Thursday, September 25, 2008
Monday, September 22, 2008
Tuesday, September 16, 2008
I am NOT a labor and delivery nurse. I hate taking care of whiny pregnant women, and the littler the baby is the scarier it is. The problem is that no one at the hospital is a labor and delivery nurse. The hospital does not have a labor and delivery floor. Labor and delivery and women's center is at the sister hospital downtown. We do occasionally get the pregnant gal who has not had prenatal care or who is new or visiting the area and has not been instructed to go to Roosevelt Hospital if you think you're in labor. We stabilize these patients and quickly send them in an ambulance downtown. So I open the door to my patients room, she takes one look at me and screams, "I CAN'T DO THIS!!!!!!" at the top of her lungs, her eyes wide as saucers. I silence the groan building inside my throat, and successfully stop the rolling of my eyes.
I have not ever had a child. I have not ever been in labor. I have not ever been pregnant. So some might say that I have no room to talk, but you would not believe the number of people we get screaming and writhing in agony as described above and they are dilated to maybe a 1 or 2. As in 8 or 9 centimeters of screaming to go. I'm sure it's painful. But come on! The uber painful part isn't supposed to happen until around 7 centimeters. Besides, falling off a 10 story building is also very painful I'm sure. These patients never scream and writhe in agony. They can't. We sedate and paralyze them and shove a tube down their throat in the interest of keeping them alive. You can't do this to a pregnant lady. Unfortunately for me. This is why I am a trauma nurse :)
So, back to my screaming out of control patient:
Me: "Hi! My name is Toni, and I get to be your nurse tonight. How long have you been having contractions?"
SG (screaming gal): says nothing, holds her breath, her face scrunched up and turning a brilliant shade of red.
Me: "Ma'am, you're going to need to breathe. Take a big deep breath. There that's it. Now, next time a contraction comes, I want you to breathe through the pain. I want you to take big deep breaths in, then blow the pain away as though you were blowing out candles on a cake." (Where did that come from? I don't say shit like that, I must remember more from nursing school than I thought.) "Now, is the contraction gone?"
She says that she thinks so. She tells me that she has been having cramps for the last two hours. She has not seen a doctor at all for her pregnancy. This is getting better all the time. She doesn't remember her last period, but thinks it was in December. The last time she had sex was on New Years Eve when she was raped. Fantastic. Poor girl. She wants nothing to do with the baby. Understandable. Some lucky couple was about to have all their dreams come true because this baby will be placed for adoption. She does not want to see it or hold it or touch it when it comes out. She denies any alcohol or drug use during pregnancy. This means nothing to me. They all do. So what I have here is a 25 year old girl who is who-knows-how-far pregnant, but appears to be full term, who has no idea if her baby has a heartbeat, or an enclosed GI tract, or any one of a myriad of things that can go wrong in pregnancy --add to it the possibility of drugs and fetal alcohol syndrome, ad I've got a nightmare. A screaming, dilating, breath-holding nightmare.
I leave the room to go find the doc who signed up for the case. By some small miracle the attending had picked up the case. Yay! Maybe God didn't hate me so bad after all. I mean, at least I didn't have to deal with a baby doc (what we call the residents, interns, and students --lovingly of course ;) ). So I give Ashley the rundown on the patient and get stuff to start an IV and draw labs while she goes to see the patient. I get the IV started and hook the patient up to the archaic toco monitor that we have. This is the monitor that watches baby's heart rate and mom's contractions, and the correlation between the two. I dust off the cobwebs in the far corners of my mind and remember not only how to apply the pads, but vaguely what a monitor strip should look like. The baby does indeed have a healthy heart rate. The contractions are every 2 minutes and last for 30 seconds. Yikes.
While all this is going on, I am continually having to remind my patient to breathe in and out, and she is constantly screaming at me that SHE CAN'T DO THIS!!! I use my best acting patient and kind and all pink warm and fuzzy like a labor and delivery nurse would, and say, "But honey, you ARE doing it! You are doing great! I'll be here with you the whole time." I think I just threw up in my mouth a little bit, but it seems to have calmed her somewhat. By this time the Ob/Gyn resident has arrived and is ready to check the patient. Ob residents aren't bad. They tend to be scared of us ER folks. I suppose we can be intimidating, and quite honestly, I understand how we get our bitchy reputation, but that's a whole other post. So this guy comes in the room, looks at me with look of relief that there is another female in the room and shyly asks if I would possibly have a moment to chaperon as he does his exam. I grin and say, "Sure." My grin is bigger inside my head.
That is until he looks up at me in horror mid exam. "Well," he says, turning to my patient and thoughtfully removing the look of horror on his face for her benefit, and continues with the words that make me choke on the breath I was taking, "You're ten centimeters." I look at him using all my telekinesis to make him take it back. Surely he's not serious. Instead of taking it back he says, "I'm going to go page the attending at Roosevelt, and have him come up. We'll work on transferring you, but chances are, you're going to have to deliver here." "Your MOM is going to have to deliver here," the voice inside my head says. I don't think I said it out loud. So he goes out to page his attending, I turn with a smile frozen in disbelief, and look at my patient. She jumps off the bed and screams --again, at the top of her lungs, "I'm going to SHIT myself!!!" I fight the urge to giggle, then remember that this is a sign of imminent delivery. It happens when the baby is crowning, and I think to myself, "Me too!". Instead of saying this out loud, I make her lay back on the bed, I run to the doorway and scream at the top of my lungs down the hall in hopes that the charge nurse or someone will hear me, "I need the OB and a delivery kit STAT --she's CROWNING!!!"
I turn from the doorway back to my patient in time to see the baby's head peeking out. Oh shit! Then she lets out an even louder scream than before --I didn't think this was possible, turns out I was wrong --as the babies shoulders wriggle free and the rest of it's tiny body squirts out into my hands on the bed. Her screaming stops, and she resumes breathing, her head turned toward the wall and covered with a sheet so she doesn't have to see the baby. The baby isn't crying. Babies don't cry until you cut the umbilical cord. They don't need to until you clamp the cord. I don't have anything to cut the cord with. I don't have anything to clamp the cord with either. So in true ER nurse fashion I improvise with what I have. I pinch the umbilical cord with my fingers and the beautiful baby boy lets out the most beautiful cry i have ever heard. He was breathing and he was pink and he was perfect! 10 fingers and 10 toes.
With that obstacle cleared, my mind was free to further evaluate the situation at hand. I am holding the umbilical cord of a newborn baby between my fingers so the baby can live, in a room with a lady who just gave birth and wants nothing to do with the beautiful baby that is in front of me, in a back corner room where apparently no one can hear me scream. I only have two hands, and one is occupied keeping the baby alive by pinching the umbilical cord. The other hand should be drying the baby off to keep him warm, I remember that was important in nursing school. Unfortunately, I don't have any towels to dry the baby off with. Nor do I have towels to dry the baby off with or wrap it up in or clean up the very large pool of blood and post-baby goo that my patient is now laying in. Ew. Again in true ER fashion, I improvised. I reached across the bed to the small pile of clean gowns on the shelf above the bed, and pulled a few down. I used the clean gowns to start drying off the baby, and ask my patient if she is doing ok. I tell her that she did a great job. It's true. She did. She pushed an over 8 pound kid out with NO medication whatsoever. Strong work! She sighs happily, and says "Yes, I'm doing fine."
At this moment the OB resident comes back in with a delivery kit, whistling as he slowly saunters in. "You're late," I say. I was stating the obvious, but I don't think my voice was as venomous as I intended it to be. He looked at me in shock that turned to disbelief as he looked at the little boy in my hands and the not-so-pregnant-anymore girl laying happily --and quietly --in the bed. He went into a flurry of activity, throwing the delivery kit on the bed, and started mumbling half orders. "Ok. It's fine. We need ...clamp ...scisso --ooh, we need to dry ...and a warm ... ...wait! Is he breathing?" "DOCTOR!!!" I snip at him, perhaps a bit louder than I needed to. "Yes the baby is breathing, that's the small screaming noise you hear. It's fine, just breathe." You can't make this stuff up, maybe all residents are the same after all. I felt like I was in the middle of a tv show. This should not be happening. The baby doc recovered, and clamped the cord freeing both my hands to finish drying the baby and wrapping it in the blankets that came in the delivery pack.
As we transferred mom and then baby to Roosevelt, she thanked me profusely and told me that I had been wonderful. I smiled genuinely and told her to take care. I hope everything starts looking up for her. She seemed like a great girl now that she wasn't screaming in my face. And the baby was just cute. All was well with him and we eventually transferred him to the nursery at Roosevelt. I walked out of the now empty room that looked like a war zone, and there was suddenly a plethora of people as I walked back to the nurses station --patients waiting for x-rays, my coworkers, and security guards who all told me good job and congratulations. I was pretty proud of myself. I had survived. No time to revel in my glory though, I still had 8 patients who with various complaints --all of whom I was sure needed something. I was ok with the fact that they all still had airways.
This is a really really long post, but I have to tell you about the other thing that happened last night. It's worth it, I promise :) Read on...
So there we were. It was 0445 and we were finally slowing down. We had slowed down enough that most of us were sitting around chatting, waiting for lab and radiology results to come back. One of the nurses was trying to discharge a homeless patient. This is always a challenge. If we have the room, we will let them stay in a stretcher somewhere and sleep for the night, but in the morning, we have to let them go. None of them want to go, and they put up varying degrees of a fight when you tell them they have to. Sometimes we even have to have security escort them out. The patient this nurse was trying to discharge was particularly difficult. He has even spent time recently in prison for assaulting health care workers. The nurse came back unsuccessful but unscathed, and we sent in another nurse and the resident to try again a few minutes later. We were all peering around the corner from the desk, ready to jump in if needed. The guy reaches for his bag and starts digging and sifting through the piles of whatever was in there. We immediately waved security over and the nurse and baby doc backed away. We were all expecting him to pull out some semblance of a weapon. Security was stopped short when the guy pulls a baby raccoon out of his bag and THROWS it across the room at the doctor. Then gathered his belongings and ran away. Meanwhile, 5 security guards are chasing a frightened and frantic baby raccoon around the department, while the resident stood motionless in shock, and the rest of us burst into uncontrollable laughter. It was the funniest thing I've ever seen in my life. Who keeps a baby raccoon buried under layers of garbage in a giant duffel bag? Where does one get a baby raccoon? Why does one feel the need to store said baby raccoon and use it as a weapon? Again, you can't make this stuff up! I love my job! Good times. Well, now I'm exhausted, so I'm going to bed. I get to go back to the jungle tonight. I can't wait. :)
Wednesday, September 10, 2008
That's right folks, I still have to start IVs and draw blood and start foleys and ng tubes, but now it's only when the residents can't get it. At first it was oddly refreshing to not have to do these things, but the novelty has quickly worn off. Residents tend to be idiots! There are a few who are pretty decent, but by and large --idiots! Pretty much what we as nurses at the large teaching trauma center I work at is what we know is going to be the end result that the docs want and wait for them to get there. For example, a patient will come in with a complaint, say chest pain, and we will quickly start the lines before the residents can blow them all, and draw the labs we know they're eventually going to want. Even thought when we ask them, they say, 'no we don't need that.' So we draw them and keep them labeled in our pockets and wait for them to change their minds and order the tests. Every once in a while it is fun to be smarter than the baby-docs, but for the most part, it gets old pretty fast.
That having been said, I love my job! I work at the level one trauma center for northern Manhattan, Harlem, and the southern Bronx. Not nearly as active of a knife and gun club as I would have hoped, but I suppose that's a good thing. The people I work with are great, and you really can't beat living in the city. It really is the greatest city in the world. Only in NY can you walk from the most affluent privileged neighborhoods in the world to the poorest of the country's ghettos in less than two minutes. There are have's here and there are have not's. But there is also a large working, middle class population. There is also a large immigrant population that are living the American dream. They are the people that have the light and glimmer of a hope for a better future for their family and work every day to live their dream. It is an amazing thing! Honestly, it's strange when I walk down the street and hear someone speak English! Then again, since labor day ended all the tourists are Europeans. That's a different story though :)
Anywho, not much else going on, but I'll leave you with a few pics of my new "locale" :)
My hospital --two buildings --the ER is the first floor of the building on the right.
Grant's Tomb in Riverside Park
My favorite spot in Riverside Park
Church is the brown brick building to the left of the white one. The chapel is on the 4th floor :)
Me in Central Park
Me in a canoe in Central Park --by far the coolest thing I've done in the city!
View from the fire escape night of the hurricane!
View of Manhattan from Brooklyn with the 9-11 tribute lights
Me and 2 of New York's bravest in my apt building :)