whitewriter (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
whitewriter) wrote2021-06-22 08:09 pm
whitewriter) wrote2021-06-22 08:09 pm
Entry tags:
Terrible day
Yesterday was so terrible I didn't even want to write about it, but I feel like I should.
What made it so terrible? I think it was terrible because I feel like I failed on so many fronts.
Failed to keep up with the work (actually, to be more specific - the paperwork).
Failed to find proper help.
Failed to teach the student I was with.
It really is a dog eat dog hospital. You just don't have time to do what you need to do, properly. It's sorta like working in a factory except they gave you more work in the same amount of time, and expected you to document in 3 places, the same thing - rather than once - and oh, you need to work in 2 sections at once, and in one of those, with a trainee... and the other room isn't simple either.
So let me just state the facts.
1. I got given 2 rooms: a not simple IOL to start and a student starting with me at 08:00 specifically for that room
2. a postnatal woman who just delivered 30 mins ago and the baby needs everything.
Lady 1:
IOL for non reassuring CTG (kid you not) wants an epidural before we start. One of the midwives (could have been the student) thought the woman had heard from someone that epidurals were great and she should totally have one.
On handover the midwife phoned an anesthatist at 0700 who didn't ring back.
At 0800, I phoned. They said "we are handing over now i'll tell the next person"
At 0900 I start to wonder where the hell they are and call them again to hear "no one handed that over".
They get there around 0930 and after all that fluffing around its 10:25 before the thing is in, and we can commence.
That's a 3 hour delay.
'Course the fetus already has a poor CTG. -- who in their right mind ever thought that oxytocin infusion would make the CTG any better (no body) what they were hoping was, that she'd go super quickly and the baby would be out before the CTG had time to get bad.
... no one mentioned epidural slows things down and well, yeah.
The CTG did not get better and she got to 5cm and they called it due to red zone CTG.
Meanwhile, my postnate has a fall in the bathroom because I forgot the principals of showering a postnatal woman.
1. don't let them wash their hair
2. leave the bathroom door open
3. feed them before they are allowed to get up.
Sighs.
So that was more obs and more paperwork-- and then her baby wouldn't suck. Not at 3 hours post birth, not at 4hrs and at 5 hours I was going to suggest doing a BGL but the T/L said no! it can wait 8 hours....
um. She's not GDM but 8 hours seems awfully long.
Here's the problem with on demand feeding regimes which are recommended by Baby Friendly (aka. breastfeeding friendly organisations) is what to do with a baby who won't suck.
At MSH I would express colostrum and finger feed. Now that is extremely time consuming and I have a complex induction going on across the hall and down a few doors with lactates and all sorts going on in there with a student, no less (luckily, a good one). And I don't want her concerns not being attended to properly. But honestly I am so not good at breastfeeding ( and it is a time consuming task (BF assistance). --- Since the cesar got called, however. I had to hand that over...
later I find out i forgot to do a stack of paperwork with that lady (Damn that paperwork) so whilst I was still fixing up the post cesar lady, I managed to put some of that through (but Im sure I missed a bunch).
So the kid comes out at the cesar right: and I have a paediatrician there because its an emergency cesear with pathological trace -- APGAR is 5, then 7 then 9. We did 10 minutes of CPAP for RDS/ it was flat and had poor tone by the time I got it onto the panda. It had quite a large caput actually which was interesting. Baby must have been bearing down on that poor woman's cervix.
Here's the kicker. So she was a BMI 46 and running an IOL with epidural on a BMI of 46 is just such a horrible thing. I can barely palpate the abdomen and baby's position let alone contractions...turning up oxytocin (which stresses out babies, especially those with poor CTG traces) without knowing what kind of contractions are happening is dangerous.
So why this woman had an IOL is still, beyond me.
Anyways so baby had crap APGARS. Doc was like "it's fine to stay with mum" so I'm like ok... (dumb me) get to birth unit and theres a phone call from SCN - "actually low apgar has to come to be admitted" COOL! grab the baby get the notes: I can turf it in SCN. Walk the 50 meters to SCN "oh actually we have no beds and no staff, so we need to do a blood test on baby and if its good it can stay with mum".
Well what is the point of having a hospital policy that baby with apgar less than 7 at 5 min of life, should be admitted to SCN?-- if you cannot follow through with it -- and if something happens to this kid in the middle of the night and it's not in SCN under monitoring ---
What can I say, the blood test met criteria (lactate <6, it was 5.2) so then I hustled back to the ward having wasted 30 mins of my time going through that hoop.
By the time I'd left it was an hour late (the boss knew). I had to cancel my walking date with a midwife from MSH via phone where after I explained my day was like "dude. you gotta leave.... "
and went for a burger on Parramatta road in dense traffic because,
I spent my "lunch break" of 10 mins sorting out my own dating scan.
Nightmare of a day. All I had was an apple and water. and I couldn't keep up with the paperwork and everything kept becoming more complicated and people were making me jump through hoops for no reason.
That place is just a nightmare.
I still have to do the IIMs on the fall.
What made it so terrible? I think it was terrible because I feel like I failed on so many fronts.
Failed to keep up with the work (actually, to be more specific - the paperwork).
Failed to find proper help.
Failed to teach the student I was with.
It really is a dog eat dog hospital. You just don't have time to do what you need to do, properly. It's sorta like working in a factory except they gave you more work in the same amount of time, and expected you to document in 3 places, the same thing - rather than once - and oh, you need to work in 2 sections at once, and in one of those, with a trainee... and the other room isn't simple either.
So let me just state the facts.
1. I got given 2 rooms: a not simple IOL to start and a student starting with me at 08:00 specifically for that room
2. a postnatal woman who just delivered 30 mins ago and the baby needs everything.
Lady 1:
IOL for non reassuring CTG (kid you not) wants an epidural before we start. One of the midwives (could have been the student) thought the woman had heard from someone that epidurals were great and she should totally have one.
On handover the midwife phoned an anesthatist at 0700 who didn't ring back.
At 0800, I phoned. They said "we are handing over now i'll tell the next person"
At 0900 I start to wonder where the hell they are and call them again to hear "no one handed that over".
They get there around 0930 and after all that fluffing around its 10:25 before the thing is in, and we can commence.
That's a 3 hour delay.
'Course the fetus already has a poor CTG. -- who in their right mind ever thought that oxytocin infusion would make the CTG any better (no body) what they were hoping was, that she'd go super quickly and the baby would be out before the CTG had time to get bad.
... no one mentioned epidural slows things down and well, yeah.
The CTG did not get better and she got to 5cm and they called it due to red zone CTG.
Meanwhile, my postnate has a fall in the bathroom because I forgot the principals of showering a postnatal woman.
1. don't let them wash their hair
2. leave the bathroom door open
3. feed them before they are allowed to get up.
Sighs.
So that was more obs and more paperwork-- and then her baby wouldn't suck. Not at 3 hours post birth, not at 4hrs and at 5 hours I was going to suggest doing a BGL but the T/L said no! it can wait 8 hours....
um. She's not GDM but 8 hours seems awfully long.
Here's the problem with on demand feeding regimes which are recommended by Baby Friendly (aka. breastfeeding friendly organisations) is what to do with a baby who won't suck.
At MSH I would express colostrum and finger feed. Now that is extremely time consuming and I have a complex induction going on across the hall and down a few doors with lactates and all sorts going on in there with a student, no less (luckily, a good one). And I don't want her concerns not being attended to properly. But honestly I am so not good at breastfeeding ( and it is a time consuming task (BF assistance). --- Since the cesar got called, however. I had to hand that over...
later I find out i forgot to do a stack of paperwork with that lady (Damn that paperwork) so whilst I was still fixing up the post cesar lady, I managed to put some of that through (but Im sure I missed a bunch).
So the kid comes out at the cesar right: and I have a paediatrician there because its an emergency cesear with pathological trace -- APGAR is 5, then 7 then 9. We did 10 minutes of CPAP for RDS/ it was flat and had poor tone by the time I got it onto the panda. It had quite a large caput actually which was interesting. Baby must have been bearing down on that poor woman's cervix.
Here's the kicker. So she was a BMI 46 and running an IOL with epidural on a BMI of 46 is just such a horrible thing. I can barely palpate the abdomen and baby's position let alone contractions...turning up oxytocin (which stresses out babies, especially those with poor CTG traces) without knowing what kind of contractions are happening is dangerous.
So why this woman had an IOL is still, beyond me.
Anyways so baby had crap APGARS. Doc was like "it's fine to stay with mum" so I'm like ok... (dumb me) get to birth unit and theres a phone call from SCN - "actually low apgar has to come to be admitted" COOL! grab the baby get the notes: I can turf it in SCN. Walk the 50 meters to SCN "oh actually we have no beds and no staff, so we need to do a blood test on baby and if its good it can stay with mum".
Well what is the point of having a hospital policy that baby with apgar less than 7 at 5 min of life, should be admitted to SCN?-- if you cannot follow through with it -- and if something happens to this kid in the middle of the night and it's not in SCN under monitoring ---
What can I say, the blood test met criteria (lactate <6, it was 5.2) so then I hustled back to the ward having wasted 30 mins of my time going through that hoop.
By the time I'd left it was an hour late (the boss knew). I had to cancel my walking date with a midwife from MSH via phone where after I explained my day was like "dude. you gotta leave.... "
and went for a burger on Parramatta road in dense traffic because,
I spent my "lunch break" of 10 mins sorting out my own dating scan.
Nightmare of a day. All I had was an apple and water. and I couldn't keep up with the paperwork and everything kept becoming more complicated and people were making me jump through hoops for no reason.
That place is just a nightmare.
I still have to do the IIMs on the fall.