short and sweet

Well, it’s frightening to me that integration is actually in its final couple of weeks. Another long stretch with no births but more than enough labor management experience to make me feel incompetent and humble on a daily basis. I know all that is normal and expected but it is such an exhausting feeling to second guess myself constantly, wonder how to make nice with the nurses and continue to care about a laboring woman when it’s 3 in the morning and she’s been stuck at 4cm for hours and the pit is at 30. I spent a good 5 hours of my 12 hour shift last week convincing myself that my SVE was inaccurate because the woman had a bulging bag and her cervix was paper-thin plus she had no pain meds on board so I was trying to make the exam as quick as possible (generally, just a tough assessment). I was pretty confident she was 6-7cm but when she was walking around the hospital hallways doing squats with her doula (who kept correcting me every time I called her “surges” contractions) right after that, I wondered how she could possibly be in transition. My only thought was that my exam must have been wrong. Her contractions spaced out even after her nubain and vistaril should have worn off and I expended vast amounts of mental energy playing a scenario over and over in my head where she keeps laboring, 7:30pm rolls around and a new midwife comes on. She does a SVE of her own and calls the woman 3. The story goes on to find all the midwives thinking I am an idiot because word gets out that even though I’ve been in the hospital for close to 2 years now, I apparently can’t do vaginal exams. The nurses are annoyed because they aren’t confident in my skills and I have to spend the final few call shifts I have being more than perfect so that I can redeem myself in some small way before I come crawling back to YSN for competency exams and an anticlimactic graduation.

In reality, I ended up checking our patient about 3 or 4 hours after I called her 6 and she was fully dilated. I was happy for her and definitely embraced the relief she was feeling in finally being able to start pushing, but, I have to admit, I might have been more happy for me and my own personal relief that my exam could have potentially been accurate or, at the very least, that night, that exam was not going to be the one to blow my cover. Not yet.

You know what they forget to tell you when you’re applying for school? They forget to tell you that when you graduate you might not actually have a good sense of what the hell you are doing. That it helps to be a really good actress, that you might think you are unsafe for a while, that you are constantly exhausted by all the anticipation of messing up just as much as you are exhausted by the job itself. And even though no one warned me about this, I am learning that clearly every day now. And waiting-sometimes patiently, sometimes not-for things to start falling into place. Graduation, Boards, Comps, Job hunting, a major shifting of gears, is looming. And I’m finding myself wanting to run away as fast as I can. Too bad I need the cash.

Car theft!

It took two and a half years of living in New Haven, the car theft capitol of the world, to have my car (“Carlos”) broken into in Boston, MA. Parked on the quiet and residential street of Eastland Rd, sometime last night between 9pm and 8am this morning, Carlos was vandalized. I walked out today on my way to work and first noticed that the back door on the driver’s side was unlocked. “Oh, Sarah.” I said out loud to myself, “You idiot. You left your back door unlocked all night. Oh well.”

Well. As I put my key into the car door I noticed that the middle of my steering wheel was gone. And as I peered further into the car I saw that the glove compartment was basically ripped off and the air bag cover on the passenger side was gone. Basically, both of my air bags were swiped. No one wanted Daryl Hall and John Oats’ Greatest Hits or Fleetwood Mac’s Rumors. They didn’t want my stained yoga mat or my moldy smelling towel. They didn’t seem to have any interest in my Ambulatory Obstetrics book or the tripod that I borrowed from YSN. None of those items seem to be hot commodities. Just the air bags. Yes, the air bags. They were both gone. Taking a step back I realized that I hadn’t left the door unlocked at all. The thieves bashed in the vent window on the driver’s side and unlocked the door themselves.
I called the police: A nice policewoman took my story down (see photo) and let me know that the detectives would not be coming to do any other investigation around who might have done this to my car. I called my insurance company: Turns out I have an insanely high deductible and no freaking car rental insurance coverage. Not good. I called an auto-body shop and talked to the wonderful “TK”, very very short for Tsuyoshi Kaneko and he said he would take care of me right away. I called a tow truck. I called my dad to see if he had any advice for me. “You know why the detectives didn’t come out to do any further investigation? Lazy. Plain lazy, Sarah. If I was there I would have demanded it. But whatever. You know why those theives took your airbags? I know what happened. An order went out. Need Honda airbags. And some guys made a bundle of money.” A friend of 16 Eastland thought otherwise. His theory was that there might be gold in the airbags, a rumor he had heard on a commercial not too long ago. (You can offer your own thoughts in this week’s poll)
When the tow truck guy came he asked if I could start the car and when I told him that I had been afraid the dashboard would blow up in my face if I tried, he took the key out of my hand and put it in the ignition. Not a second thought. Even with cords and wires and loose materials hanging out of the middle of the steering wheel (see photo). The car started fine but it still looked pretty sorry. And how often to you get a chance to ride in the front of a tow truck? So, we loaded up Carlos and off we went. The tow truck smelled like B.O. but we arrived at Allston Autobody (which smelled like bleach) with Carlos still intact. (see photo) I spoke with TK and his secretary and they said they could take care of everything from this point on.
Just got back to 16 Eastland. The car, I think, is in good hands. The day was long but, alas, as difficult situations always are, a learning experience as well. I think a yoga class is in order for this evening. Though, I'm just remembering, I left my mat in my car...

3...Is the magic number!

Up all night on Friday and delivered three babies. It seems to be the pattern for me here. Long, long days of no action and then-bang!-three women in labor, no sleep, triage calls all night long. It’s like that quote that goes something like: Nothing happens and nothing happens and then everything happens. There was supposed to be a big snowstorm that night in Boston so I had a feeling we would get all the nervous nellies coming in, afraid that if they really were in labor they wouldn’t be able to get to the hospital in time because of the storm. As I predicted though, the first flakes didn’t fall until daylight, right as baby number three was crowning. Despite the high numbers of women all over the city of Boston who pushed for an induction on the 29^th of February just so that they could have a leap year baby, only one of our three was delivered on the special day. This particular family went into labor naturally and didn’t really care when their baby was born, so long as it came out safely-their last baby was a face presentation and was badly bruised and swollen for weeks after the birth. They were mellow and cool, this couple. Making jokes the whole time about the hot anesthesiologist who placed the epidural the last time they were in the hospital and how they didn’t want to show their first baby to anyone until his one month birthday because he looked like Rocky Balboa.

The second birth of the night happened quickly. A young and tiny Asian woman called us at least three times during the night c/o RUCs before finally arriving at the hospital. Each time she called she reported her contractions being 5-10 minutes apart. No LOF, no bloody show etc etc. We told her to stay home. She was a primip with good support, talking through each of the contractions while on the phone…And then she just showed up in triage. At 8 cm. She was there with her husband and mother-in-law (both of whom were almost as small as the laboring woman herself). Only the woman in labor seemed to speak English so I talked mostly to her while I watched her mother in law never take her hands off her daughter. Rubbing and grabbing and massaging her legs and arms and hands and feet and making quick little taps on the woman’s sternum to get rid of her heartburn. I’m not sure what she was doing but it seemed to calm everyone in the room. And it’s not clear whether the sternal taps or the antacid we gave made her heartburn go away her but it was obvious that the mother in law had some purpose to what she was doing and I was absolutely fine with it. After warding off the AROM police I feel the burden of so often at the hospital, our patient SROMed all over the floor. I wondered for a second if this is why so many people prefer AROMing. Just less messy. It always confuses me when I see people who need to be neat and tidy all the time working on a labor floor. Birth is messy and unpredictable and I am constantly seeing people trying to control what they cannot and creating more of a mess than if you had just left your hand out of it. The baby was 5lbs 7oz and gorgeous.

I woke up our last woman to deliver that night pt at 5am and even though she had a pretty heavy epidural she was c/o some pelvic pain. Could be a window, I said. Could be that you need a bolus, I said. Could be that she is fully, the nurse said. Good idea. Let’s check her: not only was she fully, she was easily +3. The baby’s head was just hanging out in the vagina and laboring down like a champ. Dad woke up, brushed his teeth, wiped the sleep out of his eyes, punched one hand into the other and said “Let’s do this”. At 7:00am we were still pushing and there was a shift change. A nurse who I am not extremely fond of and who is not extremely fond of me, came on and immediately took over the room. She was telling stories, having the woman push in just the way she wanted her to and telling my preceptor she was just gonna get on a sterile glove and do some perineal massage to give this baby some room to move. I froze. And when my preceptor gave her the okay I almost fainted. As a student, I have virtually no power in the room. And even as a midwife it seems like you are constantly making decisions about how to provide good, evidence based care but at the same time, not make any enemies. I watched while the nurse pushed at the perineum and gave her a blank look when she said to me: See Sarah! See how that head is moving now? Easy for her to say. She won’t have to repair this woman’s perineum after her baby comes out. I’m sure she felt very very important. Getting her hands in there and making the birth go as quickly as possible. Check it off the list and move on to some juicy gossip at the nurses’ station. She approached me after the birth to explain herself again in more of an I-told-you-so voice than an apologetic voice and told me that when it’s a doctor birth she is always in there doing her thing, “I’m doing this, I’m doing that (while she is telling me this she is bending her knees and putting her elbows out to the side-you’re doing the chicken dance when it’s a doctor birth? I wanted to ask)…and that’s why, she said, she had to “elbow me out”. And then she walked away. I looked at my preceptor. “Just smile and nod she said. It’s not worth the confrontation.”

My father disagrees. I mentioned all this to him the next day when we were on the phone catching up. His response? Priceless. It went something like: Listen, Sarah, I’ve been a business man and my own boss for over 30 years. And you can’t get to where I’ve gotten by letting people walk all over you. Here’s what you gotta do, sarah. You go up that nurse and you ask her out for coffee. You sit her down and you say, listen bitch, (not in those words of course) you can’t talk to me that way. We need to find a way to work together and you can’t talk to me like that in front of a patient. Not now and not ever. Okay? Nobody walks all over Jimmy Kleinman! Listen Sarah, she puts her pants on one leg at a time just like you. You have to nip this in the bud. Okay?

Okay Dad. I love you.

Omission

I forgot! Valentines Day was spent taking advantage of a fairly new Boston hot spot with my midwifery friends. The Beehive is an only slightly pretentious bar/restaurant/music club that had a Love Fest for V-day. Standing in line for an hour, live soul music, creative drinks and some sort of anonymous love note writing that we never quite got the hang of left us wanting...but not before I took the dance floor with some of the other party goers. They were much more appropriately dressed than me. Thankfully, Patty caught me in the act on her cell phone.

Triage

Well, I’m back in Boston. Drove through the blustery snow storm from New Haven with my friend Ryan who needed a ride to Newton, MA for a job interview. And even though the drive, which should have only taken me 2 hours, took me four, and even though I had to crane my neck way over to the right side of the car in order to see out of my window because there was so much ice glommed onto my left windshield wiper, and even though I almost (!) missed my hair cut appointment, it was a good ride. Nice to catch up with Ryan, nice to arrive to a city covered in snow and nice to end the journey with a new do and an eyebrow wax! Ryan, Alice, Pete and I ate at a place in the outskirts of the south end called the Union Bar and Grill. All in all I would give it a 5. It was fine. But the walk from the train was longer than I had anticipated and even with Jenny and the Watson twins playing on my ipod for my walk there, by the time I got to the restaurant my legs were soaked and my new hair was matted with snow. Also, I decided on the Union Burger for my dinner and though it was cooked well (as in good-I asked for it medium) the bun was down right stale. And the fries were...salty but limper than they should have been. The pluses of this place were that my water glass never went unfilled for more than 1 minute, our waiter responded appropriately to my jokes and Ryan’s risotto was otherworldly. Again though, a 5. Wouldn’t necessarily go back unless I found myself on that block and starving or in dire need of risotto.

Call today was mellow but filled with phone triage. Not only were there 5 or 6 pp patients who called in c/o large clots, high fevers or sudden increased vaginal bleeding, I had seen all but one of these patients in clinic. Talk about continuity of care! It felt so good to be familiar with these patients’ voices when they called in, to have been at their labor or to have taken part in their prenatal care. And the investment in their own health care was remarkable. One of the women we evaluated who was 10 days post partum brought her golf ball sized clot with her to the hospital in a ziplock bag. We looked at it and then promptly threw it in the trash. And now I must start mentally gearing up for a night on call tomorrow.

Tonight I’m relaxing with some chicken stew I got from Trader Joes. Still in my scrubs, waiting for Anna and Anders to come home from some PTA meeting, putting off entering my visit numbers into the typhoon tracking system, and watching some SVU to wind down. The stew gets a solid thumbs down. Believe it or not, too salty. I need a shower and goodnight’s sleep. Unfortunately, House is on in 6 minutes…it’s not looking good.

06511

On the heels of a three-births-in-one-day call shift last week, my first ever diaphragm fitting, some lousy teaching, some great teaching, watching a baby’s head be delivered more slowly and more patiently than I have ever seen, and being witness to some sort of raging vaginal infection on a woman who was ppd#5, I headed south, back to CT.

I drove back here Friday to work at the hospital, take some time to work on my praxis and sleep in my own bed for a few nights. I’m beyond tired at this point. I walked out of work today at 4 and could have easily been convinced that I had been there all night. Detached and foggy, I’m secretly hoping I might be called out of work tomorrow morning because when I left today our census was only at 12 and, since I am only a per diem RN, I am usually the first to get the 5am phone call from the charge nurse saying to stay in bed. Work has been both humbling and rewarding as always. And being back in my apartment is wonderful. Though, I must admit, I do miss Anna and Anders sitting and watching hockey in the TV room when I walk through the door.

My days and nights have been filled from the moment I arrived: Yoga with Meredith, homemade pizza (thanks kate!!) by a homemade fire in Middletown where it turned out to be a party where everyone had unknowingly dressed like someone else! (See the evidence below!) And The Savages tonight with the Meg(h)ans. The movie slow and sad but hopeful and well written. I recommend it.

There is a soaking rain here in New Haven tonight. I can’t think of better weather to have licking at the windows while I fall asleep.

Murphy's Law

There was a turn of events this week, I think. Boston moved up a notch as a city for me. There was rain, thunderstorms actually, which makes me much, much happier than snow. There was a fun and comfort food filled dinner with my peeps from Yale who are based in Boston this semester. There was a lovely dinner and a movie date with my dear friend Margot where we went to see Harold and Maude on the big screen!! I took a kick ass yoga class taught by my friend Fez, had a yummy Irish brunch complete with blood pudding and live Celtic music, I won some body butter at a Yankee swap and was reminded that I am a complete idiot when it comes to Dance Dance Revolution, and, most importantly, I spent a call shift with a wonderful preceptor.

Last Tuesday, though again, I had no births in a twelve hour period, I did have some fantastic mentoring. My preceptor, let’s call her…Gayle, was funny, smart and gave me such a perfect balance between independence and support. She critiqued my notes, challenged me to stay with a laboring woman even when it was frustrating or exhausting or when I was growing impatient, and she complemented me when she saw me doing something well. And her confidence in me only made me want to work harder and learn more. But, like I said, no births. In fact, I was with our patient through each and every one of her contractions until we left the hospital. She had been at 4cm for over 4 hours at that point. The next day I learned that she had gone to C-section after receiving the diagnosis: failure to progress.

Thursday, I was on call again. After 6 shifts with no baby catching, I wound up with two woman fully and pushing at the exact same time. One woman, a Sri Lankan primip doing natural childbirth was somehow, through each contraction, able to maintain her humor. She would come up from a contraction, look at her husband and say: “I see you there, all relaxed and smiling and I just wish someone would come in and strangle you.” Or: “It would be nice of someone came in here and just dropped something very very heavy on your foot.” Or: “Don’t you even have a headache? I think, for my sake, you should at least have a headache.” She was wonderful.

But we admitted a multip at 6-7, thought for sure she would go first and so stayed with her to push. After the third or fourth push my prececptor and I heard screaming coming from down the hall. “I hope that’s not our patient.” My preceptor and I said to each other. Another scream. “Yep. That’s her.” We said. She had come out of the shower crowning and had just enough time to quickly waddle to the bed for our back up doc to deliver her. I ran into her delivery room as soon as I could to see how she was doing: Already breastfeeding and cooing to her new son like she had been a mom a million times over. I never cry at births. Honestly, never. I am so distracted by where the baby is, the mom’s perineum, whether or not the uterus becomes firm after delivery, that I don’t have any time to soak in just how incredible an experience birth is. But seeing this new mom, looking perfect with her swaddled baby boy, having worked so hard for his arrival, brought tears to my eyes.

Tonight is Anna’s birthday party. Ice hockey at the Lars Anderson rink here in JP. I have been coaxed into actually playing. But not without the correct accoutrement. Below, please find pictures of the game, both before and after. All told, it was a fabulous night. Only one person was sent to the emergency room (as predicted by Anders) and, thankfully, it wasn’t me! (Extensive hockey equipment: $2,000. Some other guy’s expenses for 12 stitches in the forehead: $350. Staying on the ice all night with no lasting injuries to speak of…Priceless!) Actually, I did take a hard fall at the very end of the night. While everyone was leaving the ice I attempted to do that plow sort of stop in my hockey skates. The result? Crashing to the ice on my back and hitting my head pretty hard. After Anna evaluated me though, (see photo below of a neuro exam) I am pretty certain that I am free from concussion. And pretty sure I’ll be hitting the ice again sometime soon. Enjoy the photos and the video of my confronting an opponent!! Happy Birthday Anna!