An overheard conversation....

As a fix for our staffing problems, the management has decided to cross-train L&D nurses to float to Mom/Baby if we are short. One of those L&D RNs was having her first orientation day on the unit. Our scene finds us sitting at the station; they are discussing the pertinent info for shift report, and I am charting about 10 feet away.

[a muffled scream filters down the hallway]

L&D RN: Um, what was that?
MB RN: Sounds like a natural childbirth to me. *grins*
L&D: You guys can hear that all the way down here....?
MB: Yep. Especially if it's one of the rooms at the end of our hallway here.
L&D: [looks concerned] We had no idea you guys could hear things over here. I'll make sure to close the doors next time I have a mom without an epidural.

I dunno why but this brief exchange made me giggle like crazy.

I may have a problem....

Ok, so this might be kind of stupid.... I'm watching through all of Xena right now on Netflix, and I'm on the last episode of season one. One of the side characters is in labor, spending most of her time sitting off on the sidelines while the main action is occurring.

Cut to her lying on her back with her legs bent, and another character is telling her that the baby "hasn't come down at all" and I'm thinking, "Dammit, woman! You're an Amazon! Get off your back! You're better than this!" (also, since when did ancient greek warlords know anything about childbirth?)

And then they determine that the baby (apparently a half-centaur!) is breech and she has to have a C-section using candle-related hypnosis as a method of anaesthesia and the baby that comes out could *not* have fit inside that woman and then I realized I need to stop taking things so seriously.....

A quick story

Was helping out with a procedure on the Mom/Baby Unit that involved the pt getting a little bit of fentanyl beforehand to help chill her out beforehand.

I don't know exactly how it came up, but the other nurse I was working with said something about the doctor having to give it. I dunno, I guess we don't give fentanyl on our unit? *shrug*

So I do the doc a favor and draw it up using a cannula access needle
and put the plastic covering back on to keep sterility while we got everything else together.

The doc comes in and pulls the plastic cap off, exposing the red-hubbed blunt needle and asks (confusedly) "So, um, I just put this into the IV?"

I take the syringe away from her and put the plastic cap on so I can unscrew the access needle. "No, it's a needle-less system. Just screw the syringe into the luer-lock on the IV"

She turns to the patient and tries to figure out how they go together (without even alcohol wiping the IV port!). "Um, I don't usually give medications......"

"How about I give the med and we'll just say you did, okay?"

"Sounds good to me."


I don't think this incident is limited to this one particular doctor. My guess is that most wouldn't know how to give an IV med if you asked them to. Which is why my blood boils when I see doctors doing nursing jobs on shows like House.... If it were realistic, they'd have no clue.

Party Pitfalls....

Beyond, "Can I get a little help in here?!" there is only one other phrase that strikes terror in the hearts of nurses everywhere:

"You should talk to PurpleRN. She's a nurse!"


I was at a party this past weekend and heard the words careen out of a friend's mouth, hitting my good-time-spirit like lead weights. Before I had the chance to avoid eye contact and slip away, I was pulled into the conversation.

Friend: "This guy here is afraid of having surgery."

Me: "Oh? What surgery are you having?"

Guy: "I'm not having surgery."

Me: "Um.... okay..... Then how did this come up?"

Friend: "Tell her about your brother."

Guy: "When my brother was a kid, he had appendicitis and had to have emergency surgery cuz it burst"

Me: "Uh huh....."

G: "So now I'm really worried I'll get appendicitis and have to have surgery."

Me: (Why am I talking to this guy instead of having fun? *sigh*) "I'm guessing he had stomach pains for a few days and your parents didn't take him seriously until it was too late. Generally appendices don't burst without warning.

G: "Yeah, I do remember that happening."

At this point I hoped that our conversation was over, but for the next 20 or so minutes (felt like F O R E V E R) I had to reassure him that no, he was not likely to get appendicitis, that it was even less likely it would burst, educated him about "rebound tenderness" as a classic sign, told him that *if* he had appendicitis and it wasn't an emergency, he could likely request a spinal block rather than general anaesthesia if that was one of his concerns for surgery (at which point I had to explain what a spinal block was...) and I think I'm *finally* done with this guy when he asks again "So you don't think I'll get appendicitis?"

"No. It's not very likely. Judging by your hair color (it was grey) I'd say if you were concerned about something happening to your intestines, I'd get a colon cancer screening."

"People with grey hair are more likely to get colon cancer?"

[facepalm] "......no. You're supposed to get a scope done at age 50 to check for colon cancer."

"Ohhhh.... so you think I'm going to get colon cancer?"




At this point I was interrupted by someone wanting to know if I'd like a drink.

Yes. Yes I did.

Back..... to Telemetry!

I was briefly excited when I didn't see my name on the census board. "You're not on my list...." said the Charge. Took a brief look at the list from Staffing, and handwritten off to the side was "PurpleRN - Telemetry."

Good thing I just renewed my ACLS.

As you may recall, my old unit converted to 12hr shifts, so I'd be coming to them a full 4 hours after everyone else started. Apparently I was to take over the patient load of one of my no-longer-new grad comrades. As far as a first assignment after such a long break, I lucked out.

There were two alert CHFers, a new admission (that had just been done by the previous RN) who was super fun and talkative, and only one confused fall risk patient.

It was hard remembering all the stuff I was supposed to do for the shift. Totally forgot about all those stupid skin notes and turning notes. Still good at identifying rhythm strips at least.

They got new Dynamaps, which totally threw me off. You have to take them out of standby mode and respond to prompts on a screen, which is very weird.

The most interesting/annoying new thing is a different style of bed alarm. It looks like and it works by clipping a tether to the patient, and attaching the magnet at the other end to a contact point on the pager-type-thing. And it is only effective if the tether is, say, adjusted short enough so that it rings if the patient sits up. If it is long enough for the patient to get to the edge of the bed without alarming, it's not good....

This pt had been given Zyprexa before bed, with the intention of knocking her out. It did a great job, and I managed not to wake her up until I had to around 0530 for a vital sign check and BP meds. I hadn't noticed how long her tether was, as she was more or less sleeping on it.

The alarm went off around 0600, and two RNs managed to catch her before she slid off the side of the bed. The pt thought she had to go meet her husband. Tried to reorient her (with minimal success) and readjusted the lead. Also set the main bed alarm again.

I forgot how much fun that part was.

All in all, though, it was a pretty good experience going back. And it was hilarious seeing people's surprise when they realized I was working there.

Update on the last post I made....

I would not have thought it possible, but miracles do happen.


She survived.



We got more details of the ordeal after she was transferred to ICU. Apparently she developed abdominal compartment syndrome and had to be opened stem to stern to relieve the pressure. Someone manually massaged her heart while they had her open. They had to wait >24hrs before closing her back up because it took so long to stabilize her.

And yet she made it. With no major neurological deficits. There was some issue with her placement in the hospital after she no longer needed ICU-level care. They transferred her straight back to us, because they were not quite honest about her condition. Normally we don't take care of practically-immobile full-care patients with 3 abdominal drains. She shoulda gone to Tele or something at least. It's hard to turn a patient every 2 hours when you don't have any CNAs on your unit, and the House Supervisor isn't willing to budge....

But she made enough progress that 2 weeks after the ordeal, she's going home. I know there will be some drama for awhile, because no one goes through that sort of trauma unscathed. Especially since her family didn't tell her what really happened to her (it's a cultural thing) after the delivery.

Regardless, I wish her and her family the best of luck.

The rumors came in hushed tones at first, as they often do....

As if speaking them more loudly would make them truer. Which we all hoped would not happen. The first of them came when the baby was wheeled, alone, into the nursery.

"I heard the mom lost 6 litres of blood."
"They're going to have to do a hysterectomy."

Then even more quietly.... "They say she might not make it......"

Whenever there's an emergency with a mom in L&D, they bring the baby to our nursery so that everyone, including dad, can focus on mom for awhile. We became more concerned when dad showed up in the nursery to visit.

He had so many questions, a wide-eyed first-time father. To us seasoned vets, some of the questions were funny:
"How often does a baby poop? Every 3 hours?" "Well, you can't really predict that...."

Some were strange: "Did he cry when you fed him?" "Do you mean did he cry before because he was hungry, or during the feeding?" "During the feeding." "...No... he was pretty happy about it."

And then there was an overhead page. "Code Blue. Labor and Delivery. OR"

You could practically feel everyone in the unit's hearts collectively stop.

Dad then asked the question that we all hoped he wouldn't: "What does Code Blue mean?"

The break nurse and I exchanged a brief glance of panic, before I gently said, "It means there's an Emergency." I didn't want to tell him the truth. The dad said, "It's probably my wife. There were some problems after the delivery." The break nurse suggested that he go back to L&D to check in, but he stayed in the nursery for an agonizingly long minute or two before finally leaving.

The mood on the unit was funereal and somber. You could see the prayers on peoples' faces.

Another overhead page, specifying that a certain doctor come STAT. One nurse turned to me and said "I hope she's not gone."

Down the hallway we see a doctor and a security officer talking with dad. You can't hear from so far away, but you can only imagine the conversation. Dad looks like a small, lost little boy, with his hands clasped tightly in front of his chest, as if he's trying to keep his heart from falling out and shattering on the floor.

A doctor/nurse/tech (didn't see his name tag) in green scrubs came by to offer some information to our charge nurse. "We lost her pulse twice. They're working on getting her to the ICU. We poured so much blood into her, but it all kept just coming right back out. We didn't even get to finish stitching her back up all the way"

I was in the hallway when they wheeled the mom towards the elevators. A sea of green scrubs like waves carrying the bed along, with a person kneeling at the head of the bed, rhythmically pumping the ambu-bag while someone else followed, carrying the bed's headboard.

The person in the bed looked like an intubated wax mannequin, no signs of life whatsoever, and a horrible damp sheen over the unreal ashen skin.

Another doc came by the nursing station and uttered the most terrifying acronym in the maternity world: DIC. The body uses up all its clotting capabilities and just bleeds and bleeds and bleeds and there's not a lot you can do about it.

The last of the information comes from the janitorial staff. "They say she was fine for the first hour and a half, and was holding her baby. Then after that she started having problems."



"It took us two and a half hours to clean up all the blood."





I know I don't have a huge blog readership, but if any of you out there reading this could spare a moment, I'm sure prayers/happy thoughts/good vibes would be greatly appreciated by the family, even if they don't know it's happening.