Looking Back: Week 1 of Integration

This is pulled from my electronic journal. This is how my first week went:

Monday: L&D 8 to 11:15PM. Triaged three women in the AM with the same due date who were all post dates, 2 were teens in active labor, and the other was not in labor but wanted to check on her baby. One of the teens kept getting into it with the nurse (who was not nice to her and so I really didn't blame her) but the final straw was when she kept asking her to take her to the bathroom (she was hooked up to IV) and the nurse kept avoiding her (She admitted that she didn't like going into the patients room because the "little girl" had a "very bad attitude and an even worse mouth") and this girl just got out the bed, stood next to it and peed all over the floor. I could not believe the whole thing. I went in to talk to her and she said "I was not going to pee on myself, then she woulda left me in the bed laying in it." It was just a crazy situation. I was laughing with the nurses saying "well, welcome to integration hospital!" and they said "oh you aint seen nuthin yet!" and I thought, omg. I ended up delivering her and the other teen from the morning triages. (15 and 16yrs old) The lady who was also post dates and wanted to check on her baby was from the continent and lives with her cousin and his wife while she takes her last class here in the US. The entire rest of her family is back home. She did not want to be induced, but ended up staying for induction. She cried and cried and cried because her family back home was telling her not to be induced, to leave the baby alone and let it come on it's own. But then while she was hooked up to the monitors she was having decels, so of course we wanted to keep and induce her. I felt for this woman. Here she is, her cousin's wife dropped her off at the hospital, no one was going to be with her in labor or for the birth. She hadn't eaten since 5pm the previous day. She did not want to be induced and could recite the cascade of interventions that she was worried about, and I couldn't even pretend that it wouldn't happen. But, it was so nice to see the midwife and the doctor work together to help this woman. They are from the same part of the continent and so they came in together and talked about cultural customs and how they understood the pressure she was under. They talked about tradition vs the American way of doing things, and helped her figure out what to say to her family back home. The conversation happened in English, French, and their native tongue. The four of us in this tiny room together going over the risks/benefits of induction, still birth info, showing her the strip, asking about her needs, reassuring her that we weren't going to leave her, and just an overall understanding that were in this together. I was so happy to be able to witness it and be a part of it. She delivered vaginally the next day.

The other lady I delivered was a multip who came over from the clinic at 6cms. She was 5'2" and having her second VBAC. The baby came out fine, but then the placenta stuck. After about 30 minutes, she started to look a little shocky- basically pale, and we realized that her last H/H was like 8.9 and 25! We opened fluids, lowered the head of the bed , and called the MD stat. The MD tried to see if she could get it out (light manual removal) but couldn't (and the woman didn't have any pain med left- she was feeling everything!) and so then there was this big rush to get an interpreter phone because the doctor couldn't take her back to OR without informed consent for the anesthesia and hysterectomy she thought she might need (basically the doc felt that the placenta was probably stuck on the old c-section scar and she was going to try to really manually remove it but she would have to anaesthetise the patient, and if she couldn't get it out, she would have to have a hysterectomy) This probably would have been a lot scarier if we hadn't have just passed off the patient and went straight to our other patient who was pushing in another room! I had also done postpartum rounds during the shift, so by the time 11pm rolled around I was exhausted and ready to cry.

I was also upset that I really hadn't been prepared, like didn't have the experience of managing more than one patient at a time. Everything had to be done so fast and there were so many women to check on and strips to read and details to keep straight that I was really overwhelmed.

Tuesday: All day in the clinic connected to the hospital. Another long day. 34 patients showed up. The midwife said that it was a lot, even for her, so she called over to the hospital to ask the midwife on call if she could come help. Well she had three women in labor so she couldn't leave. I felt a little better knowing that the midwife herself felt a little flustered. I don't like how the clinic operates, but I guess this is what it's like at a high volume place. Women are given a number and called back by that number, never their names. She said this is not how midwives like to practice, afterall, this is why we went to midwifery school in the first place, to not practice this way! But this is how it is, you just have to work with it. The RNs do all the teaching- you write in the plan of the soap note what you want them to teach the woman before she leaves. You only have time to do leopolds, fundal height, and fetal heart tones. Also paps, GBS, etc.- the clinical exam stuff. Everything else, the nurses do. The MAs stay in the room with you and hand you everything so that it goes faster, and basically rush you to keep you on schedule. By the end of the day, again, I was exhausted. The midwife apologized for having to feed me to the wolves, but basically I was in shock. We both saw patients at the same time (she in her room, me in mine) and other times I saw patients with her in the room if it was something I didn't know how to do or couldn't find. It was crazy, and I did not feel like I was giving good or safe care, but I do know that I was doing the exact same thing she was doing. Also, almost every patient speaks spanish only. I swear I just can't get away from this. I'm telling myself that there's a reason this keeps happening. The only good thing is that they have multiple translators on site, and they come to you literally within a minute of asking for them, much better than those damn phones!

Wednesday: similar to Tuesday, except it was all GYN/Family planning and I only had a half day, which was lovely.

Thursday: Call- similar to Monday, except I had even more PP rounds to do, and one of my births was in the birth center!!! It was actually almost a waterbirth but she had light mec on AROM and you can deliver in the tub if you have mec stained fluid. So, she delivered in the bed and something funky happened with the cord after it was cut- blood sprayed everywhere! (even though both clamps were still on) The midwife said the cord snapped, but I couldn't tell how or where. It was really nice to see a birth in the center with the woman laboring in the jacuzzi. It was so much calmer, and the midwife seemed so much more like a midwife. It was also a beautiful birth because of the woman. She was this dreadheaded woman with this dreadheaded man for a partner. She was spiritual and really into symbolism. She had prayed the whole pregnancy that this particular midwiwife would be on when she came in (the practice has 'double digits' of midwives in it, so you never know) so she was really happy to have her there. Plus she was in nursing school and wanted to go to midwifery school so she was actually happy to have me there too and we talked about what midwifery school is like. Then, her partner had a friend who was struck and killed by a truck the night before, so they had talked about how with death comes life, and her partner's best friend was having a baby at the same time in the other part of L&D. The woman was also excited that she was having her baby on MLKs birthday in this year of Obama. It was just really good energy all around. Again a room full of women of color (the nurse was from India) feeling the love. As you can see, there have been good moments mixed in with all the scariness.

But it has been scary.

I feel underprepared by my school, and this doesn't feel like IP at all. All of a sudden my hand skills at birth SUCK. And per usual, they ask me stuff I feel like I should know but dont. Plus I really miss electronic charting- writing soap notes fast has been rough. Plus I think I work too many hours. I can see myself getting burnt out here very quickly.

Early morning tomorrow, again, going to bed!