Random Monday musing.

Did this morning stupidly: was about to step onto the bus only to realize that I forgot my ID badge which has my Metro card. Ended up driving to school this morning, blah.

Seen this morning: a man driving near medical center vicinity in an old vintage car with the roof open and the license plate reads "APGAR X". Well, alright then Mr. OB/GYN/Neonatalogist, carry on....

Received this morning: a bar of quite a fancy chocolate from a friend out of the blue right before lecture starts. I like friends who give little surprises, made my Monday. :)

Popped up in my mind this morning: a quote by a mother of a patient as told by the night shift nurse to me and preceptor as we were getting report. Mom sought the nurse because the kid was crying in the middle of the night, when nurse came, mom said to said nurse, "Can you please calm him down? He needs some human contact." Most outrageous quote I have ever heard in a hospital setting.

Watched this morning on the laptop before lecture: Gossip Girl episode from season 1. Shut up, I'm trying to catch up with TV shows these days. I'm trying to stay connected to the outside pop culture world here....

Last.

Last night was my last OB clinical, and I was sad to leave. I have truly enjoyed the experience due to my amazing instructor, who has a wide range of experience and tries so hard to let us see and do things we've never seen an done before. She is amazing. My friend said, "If I could have all of my clinicals with her for the rest of my school career, I would". I agree, she's just so wonderful, and I'll miss her.

The hospital we were at is not one of the magnet hospital in this city, it's a general hospital where the low income population and everyone else who has no insurance go to. I knew of the fact that I will not have an encounter with, as my instructor said when we started, "the Gerber baby family" who lives in the suburbs, 2 cars, 2 stories house with a front and back lawns and white picket fences surrounding it. It's an entirely new and different experience for me, but I'm so grateful I had the experience.

It taught me what being a nurse is about, that when you care for your patients, you see past what society has labeled them and you just see them as persons who need you and your care, and that is who they are. Their history may say they're drug addicts and the CPS is going to take their baby away, or they're brought from jail with one leg chained to the bed, or they're 37 weeks who've had no prenatal care and not taken any prenatal vitamins, or they're unmarried teens with their 2nd baby, but you don't dwell on that piece of fact. They don't deserve less medical attention based on what their history says, they still need the doctors and you, as their nurse to care for them. I love what my nurse said last week, "When you take care of a patient, you take care of them like you take care your family. You'd want them to be comfortable and you'd make them comfortable". And that is one of the things I will take with me throughout my career.

Last night was great for a last clinical day. I got to draw blood and saw another C-section, this time less traumatizing for the mother--and me for that matter. A complete opposite of the C-section last week, phew. The mother was actually my patient that was admitted to the triage. They were going to admit her to Mother-Baby, but at last decided she would go for a C-section due to a few circumstances. Then after the baby was out, the surgeons lifted up the uterus for us--4 nursing students lined up against the wall--to see and showed us the ovaries and what not.

One other thing to mention about that, is it was very nice of the surgeons to do that, but my friends and I still joke that they did so because they felt guilty about kicking us out of the OR in the beginning. It was all good though, we knew they were really concern about the amount of people in the OR as they were prepping and fear of contaminating the sterile field. So after one of them contaminated her gown when one of the staff accidentally touched her, she ordered us to "stay outside and come in after the baby was out or something". We were like "What?! Until the baby out?! What the heck?!" So we watched from the window until they made the first cut, and she actually sent a nurse to get us back in before we were going to sneak back in regardless of waiting until "after the baby out or something". Afterward, as we were about to start post conference, she came to find us and apologize for earlier, so that was very nice of her. See? Doctors and surgeons are nice, and I like them a lot when they're that way.

So that is it. That is the end of OB clinical this semester. Wow, I can't believe Junior II is ending in a matter of 4 weeks. Yesterday, I also registered for next semester as Senior I. It's surreal, time has really gone by fast. It seems like it was just yesterday that I started this blog to journal my journey (heeey, rhymes!) as I started nursing school.

Senior I. Dang.

Fetal demise, PIH C-section, late decels all in one night.

Last night was all kind of things mixed into one. I mean, damn, was it a full moon or something?!

Before I ramble on, you might wanna stop reading if you're squeamish.

So, it started off slow, my patient was 5 cm when I came in and stable. After a few hours with her, I ventured around the corner to where my two group mates were, and that's when I saw something odd in the basinet next to the baby warmer across from us. It was a bunched bloody blanket and I saw a surface of red flesh and I thought it as a placenta and wondering why would they wrapped a placenta and put it in the basinet?

My friends spotted the same thing and all three of us went to take a closer look, and that was when the nurses told us that earlier that evening a 24 weeks mom had come in saying she hasn't felt the baby moved in a week. Sure enough, it was a fetal demise, and she was induced to give birth to a stillborn baby.

I will never forget what I saw last night, I don't think I will ever that image of the nurse unwrapping the blanket to reveal the red glob of fetus beneath it out of my mind. Judging by the appearance of the fetus: red, floppy with no apparent bone structure (it looked like a red blob of Jell-o or a red water balloon), underdeveloped features, and peeling of the skin, they were thinking it died due to chromosomal abnormalities and that it had died a week or more before the mom came in last night. As I went back to my patient's room, I caught a glimpse to the stillborn's mother's room, where silent grief enveloped the family that had gathered there. I said a prayer for them.

My patient, in the meanwhile, was progressing slowly, only going from 5 cm to 6 cm, so the doctor order the Pitocin to speed it up. Sure enough, minutes later late decels started showing up on the monitor and it was a "Holy crap! Is that what they meant when they talked about that in class?!!" moment for me. We turned the mom to the sides, put her on O2, and turned the pit off.

It's funny because in class, my instructor taught us a song to help us remember what to do when decels happen, and that exactly what was done last night. I'm still getting used to the feeling when things I've studied in the textbook happen in front of my eyes, it's like "HEEEEYYY!!!", the dots connected, light bulb goes on, whatever.

Mother and baby were okay after that, and nearing the end of my shift, my instructor came around telling us that she was going to sneak us into a C-section in a few minutes after they got the mother settled down and ready to go. The mom was 32 weeks along with PIH and overweight, which is not a good combination for the surgeons and the anesthesiologists.

They started and not long after that the patient started moaning and you can see everyone was alarmed, but the anesthesia team reassured that she was just feeling uncomfortable from the tugging and retracting they surgeons were doing to try to locate the uterus. As they cut through more layers of fat, the patient started groaning and it got louder and louder.

My friends and I looked at each other wide eyed, thinking "What in the world?!!", then we saw the surgical tech and my instructors rolling their eyes and giving each other "What the hell are they doing?!!!" It was bizarre to see someone with their abdomen open and blood flowing out and hearing them making noises that indicate that she is obviously in PAIN!

All this time, the surgeons continued to try to get to the baby as fast as they could, and the anesthesia team announced to the room whatever everything they cannot do because she was so large and hypertensive with low platelets therefore the pending complications, and I was just screaming in my head "DO SOMETHING, SHE IS IN PAIN!!!!"

They finally got the baby out after a series of groaning from the mom, who was still groaning as they sew the uterus. The baby needed intubation and some helped to breath, but the NICU team finally go the baby to cry, so that was good. We left right after that and didn't see the rest of that procedure.

I had no idea why the anesthesia didn't seem to work completely and why the team couldn't get it right. I knew the mother posts a series of complications but it doesn't mean you would just let her feel the pain of her surgery. Uncomfortable? Okay. Pressure? Okay. Pain? Oh hell no! That's not right, but unfortunately, it happens.

So that was my night on the OB floor yesterday. It was a night to remember for sure.

Lost in Translation.

The hospital I'm at for OB clinical is a county hospital where the majority of the patients is of the Spanish speaking population. In the time that I've been there this past month or so, I've only come across one who can speak both English and Spanish. Have you seen the movie Spanglish with Adam Sandler and Tea Leoni? The experience is something like that. Language barrier sucks, I tell you.

The first clinical was something else, I thank God for my Spanish freaking friends, otherwise the patient and I would be playing charade/gesture the whole night. I don't think she'd appreciate that. I bet that resident taking the history thanked her lucky stars too, she was flipping through her neat pocket notebook with cutouts of medical questionnaires in Spanish and stumbling through the pronunciation. Though I feel for her because we're on the same boat, I still have to say it was comical.

Anyway, so after that beginning part, patient was ruled to be "safe", only needing monitoring for an hour or so. Of course me, being a student nurse, is responsible for that. So I sat by her, reading the fetal monitor, and then silence.

*crickets*

*crickets*

Patient looked at me, obvious concern in her eyes. I smiled and said, while pointing to her pregnant belly, "Bebe es okay, I mean, bien," and then I gave her a thumb's up.

Wow, way to go Cee. You took how many years of Spanish in high school? Two. Yes, and how many semesters of Spanish in college? Two. Yes, and that's all you managed to say?! *headdesks*

Silence pretty much consumed the room that night. I felt HORRIBLE. I wanted to talk her, I wanted to comfort her, I wanted to build that rapport with her, but I can't. Other than "Me llamo Cee, soy estudiante de enfermera, como esta?", this girl right here no se habla Espanol! I understand conversation (phew, at least I got something out of those Spanish classes) but as far as speaking go, well, it's a no go! It brought me back to the first time I stepped on the soil of this country, back when I was fourteen and only knowing little English. Frustrated I say, frustrated!

Then 2 weeks ago I was in Mother-Baby, the floor where conversing to laboring mother would be, you know, beneficial. Again, I felt horrible that I couldn't talk to her, couldn't comfort her, nothing. All I could do was to sit by her, watching the monitor, touched her hand when the contractions hit, and held her when she got the epidural (before the nurse took over and told me I should watch how they put in the epidural). I hated that I couldn't tell her what I was about to do when I had to put in a straight cathether.

I was there for about 5 hours and all I said to her were:
- The introduction, which I said in English and the nurse translated, so this doesn't really count.
- "Bebe es nina or nino?", in which she answered "nina".
-"Su esposa?", when I came in to find there was a man in the room, in which she nodded and said "si".
- "Puje, puje, puje, mas, mas!", which I chanted with my charge nurse as she gave birth.
-"Es nina!", which I exclaimed when the baby was out.
- a "Congratulation" in plain English because my brain does fart sometimes, usually when I need it not to.

I've got four more clinicals at this hospital I think, so we'll see how much Spanish I could pick up. The fact that I just discovered a English-Spanish translations on the back of my OB clinical pocket book also helps. I'm quite surprised that I actually managed to find this before clinical ends.

Say what?!

Maybe I really am naive in thinking there is good in all people. I hear stories about doctors being rude, arrogant, and unappreciative to nurses--well, to anyone in general--but I've always thought "Really? Would people really get all high and mighty like that?" Not that I don't believe there are people like that, it's more like "I can't imagine why or how someone will act like that."

Then I met face to face with that kind of doctor today.

We were at the hospital's OB clinic this morning. There were several exam rooms and each doctor was assigned with a med student and, eventually, a nursing student. The doc I was assigned to seemed okay with it before we went in, even told me and the med student we could learn together. So, med student and I took turn with patient assessment while doc looking up info on the computer, and it was a normal regular visit.

But once the patient is out of the room, doc stormed out of the door to the nurses station announcing "I don't want a nursing student with me, I'm a doctor! Nursing students need to be with the nurses!" Then she went into a nearby room to find someone and just made the same announcement she just made to everyone that was in the area, where the nurses, staff, and patients were present.

As you can imagine, the nurses were not happy. They "saved" me from the wrath of that doc, immediately finding me another exam room I could be in, and apologizing for the doc's behavior, saying "They're just being their typical self, they know it's a teaching hospital but they just got big headed." Apparently said doctor was infamous for their attitude because the nurses have dealt with that doctor in the past but today was the last straw when they blatantly rejected to teach a student. Needless to say, that doc's boos is going to know something today.

I was put with the OB Nurse Practitioner afterward, and within ten minutes my friend came in with the same reason as me. Apparently, that doc went to her other assigned exam room, where my friend, a resident, and a med student had seen a patient. Doc came with "Is there a nursing student here?!" to which my friend replied "I am." Then doc said "Nursing students can't be with the rest of the doctors. Nursing students need to be with the rest of the nurses."

What the hell is that doctor problem?!

Look, I know normally in other clinical setting, the med students follow the doctors and the nursing students follow the nurses, but this is an OB clinic. An OB nurse practitioner more or less does the same thing an OB doctor would do during a regular OB visit, unless a more serious complication arises then the nurse practitioner would refer the patient to a doctor. The med students are learning more or less the same thing the nursing students are doing: getting history out of the patient, fundal height, fetal heart rate (the difference is that the med students get to do a vaginal exam whereas I won't without my instructor's being there with me). For that reason, the nursing students are assigned to be in the room with the OB doc, med student, and the patient.

Having said this, I know not all doctors are asshats, just like not all nurses are heaven sent. There are asshats nurses too, I'm not going to pretend my profession is the better one here. But as for today, this is what happened to me. I was fine about it afterward, sure I was taken aback by the attitude, but I felt more for the nurses on that floor because this doctor just pissed off every nurse there with their inconsiderate comments.

Now when people are talking about asshat doctors, I can say "Yeah, it happened to me once" instead of "Yeah, I heard about that."

"Oh, there is another one....."

On the morning of 27th, I received a phone call from my mom. It was night time where she lives (we originated from an South East Asian country) and she sounded tired yet happy, the reason being that she and Dad had just become proud grandparents to twin baby girls. My SIL gave birth--4 weeks early--after long hours of labor.

But that is not the whole story.

The whole is that all along we were expecting a single baby girl, ultrasound technician and OB/GYN himself confirmed a single baby girl, that is until a baby girl did come out but OB/GYN noticed that SIL's tummy was still round and swell. So he prodded around and lo and behold, there is another one, say hello to baby #2, y'all!

Bah! What the hell?! How could they missed twins during 8 months of prenatal care??!! I realized that they opted with the old school ultrasound, none of that fancy schmancy level 4 one, but still! There are two heartbeats, is it really possible not to hear two?! Or was it just pure carelessness?

I think it was the latter.

SIL's OB/GYN was the doctor who birthed my two brothers and I, so my mom was quite loyal and defended him when I criticized bitched on his (and the ultrasound technician's) skill, or lack of thereof. The OB/GYN blamed said ultrasound technician for the mishap and excused it with the twins' on top of each other position instead of side by side, hence the appearance of one baby on the screen. As for the heartbeat, he made an excuse of they were beating at the same time so he could not differentiate, plus he was going on the confirmed ultrasound of one baby. Mom seemed to accept it and let it go, but I beg to differ. I (and a few friends and a nurse I've talked about this to) still can't wrapped it around our mind that they missed it.

Fortunately, the babies are healthy. Baby #1 weighed in at 2. 3 kg (4 lbs. 7 oz.) and baby #2 was 2. 248 kg (4 lbs. 648 oz.). Baby #2 had some breathing difficulty shortly after birth, but she's pulled out of it and is going to be fine. My grandparents who live here are elated at the news, seeing their faces when I told them the news were something I would never forget, though it broke my heart a little that they won't be able to see their great granddaughters in the near future. They haven't been officially named, though Mom just said they are thisclose to putting the names down on the birth certificates--the last I heard they are Arabella and Aurelia. I, as the proud aunt, approve of the names.

Now I have to shop double for the baby stuffs. Le sigh. I'm turning into one of those aunts who spoil the kidlets rotten....

In other news, aka nursing school wise, final is a mere two weeks away. Comprehensive final, 'nuff said. I can foresee a lot of long hours and late nights studying and very little to none going out of the house in the next two weeks, very bleak and gloomy future I say. Oy....