Hospital rumour, and the theme of the last 2 days: women with high BMI

[whitewriter]

Rumour
I went out for lunch with Sally (my adopted auntie).

She told me that little D (lady with twins! and she's a tiny size 6) works in another private hospital somewhere else; and didn't inform her CICU manager. She feels like she's in the doghouse with said manager; which isn't a great place to be and felt like maybe she needs to think about resigning. CICU manager told her she felt "disappointed" and due to this doesn't want to give D the roster she usually requests. D is a senior in cicu. Losing her would be a blow. She's super friendly. I have no idea what her roster arrangements were: I wonder if she was using her children as an excuse to get the roster she wanted- rather than the real reason: a second job.

Whilst I understand that CICU manager might feel a little hurt, is this the right way to go about the issue with her staff member?

If you count my volunteer shifts - which apparently also count as a job or work (after all, we do have to dress and act professionally during our shifts: even if we are usually rather relaxed- which is why mentally I do it on top of everything else) then I have 3 jobs.


I guess Sally was just trying to warn me. However this is why I preferentially did not want to work in CICU. That manager has a reputation of being unapproachable; and she doesn't see it that way.


Undertelling can be worse than overtelling (not always) and walking that fine line is the art of professional life.


You want to seem approachable; and super open. But you want to keep the most personal of information to yourself; is something a lie if you choose to omit it?

X-files reference:
Deep Throat: A lie, Mr. Mulder, is most convincingly hidden between two truths.


Example:

Yesterday I was told in the tea room that the PM educator at SSH is pregnant.

I was wondering when that would happen. She hits the vital statistics for it - thats the first flag -- (reminds me of the boss at regional hospital and his red dot list down the roster: every female on staff who was a potential to get pregnant in the next year had a red dot) - married; loves being a midwife; in her late 20s/early 30s. The second flag was when she was talking about her Thyroid in the tea room and said how she had zeo symptoms (one way to be open without being open) - and I wondered why she would even bother to get that checked unless she had an agenda.



Happenings of the past two days
Today, I came in for my second casual shift at SSH for the week.

I had a Sunday yesterday - and it was bat boring but super sweet so initially I wasn't planning to write a post. However despite this; it seems today's events are predicated on yesterday's events and the more I think of it- there were interesting things that did happen (just not directly related to myself).



Yesterday, I had a P1; from poland, little cute thing having her 2nd baby, previous was a NVB with nitrous only. She was fearing a c-section because she needed a balloon foleys prior to the IOL. IOL was for decreased FM second presentation and oligohydramnios AFI 5.6. I read today in the notes that she had a lovely NVB at 17:30.



Then the AM senior is like "I need to know who checked the synto with x yesterday because it was found not to have been running".

-- So the bad thing here; is that a woman laboured for an excessive period of time- without augmentation or the IOL she came in to have.-- she essentially got a placebo all shift; and clinical decisions would have been made based on her progress -- (or lack thereof) which wouldn't have been helped by no synto in the bag --

I signed a bag of fluid : fixed the line for bubbles. But I didn't touch the synto line, so I don't know what happened with that.

X had a lady BMI 57 having her 1st baby. X was pretty stressed because Di was incharge and Di is pretty damn full on as an incharge.

Maybe it was the stress, that caused her (and whomever checked the line with her)'s error.

I can't imagine what she was like as a NUM of my old unit (before my time) but I've heard rumours (strict/ridiculously perfectionist type vibe), and today I got a taste of it.

She was super strict regarding the visiting policy (okay yeah I get it, covid. -- ) but she declared X's lady is developmentally delayed (DD) or "something isn't right" and that we shouldn't let her mother to leave and swap with her sister as a birth partner because of legal guardianship.

This wasn't documented anywhere that she was DD nor the legal guardianship thing.

I was thinking if you were a DD person; and no one ever advocated for you to get tested and you never got tested then nobody would know; right?

So technically this lady COULD be a DD person; but say, undiagnosed [This is me defending Di whose been nothing but nice to me since I came to SSH and dished out some good goss on MICH staff to boot].

Doesn't matter though. Imagine being judged your a DD person, but your not DD.

So Di was stressing X out about some stuff she made up -- ( essentially )

Anyways, so I went in to help X and relieve her for a break. X convinced Di to let the woman swap her visitor (seriously, the previous visitor was horrid with the lady in labour)

-- and when I did meet her, I swear she didn't seem DD at all. I did get Indigenous vibes from her and her new support person; but not the DD vibe at all.

I helped X put in an IDC and when she was inflating the balloon I noticed she was using normal saline (seriously) and I was thinking, who trained you... instead I politely said, I don't think we use N/S because it can crystallise in the balloon : always water for injection - but it's only going to be in for today so it probably doesn't matter. She's like oh. I always use N/S but I trust you... (what, cause, 9 yrs nursing Hx ? Surely there's a policy somewhere...)

Apparently there's going to be an investigation about the synto line thing and as a heads-up I may be called re: this.

Great.








It's all about how you explain it

Today's lady

31 yr old P1

"trial of scar" (which sounds so dramatic) but at MSH we called it the less dramatic VBAC (vaginal birth after cesarean)

The big issue, BMI.



BMI 47 at booking in (to be fair, she was a late booking in at 25+4 due to unplanned pregnancy).



This unplanned pregnancy deal seems to happen a lot with those with a high BMI. One lady at work had a very high BMI during pregnancy (IVF and mandatory cesar, weight was about 150kg) and she says that during the whole pregnancy she didn't feel her son move not once. She has a tonne of ultrasounds and CTG to check the baby was okay despite her not being able to feel him move.

I asked her if she felt "robbed" of this pregnancy experience (feeling the baby move) but she sorta got a look in her eye that sounded like it didn't seem to change anything. She also talked about how the whole experience at MSH was horrible - she got yelled at for wanting to formula feed, no one would look at her wound, her wound got infected...

So essentially the O&G on today don't think she should have been allowed to VBAC. That she shouldn't have been cleared from the get go, because she's high risk. High risk for everything. They (the doctors) would rather not have to rush a c-section and take their time,

I sat in on the conversation re: MOD.

They didn't bring up the BMI as being the reason they didn't actually want her to VBAC.

They did bring up the reasons for not having a c-section as per the woman's voice - (they asked her to list her reasons for choosing VBAC initially).

These were:

> lengthened recovery time for c-section (4-6 weeks) and during that time shes not to pick up anything bigger than 5kg (that includes her 2 yr old child).


So that for 1 month she would not be able to pick up her child, but would need to sit on the sofa, and then have the kid come up for cuddles. This could be difficult to explain to a 2 yr old.

She's not really labouring at the moment. Thats me judging her with palpation and watching her face during contractions. If she was screaming I'd probably say differently (until the vaginal exam and then if the result wasn't 9cm I'd call it overacting/super sensitive/lady would you like an epidural?)

They did mention to her that she was high risk factors for wound issues (but didn't say why she was high risk, again, skirting around the BMI issue which to me seems like the biggest elephant in the room).

Initially, I wish they'd just be straight with her. But then again - it wouldn't have changed anything; not at this stage. This is something that should have been discussed... postnatally last time perhaps.

Behind her back, the incharge is preparing her for a c-section and I've done the pre op checklist.

She's sitting and thinking and the CTG is on, despite her very modest contractions.

Worst time to have a MOD think : is when your in pain and someone is offering you a "way out" and there's uncertainty in the mix (you could labour for 9 more hours and not dilate).

Apparently caseload women going for a VBAC have a high rate of success- mostly cause somehow, (it is rumoured) the caseload midwife must get them to hide at home and labour there as much as possible (no CTG unlike if you come to hospital with 2:10 milds its automatic CTG as per policy for VBAC women) and then reappear when they "can't cope" and then whoopsie their 9cm -- and soon 10cm -- and oh, vaginal birth ! Successful VBAC!

I'd also like to mention a woman with a BMI of 47 wouldn't be allowed in the caseload program

The doc has an app that calculates risk for certain procedures and this lady comes up as 50% success of successful VBAC..

Is 50% really 50% when you give everything the least possible success? (early CTG; negative vibes during conversations; calling 2:10.tightenings labour)...

It was classified as an emergency c section category 3 so I had to do cord gasses to ?justify the emergency part of the c section.

Its funny. It's not really an emergency but we also can't let her just labour if they've decided it's unsafe to do so.

The Doc said the baby palp'ed large (honestly, how can you palp anything on someone with a BMI of 47).

So it came out at 4.1 kg. Not excessively large (remembering normal is 2.5kg-4.5kg).

For this c-section I had lunch at morning tea and... 2 ferrero rochers when I was handing over the baby on the postnatal ward at 15:30.

All day I had managers who had been on their Christmas break but whom were now back saying hello and wondering how my new job was, and saying they were glad I was still coming and working at SSH (*cough* desperate for staff *cough*) - I gave them pretty neutral face about ICU. I'm still figuring out the whole working 2 jobs and ensuring I get enough rest and chill -- and education to keep up to speed in both units. I don't want to be caught out making mistakes from "overwork" 2or "unable to keep 2 places straight"; and having to have a meeting about that or anything.