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whitewriterP.S the LJ app sucks. It deleted half my post. I managed to post off of chrome much better than I did utilising the app.
If my father hadn't died in Oct 2019 (literally, 3 months into midi) would I have made it through with the same conviction that I could?
On Friday when talking to the student, I realised my biggest fear when I stepped foot to work as a midwifery student was as a currently ICU trained RN- that meant that I knew everything, and that I was good. That I was smart (I'm not saying I'm not -- but hear me out) and that clinically, I was sweet with most things). I am confident as an RN. I know what I'm doing. But only so much in the narrow field of ICU.
Midwifery .... is a whole different kettle of fish.
When I don't feel any of those things at all --- in a new profession where I haven't had any offhand personal experience with any age of any child myself in any stage of pregnancy or otherwise ---
I just couldn't fathom how ICU was at all related to midwifery (unless your patient was pregnant or postpartum and RPAH we rarely got those). I can only remember one case.
In my memory it was likely to be 2016. ICU at MICH. My old workmate A who ended up doing midi at a different SSH 6 months ahead of me (and gave me tips when I started at Westmead) and I only recently reminisced about this case that never left us.
She was a migrant lady, ?pakistani or Indian descent. Her and her husband and previous child about 2 years old lived in a suburb that was in MICH district.
During her labour (no idea if it was spont or IOL, the details, were not available to me at the time and I wouldn't even have understood their implications if I had sought them). I think it she wanted/ or was bullied --- who knows --- into an epidural.
The story goes, that the anesthetist put in the epidural. Her blood pressure dropped.
They ended up giving her metaraminol (seriously haven't seen this since I started midi-- usually we give fluids. I don't know how low her BP was at this time, I don't know how long it had been low for, I wasn't there) and her blood pressure shot up so high after the metaraminol, that she stroked out.
Left hemiparesis and slurred/jumped speech.
She had a hemorrhagic stroke.
Quiet a dramatic way to have a very severe and rare outcome related to an epidural.
In ICU, we always just see the worst of anything. At MICH it's even worse, because we also see all the mistakes SSH in our districts make. When all you see all day is errors and bad luck and complications, it can really skew your view on the world.
Already I felt for this mother, her first child now left with a disabled mother. The father now left with a disabled wife. This felt entirely preventable (again, I have no idea what the reason for the epidural was, there are times when they are necessary). It just seemed so cruel and unfair. They were migrants so low in support (and possibly, low in petty cash).
As a 20 year old. I couldn't think of anything worse to happen to a young family.
Now as a midwife, I see the case slightly differently. I wish I could gather more information on what happened on the midwifery side of things. How much function this woman recovered, I don't know. But she still lives in my memory. I hope she's able to walk at least, and perform basic activities of daily living.
One values normality more than ever when reviewing cases as these.
Back to fear. So now in midwifery not only do I bear the responsibility of ensuring the woman is well cared for-- but the fetus too. Our tools for identifying abnormalities seem crude and prone to subjectivity -- the vaginal examination, the palp, the CTG.
Whilst in ICU everything was highly subjective. The arterial line. The 5 lead ECG. The hourly IDC. The EVD. The PAC. and countless other lines. You can set them up at their various correct levels and zero them and then majority of the time, rely on their readings. If the patient moves or something influences the reliability your there, you know how to use the lines, you fix them and rezero.
It's really not that much too it in ICU.
So that fear, that fear of now what you say to the family or the woman does influence their outcomes and choices (to get an epidural or not. To get the c-section or not. To allow the vaccume delivery or not) -- and to watch medical override midwifery at almost every turn -- and not always agree with their reccomendations. --- Whilst in ICU, RN is always overriden by medical, theres a much clearer delinneation of roles. RNs dictate RNs stuff. Doc arranges the scan and we do the rest: arrange the time, pack up the pt, prepare the pt, prepare the notes, accompany the pt,-- arrange if the Dr needs to come to. They might come. Help them get onto the scan table. rinse and repeat on the way back to ICU. The doc reads and reports the scan. Explains to us what it means and how it influences care. We take it from there.
There's no, vaginal exam done by a midwife, then redone by say, a doctor, who then disagrees with the answer -- and decides that it means something that changes the course of care. In midwifery its 2 professionals in one case. Hopefully on the same page. Sometimes not and medical wins.
In ICU its team work. Division of labour. We have the same goal. And we work on the task at hand.
So I have no idea why someone would think an ICU nurse who absolutely loves the world of ICU would enjoy the world of midwifery. I don't think I ever came into it thinking that I'd leave completely in love with the profession. I was aiming for competence, at the least.
But to get it, one must go through the pain.
If my father hadn't died in Oct 2019 (literally, 3 months into midi) would I have made it through with the same conviction that I could?
On Friday when talking to the student, I realised my biggest fear when I stepped foot to work as a midwifery student was as a currently ICU trained RN- that meant that I knew everything, and that I was good. That I was smart (I'm not saying I'm not -- but hear me out) and that clinically, I was sweet with most things). I am confident as an RN. I know what I'm doing. But only so much in the narrow field of ICU.
Midwifery .... is a whole different kettle of fish.
When I don't feel any of those things at all --- in a new profession where I haven't had any offhand personal experience with any age of any child myself in any stage of pregnancy or otherwise ---
I just couldn't fathom how ICU was at all related to midwifery (unless your patient was pregnant or postpartum and RPAH we rarely got those). I can only remember one case.
In my memory it was likely to be 2016. ICU at MICH. My old workmate A who ended up doing midi at a different SSH 6 months ahead of me (and gave me tips when I started at Westmead) and I only recently reminisced about this case that never left us.
She was a migrant lady, ?pakistani or Indian descent. Her and her husband and previous child about 2 years old lived in a suburb that was in MICH district.
During her labour (no idea if it was spont or IOL, the details, were not available to me at the time and I wouldn't even have understood their implications if I had sought them). I think it she wanted/ or was bullied --- who knows --- into an epidural.
The story goes, that the anesthetist put in the epidural. Her blood pressure dropped.
They ended up giving her metaraminol (seriously haven't seen this since I started midi-- usually we give fluids. I don't know how low her BP was at this time, I don't know how long it had been low for, I wasn't there) and her blood pressure shot up so high after the metaraminol, that she stroked out.
Left hemiparesis and slurred/jumped speech.
She had a hemorrhagic stroke.
Quiet a dramatic way to have a very severe and rare outcome related to an epidural.
In ICU, we always just see the worst of anything. At MICH it's even worse, because we also see all the mistakes SSH in our districts make. When all you see all day is errors and bad luck and complications, it can really skew your view on the world.
Already I felt for this mother, her first child now left with a disabled mother. The father now left with a disabled wife. This felt entirely preventable (again, I have no idea what the reason for the epidural was, there are times when they are necessary). It just seemed so cruel and unfair. They were migrants so low in support (and possibly, low in petty cash).
As a 20 year old. I couldn't think of anything worse to happen to a young family.
Now as a midwife, I see the case slightly differently. I wish I could gather more information on what happened on the midwifery side of things. How much function this woman recovered, I don't know. But she still lives in my memory. I hope she's able to walk at least, and perform basic activities of daily living.
One values normality more than ever when reviewing cases as these.
Back to fear. So now in midwifery not only do I bear the responsibility of ensuring the woman is well cared for-- but the fetus too. Our tools for identifying abnormalities seem crude and prone to subjectivity -- the vaginal examination, the palp, the CTG.
Whilst in ICU everything was highly subjective. The arterial line. The 5 lead ECG. The hourly IDC. The EVD. The PAC. and countless other lines. You can set them up at their various correct levels and zero them and then majority of the time, rely on their readings. If the patient moves or something influences the reliability your there, you know how to use the lines, you fix them and rezero.
It's really not that much too it in ICU.
So that fear, that fear of now what you say to the family or the woman does influence their outcomes and choices (to get an epidural or not. To get the c-section or not. To allow the vaccume delivery or not) -- and to watch medical override midwifery at almost every turn -- and not always agree with their reccomendations. --- Whilst in ICU, RN is always overriden by medical, theres a much clearer delinneation of roles. RNs dictate RNs stuff. Doc arranges the scan and we do the rest: arrange the time, pack up the pt, prepare the pt, prepare the notes, accompany the pt,-- arrange if the Dr needs to come to. They might come. Help them get onto the scan table. rinse and repeat on the way back to ICU. The doc reads and reports the scan. Explains to us what it means and how it influences care. We take it from there.
There's no, vaginal exam done by a midwife, then redone by say, a doctor, who then disagrees with the answer -- and decides that it means something that changes the course of care. In midwifery its 2 professionals in one case. Hopefully on the same page. Sometimes not and medical wins.
In ICU its team work. Division of labour. We have the same goal. And we work on the task at hand.
So I have no idea why someone would think an ICU nurse who absolutely loves the world of ICU would enjoy the world of midwifery. I don't think I ever came into it thinking that I'd leave completely in love with the profession. I was aiming for competence, at the least.
But to get it, one must go through the pain.
