Friday: Passing the buck
May. 14th, 2021 09:12 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterDid I mention they kicked out the MUM of SSH BU?
And replaced her with another.
I'm not sure if she's any better. Cautious optimism. Haven't heard anything bad or good.
Today, she stopped in the hallway to say hello and introduce herself. I feel like I was really mean when I replied oh yes I know who you are, I was here on your first day - last Friday. She replied that "that day was much of a blurr" and I said "oh of course." I wish I'd been nicer and not mentioned it."
The clinical MUM gave a huge speil this morning about how we need to think smarter about our workflows in MAC. For example, if a lady has mec liquor we need to be thinking to do a VE to see how far along she is so that we can communicate that to her so she can find a bed in BU, cause that's an immediate IOL. Or, if they are a breech to do a VE and see how dilated they are so decisions about c-section or whichever can be made asap. Or if they are a SROM GBS pos to also communicate that to her asap so that a bed for IOL can be found.
That women for iron infusions don't need a bed, because they don't need a CTG so they could be in a treatment room.
That women waiting for doctors review also, shouldn't be in a bed. They need to be moved around the corner and a file be put onto the table in the review room and the woman be made aware that the only thing she is waiting for, is a doctors review. --- Rather than having her sit and wait in a bed, thinking that us midwives - is what she is waiting for. And also, now that bed has no body in it, it can be cleaned and the next person can sit in it.
Then she announced who was going to work in MAC that day and everyone giggled because, no pressure...
I met a lady today with the same name (first and last)as my cousin (whom I didn't think had a very common name) and knew of mine because - presumably they work - in a similar field and their both listed on Linkedin. I figured this cause when talking to my cousins about how weird that was, they looked up people on Linkedin with her name, and we could identify the woman based on her name and corporate photo.
Insider information. What a small world. Creepy how you can just find people on there like that.
The phone call
The culmination of my day and a good example of passing the buck that happens in MAC is this phone call I was asked to make.
A woman, had a growth scan for some reason at 30 something weeks (not sure why. didn't dig in the notes that hard). The consultant had decided she needed a CTG and a plan based on the result of the scan. So, I found her number in the file and phoned her to say "can you come in today for a CTG and a plan based on the scan". She asked a very pertinent question "why, whats wrong with the scan?". I said- (like an idiot, after a huge long pause where I quickly looked in the file and tried to find the scan and it wasn't there) that's a very good question let me find out and phone you back-
So I started looking for it. I looked at her old scans. I knew from her (not the person that asked me to call her) that the scan was done on a certain date. And I saw she had other scans at one ultrasound spot so like a sleuth (or someone who didn't wanna bug the clinic midwife that asked me to phone the lady) I phoned them, explained I needed the report - and got them to fax it to BU after they'd clearly already sent it to clinic this AM. Then I read the report, which didn't jump out with anything obvious. So I then had to ask OUR MAC doctor to explain to me, why this woman needed a scan.
Because she wanted to know, and wasn't going to come in without a reason (good point).
The Doc looked at the scan, and said its fine. And she didn't know either. So. She had to go to clinic, and find out (it was either that or sit on the phone and wait in line to talk to the consultant)
So. Turns out. There are multiple tables for growth measurements.
Turns out the one we use at SSH is super conservative.
Different charts use different measurements. On some charts this baby is 17% centile and fine.
On the one we use it's 10% centil and considered "small".
Honestly, we just go looking for problems with women and their babies, don't we.
Anyhoo. Due to this reason, that's why we want her in for a CTG.
So I phone her back. She told me that the reason she's asking so many questions (which is totally in her right, btw in my opinion) is because she was explained that a CTG prior to 34 weeks is not good for the baby. -- not sure exactly of all the history of her and clinic and the MAC and etc.-- so she was surprised now, that at 30 weeks they were asking her to come in to the clinic for a CTG and etc. despite the report showing the baby is (according to the report) small size but normal. (17% centile) --
she's like "I was told it's not that bad."
Sighs. How do you answer that.
I had the doctor standing right next to me telling me "I'll explain it to her when she comes in". And i'm like do you want to talk to her.... lol. The doc says no (well I don't want to either, like she was reasonable and all -- but -- this is a bit like playing Chinese whispers here.) I managed to explain somehow...and she said she could come tomorrow (which was fine) she inquired if the baby was ok, and I'm like well, I can't tell over the phone but is it moving well? to which she said it was.
I tried to make the most diplomatic sounding notes in the online file - and I'm pretty sure the scan made it inside the file so that tomorrow, when the woman comes, it's ready to go. The doc also wrote a very good note in powerchart.
-Imagine if the woman had come in without asking why. I'd have no scan on me. I'd have to go through the hooha of finding the damn thing while she waits. What a waste of time. So the moral of the story is.
... > either say you don't have time to make the phone call
or
> dig around and know all the facts before you do.
I'd be confused if I was that woman too. And a trip to the hospital because one chart says its small...
People I worked with that day
I worked the day with a relative newbie (I think she was in the 6 months post me) but ex-ICU SSH from 9 yrs. She had a similar story. I asked her why she left, and she couldn't really say why. She was still just starting the whole midi thing so I was like : if I had stuck it out longer, perhaps I would have turned to like (doing it full time). Then again, the midwife who rotated out of BU to women's health (where I was meant to go next rotation) - I met her in the tea room because she wanted to eat with friends. -- in women's health, there's you , and an RN - so that means you can't take break with others because one of you will always be on the floor. That sounds sorta lonely.
I could imagine having to make my first 2222 MET call up there. 9 years and I've only made one once, and the T/L was standing right next to me... the baby I gave to the student last week with the borderline crappy CTG who came out in my lunch break.
The senior was cool, her name is Nargus. I never thought I'd meet another Nargus until one day, there was a woman in clinic also called Nargus (like, having her baby) and we were all like "oh, we have a Nargus that works here too!" heh. She asked me what I thought of her when we first met and I said "I thought, Mama Nargus is going to take care of us we'll be ok"- and she said she asked because she recently got feedback that someone said she was intimidating. Oh honey no. I wonder who said that. ..
Have I mentioned how much I like working in MAC.
And replaced her with another.
I'm not sure if she's any better. Cautious optimism. Haven't heard anything bad or good.
Today, she stopped in the hallway to say hello and introduce herself. I feel like I was really mean when I replied oh yes I know who you are, I was here on your first day - last Friday. She replied that "that day was much of a blurr" and I said "oh of course." I wish I'd been nicer and not mentioned it."
The clinical MUM gave a huge speil this morning about how we need to think smarter about our workflows in MAC. For example, if a lady has mec liquor we need to be thinking to do a VE to see how far along she is so that we can communicate that to her so she can find a bed in BU, cause that's an immediate IOL. Or, if they are a breech to do a VE and see how dilated they are so decisions about c-section or whichever can be made asap. Or if they are a SROM GBS pos to also communicate that to her asap so that a bed for IOL can be found.
That women for iron infusions don't need a bed, because they don't need a CTG so they could be in a treatment room.
That women waiting for doctors review also, shouldn't be in a bed. They need to be moved around the corner and a file be put onto the table in the review room and the woman be made aware that the only thing she is waiting for, is a doctors review. --- Rather than having her sit and wait in a bed, thinking that us midwives - is what she is waiting for. And also, now that bed has no body in it, it can be cleaned and the next person can sit in it.
Then she announced who was going to work in MAC that day and everyone giggled because, no pressure...
I met a lady today with the same name (first and last)as my cousin (whom I didn't think had a very common name) and knew of mine because - presumably they work - in a similar field and their both listed on Linkedin. I figured this cause when talking to my cousins about how weird that was, they looked up people on Linkedin with her name, and we could identify the woman based on her name and corporate photo.
Insider information. What a small world. Creepy how you can just find people on there like that.
The phone call
The culmination of my day and a good example of passing the buck that happens in MAC is this phone call I was asked to make.
A woman, had a growth scan for some reason at 30 something weeks (not sure why. didn't dig in the notes that hard). The consultant had decided she needed a CTG and a plan based on the result of the scan. So, I found her number in the file and phoned her to say "can you come in today for a CTG and a plan based on the scan". She asked a very pertinent question "why, whats wrong with the scan?". I said- (like an idiot, after a huge long pause where I quickly looked in the file and tried to find the scan and it wasn't there) that's a very good question let me find out and phone you back-
So I started looking for it. I looked at her old scans. I knew from her (not the person that asked me to call her) that the scan was done on a certain date. And I saw she had other scans at one ultrasound spot so like a sleuth (or someone who didn't wanna bug the clinic midwife that asked me to phone the lady) I phoned them, explained I needed the report - and got them to fax it to BU after they'd clearly already sent it to clinic this AM. Then I read the report, which didn't jump out with anything obvious. So I then had to ask OUR MAC doctor to explain to me, why this woman needed a scan.
Because she wanted to know, and wasn't going to come in without a reason (good point).
The Doc looked at the scan, and said its fine. And she didn't know either. So. She had to go to clinic, and find out (it was either that or sit on the phone and wait in line to talk to the consultant)
So. Turns out. There are multiple tables for growth measurements.
Turns out the one we use at SSH is super conservative.
Different charts use different measurements. On some charts this baby is 17% centile and fine.
On the one we use it's 10% centil and considered "small".
Honestly, we just go looking for problems with women and their babies, don't we.
Anyhoo. Due to this reason, that's why we want her in for a CTG.
So I phone her back. She told me that the reason she's asking so many questions (which is totally in her right, btw in my opinion) is because she was explained that a CTG prior to 34 weeks is not good for the baby. -- not sure exactly of all the history of her and clinic and the MAC and etc.-- so she was surprised now, that at 30 weeks they were asking her to come in to the clinic for a CTG and etc. despite the report showing the baby is (according to the report) small size but normal. (17% centile) --
she's like "I was told it's not that bad."
Sighs. How do you answer that.
I had the doctor standing right next to me telling me "I'll explain it to her when she comes in". And i'm like do you want to talk to her.... lol. The doc says no (well I don't want to either, like she was reasonable and all -- but -- this is a bit like playing Chinese whispers here.) I managed to explain somehow...and she said she could come tomorrow (which was fine) she inquired if the baby was ok, and I'm like well, I can't tell over the phone but is it moving well? to which she said it was.
I tried to make the most diplomatic sounding notes in the online file - and I'm pretty sure the scan made it inside the file so that tomorrow, when the woman comes, it's ready to go. The doc also wrote a very good note in powerchart.
-Imagine if the woman had come in without asking why. I'd have no scan on me. I'd have to go through the hooha of finding the damn thing while she waits. What a waste of time. So the moral of the story is.
... > either say you don't have time to make the phone call
or
> dig around and know all the facts before you do.
I'd be confused if I was that woman too. And a trip to the hospital because one chart says its small...
People I worked with that day
I worked the day with a relative newbie (I think she was in the 6 months post me) but ex-ICU SSH from 9 yrs. She had a similar story. I asked her why she left, and she couldn't really say why. She was still just starting the whole midi thing so I was like : if I had stuck it out longer, perhaps I would have turned to like (doing it full time). Then again, the midwife who rotated out of BU to women's health (where I was meant to go next rotation) - I met her in the tea room because she wanted to eat with friends. -- in women's health, there's you , and an RN - so that means you can't take break with others because one of you will always be on the floor. That sounds sorta lonely.
I could imagine having to make my first 2222 MET call up there. 9 years and I've only made one once, and the T/L was standing right next to me... the baby I gave to the student last week with the borderline crappy CTG who came out in my lunch break.
The senior was cool, her name is Nargus. I never thought I'd meet another Nargus until one day, there was a woman in clinic also called Nargus (like, having her baby) and we were all like "oh, we have a Nargus that works here too!" heh. She asked me what I thought of her when we first met and I said "I thought, Mama Nargus is going to take care of us we'll be ok"- and she said she asked because she recently got feedback that someone said she was intimidating. Oh honey no. I wonder who said that. ..
Have I mentioned how much I like working in MAC.
