Touchdown!

At first I thought it was going to be like our last few clinicals where I was bored to tears. For the first two hours or so, we watched the nurses eat their full-course breakfasts complete with omelettes, bacon, home fries (which everyone complained were too salty), bagels smushed with avocado (WTF?), and toast—with Smart Balance spread of course. We did not partake in their feast though one nurse offered me a Starburst. When they were done eating they proceeded to cackle about the Kardashians, the Gosselins, and just about every other celebrity as they perused their mile-high stack of trash mags. The conversation then shifted to Martha Stewart, how they liked their Bloody Mary’s spicy, and so on. One even remarked, “Oh, I remembered to bring my iPod today.” None of them wore stethoscopes (not much patient care going on anyway) and honestly you couldn’t tell the nurses from housekeeping as both wore varicolored scrubs.

But it got better.

When it was all said and done I got to see a vaginal birth, a C-section, an epidural placed, and a D&E (dilation and evacuation). Just for that stroke of luck, you can bet your sweet ass that I won’t see anything else the rest of this rotation. The vaginal birth was great—as the mother of three I had been wanting to be on “the other end” for once. The baby was big (8+ pounder) and mom was small which unfortunately landed her with a third-degree laceration (tear) in the end. The C-section was a lot faster than I’d thought it would be—if I had blinked I would have missed it. The patient came in actually wanting to try a VBAC, but the doc wasn’t having it. I think they did entertain the idea at first until her blood pressure went up and the baby starting having decels. Third patient had a history of a LEEP and was dilating slow as molasses (which I’m told often occurs with LEEP patients). She was only 2 cm dilated when they gave her the epidural (I thought you had to be at least 4 cm), but she just couldn’t take the pain anymore—the Nubain just wasn’t cutting it. They were also augmenting her labor with Pitocin (which in my experience creates the worse contractions), and she was now having contractions every 2-3 minutes. Hell I’d want my epidural too. It was the D&E that kinda bothered me. A D&E is a surgical/therapeutic abortion done in the second trimester. Basically the cervix is dilated and the contents of the uterus are removed by vacuum. They use an ultrasound to make sure they got all the tissue out. But it just seemed like there was blood everywhere—they were slinging it and tossing bloody gloves and instruments and whatnot. And right after that—we got to eat lunch! Sheesh…

That’s all for now folks—a nap is definitely in order!

Some Boo-boos You Can’t Kiss Away…

A lot of boo-boos and ouchies in clinical today. First, I had a postpartum mom with a fourth-degree episiotomy. She was postterm so of course the baby was big, and they “had to” use the vacuum to assist with the delivery (I’m not a big fan of vacuums and forceps and such). To me, the situation just screamed C-section, but hey what do I know? So for those not fluent in the language of OB, a fourth-degree is the most garbungular type of episiotomy you ever want to have. This cut goes not only through the skin (first degree), muscle (second degree), and rectal sphincter (third degree), but through the rectum as well. “Ouch” really does not even graze the surface. I’ve had a second-degree episiotomy myself and while I hardly noticed it compared to the “ring of fire” during birth, afterward it felt like I slid down a razor-blade-lined water slide and landed in a pool of lemon juice. So I could only imagine what my patient was going through. And those puppies take time to heal. Cold packs help reduce the swelling and pain; and sitz baths circulate (warm) water to the area increasing circulation which promotes healing. You have to be careful with sitz baths though; if you sit in that water too long (which is a breeding ground for bacteria) it increases the risk of infection–15 minutes per sitting is fine. Some women also find witch hazel pads (better known as Tucks) to be soothing.

Second, I got to see a circumcision performed. Let’s just say it made me want to go home and profusely apologize to my 10-year-old son. It just seemed like so much trauma for that little piece of skin they removed. However, the doc that performed it informed me that it “really wasn’t that traumatic for the baby.” Yeah, okay–if that helps you sleep better at night… She used the Mogen Clamp method, which I wasn’t familiar with though all of the methods look pretty unpleasant to say the least. For those of you that have the curiosity and the stomach, you can find a video of the procedure here. I will say I’m glad that the myth (or maybe it was just denial) that babies do not feel pain was finally debunked–it is obviously so not true.

I Just Didn’t…

Clinical this past Sunday was a little more interesting than last week—but not much. I did a newborn assessment, and charted a little in the paper and computer charts. Oh, and I got to help make a couple of beds—exciting stuff for a student nurse thirsty for hands-on patient care right? I did not get to do a postpartum assessment on mom (her regular nurse completed it when I whisked the baby off to the nursery). I did not get to see a birth (vaginal nor c-section). I did not get to pass meds. I did not pass go and I did not collect $200.

It was a little strange at first handling “normal” newborns. I’m used to my NICU babies who have various catheters and such attached to them; these babies were so….free—bundled up like little burritos. Mom was still kind of out of it and preferred that I fed her daughter so I did. It just felt weird being able to scoop up the little peanut from her bassinet and stroll over to the rocking chair with no IV poles or monitors to navigate around. Sitting there with that 7lb bundle of joy made me think back to when my own children were that small (and before they learned to say words such as “no” and “mine”). My lecture instructor said in class that someone always gets pregnant during this rotation—uh, no thanks, I’m retired from that line of work. I already have three strikes, so I’m out of that game.

Sadly, most of the nurses weren’t any better (read: nicer) than the ones we had last semester. I thought (or hoped) that since these nurses cared for hormonal women and babies their demeanor would be a little more accommodating—guess not. No one was outright hostile like my dear Nurse Nasty from last semester, but they did tend to make you feel like some colossal inconvenience. I still don’t quite get that whole “nurses eat their young” thing…

No clinical next weekend since it falls on Easter. Good thing too since I could really use a solid weekend to catch up on some much-needed reading.

Zzzz…

Our first day in Maternity/OB clinical was pretty uneventful–almost downright boring. Part of the problem is that we have clinicals on the weekend. C-sections and inductions are not typically scheduled for weekends. So we are basically just sitting around waiting for someone to spontaneously go into labor (and with all the planned C-sections these days I’m not sure if people still do that…). There was a single postpartum mom on the entire unit. The clinical instructors had to go “find” a baby so that they could show us how to do a newborn assessment. I will admit technically it was just our hospital orientation day (which translates into boring computer training on yet another EHR system), but I was all ready to palpate some funduses (fundi?) or something. I also heard that we’re not even going to be giving meds which leaves not much else to do than a lot of patient teaching–if there’s anyone there to teach…

So although many of my fellow students are still excited about this rotation since some would like to work in maternity, I can already see it’s not my cup of tea. I need more “action”–like in an intensive care or ED environment (but real emergencies–not “my baby has hiccups”). Not that I thrive off of dire emergencies or people being critically ill/injured but when you’ll be working 12-hour shifts I’d like to be doing a little more than reading the tabloids at the nurse’s station (don’t act like you haven’t seen it). Who really cares how Kendra Wilkinson lost 10 lbs in 10 days?–she probably ran 5 miles a day on a strict diet of romaine lettuce…

Of course now I’ve totally jinxed myself and this weekend it will be on and popping (hopefully)…