journaling

I meant to keep a journal of my summer in Oklahoma but now it’s half over and I haven’t written anything.  I’ve been keeping a birth log, which helps me remember the babies I’ve caught so far and their parents, but already the details are fading and I can’t remember things like names and ages and how many weeks my patients were when they delivered.  I know it’s unrealistic to expect that I’ll be able to remember names, but I want to.  I can picture mother’s faces really clearly and I can remember them with their babies … but I need to write down more than that.

Dad tonight missed his first baby’s birth because he went out to smoke a cigarette.  It was unfortunate that nobody caught him on his way down to the first floor … or thought to call him when mom started pushing.  It was her third baby so he only took a few pushes to get out.  Dad came back after she was already cleaned up … “Are you serious?”  There he was, a little chunk of a baby, much fatter than we expected and just awesome.  Mom had limited prenatal care and was unsure about her last period, so at first we thought she was seriously preterm and gave her MgSO4 to stop labor.  Lucky lady got to puke crazily for a few minutes after that got started.  However: he measured bigger on ultrasound, and he came out bigger than we expected.  I didn’t stay to check on his actual weight.  I had been there 12 hours already and had a headache.  I took myself home and drank a ginormous glass of wine.

Drinking alone is so not very fun.  Also I need to write more about these births.  Also … I am still shocked every time by the amount of traction you can put on a baby’s head to get it out of its mom.  I need to get used to that part.

A birth

At the last birth center birth I was privileged to attend, the mom was a woman from one of the Centering classes I had gone to several times.  The midwife who led those Centering classes was on-call that day, so it was exciting she was able to catch this mom’s baby.  The parents already had one son, an adorable 2 year old, who was over 9 pound at birth.  I was a little … not nervous, but well … ok, maybe a tiny bit nervous.  I know that some moms grow big babies, and this lady was completely healthy (very rare for the population served by this birth center), and she had one big baby already no problem.

There’s just always that moment of adrenaline rush when the head comes out and you think, god, that’s a big head, I hope the shoulder comes out soon after … and then it usually does.

I wanted to write a quick note about this birth so I don’t forget it.  It was such a positive experience for everyone involved, even me, and all I did was stand there.  The mom coped so beautifully with labor, the dad was such a perfect support for her, and the atmosphere was completely peaceful and quiet.  She stayed in the tub until she was almost complete, when the midwife broke her water and there was light meconium … another moment of “oh my god I know that’s normal but what if it’s not oh god I hope the baby’s okay” for me, standing in the corner.  Paranoid student.  A  minute  later she got out of the tub and onto the bed, we turned the lights down low and J (midwife) started encouraging her to push.

I loved the two births that I was able to see with J catching.  I mean, I loved all of them, they were all totally awesome in their own way.  I should really write about them all, I think I’ll do that … but J had this incredibly calming and reassuring presence that I aspire to have some day.  She is older than the other midwives at that birth center and more experienced.  As the mom was pushing this day and getting distracted by the pain, J would catch her eye and say, in a quiet voice, “Everything is fine.  Everything looks very normal.  Take a deep breath.”

But my favorite moment was after the head came out.  Mom paused, saying, “whew, that’s better” after the widest part of the head was delivered.  A moment or two later, as my shoulder dystocia nerves were making themselves known again internally, J looked at her and said calmly, “Ok, push the rest of him out,” and she did, one big push and a huge fat baby boy was born and was the most vigorous baby I have ever seen.  I think he was crying before he was even all the way out.  He looked EXACTLY like his brother, and he ended up being even bigger.  9 lbs 9 oz, I think.

(And she had not even one stitch worth of tears on her perineum.  Gorgeous.)

An hour or so later, she was back in the tub with the baby, relaxing and watching her new son enjoy the warm water.

This is why I think I want to work at a birth center.

A new year

If everything goes as planned, in approximately 8 days I will be a registered nurse.  This is exciting and surprising and I’m trying not to freak out about the test I still have to take.  I think it’ll be okay … well, most things usually end up okay in the end.  But I mean to say I think I can pass it in the first go-round.  Nerves never have helped me perform well, so I’m just focusing on the fact that most people pass the first time and I like to fancy myself to be at least as intelligent as the majority of nurses that exist.  It’s good to not be very nervous.  I’m starting to have a bit of insomnia/nighttime anxiety about it, but whatevs.  It’ll be over soon.

I have started my second year, my specialty year, the MIDWIFERY YEAR.  A week from now, as well as having taken the NCLEX, I will have done my first internal pelvic exam.  In fact, I might have done two already.  This is something else that I feel some anxiety about, but really not too much.  Although I still don’t know that much about how to be a nurse, the past year has definitely made me infinitely more comfortable with the human body and all of its oddities.  Everyone is a little different, but we all have more in common than not, and this is comforting and interesting at the same time.  I find myself able to discuss strange and sometimes off-putting things that bodies do, and not feel grossed out or awkward or whatever.  I guess this is a good sign.  And that’s why I’m not too worried about hopping up onto an exam table and letting my midwifery classmates practice using a speculum on me.  Better me than an innocent, unknowing patient, I think.  It’s good to have the practice.

This semester is going to be a bitch and a half, but our women’s health/midwifery classes & labs are so much better than anything I’ve ever done in nursing school before.  We still have theory, and boring pathophysiology (SO BORING), but seriously, last week on our first day of class, time actually passed relatively quickly.  I was at school for eleven hours, but most of it was interesting.  Fun, even.  Finally!!

I think I can

The other day Patrice asked me if I died this week, would I be disappointed? The following conversation went something like this:

C: YEAH … there’s still a lot of things I want to do.  If I have to die when I’m 24, at least let me die after next weekend when I get to see Ringo and after August when I get to see Bob Dylan.

P: Dude, don’t be greedy!  You already saw Bob Dylan once.

It’s almost July.  I haven’t gotten a letter from the kiddos in a long time … I think they’re probably having some vacations in various parts of the country.  I wish I was traveling at this moment — well, maybe not this very moment, I’m fucking exhausted.  But I’ve been really feeling the travel bug lately, my latest craving is to go to Bosnia or Croatia.  I was looking at pictures of Sarajevo today online, it’s so beautiful.  But I can’t, and I’m here, plugging away, so close to being done with this year that I can taste it.

Good news is, I’m starting clinicals tomorrow NOT at the depressing hospital where students aren’t allowed to do anything.  I’m going to the hospital I can walk to, which is a considerable benefit when I have to get up at 5:30 and be there by 6:15.

Bad news is, I have a final the next morning at 8am.  I don’t understand why they would do this to us, a final at 8am after a 12-hour shift the day before, not to mention the 9-hour workshop we had today, but whatever.  WHATEVER.  I can handle it.

I still feel overwhelmed by self-doubt and anxiety a lot of the time, when I think about what’s coming up in the near future, but I try to remind myself that I have handled a lot of shit in the past year that I had doubts about, and I’ve overcome my fears, been pushed out of my comfort zone and only made a couple of mistakes.  That’s not bad.

I’ve completed a head-to-toe assessment, written it up, passed a skills test, interacted successfully (therapeutically?) with most of my patients (and very awkwardly with others), started a foley catheter, tested blood glucose, given insulin injections, pulled out a nasogastric tube, hung a blood transfusion, started IVs, given an IM injection and drawn blood.  I have discontinued IVs & catheters, given tube feedings, flushed PICC lines and pushed IV medications.  I have presented papers, projects, case studies …  I have watched two c-sections & insertion of a pacemaker, given bed baths and written countless pages of care plans.  I have rocked babies, walked the halls with post-op patients and gone in search of toys for bored little ones.

I have accomplished a lot, and I try to keep this in mind, because I’ve decided I’m going to do my best to just fake it.  I’m going to ask a lot of questions, but I’m going to fake the confidence that I don’t feel until I do feel it … fake it ’til I make it.  I feel like I still know nothing, but that’s not true, it’s just that I still know very little compared to all there is to know.

A year from now, if all goes well, I’ll be catching babies.  For now I’m going to go review that whole insertion-of-a-catheter thing, because I haven’t done it in a while and I don’t want to give anyone a UTI.

After that

I thought I should write now, about the fun I had last night, so something positive goes on record in this meager blog.  First I engaged in some retail therapy, which I have been doing far more than I should lately, but it was still great.  P and I got glammed up and went dancing at this place which, conveniently, is right across the street from my apartment.

70’s funk music is awesome.  So is whiskey and club soda.  We danced for hours like the hot dancing nursing students we are, it was great.  We got home a little after 2 and crazily enough I am already up and out of bed, feeling slightly bleccch in the stomach but not bad.

Today is a library day.  I have to finish my paper on “self-efficacy and pain perception during labor and delivery.”  Actually an interesting topic, a very interesting topic, but I have no desire to write this paper.  Surprise surprise.

Mmm, tea.  I love tea.

Nothing much new

Tomorrow is supposed to get up to 90.  Hello, summer.  Spring was nice but I knew it would be short here.

I have paid back some of my sleep debt, after a four-day weekend and a short week, finishing clinicals for the semester and writing a good chunk of the fun paper due on Tuesday.  I’m feeling annoyed at pretty much everyone and everything in my life right now, but I’m going to go ahead and chalk that up to hormones for the moment.  At least for today.  I don’t actually think everyone and everything that I come into contact with are inherently irritating.  A fair amount of it is probably me.

Today I became trained in the art of phlebotomy.  Actually, it’s really easy.  Drawing blood is so much simpler than starting an IV, it gave us all a little boost of confidence so we could go for the needle with the catheter right after.  We aren’t supposed to be starting IVs on each other at this point because the school hasn’t officially trained us to do it yet, but this is something that seems totally idiotic to me.  They should be encouraging this type of thing: one instructor, six students, careful supervision and experience gained.  It’s totally stupid to think we can learn something like IVs in a one-day four-hour seminar.  It doesn’t happen like that, OBVIOUSLY.  It doesn’t happen in a classroom.

Anyway, it was fun, and it was our second time doing it so that’s good.  If we have an instructor in July who drags us into a patient’s room to start one, we won’t be quite as scared.

Speaking of which, I don’t know what I’ll do if I have “boot camp” at the hospital where we had our OB clinical experience.  Our instructor was fabulous, but OMG.  That place is so depressing.  It just really creeps me out the way the patients have practically zero control over their own experiences.  They put everyone -everyone – on pitocin to “augment” labor, and I would bet my bottom dollar most of those women do not know the risks involved with that drug.  It’s not informed consent if the woman doesn’t speak English, Miss “I’m a third year med student and I know everything.”  And it’s certainly not informed consent if you say, “No there are not any other options if you want the baby to be okay and you want the baby to be okay DON’T YOU,” Dr. 80% C-section rate.  YUCK.

Also they don’t let students do ANYTHING.  I probably shouldn’t get started on how totally stupid it is to not let students ever do anything (simple shit, not like actually delivering babies.  Not that they do that there very often except in the OR).  We don’t have any experience, you say?  Well, help us out then by not letting us do anything.  That way, when we’re actually nurses, we still won’t know how to do anything.  It’s clearly the best system.

Wow, I really am full of whine.  Let’s see.  Um.  Good things, good things, happy things …

I’m coming up blank.  I think I only write in this thing when I need to vent.  And the fact is that I need to vent a lot.  Oh well.  The next time something thrilling and wonderful happens, I should write about it.

Teetering

Week 3?  It’s only week 3.  Third semester, third week, oh.  god.

Every time I leave my apartment I have this horrible feeling that I’m forgetting something crucial for my day.  (And the number of times I’ve had to go back –for my stethoscope, a book, my lunch, etc –is very high.)  But it’s SUCH A BAD feeling.

I wake up in a panic every morning, totally disoriented by my alarm clock.  What time is it?  What day is it?  What do I have to do today?  Where am I supposed to be?  Am I late?  Am I ready?  Why is it still so dark, why do I have to get up?

Stressed, yes, just a tad.  And anxious.  Mostly so tired.  I’m really starting to develop my theory that the school of nursing wants us to suffer.  Is this all a big test?  Are they waiting to see who’s going to fess up and say, HOLD ON.  This is too much for me.

That’s what we’re supposed to do when we’re nurses.  We’re not supposed to accept assignments we’re not comfortable with, that we don’t think we can do competently.

One day at a time, that’s my motto.  I lay down to take a nap today and started picturing the little baby I took care of today … did I stick that thermometer too far up her butt?  I didn’t hurt her, did I?  Maybe I should have told the primary nurse about her spitting up later on?  But it wasn’t too much.  Maybe I should have measured her head circumference.  Then I briefly imagined getting a phone call that something I did, today, had killed the baby.

Unlikely, but crap.  Do all nurses go home every day and thank the lord that they didn’t kill anyone this shift?

6 more weeks of the semester.  Suck.  I just want to sleep for a week.

Leaning to the left, to symbolize freedom

It’s beautiful outside right now.  I am inside, studying flashcards on musculoskeletal & gastrointestinal conditions.  My apartment has so many windows that it’s really not all that bad to sit on the couch when the sun is shining and enjoy it, even if I do have to force details about, oh, gout – and congenital diaphragmatic hernias – and Crohn’s disease – into my head.

Last night I took a friend of mine across the street to the Chabad house.  It just happens to be less than five minutes from my apartment, which is convenient.  We had an awesome seder … really awesome.  Not super long, amazing food, good stories & religious explanations.  The family who hosted it run Chabad at the school.  Their apartment is basically an open house for anyone who wants to spend time there, at any time.  There were people at the seder last night who just happened to be traveling through town and wanted/needed a seder to attend.  I’ve only met this family one time before, but they were so incredibly welcoming and happy that we were there.  My non-Jewish friend was nervous at first, but after chugging the first two glasses of wine she calmed down and enjoyed it like I knew she would.  I love Passover.

On a tragic note: the father of another friend, who lives back in CA still, recently had brain surgery to remove a tumor from behind his eye.  He was given a prognosis of about 6-12 months to live – from now – if he does all the chemo and radiation and everything.  I can’t believe it.  It’s SO UNFAIR.  He’s so young, he shouldn’t be dying, he should not be getting ready to say goodbye to his family forever.  And she has already had so many struggles to overcome in her life.  It’s completely wrong that she will lose her father so soon.  It really pisses me off.  And it puts into perspective everything I might bitch about, because seriously.  What could be worse than what they are going through?  Some things, I guess.  But not much.

I wonder if I’m going to be sick.  In between those two paragraphs I had to jump up and hang my head over the toilet because I was certain I was going to puke.  Yay.  What perfect timing!  Being sick for finals is AWESOME.

a happier thing

I got G & S’s 2007 interviews & pictures, done by mom.  There are a few highlights.  I don’t have Grace’s on-hand right this second, and I’m situated on the couch, so I’ll just post a few of my favorites bits from Nini’s.

Q: What do you like to do right now?

A: I like to read with my sister, bike ride, have circus class, & not have Soren mess up our room all the time.

Q: What do you want to do when you grow up?

A: I don’t know but maybe I could be a doctor or an archeologist.  I would like to be an archeologist becuase you get to dig up all this cool stuff.  You might not find anything, but you would know you tried your best.

Q: Favorite movie or DVD?

A: Ratatouille, because it has cooking in it and I think it’s really cool that a rat learned how to cook.

Totally awesome kid … love her. 

OK, now I have to go get Grace’s because there were some fantastic quotes from her too.

Q: Tell me something you liked about school this year.

A: [...] I like doing dioramas.  I made a diorama of “The Death of Dorothy Bradford.”  She was William Bradford’s wife, and when they went to the New World, they left their son behind.  She was never able ot see her son again.  She died when she fell off the Mayflower and drowned.

Q: Mom & Dad don’t let you watch a lot of TV, but when you do, what are your favorite programs?

A: Project Runway.  It’s addictive.  I like Heidi Klum and Tim Gunn.  Sometimes Tim Gunn says really discouraging things and then says, “Make it work!”  I think that’s funny.

heehee.

Want to have a baby? Don’t go to NGH

Today was my day in labor & delivery and I just got home feeling frustrated, helpless and somewhat angry.  I guess maybe I need to get over this shit, but it’s not going to happen today, and when — god willing — I make it to being a midwife I’ll at least be able to do something about it.

The nurse I followed today was taking care of a primiparous woman who came in yesterday.  They ruptured her membranes for her (gotta speed things up, after all) and started pitocin (everybody gets pitocin at this hospital, gotta get those babies out quick, after all).  So she labored all night and this morning was at 9 cm/100% effaced when I got there around 8am.  She had an epidural and they gave her a bolus around that time because she was in pain from the pitocin, which was causing extremely strong & frequent contractions.  They were every 1-2 minutes and lasting up to 90 seconds, and the baby’s heart rate was going up to compensate for no recovery period between contractions.

She was 9.5cm at 10am, the baby was -1, she had a tiny little lip of cervix left, and she had a fever of 100.5 degrees.

Approximately 50% of women who get epidurals run a low-grade fever.  The doctors –actually, med students mostly — came in, diagnosed her with chorioamnionitis (infection of the uterus), told her she needed to have a stat c-section.

An hour before that, they had told her that she’d be pushing soon.  She was SO CLOSE.  She spoke no English.  She did not want a c-section.

She cried.  She was scared.

I don’t know, it was awful.  It was like this big cycle of poorly managed medical interventions that caused other problems that caused her to be forced (basically) into major abdominal surgery.  It infuriates me that people who go to this hospital all get pitocin.  I find it sick.  Without that drug, maybe it would have taken a little longer, but she could have pushed that baby out.  The heart rate most likely would have stayed within the normal range.  Or what if they’d given her something to eat?  That might have helped.  No muscle that doesn’t get food for over 24 hours is going to work very well, and that INCLUDES THE UTERUS.

It infuriates me that this doctor has a c-section rate of over 80%.  It’s creepy.  It’s all fear-based, fear of being sued and blah blah blah blah but it’s just fucked.  When we went into that OR, the nurse had to go under the table and push the baby’s head back up so the doctors could grab it.  She was totally down in the pelvis.

UGHHH.  I find myself feeling very militantly midwife-ish.  I’m sure this will probably just increase over time.

I just felt really bad for her.