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.

First night in the Nursery....

So in order to work in Mom/Baby, one must have NRP training in case a baby does something dumb like stop breathing. I'd been asking about getting my certification since I transferred back in September, and was told "Don't worry about it, we'll take care of it."

Until my manager got a call from The Powers That Be who said "If PurpleRN doesn't have her NRP, she'll be suspended without pay until she is." There were no classes available that I could go to, so I got sent home with the manual and a DVD and told to study while I was in Montreal for Xmas.

I then woke up at 0645 so I could be at work at 0800 to do the written test and practice "megacode." Luckily, it only took about 2 hours since it was a class of one :) The instructor said I'd get my NRP card in a week or so.

So imagine my surprise when I'm listed for Nursery duty when I get to work that night. Okay. Can't be that bad, right? Even if I don't have the card, I have the training.

I was blown away by the busyness. At max, I only had 5 babies at a time, but the 3 that stayed most of the night kept me crazy busy.

Started off the night with just one baby while everyone was getting report. Then the littl'uns slowly started trickling in. Nurses just wheelin' them in, saying "Purple, can you do my baby?" and walking back out. Again, I don't get that. It's one thing if you plan on having the baby stay the night; then it's my baby. But I am not a 10-minute oil change place. Or maybe I'm misunderstanding the job.

Then the overnighters started coming in. One nurse had 3 of her babies with me; she felt bad about it lol. So I'm assessing my charges and whatnot, and one of them starts spitting up. Okay, no biggy. Babies do that.

But over the course of the night, she spit up at least 6 times. I couldn't get her to hold formula down (exclusively bottle fed *frownyface*)

You know how crying is contagious with babies? Apparently so is vomiting. At least with my luck that night. When I got baby #1 cleaned and settled, baby #2 started spitting up. Ok. Turn on side, bulb suction. Meanwhile #1 spits up again so I turn and suction and then baby #3 starts. I'm thinking "WTF! I only have 2 hands!"

When the synchronized puking is finally over, someone wheels in a baby and says "This one needs Bili and PKU. Was supposed to be done last night, but lab missed him."

Ok. So drawing from a heelstick is *not* my strong suit. But I gamely put on the heel warmer and gather my supplies, and then spend the next 10 min torturing this tiny soul. Had to milk the leg to keep the blood going, and ended up having to poke him a second time to get the second lab. And while I'm drawing this baby, someone brings another one in for labs as well. I'm thinking "You sure this has to be done now? Can't it wait till 0600 labs come?" Meanwhile the nurse who brought first baby in comes back and wonders why I'm not done yet (cuz I'm bad at this, duh!) and someone recommends keeping the baby under the warmer so the blood flows more easily.

So with 2nd lab baby I fire up the warmer and get my supplies. And I dunno if it was the warmer or this baby had better blood flow but it took *waaaay* less time and the kid barely noticed. And my back hurt way less since the warmer is higher up and requires less hunching over. Body mechanics are not my strong suit.

So lab babies are finished and baby #1 starts throwing up again. I give up trying to feed her, regardless of how hungry she's acting. I look through her chart to figure out why there might be a problem. C-section baby, okay, can be a reason. Then I see a note wherein I discover that at 2 hours of age, the parents gave 25mL formula by bottle. A fresh newborn's stomach capacity is <10mL generally, and the only reason she would have to take in that much formula is if she just kept sucking for comfort...

So I give her some extra time before feeding again, and turns out she is terrible at sucking. All jaw action, no coordinated tongue movement. So at 0600 I finally give her 3mL by syringe, drop by drop under her tongue. She manages to keep it down and finally fall asleep for more than 10 min the first time in the shift.

In addition to baby care, also have to check the emergency equipment and do the Quality Control on the glucometers.

All in all, I think I like Nursery duty all right. I think the best part is that it's more reactionary need-meeting care rather than plan-for-the-shift care. Easier on the brain when you're just playing defense.

I am looking forward to when the rotation lands back on me for Nursery, if only so I can get more practice....

Why I am not moving to Montreal....

I love visiting my family up in Montreal. There's something about Christmas in that city that feels different from any other. So when I was there last week for the Holidays, I thought about what it would be like to live there.

I've been saving my pennies to buy a house; it's really expensive where I live, to the point of extreme frustration. Yet in Montreal, many of my cousins (some younger than me) are already homeowners. You can get a beautiful brand-new construction there for the price of a fixer-upper here.

So the question came up - Why not move to Montreal? "We really need nurses here!"

But I don't think I could be a nurse anywhere but California. I have never known life before the mandatory patient ratios took effect in 2005. I don't know what I would do with 8 or 10 or 12 patients, apart from lock myself in a bathroom and cry. And to have to keep an eye on a colleague's 8 or 10 or 12 patients when she takes dinner... I can't imagine.

I've never once had to work mandatory overtime. I've had to deal with annoying phone calls begging me to come in on my day off and desperate managers scouring the floors for anyone who wants to stay over. But if I say no, that's it. No repercussions.

I've never shown up and been told to go home because they didn't have enough patients to go around. They will find *something* for me to do around the unit and pay me for it. But I can volunteer for a day off if I want (and I usually do!)

I've never had to float to a unit that I am unprepared for. They can't just send me to Pediatrics out of the blue because they're short staffed; I have to be oriented to and trained for the unit.

I've never had to rotate my sleep schedule to accommodate revolving shifts. If I am hired to Nights, I work Nights. The only time I have to forgo sleep for something work-related is if we have a Skills Day, since those start at 0800 (grumble grumble).



If I had to deal with those situations as a possibly daily occurrence, I don't think I'd make it. Maybe I'm spoiled, who knows. And I suppose the kicker is that if I were to live and work in Montreal, I'd get paid 1/3 to 1/2 what I do here. And the cost of living isn't *that* much cheaper.

So, no, I don't think I'll be relocating any time soon.

Plus, my French skills are dismal.... :)

This site has the most imaginative pictures!

http://www.fubiz.net/2010/07/27/milas-daydreams/

You must go to the site to see the rest! Super cute and super creative!




(I know this has nothing to do with my work other than it is baby-related, but such is life *grin*)

Forgot to post this when it happened, but now's as good a time as any...

This is back when I was on Tele (Sept 7), but pretty near the end of my sentence there.

I was Resource, or maybe Committee. Regardless, I didn't have patients of my own. My task was to help discharge a patient who'd been admitted for CHF. I knew pretty much nothing else about him lol.

So the discharge paperwork has a lot of instructions and education on it, so patients don't have to try to remember every little thing. The CHF paperwork is probably our most common; I can quote chunks of it from memory.

So I'm going over the instructions with the patient, his wife, and his son: "Start taking these medications, this one has changed dosage, stop taking this one, etc" Then we get to the lifestyle habits that are essential for controlling CHF.

"Try to cut as much salt out of your diet as possible. Penzey's (a spice company) has some amazing salt-free seasoning mixes that really help make up the flavor. And make sure to weigh yourself every morning, after you pee, but before you eat anything, wearing similar clothes every time." At which point the patient looks rather confused. I said, "Oh. Is this a new diagnosis of CHF? Someone from the CHF team should've come to see you at some point." "No, I got diagnosed last year." "And no one has mentioned weighing yourself?" "I don't even have a scale." Ohhh boy....

So I got to explain how salt and water work to balance in the body, and increased salt makes water stick around longer. It makes the heart work harder to move around the increased volume, and the fluids tend to leak out of the vessels causing swelling in the legs and difficulty breathing. Fluids can build up pretty quickly, so weighing yourself is the best way of telling if things are getting bad. If you gain 2lbs in a day, or 5lbs 5 days, it's likely to be water, not real weight.

"Trust me on this one thing: cutting the salt and checking daily weights are the easiest way to avoid ending up back in the hospital. I *know* you don't wanna come back here. It's much better to catch it early, and just go to the doctor for a med adjustment..."

Apparently no one had explained this to them in the way they could understand, let alone told them *why* they should make these lifestyle changes. I made little extra cheat notes on the instructions to help them remember the basics.

Eventually the runner came to wheel the patient out, and I wished them luck and headed down the hall. The son called me back for a moment, smiled, and said "Thank you so much for all your help, you should at least have dinner on me." He pressed a $20 bill into my hand. I thought about protesting, but he looked so genuinely, sincerely happy that I figured I'd just keep my mouth shut.



I never thought being a nurse would involve getting tips :)

In which I am mistaken for a Stepdown nurse...

So I had this patient.... Came into ER with headache and nausea, and BP 200s/100s. 33 weeks pregnant. Stat C Section for pre-eclampsia. I took care of her her first night on the floor. Her SBP was still on the higher side (140s), but coming from Tele that's really nothing to write home about. Baby was in NICU. Mom was recovering fairly well. Sort of. Turns out she developed HELLP syndrome and her blood counts were not pretty. Still, she was pretty stable and seemed to be doing okay.

Then I had her the second night. Apparently during Day and Eve shifts, her kidneys started failing. Her urine output was scant, and she was starting to get a bit swollen. They gave a small dose of IV lasix (20mg) but no luck. By my shift, we were during hourly urine outputs (ugh) and labs q6 hrs. Lungs were starting to get a little diminished, and the slightest bit coarse. She was on nasal cannula and continuous pulse ox, with frequent vitals. Honestly, it was kind of refreshing getting some of what I was used to.

Until I realize that I was not dealing with Med/Surg doctors.

I text-paged the doc to let her know that urine outputs for the various hours was very low (totaling about 70mL for the entire shift) and mentioned the lung sounds. Asked if maybe we try a larger dose of lasix or something (would be the first course of action on tele, since it can sometimes prevent renal failure from worsening). The doc said they'd decided she had Acute Tubular Necrosis and that we should encourage PO fluids and keep the IV running.

Yes, doctor. We should keep pumping fluids into someone who is not processing them or excreting them. That sounds like a great idea. Fast forward to change of shift when we have to cut off her ring to prevent it from impairing circulation in her very swollen hands.

When I came back the third night, I was incredibly relieved to hear she'd been transferred to ICU (apparently there were no available SDU or Tele beds) and set up to start hemodialysis.

She finally recovered enough to get back to the mom/baby floor, and with any luck should be going home this morning. :)