The women of 5/11/20
Nov. 5th, 2020 08:24 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterI was going to write a post about my various managers that I've had over the past 8 years, largely comparing them to my current manager at SSH. However instead I got side tracked writing about the women of today.
I saw a twins birth for the first time today. It was amazing. The student even got to do the accouchering which is amazing as well.
I was almost sent to triage again, but then AM senior was like I've sent you there too many times this week, oh no, can't have that. Your going to have the P9 induction, I have no idea what time she will come in. **Great, cause you know, I love IOLs**
The women I saw today:
G14 P9 (I kid you not)
I'm like so we're going to have baby number 10 today!
And she's like thats cause I'm STOOPID (and she motions that the word should be stamped on her forehead) and I'm like aw, well. anyways.
(Maybe I should have brought up contraception here, but I was on a time clock here to get this induction rolling) So I'm like well lets start this CTG, and we can talk whilst this is going. Then I ask her, so why are we having an IOL? (because honestly, I couldn't figure it out from her notes because no one documented why. Seriously. They just write "BOOK IOL FOR ONE WEEK'S TIME" like they're God and they just want me to do their bidding. She's like, because I'm old (and I'm like, well... okay, if thats what they said) and then she said also my history of blood pressure and it seemed to be rising last week. So that sounds legit.
We don't truely know the gestation of the baby. She never went to the GP until 30 something weeks. She skipped the dating scan, the nuchal translucency, the morphology, lol so she got a 3rd trimester scan. I was like well we're guessing that your 38+5 today and she's like I thought i was 39 something as per the scan. And I'm like well the scan has a lot of dates on it (as it was saying the head circ was related to 39 weeks but the body length was more like 38 weeks but the leg length was 39 and something else... like thats not how you get a gestation lady). Although supposedly she had a solid LMP, so I figured thats probably how they calculated 38+5. She palped normal with normal size in my opinion so I figured that it wasn't going to be a big baby (some of the previous births were classified as shoulder dystocia and some weren't and the size of the baby seemed related to this). Shoulder dystocia is also a relevant reason to IOL, perhaps along with the guessed gestation and poor antenatal care. What if she was actually 41+ weeks along? and the kid was bigger than we thought?
Well she's only had 1 x antenatal appointment because she's got 9 other children at home-- btw I'm not even sure if all of them are or were in her care... she started having children in 1994. The anesthetists I met at the twins birth was freaking born in 1994... which we realised when the 2nd paed asked me how old the mother of the twins was and we looked at the stickers on the file and saw she was born in 1984 and the paed was like well then she's 35! and she's like because I'm born in 1994 and we chuckled at that).
Here's my judgy nature. Looking at her face I could tell she had had a hard life. I could see some sort of drug history, or some sort of trauma somewhere-- then I dig in the serologies and find shes Hep C + (thanks for telling me guys) and no HIV test (we do it for everyone). So I half freak out in a sense that can we run an IOL with no HIV result? So FSE shouldn't be put on, right, what if we decide we need one? (although, she was quite easy to put a CTG on so I wasn't too concerned there (like if she was a bigger lady and was say, BMI 30 then we need an FSE or I'm gonna struggle to monitor anything during the IOL). So we sit in her, whilst the doctors chase the bloods- takes more blood - the ex gold medalist olympian resident (ill tell that story for another day) takes her blood and has a heart to heart about how she got Hepatitis and why her "?? husband" had to leave the room for that discussion (and the ARM too). Turns out she had a troubled past (you can just see it on her face -- but honestly, her body looked young and actually, pretty nice, it was just her face that looked old. She went out for cigarettes about 3 x whilst were waiting for the IOL to be sorted (to do it, or for her to be sent home).
TWINS LADY
Whilst this was all going on: I went to the toilet because I felt that UTI urgency feeling. Sat there for ages hoping it would go away.
Then when I came out people were looking for me: AM senior needed me in the twins room to scribe and help out.
The birth was amazing. The paeds were cool, there was a senior and a junior, I took down their names (yay me for scribe) but then later on realised I forgot to write which paed helped me with twin 1's IPPV that no body noticed was going on except me and the 2 paeds who told me to write down that the HR was <100 and they IPPV for 1 min and then it came up to >100 and ceased IPPV. at room air. Although I thought she turned it up to 30% at one stage but wasn't sure. Then they stopped all the resus and were happy. I got questioned later on my notes about if it was actually CPAP or IPPV but I stated the paed said it was IPPV and actually when I think back, it was. She used her finger to pump the breaths. it wasn't CPAP like how I initially wrote on the paper towel (I tell you, hospital paper towels have a vast array of uses beyond just drying surfaces and hands...myself and may others have used them to take notes for years...). They decided to take Twins lady to OT to sort out her bleeding. She was a tiny thing and it was only later, on reading more notes that I realised she was a G4 P6 unlike G1 like i had told the paed. Then I thought, what does it matter, to the baby if she's a G1 or a G4... I wish I could have asked the paed that ... (but it was an insane 30 mins) .
Getting her to OT was rather nightmarish of people throwing out demands which at some stage got met or was discarded halfway (like transferring the lady to the transfer bed to go downstairs : that was aborted even though I brought the bed anyway). AM senior asking her when the last time she ate anything was? So I wondered does she want me to do a pre op check list? Like how does this matter, isn't this an emergency aka. get to OT in 15 mins type thing? I don't even know if anyone gave her sodium bicarb to swallow down (probably should have in hindsight I only thought of this now). At the end of the day I thought the whole thing was done alright but AM senior thought it was a mess.
I noticed that the oxygen cylinders on the panda's were empty and then was disappointed the panda wasn't attached to the wall. So I attached them.... later that day another new grad came to me and said: did u attach it to the wall? And I'm like yeah are we not supposed to? And then I was informed that actually, theres been increased incidence of pneumothorax throughout the hospital and they think theres a problem with the pressures from the wall oxygen and air tanks. Geeze guys. This should have been told to me earlier! Why isn't there a sign on all of the wall sockets?! Thanks for the info... I've been there about 9 weeks now and I'm learning of this now?!
I wrote great notes but I forgot to write which paed actually did the IPPV. Realised this on the car ride home. Whups. This is the sort of thing that would get critiqued during an investigation.
The weird phone call I got today:
A woman without her yellow card for some reason about 20+ weeks pregnant saying that she felt short of breath, worse when laying down and that her heart was beating quite fast. That this was the case for the last week? or so. She had a UTI recently diagnosed and commenced on antibiotics yesterday. On the phone she spoke quite well, I didn't detect any emergency. *That it was worse during sleeping* (this key detail, I sorta forgot about) --
Baby was moving well.
I told her to go to ED.
I explained those symptoms are unlikely to be related to the pregnancy and that she needs to get medically cleared and then if ED decided she needed a review in the MAC that then she would come to us.
She then stated she went to ED before and they made her wait hours to get in.
I didn't want to say, well lady, if that was the case, clearly it's not that bad...
But I didn't. I said well if it isn't that bad you can consider to go to your GP but what your describing sounds pretty bad so you should go to ED.
Then she's like ok...
Then I conferred with another midwife and she's like is she sleeping flat as a tack cause she needs to be elevated or side laying, and I'm like isn't that common sense? She's like : you'd be surprised. But she's only 20 weeks.... your belly isn't that big yet at 20 weeks (I guess it depends on how small you were to begin with, but still. I thought about calling her back, and decided against it. I wonder if she went to ED.
I realised that another thing about birth unit, is that unless you have a baby that day, or are in MAC or in triage, you can get this sense of an underwhelming day where you end up doing all the checks, or cleaning or trying to do HETI or helping here or there. You feel like you've done nothing all day but you get a really tired feeling. Whilst in ICU that would be my dream shift. Wandering around and helping, and not actually having a patient would be the best day ever. Hum.
I saw a twins birth for the first time today. It was amazing. The student even got to do the accouchering which is amazing as well.
I was almost sent to triage again, but then AM senior was like I've sent you there too many times this week, oh no, can't have that. Your going to have the P9 induction, I have no idea what time she will come in. **Great, cause you know, I love IOLs**
The women I saw today:
G14 P9 (I kid you not)
I'm like so we're going to have baby number 10 today!
And she's like thats cause I'm STOOPID (and she motions that the word should be stamped on her forehead) and I'm like aw, well. anyways.
(Maybe I should have brought up contraception here, but I was on a time clock here to get this induction rolling) So I'm like well lets start this CTG, and we can talk whilst this is going. Then I ask her, so why are we having an IOL? (because honestly, I couldn't figure it out from her notes because no one documented why. Seriously. They just write "BOOK IOL FOR ONE WEEK'S TIME" like they're God and they just want me to do their bidding. She's like, because I'm old (and I'm like, well... okay, if thats what they said) and then she said also my history of blood pressure and it seemed to be rising last week. So that sounds legit.
We don't truely know the gestation of the baby. She never went to the GP until 30 something weeks. She skipped the dating scan, the nuchal translucency, the morphology, lol so she got a 3rd trimester scan. I was like well we're guessing that your 38+5 today and she's like I thought i was 39 something as per the scan. And I'm like well the scan has a lot of dates on it (as it was saying the head circ was related to 39 weeks but the body length was more like 38 weeks but the leg length was 39 and something else... like thats not how you get a gestation lady). Although supposedly she had a solid LMP, so I figured thats probably how they calculated 38+5. She palped normal with normal size in my opinion so I figured that it wasn't going to be a big baby (some of the previous births were classified as shoulder dystocia and some weren't and the size of the baby seemed related to this). Shoulder dystocia is also a relevant reason to IOL, perhaps along with the guessed gestation and poor antenatal care. What if she was actually 41+ weeks along? and the kid was bigger than we thought?
Well she's only had 1 x antenatal appointment because she's got 9 other children at home-- btw I'm not even sure if all of them are or were in her care... she started having children in 1994. The anesthetists I met at the twins birth was freaking born in 1994... which we realised when the 2nd paed asked me how old the mother of the twins was and we looked at the stickers on the file and saw she was born in 1984 and the paed was like well then she's 35! and she's like because I'm born in 1994 and we chuckled at that).
Here's my judgy nature. Looking at her face I could tell she had had a hard life. I could see some sort of drug history, or some sort of trauma somewhere-- then I dig in the serologies and find shes Hep C + (thanks for telling me guys) and no HIV test (we do it for everyone). So I half freak out in a sense that can we run an IOL with no HIV result? So FSE shouldn't be put on, right, what if we decide we need one? (although, she was quite easy to put a CTG on so I wasn't too concerned there (like if she was a bigger lady and was say, BMI 30 then we need an FSE or I'm gonna struggle to monitor anything during the IOL). So we sit in her, whilst the doctors chase the bloods- takes more blood - the ex gold medalist olympian resident (ill tell that story for another day) takes her blood and has a heart to heart about how she got Hepatitis and why her "?? husband" had to leave the room for that discussion (and the ARM too). Turns out she had a troubled past (you can just see it on her face -- but honestly, her body looked young and actually, pretty nice, it was just her face that looked old. She went out for cigarettes about 3 x whilst were waiting for the IOL to be sorted (to do it, or for her to be sent home).
TWINS LADY
Whilst this was all going on: I went to the toilet because I felt that UTI urgency feeling. Sat there for ages hoping it would go away.
Then when I came out people were looking for me: AM senior needed me in the twins room to scribe and help out.
The birth was amazing. The paeds were cool, there was a senior and a junior, I took down their names (yay me for scribe) but then later on realised I forgot to write which paed helped me with twin 1's IPPV that no body noticed was going on except me and the 2 paeds who told me to write down that the HR was <100 and they IPPV for 1 min and then it came up to >100 and ceased IPPV. at room air. Although I thought she turned it up to 30% at one stage but wasn't sure. Then they stopped all the resus and were happy. I got questioned later on my notes about if it was actually CPAP or IPPV but I stated the paed said it was IPPV and actually when I think back, it was. She used her finger to pump the breaths. it wasn't CPAP like how I initially wrote on the paper towel (I tell you, hospital paper towels have a vast array of uses beyond just drying surfaces and hands...myself and may others have used them to take notes for years...). They decided to take Twins lady to OT to sort out her bleeding. She was a tiny thing and it was only later, on reading more notes that I realised she was a G4 P6 unlike G1 like i had told the paed. Then I thought, what does it matter, to the baby if she's a G1 or a G4... I wish I could have asked the paed that ... (but it was an insane 30 mins) .
Getting her to OT was rather nightmarish of people throwing out demands which at some stage got met or was discarded halfway (like transferring the lady to the transfer bed to go downstairs : that was aborted even though I brought the bed anyway). AM senior asking her when the last time she ate anything was? So I wondered does she want me to do a pre op check list? Like how does this matter, isn't this an emergency aka. get to OT in 15 mins type thing? I don't even know if anyone gave her sodium bicarb to swallow down (probably should have in hindsight I only thought of this now). At the end of the day I thought the whole thing was done alright but AM senior thought it was a mess.
I noticed that the oxygen cylinders on the panda's were empty and then was disappointed the panda wasn't attached to the wall. So I attached them.... later that day another new grad came to me and said: did u attach it to the wall? And I'm like yeah are we not supposed to? And then I was informed that actually, theres been increased incidence of pneumothorax throughout the hospital and they think theres a problem with the pressures from the wall oxygen and air tanks. Geeze guys. This should have been told to me earlier! Why isn't there a sign on all of the wall sockets?! Thanks for the info... I've been there about 9 weeks now and I'm learning of this now?!
I wrote great notes but I forgot to write which paed actually did the IPPV. Realised this on the car ride home. Whups. This is the sort of thing that would get critiqued during an investigation.
The weird phone call I got today:
A woman without her yellow card for some reason about 20+ weeks pregnant saying that she felt short of breath, worse when laying down and that her heart was beating quite fast. That this was the case for the last week? or so. She had a UTI recently diagnosed and commenced on antibiotics yesterday. On the phone she spoke quite well, I didn't detect any emergency. *That it was worse during sleeping* (this key detail, I sorta forgot about) --
Baby was moving well.
I told her to go to ED.
I explained those symptoms are unlikely to be related to the pregnancy and that she needs to get medically cleared and then if ED decided she needed a review in the MAC that then she would come to us.
She then stated she went to ED before and they made her wait hours to get in.
I didn't want to say, well lady, if that was the case, clearly it's not that bad...
But I didn't. I said well if it isn't that bad you can consider to go to your GP but what your describing sounds pretty bad so you should go to ED.
Then she's like ok...
Then I conferred with another midwife and she's like is she sleeping flat as a tack cause she needs to be elevated or side laying, and I'm like isn't that common sense? She's like : you'd be surprised. But she's only 20 weeks.... your belly isn't that big yet at 20 weeks (I guess it depends on how small you were to begin with, but still. I thought about calling her back, and decided against it. I wonder if she went to ED.
I realised that another thing about birth unit, is that unless you have a baby that day, or are in MAC or in triage, you can get this sense of an underwhelming day where you end up doing all the checks, or cleaning or trying to do HETI or helping here or there. You feel like you've done nothing all day but you get a really tired feeling. Whilst in ICU that would be my dream shift. Wandering around and helping, and not actually having a patient would be the best day ever. Hum.
