I wish I could tell you all that more is going on than there really is. The only things that are exciting right now are going on in clinical and those are only two days a week. So unless you want to hear about the lecture on complications in the postpartum period or juvenile diabetes...I am going to skip the lectures. But I am going to tell you they are very boring and Praise Jesus that this is my last week! Ok so on to the funness that is maternity clinical!!!!
Day 110: Postpartum! The only real thing you need to know about postpartum is: MASSAGE THE FUNDUS! Which I did. So I had three patients. One of my patients needed a blood transfusion. She looked like death. I did not see her crack a smile once, not even when she was breast feeding her baby. She was 19. We started the transfusion, and left the room. She apparently called her parents and they got pissed we were giving her a transfusion! The father got on the phone and yelled at the nurse. So we had to get the charge nurse and figure out why the girl (15 minutes into the transfusion) was refusing the transfusion. Her parents had convinced her that her blood would regenerate (they didn't tell her it would take weeks...even months for her blood to regenerate) and that her lack of strength will effect how she cares for her infant. They convinced her that no matter what we may say about the blood being clean, she could still get AIDS or something from it. I kinda stood there and stared at her. Stupid, stupid girl! She clearly needed the blood! And she was already 15 minutes into the infusion. So if the blood wasn't clean (which there is probably no possibility that it wasn't), whatever was in the fucking blood was now in her system. So we had to waste an entire bag of blood!!! And a rare blood type too!!!! Does she realize how low and rare it is to get blood. Supplies for blood are low!! That is why they are always running blood drives. She needed the blood for herself and for her baby...which it looked like she didn't even want. It was sad.
People wonder why medical care is so expensive. Its a multi-tiered problem. While companies are over charging for procedures, insurance companies are just wrong these days, and doctors are wasting money by "CYA" procedures, its also the people who take advantage. This young girl was the perfect example. The doctor talked to her and the nurse talked to her. Her husband was there the whole time. But instead of consulting her parents BEFORE we pulled the saline, blood, tubing, and other prep materials, she did so after we had started the procedure and we had to waste hundreds of dollars worth of supplies, not mention precious blood. All parents are given a little cart with supplies in it for the baby while they are there. They take EVERYTHING out of the cart when they leave and some parents try to convince multiple nurses to give them more diapers, bottles, wipes, booger suckers, and other things. Now I can understand taking an open bag of diapers and wipes because I know those things are expensive, but if you can't afford to take care of a child...why did you get pregnant in the first place or at least give the child to a family that can? I just felt we kind of perpetuate our own problems. It just made me think before we go pointing the finger at companies and hospitals and the federal government, we should take a look at the things we are doing to add to the problem...like stealing extra diapers just to stick it to the man.
Day 114: Labor and Delivery. I got to start my morning by observing a c-section. I did not realize how violent the procedure is!! They give the mom a spinal then strap her to the table for safety. Create a sterile field and then cut her open. When its not an emergency they go layer by layer and when they cut through the muscle the OB takes one side of the opening and the surgeon takes the other side and both use their full weight to stretch the mother out!!!!!!!!! Then they grab the uterus and make a small cut then forcefully push on the mom's tummy like a pea from a pod (the nurse said like a white head from a pimple and that grossed me out a bit). If the baby doesn't pop out they put this little sucker on its head and pull. When the head pops out they grab it by the neck and yank the rest of it out. Not gently either. The baby is mostly blue when it comes out. The first c-section I saw there was blood everywhere!! Blood and all kinds of crazy fluids came pouring out of this poor woman like a river! Have you ever seen a flash flood? Thats what it was like. Then they sew her up and clean her up...but thats after the nurse and I pushed on her fundus again to get out some clots and blood. I was cringing for that poor woman! Why would you voluntarily put your self through that procedure if you didn't have to, just to spare your lower parts?
The second C-section I observed that day is what made day 114 one of the worst clinicals I have experienced. The woman came in all nice and sweet, but she was a big freaking baby. The nurses and the mom let me try my first IV stick. I was so nervous because the mom whined about how she doesn't like needles and how she didn't want me to turn her into a pin cushion (no pressure or anything). Found the vein did everything right, got the vein the first shot, got flash back, she flipped, and was scaring the shit out of me and I blew the vein. Fuck. I almost started crying. I apologized profusely, damn near threw-up and passed out on the floor. My instructor asked me if I need to sit and have some crackers or something, but I was so pissed at myself for missing (or well just blowing it), I just wanted to run screaming from the room. So an hour later she was in the OR ready for the procedure. She cried her eyes out when the anesthesiologist gave her the spinal. The worst part about this c-section was the surgeon. Now everyone says he was just picking on me...apparently he does this with everyone, but it didn't come off that way to me. The man was three inches from my face quizzing me like I was up for some oral board. He talked to me like I was child or some kind of retard. I could only see half of his face because we were wearing masks. He kept pushing me around (until he got in sterile field) like I was blind and deaf. Then he wanted me to do the foley cath on this woman. He stood three inches from my face and kept grabbing me and the equipment the whole time. With the first foley kit he said I broke sterile field so he threw away the whole bloody kit (and I talked to my instructor after and told her how I was setting everything up and she said I did it right and did not break sterile field.) He pulled out another kit and yelled at me through the whole procedure (by the way first time I have ever put in a foley.) He was sticking his hands in my space (which happened to be the mom's area), I just wanted to turn to him and scream "Back off!! I can't do the fucking procedure if you are going to be in my damn face!!!" I was already nervous about doing anything with this woman, he was just exacerbating the problem. Then he asked me to close his sterile gown. Well the ones that they use in the hospital are different from the ones we use in lab and are different from the ones in our videos, so I had no idea that there was a tie inside the gown, I just tied the sides together like we did in lab and he turned and yelled at me for that. But I didn't break his sterile field so I don't see what the problem was...he could have just told me "for future reference, there is an inside tie on these gowns, you tie that one first, then I hand you these cards and you tie the outside." I would have apologized and said I didn't know, thank you for teaching me. Finally the damn procedure started. And the jerk kept quizzing me! I just wanted to scream "Shut up and do your job!!! I am just here to observe!!!" The procedure went the same as the first one except not as much blood. When they ruptured the amniotic sac fluid came shooting out like a geyser!! The scrub tech almost got hit the face! The baby came out ok. The OB waved me in closer (really nice doctor) and explained the type of tubal she was doing and why. She was very informative and very nice. By the end of the surgery I was just so upset with the surgeon, I was crying and trying not to let anyone see me. I was exhausted and just hated myself. The surgeon at the end of the surgery asked me if I thought I was teachable, if I was going to to pass my classes. I was just taken aback. I told him I was passing all of my classes and none of my professors have ever expressed to me that I should be doing something else. And he retorted "Really?" I kept looking for help from one of the nurses, even the scrub techs and NOTHING. I was done. DONE. I ended up almost breaking down during post conference with my instructor. She is going to have a little talk with the surgeon. I have never felt more like a failure in my entire life than I have this semester.
Two final notes. For those of you having babies (especially scheduled c-sections) TAKE A BLOODY SHOWER BEFORE YOU COME!!! Good lord L and D smelled like dirty bodys and unwashed women parts. It was almost as bad as taking care of old folks in an old folks home. And finally, 114 solidly confirmed the fact that I will NEVER be an OR nurse or an Land D nurse and that surgeons are egotistical ass holes. Sorry Stephen H.
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