I'm so happy it's not just me!!!!!
Check out Labor Nurse, CNM's post on her blog ReBirth....
I've had these issues as you all know....you can review my trials and tribulations of poor nursing care in this post about Nurse Sucky, and this post about Nurse Crappy.
I'm not alone!
Friday, October 30, 2009
Saturday, October 24, 2009
Patients (patience)
Here are some patients I have had recently...and their families in some cases...
18-year-old multip who has class B diabetes and hypertension - she was being induced for these reasons at 38 weeks. Trust me, that baby needed to come out...much safer out than in as momma was very non-compliant (I hate that term but appropriate in this case). She had been on insulin prior to getting pregnant. They stopped the insulin when she got pregnant and she was to do diet and exercise. I thought that sounded a little odd but whatever. She came to us late in the pregnancy because she didn't like the care she was getting from her previous doctors. Or perhaps they wanted her to do things like eat right, monitoring, etc. Low and behold, we asked the same thing. She would apparently just not show up for NSTs and things of that nature. She also comes with an overbearing mother. Her mother is very much focused on looking like someone who knows something about everything. When I met her on L&D, she informed me that her daughter has diabetes and htn....uh yeah, I kinda got that from her H&P, from the midwife who scheduled the induction. And that might be why we are checking her blood sugars periodically and told her she could only order certain foods from the menu. How's that for a clue. The mother than proceeds to ask me all kinds of questions such as...
18-year-old multip who has class B diabetes and hypertension - she was being induced for these reasons at 38 weeks. Trust me, that baby needed to come out...much safer out than in as momma was very non-compliant (I hate that term but appropriate in this case). She had been on insulin prior to getting pregnant. They stopped the insulin when she got pregnant and she was to do diet and exercise. I thought that sounded a little odd but whatever. She came to us late in the pregnancy because she didn't like the care she was getting from her previous doctors. Or perhaps they wanted her to do things like eat right, monitoring, etc. Low and behold, we asked the same thing. She would apparently just not show up for NSTs and things of that nature. She also comes with an overbearing mother. Her mother is very much focused on looking like someone who knows something about everything. When I met her on L&D, she informed me that her daughter has diabetes and htn....uh yeah, I kinda got that from her H&P, from the midwife who scheduled the induction. And that might be why we are checking her blood sugars periodically and told her she could only order certain foods from the menu. How's that for a clue. The mother than proceeds to ask me all kinds of questions such as...
- Shouldn't she have the baby 2 hours after water breaks?
- Won't she have a dry birth?
- I've seen a baby with a rash because the water was broke for 6 hours (huh?)
- They'll start with a low dose for the epidural right?
- It goes in the spine right?
And on and on in that vein. The patron saint of patience must have been by my side as I answered all her questions that had nothing to do with the real concerns (a wbc over 17, baby sky high for even a multip, etc). And it isn't like I broke her water, it was spontaneous.
A patient came in through triage, after being seen in the office by the nurse practitioner. Her first visit with us was at 27 weeks. Then she disappeared. Now she's 36 weeks, contracting, blood pressure is up - lovely. Who needs that silly ole prenatal care - blood pressure issues are no big deal!
Another patient unfortunately had to have a c/s for CPD (this is actually a rare diagnosis - it gets tossed around a lot though). The baby was in the 9-pounder range, momma was a very large lady with a smaller pelvis :( Bad combo and unfortunate for her. We tried everything we could think of to get her dilating better and get some descent of that head, but nothing was working.
I have a momma in the office who stinks of cigarette smoke and has some very strange dreams about chihuahuas.
I have to start taking notes on things I want to blog about. I'll be thinking 'oh, I need to share this, this is good!' But now I can't remember a d*mn thing!
Friday, October 23, 2009
Paranormal Activity - one small spoiler
I went and saw Paranormal Activity recently with a friend. It's been touted as the scariest movie of all time. Not so much. It was very good though - nice build of suspense. I do recommend it!
We have some paranormal activity in our house. Sometimes I see figures of little children at my bedside. They usually are whining and wanting to get in the bed. Nothing seems to make them go away...even closing my eyes and trying to go back to sleep. I sometimes am bitten while lying in my bed...even in the daylight! After the cat bites me, she seems to magically fly across the room. I hear voices late at night - in the form of sportscasters. My husband apparently can't hear the voices.
After watching the movie, I told my friend that the first time I found out that my husband was standing over me for two hours watching me sleep...his a$$ would have been gone! Anyone who knows their scary movies, knows that's a set-up for disaster! Course one might deserve what they got for pulling the stupid sh*t that the boyfriend was pulling!
Anyway, go see it!
We have some paranormal activity in our house. Sometimes I see figures of little children at my bedside. They usually are whining and wanting to get in the bed. Nothing seems to make them go away...even closing my eyes and trying to go back to sleep. I sometimes am bitten while lying in my bed...even in the daylight! After the cat bites me, she seems to magically fly across the room. I hear voices late at night - in the form of sportscasters. My husband apparently can't hear the voices.
After watching the movie, I told my friend that the first time I found out that my husband was standing over me for two hours watching me sleep...his a$$ would have been gone! Anyone who knows their scary movies, knows that's a set-up for disaster! Course one might deserve what they got for pulling the stupid sh*t that the boyfriend was pulling!
Anyway, go see it!
Monday, October 19, 2009
Mommy Wars
I was watching a episode of Dr Phil (yes, I admit it - I watch him) covering the debate on stay-at-home moms versus working moms. I'm sure you all can figure out which side I am on.
I found it really interesting to hear from a SAH mom who was very outspoken about her belief that women who have children and work are selfish. She stated that "if you don't have time for children, then maybe you shouldn't be having them". I would actually agree with that statement but not in the context in which she made it. She's implying that any woman who works, couldn't possibly have time to spend with her children. That a woman who works could not contribute to the health and well-being of a child. That a woman who works couldn't possibly raise a wonderful human being.
Yes, this lady was really opinionated. In fact another SAH mom stood up and said that "she does not speak for all of us!".
In general, it seemed that the SAH moms were more likely to be judgemental about working moms. I did not hear any judgements made towards women who choose to stay home. I understand that SAH moms are often undervalued. Working in the home is a career like any other. But I wonder where that defensiveness comes from. Perhaps SAH moms have had to spend so much time justifying their choice, they opt to criticize those who made a different choice.
Dr Phil mentioned some interesting statistics that over a lifetime working moms will spend 80% of the time that SAH moms do with their children. He also mentioned that children who had working moms and were in quality daycare (quality being a key word) were more likely to score higher on school readiness tests, have higher vocab, social skills, etc.
Women raising children are very likely to raise children in their values and traditions. Some women value their children above all else, including themselves. The SAH moms seem to feel that raising their children is the most important thing in their life. I can respect that.
But it's not the most important thing in my life. It's one of the most important things in my life. But my life as a woman and a human being does not begin and end with my children. I had a life before they arrived and I will continue to have a life after they grow up and move on to their own lives. I am not the type of woman who can give up myself for my children. Maybe that does make me selfish in some eyes. I like to think it makes me a better person for my children, my husband, and those around me. Because I could not be a happy person as a SAH mom. I would go insane and might take that out on my family! I love my job and am very passionate about it. Do I feel guilty at times? Sure I do. Being a midwife isn't always an easy career when you have children. But I contribute to society in a very valuable way. I also think that I contribute to my children's health and well-being. I am raising my daughters especially to be strong, beautiful women who can do whatever they want in life.
I also like to think of the women who were working moms who made huge changes throughout our history. What would one say to some of these women? You should have stayed home with your kids instead of fighting for civil rights, for freedom, for healthcare, etc. The world would be a better place had you done that. Yeah, not so much!
I really do have respect for women who choose to stay at home and make child-rearing their top priority. Not all of us can afford or choose that though. We women need to stick together and hold motherhood up, in all its forms, as a tough job and one to be greatly valued.
I found it really interesting to hear from a SAH mom who was very outspoken about her belief that women who have children and work are selfish. She stated that "if you don't have time for children, then maybe you shouldn't be having them". I would actually agree with that statement but not in the context in which she made it. She's implying that any woman who works, couldn't possibly have time to spend with her children. That a woman who works could not contribute to the health and well-being of a child. That a woman who works couldn't possibly raise a wonderful human being.
Yes, this lady was really opinionated. In fact another SAH mom stood up and said that "she does not speak for all of us!".
In general, it seemed that the SAH moms were more likely to be judgemental about working moms. I did not hear any judgements made towards women who choose to stay home. I understand that SAH moms are often undervalued. Working in the home is a career like any other. But I wonder where that defensiveness comes from. Perhaps SAH moms have had to spend so much time justifying their choice, they opt to criticize those who made a different choice.
Dr Phil mentioned some interesting statistics that over a lifetime working moms will spend 80% of the time that SAH moms do with their children. He also mentioned that children who had working moms and were in quality daycare (quality being a key word) were more likely to score higher on school readiness tests, have higher vocab, social skills, etc.
Women raising children are very likely to raise children in their values and traditions. Some women value their children above all else, including themselves. The SAH moms seem to feel that raising their children is the most important thing in their life. I can respect that.
But it's not the most important thing in my life. It's one of the most important things in my life. But my life as a woman and a human being does not begin and end with my children. I had a life before they arrived and I will continue to have a life after they grow up and move on to their own lives. I am not the type of woman who can give up myself for my children. Maybe that does make me selfish in some eyes. I like to think it makes me a better person for my children, my husband, and those around me. Because I could not be a happy person as a SAH mom. I would go insane and might take that out on my family! I love my job and am very passionate about it. Do I feel guilty at times? Sure I do. Being a midwife isn't always an easy career when you have children. But I contribute to society in a very valuable way. I also think that I contribute to my children's health and well-being. I am raising my daughters especially to be strong, beautiful women who can do whatever they want in life.
I also like to think of the women who were working moms who made huge changes throughout our history. What would one say to some of these women? You should have stayed home with your kids instead of fighting for civil rights, for freedom, for healthcare, etc. The world would be a better place had you done that. Yeah, not so much!
I really do have respect for women who choose to stay at home and make child-rearing their top priority. Not all of us can afford or choose that though. We women need to stick together and hold motherhood up, in all its forms, as a tough job and one to be greatly valued.
Fantasy Football
So my husband plays fantasy football. Religiously. Four months out of the year, he's mentally not available. It's lots of fun.
My BFF sent me this video to help him pick out his players...
My BFF sent me this video to help him pick out his players...
Saturday, October 17, 2009
Tales from Officeland
- I had to give bad news to an adorable couple, who I was very excited to see pregnant as she is the sister of another of my patients. She was in the process of miscarrying :(
- I saw a patient postpartum, who's baby I caught. She's doing very well with breastfeeding and looks great. The baby is beautiful of course. Her and her husbadn had given me a wonderful thank you card, an announcement, and a gift card - suuuweet! I love cards and gifts - they certainly aren't necessary - but are always very appreciated :p
- I spoke with my favorite nut. She's the sister of a friend of mine. This friend (I sometimes have to question how much a friend she is!) sent her sister to me with the warning that she was a nut. She has mental health issues but manages them pretty well, goes to school full-time as does her partner, has a great dry sense of humor. She can drive me crazy but I admire her for being a pretty tough cookie. Anyhoo, she had been in the hospital with pain issues r/t GI issues (intentionally being vague). We were medicating her, hydrating her, and trying to figure out everything wrong with her....physically anyway. The midwife on call went to see her then came to the office and proceeded to tell me how they did a UDS on her and maybe she's a drug addict and why are we drugging this baby and why aren't the docs managing her blah blah blah. This is Ms. It's-Not-About-Us,-But-About-the-Patients. We could also call her Ms. Holier-Than-Thou. She really was p*ssing me off because of her attitude. This is 'my' patient, quit dogging her out. She may be a nut but she ain't a drug addict just because she has mental health issues. I pointed out that we had been seeing this patient since 5 weeks pregnant and not once had she presented with a complaint or request for pain meds. And she's more than halfway through the pregnancy. Back off B*tch! Anyway, she talked to one of the docs to decide what to do with her as the surgeon said no surgery and apparently the GI doc talked to the surgeon and decided he didn't need to come see her?????!!!!! WTF???? Our doc said send her home for the weekend and then refer her to the perinatologist. WTF??? Why? This is totally non-pregnant related. She needs the GI consult. So guess what I'm gonna do when I see her next week? Off to the GI doc.
- I think I only said drink more water twice on one office day.
- I saw a lady for what was supposed to be a new OB but apparently she had miscarried a couple days prior. She came for her appointment anyway. I sussed out the sitch and it sounded like everything was proceeding appropriately. We discussed grief. We talked about trying again and timing for that. I suggested bringing her back for a WWE in a couple weeks. She declined for religious reasons. She told me that she didn't do paps and would return when she was pregnant. Ok. Whatever. I can respect that as long a woman understands the risks and benefits of testing. I am no longer 'shocked' by out of the ordinary preferences. I'm growing so much :) Not just my a$$ either.
- I saw a doctor patient (because I apparently had a slot open) who was around 29weeks complaining of low pressure, white discharge, peeing frequently, and not feeling the baby move as much for several days. It's her third baby. Um. ok. So I evaluate - lots of fluid in the vaginal vault. Did you have intercourse recently? Yep, the night before. Well, there ya go! No ROM. I explain about common discomforts of pregnancy...i.e. does it feel like the baby is going to fall out when you walk. She looks at me with shock and says yes. As if she is amazed that I know what she is talking about. I explain about pelvic floor muscles and multiple pregnancies. I put her on the monitor. Looks gorgeous. Lots of "contractions" - you know...every 30 seconds, very jagged looking. You labor nurses and midwives know what I'm getting at. Fake contractions! I palpated...not a dayum thing! Go home hun...chill. Come see your doctor next week and drive him crazy..I have enough pain-in-the-a$$es of my own.
- I saw a young patient who had HELLP syndrome with her last pregnancy. She complained about having to stay in the hospital for a week after the birth, being induced, etc. She's really looking forward to doing things her way this time. I said, "If all is well, we do it your way. If all is not well, we do it our way". I hope we get to do it her way!
- I saw a new OB, who is late in the pregnancy and a nut. She has schizo among other issues. I use the term 'nut' affectionately (so don't flame me, I have mentally ill people in my family and I just might be one of em!). This one was hospitalized at the beginning of the pregnancy for trying to kill herself. Her other baby died a couple months out from accidental ayphixia. And she laughed when talking about it. She said she worried that it was her fault for having the blanket in the crib. And laughed. I understand that it was likely r/t her mental status and meds but it was still creepy. It happened last year. Can anyone say social services?
Wednesday, October 14, 2009
I deserve it
What a rockin' night I had on call. I deserve to have a rockin' night after how the weekend went.
I caught a baby for the doc - it was a woman having her third baby. She did an amazing job at pushing out her baby and I got to use my fav spanish saying - "Si, se puerdo (sp)".
Another baby came very fast in a multip who's water I broke at 4-5cms. She delivered just over an hour later and it was so cool. She squatted and pushed the baby out with her arms wrapped around my shoulders, which meant I couldn't see as my face was in her chest....glad she was wearing a bra or I would have been breastfeeding! LOL! I had one hand underneath the baby's head and just felt the baby being born into my hand. I wish more women would birth out of the darn bed! I was so high after that birth...and it was her first natural birth as she had gotten epidurals with her two previous pregnancies then delivered half an hour later.
The third birth was in a patient who had some BP concerns so we were inducing her - second attempt. This would be her second baby, the first weighing at 9-6! I had sent her home a few days previously as cytotec had not worked to ripen her cervix, her labs, were normal, and her BPs weren't too bad. But then she started getting yucky with the BPs again so another midwife put in a foley bulb and had her come in in the morning for pitocin. Her bulb had fallen out during the night so she was 3-4/60/-2. I waited until she had been on the pit for awhile and was starting to feel crampy, then broke her water. She was 4/70/-2 at that point. She got an epidural shortly thereafter (which was her plan from the gitgo). The nurse checked her while I was finishing the previous delivery and she was 10/100/0! She moved along quickly once she got going. What ended up being so surprising about how fast she moved and only fifteen minutes of pushing was that her first baby was 10 years ago, this baby was good-sized at 8-9, and was OP! I was totally caught off guard when I saw this baby's face looking up at me, batting his eyes :)
I went home to sleep but then had to go back as two grand multips came in...neither of which delivered by morning :p
I had a stalker as well....the dayshift postpartum nurse called and paged me a minimum of 12 times in a 12 hour shift. Mostly for stupid sh*t. It was so aggravating as she seems dumber than a box of rocks. I tried to be past but frankly, it was all I could do to not be mean. Example of one conversation...
Me : Stop calling me on my cell phone and at the office, I'm trying to see patients. I don't have my cell phone on me anyway. Page me first.
RN: I did and waited an hour, you didn't call me back.
Me: You didn't page me correctly, my pager never went off. I know it's working because I just got a page from L&D - they seem to manage to get ahold of me the appropriate way.
RN: Oh, sorry.
What was she calling for this particular time? To let me know that the surgical consult wasn't going to happen until tomorrow and the patient needed to be admitted instead of 23 hour obs. That's reasonable right? Well, I had spoke to her an hour and a half previously about the patient's admission - I told her I would come by after office hours to write orders. Seriously, why are you calling me again.....arrrggghh!
I caught a baby for the doc - it was a woman having her third baby. She did an amazing job at pushing out her baby and I got to use my fav spanish saying - "Si, se puerdo (sp)".
Another baby came very fast in a multip who's water I broke at 4-5cms. She delivered just over an hour later and it was so cool. She squatted and pushed the baby out with her arms wrapped around my shoulders, which meant I couldn't see as my face was in her chest....glad she was wearing a bra or I would have been breastfeeding! LOL! I had one hand underneath the baby's head and just felt the baby being born into my hand. I wish more women would birth out of the darn bed! I was so high after that birth...and it was her first natural birth as she had gotten epidurals with her two previous pregnancies then delivered half an hour later.
The third birth was in a patient who had some BP concerns so we were inducing her - second attempt. This would be her second baby, the first weighing at 9-6! I had sent her home a few days previously as cytotec had not worked to ripen her cervix, her labs, were normal, and her BPs weren't too bad. But then she started getting yucky with the BPs again so another midwife put in a foley bulb and had her come in in the morning for pitocin. Her bulb had fallen out during the night so she was 3-4/60/-2. I waited until she had been on the pit for awhile and was starting to feel crampy, then broke her water. She was 4/70/-2 at that point. She got an epidural shortly thereafter (which was her plan from the gitgo). The nurse checked her while I was finishing the previous delivery and she was 10/100/0! She moved along quickly once she got going. What ended up being so surprising about how fast she moved and only fifteen minutes of pushing was that her first baby was 10 years ago, this baby was good-sized at 8-9, and was OP! I was totally caught off guard when I saw this baby's face looking up at me, batting his eyes :)
I went home to sleep but then had to go back as two grand multips came in...neither of which delivered by morning :p
I had a stalker as well....the dayshift postpartum nurse called and paged me a minimum of 12 times in a 12 hour shift. Mostly for stupid sh*t. It was so aggravating as she seems dumber than a box of rocks. I tried to be past but frankly, it was all I could do to not be mean. Example of one conversation...
Me : Stop calling me on my cell phone and at the office, I'm trying to see patients. I don't have my cell phone on me anyway. Page me first.
RN: I did and waited an hour, you didn't call me back.
Me: You didn't page me correctly, my pager never went off. I know it's working because I just got a page from L&D - they seem to manage to get ahold of me the appropriate way.
RN: Oh, sorry.
What was she calling for this particular time? To let me know that the surgical consult wasn't going to happen until tomorrow and the patient needed to be admitted instead of 23 hour obs. That's reasonable right? Well, I had spoke to her an hour and a half previously about the patient's admission - I told her I would come by after office hours to write orders. Seriously, why are you calling me again.....arrrggghh!
Monday, October 12, 2009
Sassy Pants Mommy - I Love You!
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