Tales from Labor & Delivery

Errrr....

2008-04-20T16:47:00.000-07:00

So life got the best of me, and well....I got busy.

This one wasn't the patient....it was totally the doc.

A woman came in to deliver baby number 10. She was nearly 40, advanced maternal age and probably, while most of us would have been long done having kids she and her husband, who were both very religious were going to let what may happen, happen.

Her OB was out of town, and since she is in practice by herself, another doctor was covering for her. He came in to deliver the baby and after the delivery asked if they were doing her tubal the next day. The woman's husband spoke up and said, "No, we would never do that."

"You're going to have more kids?" the doctor asks.

"God tells us that may be in his plan for us."

"God talks to you?"

From the completely mocking tone I can tell this conversation is going downhill fast.

"Yes"

"You should be evaluated for that."

I try and change the subject to the baby quickly which seems to work but only temporarily. Before the doctor leaves the room he sneaks up behind the dad and bellows out in an ominous voice. "This is God...Get a tubal."

I wanted to die.

Who would believe it?

2008-03-24T13:29:00.000-07:00

I have had a string of insanely normal patients lately. My luck has to break soon.

More Vaginal Bleeding.

2008-03-12T12:18:00.000-07:00

When someone comes to the hospital complaining of vaginal bleeding there are three possibilities:

A) They have forgotten, didn't hear, or their doctor forgot to tell them that spotting is normal following a cervical exam, stripping membranes or sex.

B) They are crazy.

C) It's not good.

Every time I hold my breath and say prayer that this patient is forgetful, deaf, misinformed, paranoid or crazy.

So, a young (very young) woman is brought in by EMS for vaginal bleeding. She is alone as the father of the baby is (and has been) out of town. She says she wore a pad in and sure enough it is saturated with blood. Crap. I give her a fresh pad, find fetal heart tones, and then call her OB.

Her doctor comes in with the ultrasound to check for placental abruption and placenta previa. Once cleared of both of those she proceeds to a cervical exam. When she spreads the labia the cause of her "vaginal bleeding" is painfully obvious. She has deep puncture wounds from a BITE on her labia that are gushing bright red blood.

"Who bit you?"

"Huh?"

"You have a bite here. Who bit you?"

"I don't know what you are talking about."

The doc pokes at one of the puncture wounds. "Does this hurt?"

The patient yelps that it does in fact hurt but again denies that she has any idea what may have gone wrong down there.

Many stitches later, the "vaginal bleeding" was cured, the baby was thankfully fine and the patient still refused to explain what had happened. I wonder what story the boyfriend will get when he returns to town.

I feel violated.

2008-03-10T11:03:00.000-07:00

I was putting a Foley catheter in a woman the other day. Simple, straight forward procedure that isn't particularly comfortable but most people say it wasn't as bad as they thought it would be and if they actually breathe when I tell them to, some say they hardly felt it at all.

I open my kit, put on my sterile gloves, get everything situated where I want it and use one hand to spread the labia so that the urethra will be visible. She lets out a long moan.

I stop. "Are you alright?"

"Yes."

Ok, I start cleaning the area. With each pass of the swab she lets out another long moan. "Are you really, OK? Am I hurting you?" (Sometimes people find the cotton a little scratchy and are very sensitive.)

"No, keep going."

So, with my still sterile hand I grab the catheter, tell her to take a big breath in and try and get it over with for her as quickly as possible.

Instead of taking in a big breath she lets out a series of moans. Then she asks, "Is that supposed to make you have an orgasm?"

"No."

Maybe coffee straw girl knew what she was doing after all.

I know what you're thinking.

2008-03-05T12:54:00.000-08:00

Ok, I know some of you must think that when I post about our "frequent flyer program" that I am being insensitive to poor first time mom's that just aren't quite sure about when they are in labor. You same people probably also think that we all laugh at these people as we send them home for being too dumb to know the difference between when they are in labor or they are having Braxton Hicks contractions. We don't. I am not talking about people that come in for a labor check, or two, or three or even four or five.

Last night, as we were reminiscing over some of our recently (and not so recently) delivered patients who were enrolled in our frequent visit rewards program we started to wonder which one actually had the most visits. The winner had a whopping 81 labor checks over a period of 2 1/2 months before she was finally induced at 40 weeks, probably because her doctors were sick of it. You can blame that one on them.

Now, when you come in to the hospital 81 times thinking you are in labor, especially when it isn't your first baby, to me that signifies a fundamental problem in following oral, written and even demonstrated instructions. And, had she have actually called her doctor first (the very first instruction always given) she could have saved herself some gas mileage on what I am going to guess is at least 78 of those visits. Although, that wouldn't be quite so dramatic and she would have missed the 18 phone calls always made to let everyone know that she had to go to the hospital again.

The point of that rant is to never fear, your nurses aren't thinking you are nuts until you have been there so many times that they have your name, address, social security number and the phone number of your seven emergency contacts all memorized, or of course you think your water broke but taste it to see if it was really pee and then admit it.

Stand Up Kind of Guy

2008-02-29T03:54:00.000-08:00

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.

A Lesson

2008-02-28T03:11:00.000-08:00

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.

Would you like fries with that?

2008-02-24T07:36:00.000-08:00

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.

Happy Valentine's Day!

2008-02-21T05:39:00.000-08:00

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.

We see normal people too.

2008-02-17T18:11:00.001-08:00

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.

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

2008-02-14T04:03:00.000-08:00

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?

You'll look back at that and laugh.

2008-02-06T11:55:00.000-08:00

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.

A couple of random thoughts.

2008-02-03T12:39:00.000-08:00

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

Kids say the dardnest things.

2008-01-30T16:06:00.000-08:00

I am pretty sure we have all heard a story about a couple that thought they weren't able to have any children of their own only to get pregnant shortly after adopting. I was taking care of one of those patients and she and here husband, a middle aged white couple had adopted two black children who were both elementary school age.

Once mom was comfortable with her epidural she started talking to me some about her blended family and how the new baby would fit in. She then told me a story about how she was out with her kids in a location where she was the only white person there. Almost immediately, her older child blurts out loudly, "Look mommie, we are the only white people here!"

Ahhh, to be young.

Thanks for the warning.

2008-01-24T11:57:00.000-08:00

A while back I noticed a patient of mine had a cyst on one of the outer lips of her vagina. No big deal. It happens.

Come time for delivery, with the patient up in stir ups and the spotlight on her girl parts I notice the doctor silently but quite attentively inspecting the cyst between contractions. I see her poke at it. Then, with no warning what-so-ever she gives it a firm squeeze and a ridiculous amount of purulent discharge comes squirting out at a speed that I am pretty sure broke the sound barrier. It is heading right at me. I manage to move just enough that it hit me in the shoulder.

I give the doctor a "what the hell was that all about" glare.

She looks at me apologetically.

The whole time the patient remained blissfully unaware.

Things that make you go hmmm.

2008-01-22T15:50:00.001-08:00

Sometimes you hear just enough of a conversation to make you desperately curious on and glad you are walking the other way all at the same time. As I was leaving today I caught this tidbit in the hallway.

Two nurses are walking together carrying about every type of restraint imaginable. Another nurse passes and asks "Where are you going with those?"

"The ER. We have a Hannibal Lector down there."

?!?!?!?!?!

What do American Idol and L&D have in common?

2008-01-17T09:33:00.000-08:00

As I sat on my couch last night watching that guy explain his collection of “finger nail peelings” on American Idol I was reminded of a girl that showed up in L&D one night with a bag of vomit she had been saving. This led me to ponder what else Simon Cowell and I may have in common.

I decided that like the DMV, American Idol gets a good sampling of the general population. The relatively normal to the over-emotional, to the bipolar and even people that enjoy dressing up in chicken costumes or drag all show up to audition thinking that they may be the next big star. Labor and Delivery is the same way. Pregnancy is non-discriminating and while admittedly when someone shows up in drag as a “patient” we have bigger problems, we too see it all.

Just like rejected auditioners get their 30 seconds in some sort of confessional where they curse Simon and blame their failure on anything other than their lack of singing ability, I too get cursed and yelled at when I send someone home who is not in labor. And like Idol, some do actually take it gracefully.

So, when you find yourself wondering if these stories could possibly be true think of glitter pixie queen (aka Willem Dafoe’s look alike) and Renaldo Lapuz belting out “We’re Brothers Forever” and think of the possibility. For me, I think my lesson is that I need an L&D video confessional out by the elevators.

The Cervical Exam

2008-01-16T05:31:00.000-08:00

When I started in L&D one of the nurses who has been working L&D for over 30 years told me that she went to a conference one time and heard someone say that your first 100 cervical exams as an inexperienced practitioner are more like social visits. You are just checking it out but don't really know what you are looking for.

She then proceeds to tell me a story about a doctor from a nearby area that was in a family practice residency, doing his OB rotation. The first time he went in to check a patients cervix he felt around and quickly pronounced her 2-6 centimeters. (Basically meaning "I have no f-ing clue what I am doing.")

Fast forward to a couple of weeks ago while I am sitting in my doctors office for a check up. We were talking about work and he asks me which hospital I work at. When I tell him where I work his eyes light up.

"I did my OB rotation there!" he says. "I came in from (insert area mentioned from above story) and I had no idea what I was doing. The nurses were so nice to me helping me out and teaching me how to check a cervix..."

It was all I could do not to die laughing. He he was, the story of legend that happened over 20 years ago...sitting right in front of me.

Shopping Around

2008-01-10T10:57:00.000-08:00

Some women don't deal with not hearing exactly what they want to hear very well. Some cry. Some curse. Some throw things at you. (I have learned to watch my back and am getting better at dodging monitor parts.) Other just leave and try another hospital, hoping that maybe there, the magic of labor will begin.

This of course means that we too get our fair share of women that have previously been seen at another area hospital and now we are their second (or third, or fourth) try. Not surprisingly, they don't like to admit that they have been somewhere else first and were sent home although we almost always find out about the time we start calling other hospitals for their prenatal.

Last week, a young woman came in with an obvious spot on her arm where a band aid had been removed. There was a bruise and it was obvious she had blood work drawn.

"Did they draw your blood somewhere?"

"Yeah."

"What did they draw it for?"

"Oh no, nobody drew any blood."

Upon further inspection it became obvious that she had been stuck in many places and looked like someone had opened an entire box of band aids on the girl. Of course, in an effort to conceal her previous whereabouts they had all been removed so all you could see was the sticky outline of each one.

"So why do you have all these band aids?"

"Oh, those aren't band aids. I fell asleep in a room full of Mexicans and they taped me up with duct tape."

At least she gets points for creativity.

I didn't know this really happens.

2008-01-07T13:22:00.000-08:00

I took over an assignment on a patient with the warning that she didn't speak much English. Her husband however was fluent.

I walk into the room and see a beautiful girl (who's admission reveals that she is 22) and her husband, a frumpy looking man who I suspect was wearing a toupee and is a self proclaimed ripe old age of 58. She was from the Ukraine. Yes, I was puzzled.

Before too long, curiosity gets the best of me and I ask how the two of them met.

The husband answers, "We met online."

Me, still showing my true naivety replies, "Gosh, it must have been hard to get to know someone online who is so far away."

"Not really, I just chose the one I wanted and went to pick her up."

Ummmkay.

Happy New Year Weirdo

2008-01-03T13:01:00.000-08:00

I was going through the prenatal of one of my patients. It read something like this:

Name: Crystal Chandeleir

Father of Baby: ~~Ronald Muggins~~ (in very neat black in)
~~Jon Walker~~ (this time in blue pen and a bit messier)
Arnie Fitz (this time in a guys handwriting)

I wounder how that process of elimination went.

Last Post of the Year

2007-12-31T16:51:00.001-08:00

As I rest here in a fit of laziness, I think of my coworkers who are probably battling the swarm of women determined to have the first baby of 2008 and it makes me thankful that I am safe at home. So, in the spirit of being glad I can enjoy the comforts of my own home, I will encourage all you women that want that are determined to have a home birth to do just that.

A couple of weeks ago a woman came in to L&D with her friend as a labor check. She knew her water had broken but didn't mention it, on purpose. The nurse taking care of her checked her cervix and told her she would check her again in two hours to see if she was making any change. The lady seemed agreeable and reminded the nurse it was her 5th baby and she was a pro. She also voiced that she wanted a low intervention labor and asked to be taken off the monitors. Her doc agreed and that was that.

In the meantime, my coworker checked on her several times and she said she was doing great. As the two hour deadline approached we start to hear grunting coming from the direction of her room. I joke that if someone doesn't go check on her she is going to deliver the baby herself.

The nurse taking care of rolls her eyes and gets up begrudgingly to see what in the hell she happens to be doing in there. The next thing I know the emergency light has been activated and we are all running into the room.

Her "friend" who was also coincidentally a midwife, had managed to turn the bed into a chair-like position that allows for squatting (something that is neither accidental nor figured out without knowing exactly how to do it). She is kneeling between the patients legs delivering her baby. As we run in she frantically asks for an umbilical cord clamp and some warm blankets. In the time it took me to reach into the warmer and grab a couple of blankets the baby has been delivered and is resting on mom's tummy.

At this point we are able to put together that the whole friggin time she had planned on having her friend deliver her. By the time each of us had wasted a cumulative several hours (have to stay after shift to get it done) filling out our respective incident reports I can't say she was in anyone's good graces.

You can probably figure out what the moral of the story is.

OK, I lied.

2007-12-30T13:43:00.000-08:00

I said I would give you a new post, but instead I got the life sucked out of me that night so instead of depressing you all it will have to wait another day. Sorry.

Happy Holidays

2007-12-19T17:31:00.000-08:00

In case I don't return before Christmas, I leave you with this thought. You nurses may have already seen it, if not please share. I can't take credit, it has been circulating the floor.

Twas the night before Christmas
and up on OB
A nurse yelled "Thick mec, I need a delee!"

IV's with Pitocin
Were all hung with care
In hopes they'll deliver
And stop pulling their hair

The patients were screaming
In their labor beds
While visions of epidurals
Danced in their heads

The staffing is short
With no one on call
Every warmer is dirty
And sits in the hall

Just when I thought
There's an end to this hell
A patient in triage
Has a major decel

So we rush with a gurney
And race to the back
The O.R. is dirty
Not one section pack

I dropped to my knees
And started to cry
When I heard the bells jingle
And looked toward the sky

There was St. Nick
On his sleigh in the rear
He had six smiling nurses
The day shift is here!

Open Mouth, Insert Foot.

2007-12-18T11:39:00.000-08:00

At nearly 7 AM after a very long night, a woman and her daughter wander on to the floor. My coworker, who was using the secretary's computer ask the girl:

"What's your name?"

"Meggan Jones" (actually I don't remember her name but roll with it)

"Who is your doctor?"

"Dr. Smith" She looks confused.

"Did you call him?"

"Ummm," (More confusion) "I am not pregnant."

Now I start laughing. The secretary who is standing at the counter behind my coworker is also laughing. My coworker doesn't catch it.

"OK, well, we are going to put you down in room 12. You can head on down there and change into a gown. There is a cup on the back of the toilet if you would please leave us a urine sample."

The girl, looking unsure of what do actually starts walking down there.

Finally the mom speaks up:

"Sweetie, SHE'S NOT PREGNANT! We are looking for her sister.

At this point my laughter was pretty uncontrolable.

A GYN Emergency

2007-12-15T10:37:00.000-08:00

Last week a frantic woman in her early 20's presented to the ER for what she called "a gynecological emergency". Since her doctor was up on L&D at the time and the ER hates anything GYN related, they sent her on up.

It would seem that the girl, apparently a virgin, sexually frustrated and amazingly unfamiliar with her own anatomy decided to take matters into her own hands and get it on with a coffee straw. She managed to shove the entire straw up her urethra and it was now, according to the ultrasound, lodged and kinked in her bladder. She was quickly passed on to urology.

I am going to guess if she had realized that her urethra was not the correct choice ahead of time she would have picked a different utensil.

A Tale from EMS.

2007-12-10T16:49:00.001-08:00

After going down to the ER to Doppler a 10 week pregnant woman, I hear the nurses at the nurses station laughing hysterically about a woman being brought into the ER by EMS with a full code going on. The problem was she was so dead that full rigor mortis had set in. Me, being curious why in the hell EMS would transport a woman who is so clearly dead to the ER, while doing full chest compressions and pushing drugs decided to stop for the story.

Apparently EMS had arrived at the woman's home way out in the country, answering a call from her daughter.
"She is still warm!" the daughter exclaims as they walk in the door.
The find the woman unresponsive in her bed. They try and sit her up and realize she is warm from holding onto a heating pad but so dead that she is stiff from head to toe. One of her arms flies right up above her head so she is now looking like she is sitting at school patiently waiting to ask a question.

One of EMT's starts trying to explain to the daughter that her mother had been dead for quite some time and there was nothing they could do. They are still trying to console her when they hear someone else come through the door.

"MAMMA!"

The daughter had called in her brother from his coon hunting on their property and there stands Bubba well over 6 feet tall pushing 350 pounds dressed in camo still holding his pellet gun.

"Aren't ya gonna help my mamma?"

"Sir, your mother has been dead for quite some time."

He starts turning red and shaking.
"AREN'T YA GONNA HELP MY MAMMA?!?"

"Yes sir, we are."

In the spirit of repeat customers.

2007-12-09T14:08:00.000-08:00

We have another frequent flyer who is still many weeks to her due date (think next year) and shows up 2-3 times a week for a labor check. Each time she shows up she acts increasingly painful as she moans that she is there for "contractions again". I honestly don't want to have to take care of her once those real contractions hit but that will be a story for after she delivers.

Anyway, she is also quite young, and while I do give her credit for showing up without her mother in tow I suspect this has more to do with her mother having an epiphany about how she no longer has to put up with her bratty daughter now that there is a father-of-the-baby/fiance to do the job. The most annoying thing about her damn visits are her dumb fiance. He gets her settled into the room and then comes to hang out at the nurses station like it's a freaking social hour where our primary job is to entertain. It clearly says, "Yeah, I don't really believe that she is in labor either so I am going to come hang out with you guys because I can't stand the freaking whining."

Last week, mid chat I think his real motive came out. He must believe that if he is nice enough and we like him then he can start asking for favors. It went something like this:

"So, I have heard that having a baby can cause you to tear. <blank stare> You know, down there. And they sew you up right? <What is this guy getting at?> So if that happens and they are sewing down there anyway is it possible that the doctor can go ahead and sew up and little extra?"

And here I thought he was just friendly.

Say What?

2007-12-06T13:43:00.001-08:00

In the middle of what was a freakishly chaotic Tuesday night I found this gem. Please note that the italics are my internal thoughts. Please try and imagine an 18 year old that walked in with silk PJ's and a lazy eye. She was accompanied by a big burly man of probably 30 something with lots of facial hair and many tattoos with rather tasteless subject matter. She sounded dumb as dirt.

Also, she is only 34 weeks and was on her 4th labor check in the past 2 weeks.

Me: So what brings you in tonight?

Patient: I think my water broke.

Me: Did you feel a big gush of fluid or did you start leaking...?

Patient: Well you see, me and hims were getting intimate (eww) and when he done put it in me it started to feel wet.

It's supposed to feel wet, haven't you figured this out by now.

Well, so then he done took it out and we looked at the blanket we was laying on and it looked like maybe it was a little damp. It was pink. We went and got ourself a towel and went back at it.

Kill me now please.

So then he puts it back in me and it was done wet again.

Dear God, it's supposed to be wet.

So he takes it out and I told him to put his hand up there and see how it felt.

You what???!?!??

He says it was still wet so I asked him to taste it and see if it tastes like pee.

Of course it doesn't taste like pee, it was in your vagina...and why did you have to tell me he knows what piss tastes like???

He said it didn't so we came on in.

Me: Ok, next time you think your water is broken, don't put anything in your vagina.

And yes, it was pee.

Award Winning Baby Name

2007-11-30T12:21:00.000-08:00

Sometimes I am sorry I asked.

Meconium Phoenix (Phoenix was probably spelled Fenyx but whatever)

For those of you that don't know:

Meconium- is the first stool of an infant, composed of materials ingested during the time the infant spends in the uterus: Intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water.

Kill me now.

2007-11-27T13:10:00.000-08:00

A couple of years ago when I got a new computer I also bought a flash drive to back up all my files and transfer them to the new computer. I did not discriminate but just downloaded everything, including some photos that were later deleted off my computer because no one needs to see them (if you catch my drift). I never used that flash drive again and haven't seen it in over a year.

I just got a call from my boss that this flash drive was found in a classroom and IT had opened it and identified it as mine. She kept apologizing. I can see why. Apparently my husband found and used it for a presentation he gave at the hospital I work at last week and then left it in the classroom there.

I might never go back to work.

Signs you may be too young.

2007-11-25T12:01:00.001-08:00

Here is my compiled experience on signs that you may be too young to be having a baby. I realize that by the time they get to me it is way too late but I still have an opinion.

Possible signs you are too young to have a baby:
- You are still giggling when I tell you I have to check your cervix
- You bring your blankie and are more concerned about not getting it dirty than anything else
- You are still using random slang like "kitty box" for your girl parts in public

Probable signs you are too young to have a baby:
- Your mother, grandmother, and great grandmother are all present for delivery
- You show up holding your own personal Teletubby doll you owned as a toddler
- Your reason for not breastfeeding includes fear of lactating through your gown for your formal

Definite signs you are too young to have a baby:
- You ask for a school excuse from L&D
- You have to ask your mom's permission to get an epidural

and, my all time jaw dropper:
- when asked for your insurance card and photo id you pull out your year book opened to the page with your picture.

Happy Thanksgiving

2007-11-22T12:09:00.001-08:00

While I was at work last night I got a whole new perspective as I had a chance to ponder some things I am thankful for.

I am thankful neither myself, my husband or any child of mine is addicted to crack.

I am thankful I do not have an overbearing and demanding mother than controls my every move.

I am thankful I don't have to carry a list of people who are not allowed anywhere near me everywhere I go.

I am thankful my husband has never thrown a television at me during an argument.

I am thankful I have never been traumatized to the point I can't take of my panties to have a baby. (I don't know the answer to the obvious question here.)

Most of all, I am thankful that after all that, because trust me, it's a lot to deal with in 12 hours, I still have my sanity.

Vacation

2007-11-20T10:45:00.001-08:00

I wanted to let everyone know that tomorrow night my much enjoyed six day leave of absence will be over. It came just in time to allow me to recover (mostly mentally) from a blow to the face I took from what was quite possibly "World's Worst Patient". Please look forward to many more stories of insanity, despite the fact that I am praying for a quiet Thanksgiving night.

Private Practice

2007-11-15T05:24:00.000-08:00

Thank God it was slow enough on the floor last night that I could enjoy watching Private Practice with some of my OB colleagues because it just wouldn't have been the same alone. One of the midwives said that when they started the show were consulting with a midwife but they ditched her to find someone less educated. It would seem they abandoned the idea of consulting anyone at all because I am pretty sure that Google would give you better instructions on how to reduce a shoulder "dis-ty-shea". In fact, I think I might test this theory in a moment but it really doesn't take a physicist to realize that you can hardly get your hands in someones vagina while she is sitting straight up with her crotch to the ground, never mind that the obvious first step would be to lay her down anyway.

Also, we are all in agreement that there is no way in hell any of us (even the most touchy-feely naturalist midwife up there) would jump in the tub with a woman about to deliver, short of a life threatening emergency. She couldn't hold it in forever. And why the hell did she take her gloves off?

Finally, I would like to thank ABC for the women that piddled in the rest of the night with mild contractions 10-20 minutes apart thinking that delivery was immanent. I will be watching my paycheck for compensation.

Token weird person of the night.

2007-11-13T13:44:00.000-08:00

By 4 am I had gotten my patient delivered and out to the post partum unit. While usually this is a bad set up for getting to take care of the next weirdo that walks through the door I was too far into my fantasy about my upcoming breakfast of Eggo's and Ambien to care.

My fantasy was disturbed by a girl being brought through the door in a wheelchair by the ER staff (gotta love them). She doesn't look pregnant at all.

"Ma'am, how many weeks pregnant are you?"

"20"

"And what brought you to the hospital tonight?"

"My baby is having a seizure inside of me."

Congratulations. That's called fetal movement. I have a Benadryl that can fix that though.

Who's your daddy?

2007-11-10T05:35:00.000-08:00

Here's some more baby daddy drama for you.

A fairly young girl comes into L&D (think born in the 90's) with her mom and two possible father's of the baby to deliver. The girl is a little blond thing and both guys are black. I will call them Grill, and Red Shorts (RS for for short).

All through the girl's labor RS is right by her side, being very supportive. In the meantime, Grill is sulking in a chair in the corner. The girls mom makes a point of mentioning that she hopes the baby belongs to RS about every 10 minutes. Grill doesn't look happy at all.

Finally, the baby arrives and lets just say that it was obvious to all the staff that this little fair blond hair baby didn't belong to either of the guys. The new grandmother can't stop gushing on and on about how much the child looks like RS and how she just knew it would be his.

Now Grill is pissed. He gets in a huge shouting match with grandma that she doesn't know what the hell she is talking about. He is screaming that the baby doesn't belong to RS and she is obviously blind. In my mind I am slightly relieved that at least he has seen the light and pondering whether or not I need to call security. Luckily he saves me the trouble and storms out of the room.

Fast forward about an hour and a half to when I have returned from taking the baby to the nursery. I go in to check on the new mom and there is Grill, in the labor bed, spooning her (please don't make me get in to how icky that is) and telling her that he knows the baby is really his.

I guess he must have failed his genetics test too.

We don't want an epidural.

2007-11-08T14:47:00.000-08:00

Excuse me? "We" is not an option for an epidural. Your wife is allowed to not want an epidural but not "we". In addition, if you tell me one more time that "we" don't want an epidural while the woman birthing your child moans in pain and looks at me with big begging eyes I may have to insert and watermelon in the only logical place so that "we" can make an informed decision.

Weekly Schedule

2007-11-05T06:16:00.000-08:00

It is amazing how a simple trip to the hospital can halt labor. I think any L&D nurse out there would agree that it is amazing how many women that are having contractions that are 2-3 minutes apart at home and in the car suddenly slow down to every 10-15 minutes or stop contracting all together once they get to the hospital. I have noticed that once we get a story out of them, the reason for the "labor check" seems to run on the following schedule:

Sunday- Their significant other has been watching football (or another sport) all weekend and they are severely lacking attention. A trip to the hospital can fix this.

Monday- Isn't it obvious? Someone had already resigned to the fact that she couldn't face another work week.

Tuesday- Leftovers from Monday who made it in that one day and couldn't go on.

Wednesday- These are the girls that were checked in the office Monday or Tuesday. Even though they were told some spotting is normal after a cervical exam they are pretty sure the world is coming to an end.

Thursday- It's poker night. Enough said.

Friday- Similar to Thursday. The significant other is on their way out of town for their last weekend out with the guys and she needs to find a way to get him to stay home. These girls are usually not even term but they will give it a good shot anyway.

Saturday- The whole family came into town because she was due that week and they need to see a baby before they leave damn it.

Scattered in this are the women who have previously delivered a pre-term baby. Once they reach that magic number of weeks they delivered at before they decide they are done being pregnant and start showing up frequently thinking they are in labor.

Oldies but goodies.

2007-11-03T23:13:00.000-07:00

Way back in the day, when I was a mere volunteer in a city far, far a way there was a 5 foot tall, 500 pound woman that the doctors referred to as "old half ton" upstairs. Don't shoot the messenger.

Anyway, this lady was being kept in the hospital on bed rest for reason that I can only imagine now were complications that were somehow related to her being so large. One fine day, it comes time for her to deliver by C-section and due to my "awesome" connections, I had the pleasure of watching.

After a long prep of taping this woman's fat folds up to the top of the table, to expose the proper area and hunting down stools for the doctors to stand on so that they could actually see what they were doing the surgery began.

There were all sorts of people with their hands in there retracting skin in attempts to be helpful and and yet it was apparently not enough because shortly after the start of the proceedure we all heard.

"Ouch! Oh shit!"

The doctor with the scaple still couldn't see well enough thorugh all the fat everywhere and he cut one of the other doctors helping. To everyone's horror, the next words out of his mouth were:

"Oh hell no! If this fat bitch has any diseases I swear I am going to kill someone."

Um doc, she only has a spinal, she's not unconscious.

The lesson: choose your doctor wisely.

More to come on consequences of choosing the wrong doc later.

I can't believe this stuff still surprises me.

2007-10-31T06:37:00.000-07:00

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

2007-10-29T13:36:00.000-07:00

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.

2007-10-25T13:14:00.000-07:00

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.

2007-10-23T12:54:00.000-07:00

"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.

2007-10-19T08:26:00.000-07:00

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!

2007-10-17T13:30:00.000-07:00

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.

2007-10-16T16:14:00.000-07:00

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.

2007-10-15T17:29:00.000-07:00

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.

2007-10-14T13:00:00.000-07:00

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?

2007-10-12T08:02:00.000-07:00

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

2007-10-10T18:04:00.000-07:00

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.

2007-10-08T07:21:00.000-07:00

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

2007-10-06T09:53:00.000-07:00

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.

2007-10-04T07:49:00.001-07:00

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.

2007-10-02T17:29:00.000-07:00

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.

What are you going to name him?

2007-09-29T18:15:00.000-07:00

Whether or not I ask someone what they are going to name their child usually depends on my mood. Do I feel like I can hold in my laughter and then tuck the gem away for later use, or would I rather save myself the trouble and not know?

A long string of rather interesting baby names led me to look up a list of the top 10 baby names for the past year. I remember when these lists used to be made up with names like Matthew and Katherine and I was horrified that 5 of the top 10 boy names from 2006 were:

Aiden
Braden
Cayden
Jayden &
Hayden

Seriously? What are you people thinking? This really makes me further reconsider my already shaky thoughts on having children. As someone with a rather common name that usually had to share it with least one other classmate, I cringe at the thought of my son coming home with his birthday party list of rhyming names. Even worse, how would I be able to keep all these kids straight? "I'm not Aiden, I'm Braden and he's Hayden". Oy vey.

We charge extra for crazy.

2007-09-28T07:34:00.000-07:00

While usually families come in a big package of crazy, on occasion I will come across a perfectly normal patient with a family that makes me use every tiny bit of self control to 1) not start yelling 2) not make fun of them, to their face and 3) not start laughing, again, to their face. Number 3 is usually the hardest and I am still working on that one.

In this story, my patient, Lindsay, came in for a labor check. She was taken to her room and I came in and put her on the monitor. She seems very sweet and while I can tell she is uncomfortable, she is handling herself well. At this point, I hadn't paid too much attention to her mother in the corner but as soon as she spoke up, I knew I was in for a long day.

I really wish I had an audio clip, because nothing I could type would really give the true impression of what we were dealing with but just try and picture that girl on Intervention that can barely spell her name at the beginning of the episode and frequently stumbles into walls. She is starts rambling about how she knows her daughter is really in labor this time, how she was really screaming earlier and something is wrong because she isn't screaming now, what's my name, that's her little girl, what's that monitor, please start screaming sweetie, something is wrong, her vaginal discharge looks different this time (what the hell?), please help her.

Yeah, that's what I was thinking. She really did me in when she got in her daughters face and told her she needed to scream and really act like she's in pain. This caused Lindsay, who was just two seconds ago sitting in bed calmly, to start screaming like she is being mauled by a Pitt Bull.

Now I need to step out of the room for a moment to take a few deep breaths of my own. I go up to the desk to fill out her out-patient orders and start praying she isn't really in labor. I wasn't out of her room for a full five minutes but that was all it took for a lovely surprise on my return. Her water broke. Damn, what are the odds? I go ahead and start her IV (with her mother screaming and literally trying to crawl up the wall in the background) and get her admitted.

Early into the morning, mom decides she needs to go out for a "smoke break". I take this opportunity to calm Lindsay down and have a talk with her about people who might be causing her anxiety in her room (i.e. we can kick them out for you). Unfortunately for me, and the rest of the floor, she wanted her mom there and we spent the rest of the day alternating between ear piercing screams and peace and quite while her mom was out "smoking".

Finally, everyone had had enough and her doctor decides to let her get her epidural early. I boot the mom out of the room based on her reaction to me starting the IV earlier in the day. She was probably thankful for the opportunity to go smoke some more crack and I was glad for a few moments of quiet. The anesthesiologist comes in and gets started and I am feeling rather proud that I have managed to keep myself together for points 1, 2 and 3 mentioned above.

About halfway through the procedure, the door flies open (there is a sign on the door saying an epidural is in progress and please check at the nurses station) and her sister runs in, looking like she has some sort of drug induced mental disability, screaming, "SISTER!" with tears running down her face. All three of us look up and there is dead silence while everyone looks confused. I walk over to escort the sister out the door and point her towards the waiting room. "SISS-TER! SISS-TER!" she screams as I am backing her out the door. She is literally bawling, red faced and then reaches out dramatically with one hand and a final "SISS-TER!" before I manage to get the door shut.

That was it, I looked up and made eye contact with the anesthesiologist and we both lost it in a fit of hysterical giggles.

Not all emergencies end up in the ER.

2007-09-26T07:22:00.000-07:00

While we all like to think that having a baby will go smoothly each time, on occasion there are true emergencies. Last week, Carol and her husband show up to labor and delivery because she thought her water broke. Now, just showing up without calling anyone, your doc included, and people that think their water broke are both subjects for another day. Either way, no matter how annoying you are, or how big of a pain in the ass we can tell your family is going to be, you still get treated like everyone else.

Anyway, Carol appeared without calling and there was only one empty bed (lucky for her there was one) but the patient had just been transferred to her new room so it hadn't been cleaned yet. We let both her and her husband know that the room was in the process of being cleaned and we would come and get them from the waiting room as soon as it was ready. Dude takes his wife to the waiting room and then comes back to throw a cussing fit that his wife is having a baby and it is unacceptable to make her wait.

At this point we are all thinking, "OK jerk, everyone up here is having a baby and they are working as fast as they can to clean the room so your wife doesn't have to lay in a dirty bed or deal with a puddle of blood on the floor." Amazingly, everyone held their tongue and we escorted them to their new room ASAP.

One of the other nurses on the floor, Kelly, gathers her paperwork and heads back to her room to get her admitted while someone else makes to call to her doctor to let him know that we have one of their patients there (don't do this, call your doc first). While being admitted, Carol starts screaming that she feels like she has to poop, usually a sure sign that the baby will be there. Kelly yells down the hall for one or all of the midwives and then proceeds to check her cervix. Instead of finding a fully dilated cervix, she finds a prolapsed umbilical cord. This is the point where it hits the roof.

Kelly flips the woman over to the following position to try and relive pressure on the cord but the baby's heart rate is still slow so she crawls into bed and sticks her arm up the woman's vagina to support the baby's head and keep it from putting pressure on the cord, which was cutting of circulation completely.

The rest of us, literally every person on the floor, are frantically prepping the OR, getting anesthesia up there, finding any doc that is qualified to do a c-section, and getting Carol ready. In a matter of minutes, we are rolling her back to the operating room, on all fours in her bed with Kelly on all fours in her bed behind her, arm in her vagina, supporting the baby. Carol is prepped and draped. The drape thrown over Kelly as well, who is now under the sterile field still holding the baby. In less than 10 minutes from the cord being discovered the baby is out.

Now, back to the husband. The entire time is is standing outside of the operating room screaming that we haven't taken good care of his wife and that we didn't really need to do a c-section and how he is going to sue every one of us. Yeah a-hole, we had our hands up your wife's vagina, saving your baby's life and got her back to the OR in under 10 minutes because it wasn't necessary.

I'm scared.

2007-09-25T18:04:00.000-07:00

I am not sure I can truly put into words the difference between a woman delivering with an epidural and one delivering without. Today, I delivered two women, both without epidurals and it was actually scary (and, if you were an outsider, a little bit comical).

I don't think I will ever forget the look in my patients eyes, like a wild animal about to be trapped. She grabbed my shirt and emphatically screamed, "I'm freaking out now." I had to stop, take a deep breath and then remind her to breathe as well. In the meantime, she is clamping her legs together, coming off the table and moaning that she can't push anymore.

"Alright sweetie, the baby isn't going to come out with your legs shut and the only way for you to stop hurting is to deliver this baby." Um, doc, can I get some support here?

I don't even know where to start describing the screams and pleas for help. The sense of urgency to get the baby delivered takes on a whole new meaning as you watch someone in more than the worst pain imaginable with only one solution.

All I can say is that I am not that brave.

Birth Plan

2007-09-23T16:09:00.000-07:00

Definition of Birth Plan:
- A written outline of a woman's preferences for her labour and birth.

My Definition of Birth Plan:
- A way to guarantee that you aren't going to get what you want.

I have yet to see a woman come in with a birth plan that ends up laboring according to her wishes. In fact, I have yet to see a woman with a birth plan that doesn't end up having a C-section. If I were going to get a PhD I might research why.

Take Lisa (chill, it's not her real name). She came in for an induction with the most horribly annoying three page birth plan that basically included no intervention at all. She settled herself in her room and then refused an IV, pitocin and having her water broken. At this point it was necessary to stop and determine if she realized what induction of labor was, and if she wanted no part of it, send her home to wait for labor to happen on its own. She decided to stay and for the moment, get an IV.

Over the next four days she caved to each intervention one by one. First it was starting some pitocin to get the contractions going. After she had been there 48 hours and nothing had happened, I am sure she was getting antsy. I wonder if she thought her labor would start just by showing up to the hospital. The next day it was having her water broken. After the contraction got stronger, as they will when you no longer have that cushion, she was begging for an epidural when she previously wanted no medicine for pain at all. A whopping four days after checking into the hospital for "induction of labor" with what she hoped would be no help at all, she was rolling back to the OR for a C-section. Maybe it is karma for people that try and control everything?

More to come on this subject as I develop my theories.

Tips for expectant dads.

2007-09-21T18:02:00.000-07:00

Here are some things to consider when you accompany the soon-to-be mother of your child to the hospital.

1) Proper attire. Please consider what you are going to wear. Being showered and wearing clean clothes hardly counts if you show up wearing a MILF shirt or a T advertising your favorite strip club.

2) There is a proper amount of attentiveness. Hovering over your significant other and doing a full inquisition of every whimper is just as bad as ignoring her completely.

3) No matter how unplanned the pregnancy was, while she is pushing is not the time to start discussing a better form of birth control.

4) There is no need to video tape all 14 hours of labor. Wait until the pushing starts and unless you have prior approval, avoid the crotch shots.

5) You are not completely helpless. If the mom-to-be starts puking, get her a trash can. Don't casually wander off to get help as she continues to cover herself in vomit.

Most importantly, remember that you are not the star of this show. You may see your woman viler than ever before. She will return to normal, most of the time.

Are there 10 fingers and 10 toes?

2007-09-20T17:54:00.000-07:00

Sometimes you just need a good poker face. For example, today, my patient's baby had not one extra digit but four. Two extra fingers and two extra toes. One of these was a good sturdy finger but the others were fairly repulsive, dangling from long fleshy strings. While overall, this is a fairly common issue, this particular case about did me in. I think I have issues with body parts where there shouldn't be body parts. It was about all I could do to not contort my face into a horrified expression before mom even got to lay eyes on her baby girl.

If you are worried about this child being relentlessly teased once she is old enough to go to school, in most cases, a surgeon will place a suture around the extra finger or toe and it will fall off on its own. If it is a nice fat one, minor surgery is required. In most cases, the kid will never even know that they were once called twinkle twelve toes, unless mom is mean and took lots of pictures to pull out on prom night.

You've got mail.

2007-09-19T16:54:00.000-07:00

As some of you may know, I took a direct hit of amniotic fluid to the eye last week. I got to spend over 2 hours in the emergency room having labs drawn (but mostly waiting) and the poor lady had to get stuck again for labs as well. I wish I had heard how the scenario was explained to her.

"Excuse me. Congratulations on the baby but we need to check and see if you have HIV since your nurse got your vag juice in her eye."

Luckily, according to my detailed lab results that arrived in the mail today, all is well.

Is something wrong with my baby?

2007-09-19T11:00:00.000-07:00

If something were wrong with your baby, I wouldn't be calmly standing here smiling at you. Really.

I need to put a catheter in your bladder.

2007-09-18T18:29:00.000-07:00

With every epidural comes a catheter, due to the new inability to feel the urge to pee. Those of us who are nice (and I am) wait a little while for you to start to go numb before inserting the catheter. Sometimes, a full bladder can keep the epidural from taking full effect and the only way to ensure you a wonderful epidural is to go ahead and get that catheter in in a timely manner.

If this happens to you, it will be OK. Having a baby isn't a cake walk, something I assume most people know from before the time they realize they are expecting their bundle of joy. Having a catheter placed is going to be the least of your problems. To ensure that we don't have to use 2-3 catheters, and to keep the procedure time down to less than an hour it would help if:

1) You do not jump 3 feet every time I touch you. I will tell you what I am about to do. Coming off the bed doesn't help.

2) Please don't scream that I am stabbing you. I'm not, I promise.

3) Please don't have a panic attack. Breaking sterility to get you an inhaler will only delay the inevitable and leave me seriously questioning your ability to get through the rest of your labor.

With these handy tips in mind, you catheter insertion should be smooth, quick and easy.

Chew on this.

2007-09-17T17:07:00.000-07:00

Two women go in to the labor on the same day and show up at the same hospital. One is a happily married woman (or so she thinks), the other is her sister-in-law. A happy occasion for all involved you would think. The problem? Both babies have the same dad. So, how does this work?

One woman gets pregnant. Her husband then also gets his brother's wife pregnant at about the same time?

Two women, who happen to be sisters-in-law, cheat on their husbands with the same pool boy?

A woman gets pregnant and her husband also gets her sister-in-law, his sister pregnant? (I hope not).

A man's sister is married to another woman. He donates sperm to his sister's wife to help them conceive and at the same time gets his own wife pregnant?

I have no clue what the real answer was. Sometimes it's best not to ask too many questions.