Saturday, January 10, 2009
So, on the first day of my preceptorship, I was walking down the hospital hallway with a chilled bottle of champagne and on the second night I was watching my patient's uterus getting stitched up in a chilly OR. My mom always says about nursing: There is never a dull moment.
My first night, my pt had her whole family in the delivery room. Her dad was holding her leg as she pushed out her baby. It was just the sweetest thing in the world and they were the most adorable family and all had tears in their eyes when the baby landed and the mama had had a 48 hour labor and came through it all great. There was some drama at the end when the shoulders were stuck (dystocia is what it's called for my non-nursing pals) but babe squeezed by and mom had virtually intact tissues (and she was a primip - her first birth - too!).
I think my preceptor was dissapointed on my second night when babe 2 got stuck in an unfavorable position and the (heart) decels were too deep and too long. Two obs were in there trying to push the baby into a better position but baby was looking straight up into the sky (well, the bottom of the uterus anyways) and each contraction was bending the back of the head into the babe's back. My precpetor is very prepared and I saw her take out the sodium citrate and I knew that meant c-section. (Sodium citrate can be given before surgery to neutralize stomach acid in case any is aspirated into the lungs. Acidic stomach contents plus lung tissue do not mix well.)
So she's wheeled into to chilly OR and strapped to the table and drapes are draped and her abdomen is prepped and her arms are spread out on the armboards like Christ on the cross (isn't there some sort of crucifix-y name for that position...? Maybe I'm imagining it.) and she's gotten an incredible amount of pain reliever and anesthesia in her epidural AND Versed and Versaid again and she's still feeling it. They cut her open and I'm trying to hold her hand and every time I try (the babe's father is stil out in the hall), my preceptor walks me back around to the other side of the drape to watch which would be fine, but my pt is moaning and obviously terrified. Finally, my preceptor says, "You wanted to watch, you're not a doula, come see the medical side of things." OK. (Here I'm all torn. Wait, haven't I been told that my job is to help patients cope with illness and the treatment of illness? )
My preceptor, though, is my mentor and I'll be working with her for 9 more weeks and - let me say - she rocks in that old-school-tough-as-nails-does-it-right-the- first -time-I'll-take-questions-later kind of way that, frankly, you want your preceptor to rock. And, also, I like the way she introduces me to people sorta proud-like "*This* is my preceptee." And I like that she's as tall as I am short. I feel sometimes less preceptee and more side-kick-y.
So, they get through the skin (which is nicely wrapped in what I'm going to describe as yellow Glad Wrap (just to be funny)), they get through the fascia and they start going through the uterine muscle and I'm sent out to get dad and miss the emergence of the babe. I hear my pt moan/ scream and there's the babe when we come back in. So, pt's uterus is out on her abdomen, yes, out of the abdominal cavity and (reminder: all of my previously participate din surgeries were micro surgeries) it looks like a small, raw thanksgiving turkey (because all products of surgery are described in relation to food items: "It was about the size of a small orange." "It was the color of a blueberry." etc, I'm just upholding the traditions of my profession here).
My preceptor is doing gauze counts and they have this nifty hanging bag thing and - I'm not kidding -it's called Bag-It! (except there is no exclamation point) that looks like one of those cheapy clear plastic things you hang on the back of your closet door to hold your shoes except instead of shoes there's bloody gauze. See, it's a handy way to count the gauze: five pockets per Bag-It! and one or two bloody gauze per pocket (depending on user preference).
And then, bloop, back into the abdominal cavity goes the turkey and all the layers are stitched up and mom is still scared to pieces and babe is whisked away.
Baby is cute as a lil button and fine and mom came out of it all great: a little shakey, a little scared, but snuggling in the recovery room with her little one.
Well, happy birthday. Two ways and two cute-y pie babes and two tired mamas and two bigger families and a very tired student nurse happy to be here.
(That's part of my daughter's cake. I stole the doggy with present idea from somewhere and now I can't find where I found it. oops)