L&D Week in Review

In three days I “helped” deliver 2 babies. The first delivery was a C-section after over an hour of pushing. The second delivery was a vaginal delivery. I don’t normally get queasy, but I almost didn’t make it through the vaginal delivery. Newborn assessments went smoothly, but this experience confirmed that L&D isn’t for me. One of the nicest things (extreme positive) I saw during my L&D rotation is the love among the mother, the father, and the present family members.

Of the 5 nurses I worked with, two were pretty great. They didn’t mind when I asked questions, they invited me to try new-to-me procedures (my first real foley-yay!). I don’t want to go into negatives here, but when I become a nurse, if I ever have a student assigned to me, I will answer questions, show and explain procedures, and talk to them. I hope I won’t read Cosmo, ignore the student, or roll my eyes at the student or instructor whenever they ask a question. I hope to take advantage of teaching opportunities and, in a sense, pay it forward.

And about those teaching opportunities, here’s one where an MD got a chance to show a nursing student (me) how little she knew (not that I ever pretended to know much about nursing, much less epidurals). Be forewarned, it’s a lengthy post…

On Friday, the last day of the L&D rotation, a patient who was just admitted was getting set to receive an epidural and I was invited to observe the anesthesiologist administer the epidural (my first time).

I put on a mask and hair cover and the MD asked me why the woman was in pain.
SHIT. I wanted to say that the patient was in pain because she was in labor. So as I’m trying to not to pee my pants, I’m going on about “…well, uh, so, she’s um, in the first stage of labor….in the active stage…”

MD: Yes, but why is she in pain. What tissue is the cause of her pain?

Me: What tissue is causing her pain? Her uterus…uterine tissue? (Seriously, it felt like 2 minutes passed before I could answer that)

MD: Yes! You’re exactly right! Good. And what’s causing her pain?

(Another long pause)
Me: She’s having contractions…the baby…the fetus…the contractions…blood vessels are constricting…???(shhiiiiittt…I have no clue what this woman wants me to say. I don’t know! I feel like a certain woman from alaska!)

MD: yes, but what is causing the pain?

Me: I’m sorry….I don’t know.

MD: Ischemia. Decreased blood flow to the tissue. Ischemia is the cause of her pain.

At this point I feel like an ass. Of course ischemia is causing pain...that plus the build up of lactic acid....But it gets better.

MD: So, why is it important that I monitor the patient’s blood pressure after this procedure?
Me: The epidural is going to lower her blood pressure and we don’t want it to fall too low.
MD: yes, but why is it going to lower?
Me: (long silence). Her blood vessels are going to dilate….
MD: Ok. But before that. What is going to cause her blood pressure to lower?

I am nearly trembling. My knees are locked.

MD: We’re going to get her relaxed. That’s going to help lower her blood pressure. But what else is going to lower her blood pressure. Before (or did she say after??) we get her relaxed. Why (or what?) is going to lower her blood pressure.
Me: Numbing…we’re numbing? the numbing....I'm sorry, I’m not sure….

At this point the doctor says something about numbing the smooth muscle fibers (I think that’s what she said). Seriously, I was so low, beaten, dumb founded that I wanted to fall to the floor and faint just to get out of the interrogation.

And it doesn’t end there. The nurse I was assigned to had to leave the room and the doctor apologizes to the patient, “I’m sorry that you have to hear about this lesson while I yell at my student.”

Ally McBeal moment here: I envision taking this woman out with a karate move. But I continue standing there with my hands behind my back. I don’t even roll my eyes like the nurses on the floor.

And then just when you think it couldn’t have gotten any worse, the interrogation continues (seriously, if I was the doctor I think I would have kicked the student (me) out of the room for her lack of knowledge).

MD: Why did I use these two syringes?
MD: What happens if we get the medication in the blood stream?
MD: What will the patient feel if the medication is her blood stream?

And finally, the end occurs. The MD approaches me and tells me I should really review and become familiar with this medication, as I will be using it nearly all the time, on any nursing floor. I thanked her and she said, “No thank you! We really enjoy working with students…blahblahblah”

So that was my scary Friday. I honestly couldn’t sleep that night. True, I probably should know more about epidurals. Unfortunately, my maternity professor never went into detail about epidurals except to say that 60-70% of laboring women receive them, they are inserted between L3-L4, a side effect is hypotension, and THAT’S IT. My maternity lab instructor often voiced her opinion that too many women receive epidurals. None of our lab scenarios involved women receiving epidurals.

The questioning will strengthen my back bone (even if recounting the scenario as I just did makes me anxious). Clinical is about getting asked a gazillion questions in which you are not supposed to know the answers. However, it’s never happened to me so unexpectedly. Plus when questioned by our instructors, they help guide us and eventually, we end up recalling the processes studied in class. In my med surg clinical, if I couldn’t answer a question off the top of my head about a medication, I would tell my instructor, “I don’t remember off the top of my head, but I know that it’s in my folder on my drug sheet.”

A professor this past summer gave us some advice as we were starting our first clinical experience (med-surg). She said something to the effect of: “Don’t be that person who sits at home at night memorizing drug information and disease processes. Study the information. Take notes. Bring a clipboard containing your notes into clinical with you. Your instructor wants you to do your homework and care for the patient, not memorize facts and figures. It’s more important that you are able to find the information you need than to memorize. Over time, you will get your facts and figures down.”

Post partum rotation is next week, then psych. More soon-

Whoa Baby!

I'm starting my L&D rotation tomorrow night!

disclaimer: the exclammation point is more dread than excitement. classmates are taking bets that I'll become a maternity convert.

drink please

worst clinical day ever.

Time to crawl under a rock.

Toss-n-Turn Post

Can't sleep.

So I decided to quite literally empty the mind.

Here is what's in it now:

Job Fair tomorrow morning. Don't want to wear the typical black pants and blouse. Plus for some reason, I think my body fat is getting re-distributed. Pant crotches are nearly down to my knee (slight exaggeration). Found a great grey pencil skirt in my closet that was thrifted, but can't seem to find the matching grey jacket (I KNOW it 'came' with a jacket). Might be able to get away with wearing a blouse with pencil skirt, but the blouse didn't fit as perfectly as I'd like. Might have to wear the skirt with suit jacket combo, which will make me feel like a recruiter or a politician. Either way I think it'll make me look matronly. Granted the job fair is just for practice. Not even sure if my resume is up to par.

Pediatric clinical starts wednesday. Pray for me.

Peace. I wore my peace earrings today. I've had them for about 3 years and only one person has ever noticed them so much as to actually say something.

My professor (I believe she will be an awesome professor and can possibly be a nurse idol) mentions my earrings twice. Once before class when I ask about the guest speaker (from the career center). the teacher tells me about how the guest speaker will tell dos and dont's of interviews (no sandals, shorts, watch the type of earrings to wear...). (as if I would actually wear big earrings to an interview??)

Then during attendance, I hear my first name and immediately go "here" (I have a seriously long name). She says, "Ok. Are you married?"

I say, "yes"

"newlywed?"

"no...5 years now"

"Ah, ok. " (and then she says to the class) "Her last name has a hyphen. It wasn't like I just knew she was married because she is wearing peace earrings."

HUH?

She either hates me (because of the earrings) or is secretly excited about having me in her class (because of the earrings). I hope not to disappoint. Next week I'll go back to wearing studs, but wait until she sees what I ordered online this past weekend....

I ordered the brown on the bottom left, but now I'm wondering if I should have gone with dusty or tan...

And don't worry....I have enough sense not to wear the shoes with the peace earrings!

Double Standards?

Take it for what it is. If someone can find a video of democratic commentators/strategists doing the same (double standards, etc), I'd love to see it :)

Again...is it really sexism? Shouldn't she just "...work harder. Prove yourself to an even greater degree..."

Is it Really Sexism?

note: I'm in the middle of a 2 day sneezing fit, so hopefully this is coherent....

I've been reading a lot online and watching a bit too much tv, but it might be safe to say that a lot of people feel that the VP pick is not being treated fairly. People are asking questions that aren't asked of men.

And they are right...questions ARE being asked that aren't normally asked of men in the same position.

When we are exposed to something that we've never experienced, no matter what, we have questions. 20 odd months ago, questions were asked about a certain candidate regarding his religion, his education, and the time he spent as a child overseas. As voters, we had a right to wonder and ask these questions.

And now, once again, we have someone new on the stage. We have new questions, just as we did 20 odd months ago. Some may find this sexist, but I don't. As a women who will one day have children, I want to know how she does it.

Not because I think having kids makes the job of VP impossible (it doesn't), but because I want to have kids. I want to go back to school to earn a masters. I want to work in public health, out in the community. I want to work with the NIH or CDC in conducting research. Like my communities in nursing professor, I want to be a state representative. I want my kids to have music lessons, be on the swim team, play soccer and little league baseball. I want to see their recitals, their swim meets, and their tournaments. I want to have dinner with my family at the table.

Will I need a nanny? Will my husband have to end or change his career? Will our parents have to live nearby to help raise our children? There is nothing wrong with any of these options-I just want to know if that's what it will take.

So when I ask, how does she do it? How is she going to do it? I'm asking because, like my friends who are parents and millions of other women in this country, I haven't figured out how to make it work.

Blogcation Redux Part 3: Massachusetts

Finally! The rest of the vacay:

So after our breakfast in Portland, we drove through all parts of Maine...and decided that after seeing roughly 4 small coastal towns in Maine, they all begin to look alike...

On our way to Boston, we ended up driving back through NH and stopped for lunch in Portsmouth, which reminded me of Portland, which reminded me a bit like Charleston. The downtown area had lots of privately owned trendy businesses. My favorite was Second Run Books, a used bookstore that had their walls covered with "things found in books," ranging from train tickets to Penn Station in NY to photos, love letters, newspaper clippings, and shopping lists. It's where I bought this book.

And what is apparently a common thread of New England, we found another public garden.

After eating a slice of delicious cake with coffee, we began to head down to Boston. Honestly.

We actually stayed in Cambridge, just across the river from Boston. I liked this because it was between MIT and Harvard. We were surrounded by brains.

How to describe Boston? It's like a clean Philadelphia (which I'm not sure says much as I believe any city is cleaner the Philadelphia (aka Philth-adelphia). We walked parts of the Freedom Trail, lots of American History, historic graveyards, more seafood, and great Italian food. We were pretty disappointed in the hyped up Faneuil Hall-this was a glorified tourist trap....I imagined something more along the lines of the market at Grand Central Station in NY, not a high priced fast food hall with chain stores like the Gap.

We did take a swan boat tour....

The bookstores in Cambridge though...oh. my. goodness. My new fantasy? to be locked in the The Harvard Coop or the The Harvard Bookstore. Guess I'll have to look into grad school sooner than later ;)