and I was hoping that would work because I am not very good at code pink deliveries. After about two hours the pain started again. I had her checked and she was 9 centimeters dilated. She wanted an epidural, but the doctor suggested that she just go at it natural because she was afraid that it would have a negative outcome, but at the same time she told the patient it was her decision. Why didn't she just say no? The patient was begging me to get her an epidural and I knew that Anesthesia wouldn't allow it because she was to far gone. About a half an hour after that we start pushing.

I have a general rule about pushing, I never take the bed apart without a MD being at the foot of the bed. And this time it was for a good reason. As a matter of fact we didn't even take the bed apart, we just lowered the foot of the bed to make it like a chair. So I had the patient begin to push. I called my neonatal resuscitation team and my charge nurse. I also had all the necessary OB doctors at the bedside. My idea was that we do slow controlled pushes so that the baby would glide out gently into the doctors arms and be given to code pink. And we did do a few pushes my way, but the charge nurse had a different idea. She wanted that baby out and she wanted it out NOW! So she told the patient to curl up like she was doing a crunch and push down into her bottom with all her might. She did and after about two pushes the bay came flying out, and if the doctor hadn't been standing at the foot of the bed, that baby would have had airtime. I was mortified. I was speechless for about 10 seconds. Being pleased with the outcome, the charge nurse went over to the warmer to assist code pink and it was business as usual.

DiVa, know when to break the bed and when not. Babies are fast when no one is there to catch them!

Saturday, June 02, 2007

Just when I thought I couldn't do something more idiotic...

I prove myself wrong by doing something ridiculously idiotic. Last night was a busy night and our nurse manager was working alongside of us. This is a cool thing because I love the fact that the manager is willing to roll up her sleeves and come down into the trenches with us. At any rate my patient had a negative blood type. Here's a quick tutorial on Rh negativity and pregnancy.

If the baby has a positive blood type and the mother has a negative blood type, the mother will build antibodies against the baby. Since she was a primipara (having her first baby) nothing bad happens. However with the second pregnancy, if the baby has a positive blood type and the mother has a negative blood type, the mother's immune system will reject the baby. By rejecting, I mean it will attack and kill the baby. So in this particular delivery, it was very important to find out what the baby's blood type is so the next time or even this time, the mother can be treated with Rhogam to prevent a rejection. It desensitizes Mom to the positive blood type baby.

The baby was coming out very slowly, probably because he weighed 9 pounds, but it made me nervous because I wanted at all costs to avoid a forceps or vacuum delivery. I called the charge nurse in for a little support. I was so wrapped up in the safety of the Mom and baby that I totally forgot to collect a sample of the fetal blood. So in my mind I am organizing requests. The doctor is asking for suture to repair the perineum, and then a light and maybe some lidocaine. I wanted to keep an ear out for the babies apgars and such. Oh, and I needed a syringe to draw the blood out of the placenta because I neglected to ask for a section of cord for the blood sample. The clock is ticking because if blood sits still for too long it will clot and then the baby would probably need a blood draw. The doctor asked for a stool.

I went into a room to get a stool and noticed that the manager was taking care of my other patient. I said Hi and returned to my room with a stool and a syringe. I proceed to draw blood up from the placenta. Good, it's not clotted. I take my vacutainer and who walks into the room? The manager. While she is watching me, I take the needle and stick it into the top of the vacutainer. She says, "Aahhh!" I look up but it is too late I have already done a big nursing no-no. What if I had stuck myself with the needle?

DiVa, needs to remember to protect herself at all times...

Coming soon, "Beware of flying babies, a cautionary tale."