Friday, February 29, 2008

Stand Up Kind of Guy

A few weeks ago I had a very young patient come in laboring. I really felt for her because in addition to being young she was also alone and probably scared to death. She also had with her a really sweet birth plan that included being able to labor naturally and the father-of-the-baby showing up and being supportive. After talking with her for a little while I found out that the first part was probably going to be a go (IE. her reasons for not wanting an epidural did not include 1) needles hurt or 2) my mom/boyfriend/husband says I am not allowed) but getting a supportive dad to show up when he hadn't been involved for the past 6-7 months might not go so well.

I got her all set up and as soon as a better room opened up I moved her up to a room across from the nurses station so I could keep a better eye on her in addition to giving her access to a jacuzzi tub. I guess she must have taken care of the second part of the plan because a couple of hours into her labor the FOB shows up. To put this VERY mildly, the guy looked rough.

Before long, I am glad I moved her to the room that I did because it allowed me to hear a little better what was going on in the room. My patient was doing a fantastic job but it was obvious that dad was one of those guys that handles crying/screaming and probably any uncomfortable situation by acting like a jack-ass. He is yelling at her to "just get the damn epidural" and it doesn't take too much to realize that he is really agitating my patient. I get her alone and I ask her if she wants him to leave. Big tears appear in her eyes and I can see that she knows that her plan isn't working. I tell her that is it her choice and to just give me the signal and he is out of there.

All it took was two more contractions of him acting a fool and she wanted him gone. So in I go to try and get a guy who can quite obviously pick me up (and probably another nurse too) and run off with us, one under each arm, to get gone. I also call security, stat, for help.

I tell him he has to leave. He doesn't take it well. How dare I take this experience away from him? He loves her so much...blah, blah, blah. You know, all the stuff that being completely absent through the pregnancy clearly indicated. It quickly turns into a shouting match (or at least he was shouting) and we have three nurses and one of out scrub techs in there trying to ease the situation and move him towards the door.

Minutes pass. Where is security? The shouting continues. The four of us start herding the guy in the right direction while he is spewing off threats about how we all better watch ourselves because "I'll be back" Terminator style. We finally manage to get him to the elevator and when the doors open who is standing in there but the security guard?

Nice dude. We call you up here stat and you take the time to get on the elevator with 17 other people.

Now, we get strange calls to L&D all the time of people asking for weird and completely non-L&D related things but about 4 minutes past bar closing time the phone rings. It's A-hole. He is now obviously quite drunk and in tears about how sorry he is and how he is a total fuckup. Plus, he needs a ride home. Ugh. Tell me where you are buddy and I'll call you a cab.

At least my patient got half the delivery that she wanted, at probably a little closure as a bonus.

Thursday, February 28, 2008

A Lesson

Lesson for you: Fetal Fibronectin Test (fFN)- a test where a swab is taken of the vaginal secretions at your cervix and looks for a protein (fetal fibronectin) that can predict if you are going to go into preterm labor within the next two weeks. It is usually used in high risk pregnancies or women experiencing signs of preterm labor.

A few nights ago a woman came in 24 weeks pregnant complaining of preterm labor. She had a history of 3 prior deliveries all between 24-30 weeks and also had no prenatal care for her current pregnancy. Obviously, we were all more than a little concerned for her. The midwife on call, who is very sweet and very hands on with her patients orders a fFN, and while this is something that is usually left for the nurses to collect she wanted to do it herself. I went along to assist.

After you collect the sample (on a long q-tip like swab) you place it in a long narrow container and send it to the lab. I hold the container for the midwife and most unfortunately her hand slips and now the sample has been smeared across my bare hand.

While I head to the sink and start scrubbing, she prepares a slide. I figuring she is looking for a "ferning" pattern that would indicate that the patients water is broken. Instead, once we get to the back and look under the microscope it turns out the patient has a raging trich infection.

Lesson for me: wear gloves any time anything with bodily fluids has even the most remote chance of missing its intended target.

Sunday, February 24, 2008

Would you like fries with that?

This is an old story but since a coworker brought it up the other night I have been reminded, and thus shall share. I am afraid the nurse who this particular story is about may never live this down but in her defense, she takes it well.

As many of us know, and some have yet to find out, labor can induce nausea and vomiting. Despite that, this does not deter people from stopping through the drive through on the way to the hospital. Anyway, my coworker (who I will call Betty) was taking care of a patient who came in because her water broke. She wasn't contracting at the time, and feeling like it might be her last meal for a while apparently stopped off and Micky D's for a #1 Super sized with cheese.

As labor karma would have it, she soon kicked into active labor, and before long was begging for an epidural. Betty got her bloused, call anesthesia and returned to the room to sit her up. As soon as the patient swung her legs over the edge of the bed, she lost the previously mentioned #1 Super sized with cheese and Betty was the unfortunate target.

I can't really blame her for what happened next as I am a sympathetic puker myself. Betty, feeling the strong urge to vomit that can't be ignored makes a beeline for the patients bathroom, swings open the door and aims for the toilet. No sooner has she let all restraint go than she realizes grandma-to-be is taking some personal time in the loo.

Let this be another advertisement for visitors not using patient bathrooms.

Thursday, February 21, 2008

Happy Valentine's Day!

A twenty-something weeker showed up last night, with the very concerned father-of-the-baby, complaining of vaginal bleeding and passing clots. This, never being a good scenario, demanded immediate attention. I put her on the fetal monitor and am able to get a good tracing of the baby, who appears to be quite well. Next come the questions.

"When did the bleeding start?"

"About a couple hours ago."

"Did you wear a pad in?"

"Yes but there was nothing on it"

"Were you having bleeding that's heavy like a period?"
(At this point her doctor has wandered into the room and is standing patiently by the bed.)

"Not really, mostly just some spotting and clots."

When was the last time you had sex?

"Valentine's Day."

Since this was nearly a week prior, I quickly rule it out as the immediate cause of her bleeding. The doc has now poked and prodded his way around assessing her belly and is asking me for a sterile glove.

He goes to examine her and starts pulling out large clots. But wait. Are they clots?

On further inspection, perhaps they are strawberries.

"Honey, did you put strawberries in your vagina?" I ask.

She looks at her companion sheepishly. He answers for her. "I guess we forgot about those."

Needless to say, I am eating my Cheerios plain this morning.

Sunday, February 17, 2008

We see normal people too.

I recently had a patient get upset with me that I didn't remember her when I took care of her earlier in her pregnancy when she came in to be monitored for decreased fetal movement. I can understand the natural human inclination to get your feelings hurt when you learn that you aren't "memorable" and the wounded look on her face was a good indicator of that. I tried to explain to her without being too weird or scary that it was a good thing I didn't recall her visit several weeks prior. I have a feeling if I could have pointed her in the direction of this blog the point would have been better made.

Thursday, February 14, 2008

Who would you like in the room with you for delivery?

In general we have a three person policy when it comes to deliveries just to make sure that we have plenty of room, aren't knocking people over and are able to move around the room quickly in case of an emergency. For the most part these three people consist of the father and a couple of family members or a good friend.

A couple of weeks ago we had a young lady show up 29 weeks pregnant with no prenantal care and ruptured membranes. She wasn't laboring so she hung out on the floor while we took every precaution possible to make sure she didn't get infected while we waited for the baby to become a little more "ripe".

Now, from the start the family was a complete pain in the ass. It probably didn't help that the father of the baby was also her sister's ex-fiance and they were both there all the time. You can imagine the arguments caused by that situation. There was also some other man that stayed with her nearly 24/7 in the room that we all assumed was her dad. We thought it was a little weird and wondered why the guy never had to go to work but over all, no big deal.

When she kicked into labor, nearly a week after being admitted, she started progressing rather rapidly. Other worried people started showing up at the hospital to visit her and we'll just say that they were a strange bunch. When we asked her who she wanted in the room with her for delivery she chose her sister, the father of the baby and her pimp.

Oh, that's who that guy is! I should have known, it explains a lot.

Wanna guess how that drug screen came back?

Wednesday, February 6, 2008

You'll look back at that and laugh.

And now, nearly 6 months later I can. I think.

One night I had a patient who was a frequent flyer. Not the kind of frequent flyer that has been coming in for the better part of her second and third trimester for labor checks, but one that was actually in early labor and refusing any intervention.

She would come in screaming in pain. She was actually contracting fairly strongly but refused meds, IV, a cervical exam (at first anyway), membrane rupture to help progress the labor etc. So what exactly she wanted from us was a mystery and out the door she went again only to return a few hours later so we could play the same game over again. This went on for days and finally got to the point where I was the only one who hadn't taken care of her so I was up to bat.

At start of shift I figured she would probably be out the door again but at exam she had actually progressed far enough that she needed to stay. She was also screaming bloody murder and not just with her contractions. Constantly.

She said she wanted to get in the tub so I calmed her down long enough to check her again and make sure she wasn't getting ready to deliver. I drew her a warm bath and let her get in. Not two minutes later she is screaming like a banshee again and out she comes. I help her back into bed. The screaming continues.

She is so loud that I can literally hear her down the hallway, in the back of the nurses lounge, in the restroom with the door closed and the water running. The rest of the staff is working hard to reassure everyone else on the floor (who were all understandably freaked out) that this girl is in fact, going to be OK. I am working hard to calm her down.

When I step out of the room to give her doc a call and an update (which wasn't hard to explain her condition since he could hear her screaming over the phone) the mother steps out and says to me angrily, "I think we need some better labor support in here!"

Um lady, your daughter is a freak.

After hours and hours of constant screaming another cervical exam reveals no change and it would seem her cervix is starting to swell. Miss Priss is still refusing any sort of intervention. Finally, a team of us convince her an epidural would be a good idea and we start an IV so we can get the fluid bolus going.

If you labor nurses out there guessed that she wasn't very patient during this process you are correct. I went ahead and paged anesthesia, extremely worried that she would continue to act a fool and the anesthesiologist would refuse to do the epidural. Luckily for me, while she did continue into her seventh hour of ear piercing screams, I think the doc took pity on me and miraculously placed a beautiful epidural in a moving target.

Silence. At this point, I fully planned to leave her alone for the rest of my shift since I was worn out, was pretty sure she was worn out and most thankfully, she was sleeping soundly. Unfortunately for me, at about 4 AM her doc rolls in and decides we need to check her. Feck.

She is complete but still at a zero station. He wants to rupture her and start pushing. Me, anticipating what kind of a pusher she is going to be, and knowing the baby has looked beautiful all nights suggests we let her labor down some. I lost.

First push: Good. Second push: Good. Third Push: Good. Fourth Push: "Why isn't the baby coming?"

"This takes a little bit of work with first time moms. You are moving the baby well."

She looses her marbles again. We are back to square one screaming bloody murder. The doc comes back in to assess her. She will still push but you can probably figure not very effectively. Her mom starts screaming, "Why can't you push the baby out by pushing on her stomach."

I don't even dignify that with a response. My patient is yelling "Just cut it out, cut it out!!!". The screaming continues. The poor doc is trying to explain her options but she won't stop the damn screaming. She consents to a c-section which has to be done under general anesthesia because she wouldn't quit thrashing and yelling. Mom is pacing outside the OR in tears because her perfect baby is going to have a scar.

The silence in the OR was magical and as I had to push the baby back up this ladies vagina so that it could be extracted from her abdomen I found myself wondering where it all went wrong. Miss "No intervention" inevitably ended up on the operating table.

In a fitting end, as my patient came to, she was still swinging and I got punched square in the jaw. I look at the clock. It is 7:30 AM and in through the door walks my relief. I have never felt so thankful.

Sunday, February 3, 2008

A couple of random thoughts.

I am glad I am not working tonight. I really don't want to have to deal with

1) The women that are feeling neglected from all the football hoopla and have suddenly gone into "Labor"

2) The backlash from that article that appeared a couple of days ago on MSN about the woman that delivered her baby in her sweat pants in the driveway after being sent home from a labor check