A few years ago, a baby died in my care.
I did everything I could. We fought hard for her life, but she died anyway.
And the parents blamed me...and sued me.
This post is hard for me to write because to this day I mourn for little "Emma." I mourn for her parents and how much they wanted her; and for the relentless, sickening, violent pain forced upon them. There is nothing like the cry of a mother who has lost her baby. Nothing in this world.
As nurses we endure endless hours of training and retraining to know what to do when a life is at stake. So many times we use that knowledge and save lives...and it all pays off. But to come to a time when everything we know is useless; to try and fight and fight and...lose. And a baby dies. And we couldn't save it. What an unsurpassable defeat. It's indescribable.
And then to learn that the mother blamed me for the death of her child. I was completely broken.
In respect for Emma and her parents, I'm not going to tell the nitty gritty details of this story. My fellow medical readers will understand when I say that it involved a velementous insertion, ruptured membranes, and blood. To those of you who don't understand: it was a rare, disastrous, often undetectable situation that went as bad as it could go, and there was not a lot that we could do.
On a side note, Emma's mother came in for an induction having had a very normal, healthy pregnancy; expecting a natural, uneventful labor; and this situation is an example of why I cringe when I hear of women claiming that home deliveries are perfectly safe. They are not. If something goes wrong in labor, often it goes very wrong, extremely quickly, and although we couldn't save Emma, most of the time we can save these babies and/or their mothers if we move quickly. If you're at home, and you have to take the time to travel to the hospital when something is wrong, most of the time it's too late. Just have your baby in a hospital and quit arguing about it.
Back to my story, the parents named me personally in their case, and accused me of atrocities...and I do mean atrocities. Not only did they think I was negligent, they accused me of killing their baby. I was dumbfounded when I read the complaint. It's amazing how a traumatic experience can skew a person's memory. They not only named me in court, but they went after my nursing license, my very means of livelihood.
I went through months of interviews with the Risk Management department of my hospital. They were extremely supportive of me, which a lot of hospitals wouldn't do. They protected me when the mother demanded a meeting with me. They provided a lawyer for me who, I must say, was the smartest lady I've ever met. I had to write pages and pages of response to the parents' "Discovery" documents to answer everything from why I asked her about pain management at admission and "terrified her," to describing my hospital's policies and my understanding of them, to why I thought I had sufficient training to do my job.
Then, once that was over, I had to appear at a deposition. 8 hours of questioning by a large panel of lawyers with a video camera 1 1/2 feet away from my face. 8 hours. They questioned me on everything from each nook and cranny of the tracing, to discussing the personality of the patient. 8 hours. It was the longest, most demeaning day of my life.
But none of this was as hard as knowing that Emma died in my care...and that her mother blamed me.
The case was dropped because neither I, nor the doctor, did anything wrong. The Board of Nursing dropped the complaint against me, finding that I upheld all that my license holds me responsible for...including trying every reasonable attempt to develop a therapeutic relationship with this patient. Even though everything was dropped, and my nursing "name" was cleared of all charges so to speak, it still doesn't heal the pain and feeling of failure I felt. And it certainly didn't heal any of the parents' pain. But perhaps it filled a purpose.
For many months I desperately asked the questions: Why in the world couldn't they see that I tried so hard? Why did they think I was so unbelievably at fault and accused me of doing things I would never dream of doing?
Since then, I've come to an understanding. It's not about me. It's about Emma. It's about the parents' unbearable challenge of dealing with their grief and very deep anger over losing their baby girl. I can understand that. If I was deemed the object of their anger and they felt they were finding release and closure by their accusations toward me, then I guess I have filled my purpose...a nursing duty that I never thought about before.
Perhaps you are a health care professional facing a legal battle, and like me, you feel overwhelmed and even unsure of how you handled the situation. Remember that hindsight is always 20/20. Don't beat yourself up looking back over your actions, knowing the outcome, and thinking, "If only I..." Did you do everything you could? Did you follow policy? Did you follow your heart? Then keep your chin up and go in there and show what you know with dignity, and be proud of your plight. Perhaps you are filling a purpose too.
Thursday, July 28, 2011
Thursday, June 23, 2011
Up Your Nose With A...What?
As a nurse in any field, from working in the Operating Room, to tirelessly braving the Nursing Home, we all have to deal with an occasional problem. This problem is one we consciously chose to deal with from the time we carried out our first clinical day in nursing school, and the ability to deal with it can make or break any nursing or medical student who first faces it. It alone, can separate the professional from the unprofessional, the heroes from the wimps.
What could this powerful obstacle possibly be?
It's the mighty force of patient odor.
There are a lot of reasons why an otherwise sweet-smelling woman can suddenly become rank during labor. The hormones, the increased discharge. The waking up in labor at 3 in the morning and rushing to the hospital without brushing your teeth and having dry mouth from all the breathing. (He He HOOOO!) The long hours of sweating and leaking.
Don't worry. As long as you are a person who bathes, under certain circumstances you just can't help it, and we don't hold it against you. We just wash you. And if that doesn't work, we have some other tricks up our sleeves to help ourselves manage it. One trick is to sneak a tiny smear of an alcohol wipe or even some essential oil (from our "natural labor" kits) under our nose or the inside of our mask so we subtly smell peppermint instead of an undesirable odor.
A nurse friend of mine, we'll call her Maggie, was having a particularly hard time one night with a patient that unfortunately went beyond the normal limits of circumstantial odor. Even after she encouraged the patient to labor in the bathtub for a while, the smell was still unquenchable. Dismayed, my friend realized that the stench was not only coming from the patient, but her husband as well. This was no problem of a sweaty circumstance. This was a long-lived hygiene neglecting disaster. Maggie was having to battle gagging and nausea because it was so bad.
Having confided in the rest of us, Maggie was at her patient's bedside when another nurse knocked on the patient's door and asked if she had a moment. Stepping out, the nurse slipped Maggie a small bottle of Vick's Vapo-Rub, a wonderful comfort for colds, and in this case, an effective stink cover-up. New hope arising, Maggie figured that if a little under the nose was good, then a whole lot is better! This was a case for a full nostril lube-up. Desperate, she took her two forefingers, and scooped up the salve...and up her nose it went.
She stepped back into the patient's room and took a breath to speak. All at once, fire went up her nose, down her throat, out her eyeballs and stifled her words mid-sentence, "How are you do....hugghhh(gasp)...innggg?"
The amazing thing about nurses is that they are Oscar-worthy actresses. It's always about the patient. Did this nurse ever waver? Did she drop her professional air during those next moments of pain and terror? Did she ever draw attention to herself even though tears were rolling down her face and her "M's" became "B's" as she spoke? ("Don't worry about baking a bess if your bebbranes rupture.") Of course not! Not her!
But that stuff don't wash off....
Yep...she had to go home.
What could this powerful obstacle possibly be?
It's the mighty force of patient odor.
There are a lot of reasons why an otherwise sweet-smelling woman can suddenly become rank during labor. The hormones, the increased discharge. The waking up in labor at 3 in the morning and rushing to the hospital without brushing your teeth and having dry mouth from all the breathing. (He He HOOOO!) The long hours of sweating and leaking.
Don't worry. As long as you are a person who bathes, under certain circumstances you just can't help it, and we don't hold it against you. We just wash you. And if that doesn't work, we have some other tricks up our sleeves to help ourselves manage it. One trick is to sneak a tiny smear of an alcohol wipe or even some essential oil (from our "natural labor" kits) under our nose or the inside of our mask so we subtly smell peppermint instead of an undesirable odor.
A nurse friend of mine, we'll call her Maggie, was having a particularly hard time one night with a patient that unfortunately went beyond the normal limits of circumstantial odor. Even after she encouraged the patient to labor in the bathtub for a while, the smell was still unquenchable. Dismayed, my friend realized that the stench was not only coming from the patient, but her husband as well. This was no problem of a sweaty circumstance. This was a long-lived hygiene neglecting disaster. Maggie was having to battle gagging and nausea because it was so bad.
Having confided in the rest of us, Maggie was at her patient's bedside when another nurse knocked on the patient's door and asked if she had a moment. Stepping out, the nurse slipped Maggie a small bottle of Vick's Vapo-Rub, a wonderful comfort for colds, and in this case, an effective stink cover-up. New hope arising, Maggie figured that if a little under the nose was good, then a whole lot is better! This was a case for a full nostril lube-up. Desperate, she took her two forefingers, and scooped up the salve...and up her nose it went.
She stepped back into the patient's room and took a breath to speak. All at once, fire went up her nose, down her throat, out her eyeballs and stifled her words mid-sentence, "How are you do....hugghhh(gasp)...innggg?"
The amazing thing about nurses is that they are Oscar-worthy actresses. It's always about the patient. Did this nurse ever waver? Did she drop her professional air during those next moments of pain and terror? Did she ever draw attention to herself even though tears were rolling down her face and her "M's" became "B's" as she spoke? ("Don't worry about baking a bess if your bebbranes rupture.") Of course not! Not her!
But that stuff don't wash off....
Yep...she had to go home.
Wednesday, August 18, 2010
The Birth...Song?
I have to poke some fun. I really liked this couple, but I have to give her husband the "most corney" award. Please forgive a little well-meant teasing.
I had the privilage of taking care of a sweet little couple the other day. I say "little" literally because the patient was 4ft. 14in. tall, and 110 lbs at full term pregnancy; and her firey red-headed, gotee'd husband was just as small. They were quiet-voiced, enthusiastic about the world in general, and obviously very well-read in regard to the birthing process. At the time of admission, the patient's husband told me of her desire to have a natural, non-medicated birth. Cool.
So, she labored along nicely. She was doing a beautiful job, really hanging in there well. I chuckled to myself a little as she got toward the transition phase of labor and her deep breathing turned to...well...screams. Poor thing. She'd appologize every time she screamed. What struck me as funny is that it became a sort of pattern. She'd smile, scream, appologize, smile, scream...and so on.
"I really didn't expect to scream like this!" she said to me.
Finally, her husband, tongue dripping with honey, said the awarded comment: "It's OK love, screaming is just part of the birth song."
It wouldn't have been so bad except that he kept saying it: [Contraction, scream] "Love your beautiful birth song." He'd get on the phone with some family member, "She's singing her birth song," he'd say, dreamy-eyed. After a while it became quite nauseating, and as things got a little more intense at the end, I thought she was going to rip his red beard right off his face.
Even though she had such a small frame, (sometimes this worries us labor nurses about the baby not fitting through) she delivered beautifully, quickly, and naturally. Congratulations to her.
I just have to say that if this is all a song, then I've heard some real coloraturas.
I had the privilage of taking care of a sweet little couple the other day. I say "little" literally because the patient was 4ft. 14in. tall, and 110 lbs at full term pregnancy; and her firey red-headed, gotee'd husband was just as small. They were quiet-voiced, enthusiastic about the world in general, and obviously very well-read in regard to the birthing process. At the time of admission, the patient's husband told me of her desire to have a natural, non-medicated birth. Cool.
So, she labored along nicely. She was doing a beautiful job, really hanging in there well. I chuckled to myself a little as she got toward the transition phase of labor and her deep breathing turned to...well...screams. Poor thing. She'd appologize every time she screamed. What struck me as funny is that it became a sort of pattern. She'd smile, scream, appologize, smile, scream...and so on.
"I really didn't expect to scream like this!" she said to me.
Finally, her husband, tongue dripping with honey, said the awarded comment: "It's OK love, screaming is just part of the birth song."
It wouldn't have been so bad except that he kept saying it: [Contraction, scream] "Love your beautiful birth song." He'd get on the phone with some family member, "She's singing her birth song," he'd say, dreamy-eyed. After a while it became quite nauseating, and as things got a little more intense at the end, I thought she was going to rip his red beard right off his face.
Even though she had such a small frame, (sometimes this worries us labor nurses about the baby not fitting through) she delivered beautifully, quickly, and naturally. Congratulations to her.
I just have to say that if this is all a song, then I've heard some real coloraturas.
Monday, June 28, 2010
That Is The Baldest Baby I'VE Ever Seen
This is a story of one of my two most embarrassing nursing moments...one that I kept a secret for a long time...because nurses are perfect, you know. Especially me. (I just have to put that in there to salvage myself. That's what I'll just keep telling myself anyway.) But here it is: me, in a complete state of vulnerability just for your enjoyment.
I was reminded today of something I did as I returned to work from an extended maternity leave after my daughter was born. I had been gone for several months to attempt being a stay-at-home-mom (which I soon found out was not the right choice for me) and was thrilled to re-enter the world of moaning women, screaming babies, and miracle beginnings of life every day. I missed it more than I ever thought I would. I jumped right back in to my previous roll on labor and delivery...but I was a "little" out of practice.
I didn't realize how much until late in my first shift back. I was skipping around all day about my patient's normal progression of labor, thrilled to be nursing again and announced to my charge nurse that I was going to start pushing with my patient. I eagerly set up the room for delivery like a good nurse, checked all the recusitation equipment, layed out my prep and pads, prepared my bag of Pit....just like I remembered I was supposed to do. And we started to push.
She was a good pusher for a prime (1st baby), and as the baby came down lower I suddenly thought to myself, "My goodness, this is the baldest baby I've ever seen."
I know all you nurses out there know exactly what was going to happen.
But my ignorance was bliss. (Or at least my forgetfulness was.)
I bubbled with delight as my patient made more and more progress, but I couldn't get over the white, bald head...and so smooth! Weird. So as I enthusiastically coached and counted, I leaned over to apply perineal pressure to further investigate this myserious presentation. A contraction came. "OK!" I coached, "take a deep breath...and GO! One...two..." I coached, pressing down and leaning close to see better. "Three...four..." I touched the white, smooth...SPLOOOOOSHH! I screamed. The patient screamed because I screamed. The dad screamed. Everybody was screaming.
It was her water bag...not the baby's head.
"It's OK! It's OK! That was just the water bag breaking. Everything is OK." I played it off as if this was just how it goes...no big deal. Nurses always scream...and are always soaked to her underwear with amniotic fluid...no big deal. (I had it in my ears!)
Ugh...
Nurses do have their "off" days. One nurse I know, who I respect for her knowlege and experience above most others, had an "off" day with a similar story. She was pushing with a patient and was in wonder at how bald the baby was. After pushing for an hour, she finally realized the baby was breech and she was looking at a little butt cheek the whole time. Afterwords she confided in me. Thinking of my own story, I comforted her by saying, "Hey, we all do it sometimes..."
"Yeah," she replied, "But I should have realized it when I thought to myself that I'd never seen a bald hispanic baby before!"
(I know it's amazing, but I have other embarrassing moments too.)
I was reminded today of something I did as I returned to work from an extended maternity leave after my daughter was born. I had been gone for several months to attempt being a stay-at-home-mom (which I soon found out was not the right choice for me) and was thrilled to re-enter the world of moaning women, screaming babies, and miracle beginnings of life every day. I missed it more than I ever thought I would. I jumped right back in to my previous roll on labor and delivery...but I was a "little" out of practice.
I didn't realize how much until late in my first shift back. I was skipping around all day about my patient's normal progression of labor, thrilled to be nursing again and announced to my charge nurse that I was going to start pushing with my patient. I eagerly set up the room for delivery like a good nurse, checked all the recusitation equipment, layed out my prep and pads, prepared my bag of Pit....just like I remembered I was supposed to do. And we started to push.
She was a good pusher for a prime (1st baby), and as the baby came down lower I suddenly thought to myself, "My goodness, this is the baldest baby I've ever seen."
I know all you nurses out there know exactly what was going to happen.
But my ignorance was bliss. (Or at least my forgetfulness was.)
I bubbled with delight as my patient made more and more progress, but I couldn't get over the white, bald head...and so smooth! Weird. So as I enthusiastically coached and counted, I leaned over to apply perineal pressure to further investigate this myserious presentation. A contraction came. "OK!" I coached, "take a deep breath...and GO! One...two..." I coached, pressing down and leaning close to see better. "Three...four..." I touched the white, smooth...SPLOOOOOSHH! I screamed. The patient screamed because I screamed. The dad screamed. Everybody was screaming.
It was her water bag...not the baby's head.
"It's OK! It's OK! That was just the water bag breaking. Everything is OK." I played it off as if this was just how it goes...no big deal. Nurses always scream...and are always soaked to her underwear with amniotic fluid...no big deal. (I had it in my ears!)
Ugh...
Nurses do have their "off" days. One nurse I know, who I respect for her knowlege and experience above most others, had an "off" day with a similar story. She was pushing with a patient and was in wonder at how bald the baby was. After pushing for an hour, she finally realized the baby was breech and she was looking at a little butt cheek the whole time. Afterwords she confided in me. Thinking of my own story, I comforted her by saying, "Hey, we all do it sometimes..."
"Yeah," she replied, "But I should have realized it when I thought to myself that I'd never seen a bald hispanic baby before!"
(I know it's amazing, but I have other embarrassing moments too.)
Wednesday, June 23, 2010
Why Do I Try?
You know those patients that make you just want to beat your head against a wall? The ones that by saying a single sentence can make you wonder why you even try? Let me tell you what a patient said.
But first, you have to know her. And all you nurses: I know you know her. We all have one...maybe many. She's a frequent flyer...you know...one that comes in every other day for one reason or another. This was her 17th (Oh yes, 17th) visit to the labor and delivery unit, 10 of those visits were because she thought her water broke. We had gotten to the point of referring to her by her initials.
"A. D. is coming in again."
But it's her history that gets you. You look at her prenatal records and picture a train wreck. She's 22 years old having her 4th baby, all of which have different fathers and two of which are in the custody of the state. She has a long history of ETOH (severe alcohol abuse) and marajuana use during pregnancy. She admits to smoking 2 packs a day during this pregnancy and that's after cutting down. She has late prenatal care. In fact the only reason she came in for care this time around was because her leg was swollen and painful and she was found to be approximately 24 weeks pregnant with a DVT requiring heparin therapy. She also has Gestational Diabetes...the treatment of which she is noncompliant in following. She also is on two different antidepressants (so you picture her baby coming out looking stoned) and has a history of Bipolar Disorder and a suicide attempt. Get the picture? There's more.
Her frequent complaints of feeling that her water broke was diagnosed as being Bacterial Vaginosis, or as we affectionately refer to it, BV. Translation: An infection causing copious green vaginal goo that stinks to high heaven and back. In some cases, you can smell it as soon as you enter the patient's room. She was given a prescription for an antibiotic for the condition...and we were all very happy.
But today she called the unit again. (She's on a first-name basis with all of us now so she just calls the unit directly and bypasses the doctor altogether.) Guess what her complaint was: "I think my water broke."
Nurse: "Is it any different than it was before?"
Patient: "No. It's the same as always."
Nurse: (Wanting to shake her) "So what makes you think that this time is any different?"
"I don't know," she replies. Pretty soon, here she comes through the door...with her messed up family and their crazy malfunctioning family dynamics...but that's another blog post.
After repeating the exam again...and it's negative again, the nurse asks her about her antibiotic.
"I never took it," she replies.
"Why ever not?" asks the nurse, thinking of the lurking stench coming from the speculum.
And here it is...that one sentence that threw us all over the edge:
"Because I thought it would hurt the baby."
But first, you have to know her. And all you nurses: I know you know her. We all have one...maybe many. She's a frequent flyer...you know...one that comes in every other day for one reason or another. This was her 17th (Oh yes, 17th) visit to the labor and delivery unit, 10 of those visits were because she thought her water broke. We had gotten to the point of referring to her by her initials.
"A. D. is coming in again."
But it's her history that gets you. You look at her prenatal records and picture a train wreck. She's 22 years old having her 4th baby, all of which have different fathers and two of which are in the custody of the state. She has a long history of ETOH (severe alcohol abuse) and marajuana use during pregnancy. She admits to smoking 2 packs a day during this pregnancy and that's after cutting down. She has late prenatal care. In fact the only reason she came in for care this time around was because her leg was swollen and painful and she was found to be approximately 24 weeks pregnant with a DVT requiring heparin therapy. She also has Gestational Diabetes...the treatment of which she is noncompliant in following. She also is on two different antidepressants (so you picture her baby coming out looking stoned) and has a history of Bipolar Disorder and a suicide attempt. Get the picture? There's more.
Her frequent complaints of feeling that her water broke was diagnosed as being Bacterial Vaginosis, or as we affectionately refer to it, BV. Translation: An infection causing copious green vaginal goo that stinks to high heaven and back. In some cases, you can smell it as soon as you enter the patient's room. She was given a prescription for an antibiotic for the condition...and we were all very happy.
But today she called the unit again. (She's on a first-name basis with all of us now so she just calls the unit directly and bypasses the doctor altogether.) Guess what her complaint was: "I think my water broke."
Nurse: "Is it any different than it was before?"
Patient: "No. It's the same as always."
Nurse: (Wanting to shake her) "So what makes you think that this time is any different?"
"I don't know," she replies. Pretty soon, here she comes through the door...with her messed up family and their crazy malfunctioning family dynamics...but that's another blog post.
After repeating the exam again...and it's negative again, the nurse asks her about her antibiotic.
"I never took it," she replies.
"Why ever not?" asks the nurse, thinking of the lurking stench coming from the speculum.
And here it is...that one sentence that threw us all over the edge:
"Because I thought it would hurt the baby."
Wednesday, February 3, 2010
Ode To The Night Nurse
When I left the night shift recently, a very dear friend wisely warned me to “never forget” where I came from. You know who you are. Mind, your message was heard.
I had to leave my daughter crying tonight.
I hadn’t had time to help her with her homework, only her brothers.
Dinner was “fend for yourself.” Dishes were piled. School papers scattered, neglected.
We missed another school event tonight…Mommy has to work.
I worked last night. It was busy, stressful. I had been at work since 6:45pm the night before, worked until 7:30am and had to chart until 8:30. By the time I got home it was 9am and I still had errands to run. You can’t do ALL your shopping at 3am…when you can’t sleep at night on your days off. Places of business are very limited at that time. There were bills to pay. Sleep is only for the lucky. Once I finally lay down I fell like a rock, hard and deep. I’d overslept and the kids were home…on their own again. Struggling to “keep it down ‘cause Mom’s asleep!” So I stumbled through my shower and tried to listen to my kids tell me about their day with really nothing going on inside my head to retain anything. They could be telling me that they were shaving their head and moving to Amsterdam for all I know.
Coffee. Where’s the coffee…
My husband gets home and out the door I go. What will be in store for me tonight? A high census? Call-ins? Or worse… Will a patient’s life be in my hands tonight?
We get good at being our own resource. There’s no one there to ask for advice. No managers, no educators. We’re on our own. The Doctors are asleep in their call rooms and really don’t want to be bothered. In fact, we are so used to being barked at in the throes of half-unconsciousness that we think it’s how everybody just talks. We are given extra freedom to go with our gut…whether that’s good or bad, I don’t know.
What does the night shift do? Sometimes I feel like we are the ones who babysit the unit while the day shift is away. The night shift is an afterthought. There’s no food for sale at night because apparently night shift workers don’t eat. There’s never any meetings in the middle of the night because that would be absurd to call a meeting at 2am. (But isn’t that what you’re doing to us when you mandate us to be there at 2 in the afternoon?)
We get the crazies, the drunks, the sundowners. Nothing is ever scheduled, everything is a surprise.
The clinics aren’t open so you never know what you’re going to get. We wonder what in the world would bring you in to the Labor and Delivery unit at 3 in the morning for an aching hemorrhoid that you’ve been having trouble with for 4 days. What? Do you hear all these screaming women?? And you’re annoyed that I am in a hurry when you spend 20 minutes telling me about it? Of course I am! What about “Labor and Delivery” says a place to get my swollen butt looked at? You couldn’t wait 5 more hours to go to the clinic? I digress.
We are sleepy, but we are working hard. We are overlooked, but we are faithful. We are lonely, but united. We are irritable, but knowledgeable. We are independent, but deeply depend on each other. We work in the dark, but our humors are light. We all know what the “4am chill” is. We wake up, pep up, stay up, to try to keep up. Our stomachs are bloated, our bladders are full.
Life goes on without us, and we go on when life settles. We function in darkness, even in the daylight. Our light at the end of the tunnel is the tip of the sunrise. We have found ourselves driving into our driveways with no memory of ever driving home. And we have people’s lives in our hands like this every day.
I couldn’t do it anymore. I had to make the decision to leave the night shift because of the toll it was taking on my health. Who wants an unhealthy labor nurse? My children were suffering. In my 14 years of working nights off and on, I never really got used to it. It never became easier. I admire those of you that just have some God-given ability to do this. I don’t have it. I’ll miss you, though. The conversations that go on at night are unforgettable. You’ve made me laugh when I’ve been at my very worst. Thanks for everything, and I’ll never forget you. You truly are the “hard core” of nursing.
I had to leave my daughter crying tonight.
I hadn’t had time to help her with her homework, only her brothers.
Dinner was “fend for yourself.” Dishes were piled. School papers scattered, neglected.
We missed another school event tonight…Mommy has to work.
I worked last night. It was busy, stressful. I had been at work since 6:45pm the night before, worked until 7:30am and had to chart until 8:30. By the time I got home it was 9am and I still had errands to run. You can’t do ALL your shopping at 3am…when you can’t sleep at night on your days off. Places of business are very limited at that time. There were bills to pay. Sleep is only for the lucky. Once I finally lay down I fell like a rock, hard and deep. I’d overslept and the kids were home…on their own again. Struggling to “keep it down ‘cause Mom’s asleep!” So I stumbled through my shower and tried to listen to my kids tell me about their day with really nothing going on inside my head to retain anything. They could be telling me that they were shaving their head and moving to Amsterdam for all I know.
Coffee. Where’s the coffee…
My husband gets home and out the door I go. What will be in store for me tonight? A high census? Call-ins? Or worse… Will a patient’s life be in my hands tonight?
We get good at being our own resource. There’s no one there to ask for advice. No managers, no educators. We’re on our own. The Doctors are asleep in their call rooms and really don’t want to be bothered. In fact, we are so used to being barked at in the throes of half-unconsciousness that we think it’s how everybody just talks. We are given extra freedom to go with our gut…whether that’s good or bad, I don’t know.
What does the night shift do? Sometimes I feel like we are the ones who babysit the unit while the day shift is away. The night shift is an afterthought. There’s no food for sale at night because apparently night shift workers don’t eat. There’s never any meetings in the middle of the night because that would be absurd to call a meeting at 2am. (But isn’t that what you’re doing to us when you mandate us to be there at 2 in the afternoon?)
We get the crazies, the drunks, the sundowners. Nothing is ever scheduled, everything is a surprise.
The clinics aren’t open so you never know what you’re going to get. We wonder what in the world would bring you in to the Labor and Delivery unit at 3 in the morning for an aching hemorrhoid that you’ve been having trouble with for 4 days. What? Do you hear all these screaming women?? And you’re annoyed that I am in a hurry when you spend 20 minutes telling me about it? Of course I am! What about “Labor and Delivery” says a place to get my swollen butt looked at? You couldn’t wait 5 more hours to go to the clinic? I digress.
We are sleepy, but we are working hard. We are overlooked, but we are faithful. We are lonely, but united. We are irritable, but knowledgeable. We are independent, but deeply depend on each other. We work in the dark, but our humors are light. We all know what the “4am chill” is. We wake up, pep up, stay up, to try to keep up. Our stomachs are bloated, our bladders are full.
Life goes on without us, and we go on when life settles. We function in darkness, even in the daylight. Our light at the end of the tunnel is the tip of the sunrise. We have found ourselves driving into our driveways with no memory of ever driving home. And we have people’s lives in our hands like this every day.
I couldn’t do it anymore. I had to make the decision to leave the night shift because of the toll it was taking on my health. Who wants an unhealthy labor nurse? My children were suffering. In my 14 years of working nights off and on, I never really got used to it. It never became easier. I admire those of you that just have some God-given ability to do this. I don’t have it. I’ll miss you, though. The conversations that go on at night are unforgettable. You’ve made me laugh when I’ve been at my very worst. Thanks for everything, and I’ll never forget you. You truly are the “hard core” of nursing.
Friday, January 1, 2010
Solace Dilemma
When I was first finished with my training on L&D, I had my eyes opened to a very deep and serious reality of life…and labor nursing. I arrived on my shift to review my assignment and found that I would be caring for a woman who was 22 weeks along (a little more than half way.) She had learned that day that her baby had very serious brain, kidney and heart defects that weren’t “compatible with life.” The woman and her husband, having had extensive counseling by her perinatologist and physician, decided to come to our unit to induce labor to end the pregnancy. The charge nurse told me, “This baby won’t even survive labor.”
“OK,” I thought. Being relatively inexperienced at the time, I considered the anomalies so severe that this would not upset my beliefs. The baby’s life is lost. It’s hopeless to expect anything more than death; whether that occurs now at preterm induction of labor before viability, or to bear to carry this baby to term along with this grave anticipation for weeks longer and have it happen then. The latter would be too much for a person, wouldn’t it?
So, I cared for this dear woman that night. I began infusing Pitocin. I’d never cared for a woman who’s baby would be dead. I struggled so hard to know how to act. Do I smile at her when I introduce myself? Do I offer my condolences right away…or wait until it happens? Do I go on with business as normal to spare her pain? I found myself feeling very awkward. She and her husband were very numb. Their affects were as flat as ice. Who could blame them? There were no tears. Not yet.
Labor carried on quite quickly actually. In fact, very suddenly the woman was exclaiming that the baby was coming. We hadn’t monitored the baby’s heartbeat (a moot point, isn’t it?) After all, the baby would not survive labor. I called the doctor for delivery right away. But the contractions overtook the woman and I found the baby suddenly in my hands…gasping…and moving its arms and legs. I was in utter shock that the baby was alive. The father cried out, “Oh God! She’s alive!” and let out a cry that only comes from someone who is watching their child die. It’s beyond agonizing. The mother, paralyzed, was silent.
I feebly carried it to the warmer to wrap it and watched it gasp and struggle in my hands, helpless to control my own emotions. The baby’s heart beat for 20 minutes before it died. We, with all our technology…and arrogance…did not dictate or preconceive, or control, the time of death. We never will.
This couple wasn’t warned properly of what they might expect. Unfortunately, me being so inexperienced at the time didn’t help them. Of course any baby that is induced alive may be born alive, more often than not.
But what I took from this experience and held ever since is that we shouldn’t be deciding when a baby dies. That’s not our decision to make.
My nursing friend has a friend with a beautiful story. She, like the woman above was faced with certain death of her baby with life-threatening anomalies discovered at 20 weeks gestation. She was counseled to end her pregnancy and try again. But she decided not to. Her perinatologist actually told her that she needed no further prenatal care if that’s what her decision would be…that there was no need for him. She dealt with a lot of opposition about her decision to carry her pregnancy. But she just couldn’t end her baby’s life herself. She carried the baby for 20 more weeks.
Although this time was painful, knowing what would happen, she found herself bonding with her baby in utero. She played little games with her by pushing and feeling the child push and kick back in her womb. She and her husband took every opportunity to make the most of that time. When she finally went into labor, she described feeling like she knew that little girl so well, and loved her. When the baby was born, she and her husband held her for two hours until she died quietly in her arms. She says, “I feel like I sent my little angel to heaven.” She says that she will always treasure that time she had with her daughter, and she never regretted a second of that decision.
I, after caring for my patient, had to deal with my own guilt. I, after all, gave the medicine to induce labor. Does that mean that I killed that baby? No, I don’t think so. That will be between me and God. But what about my duty as a nurse? Just because a couple is doing something that I don’t agree with doesn’t mean that they don’t need care. In fact, they need it more than ever! I can’t abandon them!
This is why I have voiced my own position to my employer about these cases. My personal solution to this is to care for these dear patients that deal with such a hard time, but I won’t manage the Pitocin (or other induction agent.)
What are your thoughts? Stories?
“OK,” I thought. Being relatively inexperienced at the time, I considered the anomalies so severe that this would not upset my beliefs. The baby’s life is lost. It’s hopeless to expect anything more than death; whether that occurs now at preterm induction of labor before viability, or to bear to carry this baby to term along with this grave anticipation for weeks longer and have it happen then. The latter would be too much for a person, wouldn’t it?
So, I cared for this dear woman that night. I began infusing Pitocin. I’d never cared for a woman who’s baby would be dead. I struggled so hard to know how to act. Do I smile at her when I introduce myself? Do I offer my condolences right away…or wait until it happens? Do I go on with business as normal to spare her pain? I found myself feeling very awkward. She and her husband were very numb. Their affects were as flat as ice. Who could blame them? There were no tears. Not yet.
Labor carried on quite quickly actually. In fact, very suddenly the woman was exclaiming that the baby was coming. We hadn’t monitored the baby’s heartbeat (a moot point, isn’t it?) After all, the baby would not survive labor. I called the doctor for delivery right away. But the contractions overtook the woman and I found the baby suddenly in my hands…gasping…and moving its arms and legs. I was in utter shock that the baby was alive. The father cried out, “Oh God! She’s alive!” and let out a cry that only comes from someone who is watching their child die. It’s beyond agonizing. The mother, paralyzed, was silent.
I feebly carried it to the warmer to wrap it and watched it gasp and struggle in my hands, helpless to control my own emotions. The baby’s heart beat for 20 minutes before it died. We, with all our technology…and arrogance…did not dictate or preconceive, or control, the time of death. We never will.
This couple wasn’t warned properly of what they might expect. Unfortunately, me being so inexperienced at the time didn’t help them. Of course any baby that is induced alive may be born alive, more often than not.
But what I took from this experience and held ever since is that we shouldn’t be deciding when a baby dies. That’s not our decision to make.
My nursing friend has a friend with a beautiful story. She, like the woman above was faced with certain death of her baby with life-threatening anomalies discovered at 20 weeks gestation. She was counseled to end her pregnancy and try again. But she decided not to. Her perinatologist actually told her that she needed no further prenatal care if that’s what her decision would be…that there was no need for him. She dealt with a lot of opposition about her decision to carry her pregnancy. But she just couldn’t end her baby’s life herself. She carried the baby for 20 more weeks.
Although this time was painful, knowing what would happen, she found herself bonding with her baby in utero. She played little games with her by pushing and feeling the child push and kick back in her womb. She and her husband took every opportunity to make the most of that time. When she finally went into labor, she described feeling like she knew that little girl so well, and loved her. When the baby was born, she and her husband held her for two hours until she died quietly in her arms. She says, “I feel like I sent my little angel to heaven.” She says that she will always treasure that time she had with her daughter, and she never regretted a second of that decision.
I, after caring for my patient, had to deal with my own guilt. I, after all, gave the medicine to induce labor. Does that mean that I killed that baby? No, I don’t think so. That will be between me and God. But what about my duty as a nurse? Just because a couple is doing something that I don’t agree with doesn’t mean that they don’t need care. In fact, they need it more than ever! I can’t abandon them!
This is why I have voiced my own position to my employer about these cases. My personal solution to this is to care for these dear patients that deal with such a hard time, but I won’t manage the Pitocin (or other induction agent.)
What are your thoughts? Stories?
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