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.
Wednesday, February 6, 2008
And now, nearly 6 months later I can. I think.
Posted by l&d.rn at 11:55 AM