Post-Call Recap

Yesterday’s call shift was steady.  I did get to manage and assist with my first gastroschisis case.  Thankfully everything went well.  Non-medical folk, gastroschisis is when the bowel develop outside of the body and remain there through a defect in the abdominal wall.  I have not yet taken care of someone with this particular defect so it was an interesting night! I still haven’t gotten used to vaginal deliveries in the OR.  Sometimes for complicated cases (ie. vaginal twins, pre-termers) they want us to deliver in the OR because there’s more space for the additional personnel (NICU, neonatology, RT, etc.)  But for me, it’s still very weird — very lights, camera, action: theatrical birth.  I much prefer my low-key version.

Party foul of the night — my phone and Spectralink phone were both dunked head first into a giant puddle of birth goo.  Yay for Cavi-wipes.

Also, have you guys seen the new CDC recommendations for circumcision.  Sheesh.

Office for the rest of the week, however my schedule tomorrow is super light.  That’s fine with me because I am just about to renew NRP and have a zillion modules to do online.

Terrible blogger.

A lot has gone on since my last post.  Although most of it still feels the same.  I am still working at my same job in the desert and still love it.  Hundreds of babies I have helped into this world.  That’s pretty amazing.  I wonder if “New Nurse Midwife” title even still fits.  I guess so?   How long at a profession before the “new” title wears off?  I think possibly after two years, you can say you know your way around.  Although I still get lost if you ask me to navigate outside of my part of the hospital.  In general, I’m terrible at navigations of any kind.  Thank god for GPS.

As far as my personal life goes, went through a lot of changes.  Fast forward to my life now, I have met the woman of my dreams who I hope to marry (more on getting engaged later…)  She and I have settled down with a houseful of animals.  I wouldn’t change anything for the world.

In other news, ’tis the season for Christmas parties!  We have been invited to several, including the hospital party, office party and my dear love’s work party.  Not sure which ones we will actually make it to.

Hell Call Night

These last few times on call, I have been super busy.  Last night was no different.  I came on to a full board.  But only two “laboring” patients.  I use quotes because the doc on call decided to admit both patients when neither were really laboring.  Ah well…I did their admission orders and H&Ps anyway.  Rule numero uno: don’t keep ladies that aren’t in labor.

And then the night just kept getting better and better.  Basically I had 4 additional admissions…all primips…all in labor.  Real labor.  One PIH, had to start magnesium.  She progressed well and I caught her baby.  One lady came in “complete” and I broke her water and we regressed to 7cm.  Also, her baby hated everything.  Hated AROM — prolonged decel, doc at bedside.  Hated pushing, decels.  Hated contrxns. Her strip definitely gave me some new gray hairs.  I was pulling out all of my tricks.  Pushing side-lying, every third contraction.  After several consults w the doc, ended up being a vac-assist.  Despite a terrible looking strip, her baby did well…excellent Apgars, vigorous, and cord gases wnl.  Phew.  Another one, extremely limited PNC, oligo.  I caught her baby too.

Neither of my two “labor” admissions from earlier did much of anything.  So had to AROM, start pitocin.  One of them delivered right before shift change.  Nurses gave me sass about their plan of care.  Nurses gave me sass about my terrible strip.  And one nurse in particular really gave me some attitude about AROMing a different patient.  A busy night is hard enough without sassy nurses.  Admissions steady throughout the night.  Now up to 6 laboring primips.  Doc who absolutely hates me coming on in the morning and I’m terrified what he’s going to think of this mess of a board I’m dealing with.

Then the icing on the cake?  25wker s/p cerclage.  Greeeaaatttt.  Came in w vague complaints.  My little gut voice encouraged me to sterile spec her where I discovered a bulgy bag and amniotic fluid.  PPROM.  Admitted her.  Consulted w the doc. Rule number two: listen to your internal voice.  

So by the shift change, between my doc and myself, we have delivered almost everyone except one.  One of my original not super labor-y patients who puttered along all night.  And, yes, I did get chewed out for her management.  (“So you’re telling me..this pt has been here 12hrs and hasn’t done much of anything…yada yada yada”)  But I was too tired to care.  Still am.  I hope she delivers for him today.  What a night…

Things Patients Say

A long-time asthmatic pt who just recently went to the ER for an asthma exacerbation.  Pt is also an admitted everyday pot-smoker who has been counseled numerous times to quit while pregnant.

Patient: Why do I keep having asthma attacks?

Me:  Are you smoking?  Around smoky environment?

Pt: No.

Me: Still smoking marijuana?

Pt: Oh.  (pause)  I don’t do that anymore.

Another patient who is late third-trimester came in to see a fellow midwife.  Apparently last visit, this patient wanted a refill on zofran…so I obliged.  Pt was back a week later and demanding more. My coworker declined and the patient got very angry.  Turns out this pt has had 8-10 rx for zofran (just within our office) with refills.  Either she is seriously addicted or selling them — who knew zofran could sell on the streets?

Finally, a choice pt who I bent over backwards for a few weeks ago.   No showed for months.  Missed her appt but called stating I had forgotten to give her her prescriptions.  I was holding her scripts hostage so she would get her labwork done.  After I managed to get her fit in for a complete US asap and she had said US.  She was mad that I kept her there for “forever” and walked out before the appt was finished.  So, yes, I had “forgotten” to give her rx, but had she stayed to finish her appt, she would’ve been able to get it.  And, no, I’m not giving you any phenergan.  Sorry.

On call tonight.  Gotta love our pts.

A “routine” OB?

Totally did a return OB visit on a patient with a very large knife attached to her pocket. Sheesh. I need to start carrying a weapon of my own. I can’t doppler someone to death!

Valentine’s Day babies?

Sadly…no babies for me on Valentine’s.  But I did manage one February 15th baby!  I was up most of the night with a lot of triage c-r-a-p.  Labor checks.  UTI.  One choice patient called an ambulance for a blood glucose reading of 160 after dinner.  This particular pt is a newly dx GDM.  But I’m not sure why a value of 160 was an emergency requiring a trip to triage on the state’s dollar!  Just come to your regularly scheduled appointments.  And in a poorly controlled DM patient population like ours, I have seen sugars higher than 300!  And those pts never worry about their BGs ;)

Then another ambulance arrival!  Spotting after sex.  Oh goodness.  Really?  How do we treat that? Stop having sex?  Tried to explain to patient about post-coital spotting vs. alarming bleeding.

Pt adamantly states, “But this has happened more than once!”

“After sex?” I ask.

“Oh. Yes.”  Lightbulb.

My delivery was relatively straightforward.  I really wanted a Valentine’s day baby but my pt had other plans.  She was adamant that she did not want to have her baby on Feb 14th.  Absolutely.  Not.  Her labor had kinda stalled and she wouldn’t let me break her water until after midnight when it was no longer Feb 14th.  And she was a bossy little thing.  My doc laughed at how this little patient just bossed me around.  A young mama who was very very immature for her age.  We had a bit of a prolonged crown secondary to my patient not really pushing well.  And we had a nuchal hand!  Thankfully, momma was mostly intact.  Those nuchal hands can wreak havoc.  Just a tiny first.  Both did well.

 

Happy Valentine’s Day!

And as the lowest ranking employee, I’m on call tonight.  I’m actually looking forward to it because I’ve never caught any holiday babies.  I did a lot on Black Friday, but that’s not an actual holiday.  Valentine’s day babies seem super sweet.  In fact, my best friend in the whole world had a V-day baby.  I am in the middle of my pre-call ritual involving lots of napping and TV.  I do have a little to get done around the house as well.  Will update later.