I can't believe this stuff still surprises me.

We got a call from the ER the other night saying that there was a woman who was 27 weeks pregnant on her way in by EMS. She was being brought in from the county jail because she was bleeding profusely. The ER said that when they took the call they had found fetal heart tones in the 180's on the ambulance.

They bring her in to L&D on a stretcher (accompanied by a police officer) and transfer her to the bed. Several of us try and find heart tones but nobody can so we get the midwife to come back and do an ultrasound.

Diagnosis: not pregnant, on her period (I really wish I could ask EMS about those heart tones they found)

The girl couldn't use the phone in jail and apparently she had some important calls to make so she faked her pregnancy and urgent condition for a couple of hours of almost uninterrupted phone time.

Breaking Wind

I have a coworker who likes to go into an empty patient room to fart instead of the bathroom for some reason. I guess she feels like she get a whole empty room for no one to hear her as opposed to chancing someone walking into the locker room.

Last night I am walking down the hall and I see this coworker coming out of my patients room.

So, I ask her, "Um, what were you doing in my patients room?"

"I had to make a trip to my office." This is her term for "I just let out a rip roaring fart in an empty room".

"In my patients room?"

"No that room is empty."

"No, I have a patient in there."

So, we poke our head in the door and sure enough my patient has now emerged from under the covers and was laughing her ass off.

No, I KNOW what day I got pregnant.

9 times out of 10, when someone insists they know exactly when they got pregnant, and their dates are off, it is because they cheated on their spouse.

A few weeks ago I was taking care of a patient who had 6, yes 6 girls at home. She was on her 7th child with her husband. Her husband was absolutely GLOWING because he was so excited that he was having his first son. Probably the last four girls they had were an attempt at this little boy that was about to be born.

Anyway, randomly (and they always throw it out randomly for some reason) she says that her doctors are idiots because she knows when she got pregnant and she is much more than 37 weeks pregnant. With my curiosity peaked, I ask her when she thinks she got pregnant. I got the little due date wheel, put her dates in and find out that according to her she is over 43 weeks pregnant. Not happening, especially since she was dated by an early ultrasound that is very accurate due to developmental landmarks.

After a little more digging I find out that she had to have gotten pregnant on this day because after that her husband left on an extended business trip for over a month. That pretty much told all. I wonder how long it will take for the guy to find out that his little boy is someone else's.

The lies we tell ourselves.

"I really did weigh 130 before I got pregnant. I must have gained 100 pounds in the first 6 weeks."

"You guys are stupid. I know EXACTLY what day I got pregnant and I am 44 weeks." (Again, a story for another day.)

"Nobody can ever draw blood because I have really deep veins" (Yep, I am sure you weighing 400 pounds has nothing to do with it.)

"I think my water broke."

Ok, I know that last one seems weird but I can't tell you how many women are dramatically rushed into L&D by their concerned significant others after "their water breaks" when they know good and well they accidentally peed on themselves.

You have a baby sitting on your bladder. It can happen. Yes, it is embarrassing BUT I promise it is less embarrassing than spending several hours and hundreds of dollars at the hospital only to have someone tell you that the gush of fluid that you felt actually came from your bladder. This is especially true if your loving and freaked out spouse has already called your parents, in-laws and best friend to join you at the hospital for the news.

I think you are on crack.

If you have a baby, and test positive for drugs while you are at the hospital having it, I can guarantee it will get taken away. We don't test everyone for drugs but from experience here are some ways you can assure yourself a "random" drug screen.

1) You show up with track marks up and down your arms. Don't try calling it a rash either.

2) Showing up for your routine hit of IV pain meds every other day during your pregnancy for various aches and pains.

3) Showing the person starting your IV what vein you usually use.

4) Offering to help.

5) You're 9 months pregnant and didn't know it. (See below)

6) Your baby is high.

7) Having your clearly drugged out friends bring you the "special brownies" from home.

8) Trying to blame the haze and smell coming from your bathroom on your bowel habbits.

And finally...

9) Flinging poop at the walls. Yes, poop.

One month old!

This blog has reached it's one month anniversary. Yeah, I'm that kind of girl that has to celebrate but I promise I won't do it every month. I just wanted to say that it makes me happy there have been over 7000 hits in the first month. So, whether you hate it or love it thank you for reading!

The other side.

They can't all be as good as yesterday. If they were, I am pretty sure there would be reality TV cameras hanging out somewhere. Yesterday I covered "thinking you are pregnant when you aren't" so let's try the opposite: Women that get through 8-9 months not knowing they are pregnant. I think it takes a fairly freakish ammount of denial to make it through an entire prenancy without knowing it. It happens more than you think.

Last week a woman came in to the ER with stabbing abdominal pain that started around 2 AM the night before. She showed up around 10 that morning and was taken right back to be worked up. Now, the ER doesn't like to have anything to do with pregnant woman and they send them straight to L&D the moment they find out they are pregnant whether they are there in labor or have a broken toe. Seeing as how they actually gave her a bed her means they didn't even suspect.

She was worked up for this "abdominal pain" for nearly four hours. Labs were drawn, exams were done etc. and it wasn't until her shrill "I am dying" screams at about a quarter to 2 that pregnancy crossed anyone's mind. Of course, they wheeled her stretcher straight to L&D where she proceeded to deliver a full term baby a whole 2 minutes after arriving.

So, how did she not know she was pregnant? The answer is usually "I have irregular periods" and a whopping side of crazy denial.

You can't even make this stuff up.

In L&D you see all sorts of crazies. Some of the extremes are the women that come in and deliver at 9 months and never knew they were pregnant until they come into the ER for "severe cramping". We will go there later. On the other end of that are the people that come in and aren't even pregnant. We will go there now.

A rather obese woman came in, walked up to L&D and said she thought she was in labor. See the "call your doc first post" for the conversation that followed although it will soon become obvious why she didn't. Since she didn't have a doctor with privileges at the hospital she became the responsibility of the practice that was taking call for the ER. As I am walking her back to her room she mentions she is having twins. I send her to the bathroom and ask her to take off everything but her bra and change into her gown. She comes out and tucks herself into bed, much shyer than the average patient about "exposing" herself. I figure we will cross this hurdle a little later. I try to put her on the monitor and I can't find one heart beat, much less two.

Fearing the worst, I get the midwife back there who pulls out the ultrasound to see what is going on with the babies. What she saw was probably more shocking than two dead babies. Not only were there no babies but where the heck was the uterus. Upon "gentle inspection" down south, it turns out "she" was a "he" who apparently needed a psychiatrist, not an OB. I can't wait until his insurance gets to sort out that bill.

You can't sneak in and out of the hospital.

While I am on a "call your doctor first" kick, let me elaborate. I am pretty sure that at least 99% of L&D nurses agree with me on that one.

Last week we had a lady walk up to the nurses station and say "I'm here!" Um, OK. Who are you and who is your doctor? This is followed with "Did you call their office?" She tells us that when she calls the office they either tell her to come to the office or go to the hospital so this time she decided to just save herself the trouble come to the hospital.

You see genuis, that is kind of the point of calling the doctor first. They can listen to what the problem is and decide where the best place to see you is. Going to the hospital is never the easiest option.

We ask her what brought her to the hospital.

"I need an ultrasound".

"Excuse me?"

"I need an ultrasound. I haven't had an ultrasound in two weeks and I am having twins. I am supposed to have an ultrasound every week with twins".

"No, that isn't true but let's get you into a bed and I will page your doctor."

"Am I going to be here long?"

At this point I am thinking, "Crap, lady, you walk into the hospital trying to "admit" yourself for an ultrasound to Labor & Delivery and you want to know how long you are going to be here? I am sure we all hope your stay will be short." I hold myself together and explain very nicely that since she came to the hospital she will be there at least a couple of hours, maybe longer.

Now she is irate. She snuck out of her house to come to the hospital hoping that no one would even notice she was gone. It is pretty obvious her thinking is flawed. It also turns out she had spent all afternoon on the phone with every hospital in a tri-state area trying to figure out who she could con into doing an ultrasound. They had all told her it wasn't necessary.

Within the hour her husband had found her and was up there yelling at her for sneaking out (and probably other things if I had to guess) . She got to waste half her day and several thousand dollars and best of all, she didn't get that ultrasound.

Are you an ER doctor or what?

In general, I don't suggest just showing up in the ER during normal business hours and I always recommend you call your doctor first, or at least on your way. I really can't blame this girl for going to the emergency room but if she had put in a call to her doctor they may have actually made it to the delivery.

Out, further away from town there are some small community hospitals that have maybe a few beds and an emergency room. I really have no idea what goes on there or what sort of cases they see but I don't think it is too much to imagine that they have "real" doctors working there. The other afternoon the phone rings. It is an ER doctor from Bumfuck Hospital and he wants to speak to an OBGYN. His patient's OBGYN in particular. Fair enough. I put him on hold and see if I can find her. She isn't there but one of the other doctors from her practice is and he takes the phone call. This is side of the conversation I hear:

" Uh huh."

"She's complete?" (Completely dilated, effaced, etc.)

"Yeah, I'm not driving out there. I won't even be close to making it in time."

"No, YOU'RE going to have to deliver the baby!"

"You're calling who? Are you an ER doctor or what?"

The emergency room doctor had told him that if he didn't come out and help him he was going to hang up and call 911...from the emergency room.

Be patient

I have been working back to back shifts and while I have a couple of goodies, I really want to give them the attention they deserve. In the meantime, a word of wisdom. If you have to be taken out back to the loading dock to be weighed (I swear I am 100% serious) it is time to seriously consider that diet.

A borrowed story.

On the rare occassion that every one isn't running in different directions, we like to exchange stories. One day I hope to engage everyone in a "strangest thing I have found in a vagina" pissing contest but for now that will have to wait.

One of the doctors I worked with was telling a story from his residency overseas. In true, House-like fashion, a woman comes in to the ER extremely sick and nobody knows what is wrong with her. After a head to toe exam and blood work ups they find out the woman is pregnant and pass it along to OB. That's when Dr. Smith arrives, does a vaginal exam and finds a really nasty looking lesion inside her vagina. He tests for every STD in the book and figures the case is closed. Then the tests all came back negative.

By this time, the woman's health is rapidly deteriorating. She has been admitted to the hospital, has a terrible fever and barely conscious. New cultures are taken of the lesion and sent out to every lab imaginable. The results? Cat scratch fever.

If you know nothing about cat scratch fever, it is a disease carried by catch and caused by the obvious. It can cause mild to significant systemic illness with a rather nasty lesion at the site of the cat scratch.

No, he didn't ask how.

The Medicaid Bus

I don't know what it is about getting something for free that makes people want to abuse the system. No patient ever comes to L&D by EMS unless they are taking a free ride. A few days ago, one of the physicians I work with calls over to say they are sending a patient over with a raging case of trich. She wasn't in labor but the doc wanted us to monitor her baby while she was being treated..

The phone is barely hung up from that phone call before it rings again. This time it is EMS calling with an estimated time of arrival for the same patient. This is where I tell you that the doctors office is right across the street. It isn't even a busy street but more like a little side street. It would be an easier walk than getting a crappy spot in the mall parking lot. In addition, she had someone with her with a car, but by the time you walked out to your car and parked again at the hospital it would be easier to just walk. Now, we will all be paying for her "free" minimum of $250 dollar ride through the parking lot.

There is a bathroom down the hall.

Here is a lesson on why you don't use patient bathrooms. A few weeks ago, I was busy in a patients room trying to move her monitors around to find her baby's heart beat again. The baby was on the run so as soon as I would find it he would move again and the search would start over. I finally got it all settled in after 5-10 minutes of looking and as I get up to leave her husband comes out of the bathroom. First, I had no idea that he had been in there that entire time and second, when he opened the door the foulest smell spread through the room. I am sure his wife considered it a gift for her extra sensitive pregnant nose that lasted for hours.

If that didn't deter you, consider this. Yesterday, I went to take a patient out to her room on the post partum unit. She is in the wheelchair ready to roll and all she needs are her belonging that are hanging on the back of the bathroom door. Does she warn me that her husband is in there taking a crap? No. So I open the door to get her stuff and there he is, mid-poop of what sounded to be rather bad diarrhea. I grab her stuff, shut the door and then explain to him where we are going and how he can get to the room.

I wheeled my patient out to the floor, got her settled into her new room and then gave report to the nurse that would be taking care of her from there. I then head back to the room (at least 15 minutes later) to look for the slippers that were left behind in the bathroom in my haste to give her husband some privacy. I guess it was my fault for not knocking but the room had been empty for a while and the door was wide open so who would have thought? I open the bathroom door and her husband is still there, only for some reason he is now squatting over the toilet, looking down between his legs either inspecting his balls or admiring his hard work. I asked him to grab the slippers on his way out and then got the heck out of there.

It's not always happy.

If you are sensitive, or maybe just norma,l you will probably find this story disturbing. I did. If you don't want to be be disturbed stop reading. Consider yourself warned.

When a woman gets pregnant, usually the vision is of delivering a happy healthy baby, not a tragic ending. As an L&D nurse, I realize that the latter is something that happens more often than anyone would hope although I am sure it is not something I will ever get used to. I have been present at the birth of babies that for whatever reason have died before being born but today was a first for me. My patient, Jo, came in already in labor, fully dilated with her water broken and contracting. At this point there was nothing we could do to stop her labor and because she was under 24 weeks pregnant there was nothing we could do for the baby either.

We did everything we could to make her comfortable and found out she was having a baby girl she had named Claire. I called the chaplain so she could come baptize the baby, since Jo let me know this was something she wanted.

Because the baby was considerable smaller than a term infant, and because she was already fully dilated, labor went much faster than normal and starting a little bit of pitocin was all it took. I had another nurse in the room with me for delivery who is specially trained in infant loss. As soon as the baby was born she took Claire to the back to get her cleaned up so that Jo could hold her and I stayed to take care of Jo.

Once the placenta was delivered and Jo was all cleaned up and comfortable, I went to help with Claire, who to this point I had thought was born still. I had been in the back with her for a full two to three minutes before I saw her take a deep gasping breath.

It is something that you see on telivision as a comedy or a scare tactic but it is extremely startling to see someone that you thought was dead start to move. We got Claire dressed in a tiny baby outfit and took her out to her mother to spend her last minutes.

Jo's family came in, and luckily were very supporitve. It is awful feeling like you wish you could do more. Everything I did just felt so minimal. I know Jo will need the support of her family and nurses in the next days and I hope I could make some sort of positive impact in the short time I was able to care for her.