That feeling in the pit of your stomach...

I found this cool blog by a new nurse called "Fundus Chop". You'll have to read it to figure out what that means but it made me howl with laughter. She talks here about being a new nurse and that feeling int he pit of your stomach that maybe something will go really wrong and it will be because you are new, inexperienced and don't know your stuff yet.  Ya, I'm getting to be friendly with that feeling. This week I had a patient who was bleeding just a little too much postpartum. Then it was a little more, then it was a big clot, then a call to the midwife for some methergine, then more bleeding, then a foley catheter to keep her bladder empty, then FINALLY the bleeding slowed down.  My preceptor said that it didn't turn into a hemorrhage because I stayed on top of it and we intervened but it still acquainted me with that fear knot all night long.  When i go check her will she be bleeding? Will I massage her uterus hard enough to get it to clamp down? Will I recognize if it is boggy? If it's boggy what do I do??????  Thankfully I am not alone. The rest of the nurses are very nice and very willing to help and answer questions but still so much to learn! 

Good news in the world of Obstetrics!

So last week I went to a class about low risk Ob nursing. It was pretty interesting but some of it seemed like rehashing the basics of nursing school. And  most of it had more to do with labor and delivery than with post partum.  But it was a nice break from nights that's for sure! But one of the things I learned was soooooooo exciting!  For years lactation consultants and natural birth advocates have been wringing our hands about the trends of earlier and earlier elective inductions. Babies are born not ready to breastfeed, sleepy, unable to latch. They go to the NICU with respiratory distress. They can't keep their temperatures stable.  Signficant problems but problems that are often resolved with a couple extra days in the hospital. Couple problems with this...in my experience parents are rarely if ever told straight out, "Your baby is in the NICU because we delivered too early and we did it for absolutely no medical reason." Often these problems were dismissed as "just one of those things" or "Thank God for the NICU!" And when parents got the bills for these couple days in the NICU they said, "Thank God for insurance!!!!!"  (My cynical side says that the hospitals were often happy for these kind of admissions to the NICU because they weren't really that complicated but were great money makers.  But that is VERY cynical isn't it.)  But guess what, insurance companies are starting to say, "This stuff is really expensive and 100% preventable and we aren't going to pay for it!" to doctors and hospitals, especially hospitals.  So, given that hospitals have a much higher stake in this than doctors do, hospitals are starting to write policies that govern how inductions can be performed in order to prevent some of these "late pre-term" babies, one of which is that the criteria for a convenience induction has gotten much stricter. Doctors have to prove that the baby is at least 39weeks +1 day and last menstrual period won't do as proof.  In an effort to cut down on the primary c-section rate some hospitals are also requiring a certain score on a criteria that indicates likeliness that the induction will result in a vaginal birth. 
This is very cool!  And about time.  Babies deserve to cook until they are ready even if it means mama is dealing with the discomforts of pregnancy for a week or two longer.  It will be interesting to see if NICU admissions go down, and to see if this helps lower our ridiculously high c-section rate.

Done. Can I have my carrot now?

As a good Gerbil don't I deserve a carrot or some sunflower seeds or something???? 

3.14 miles (Hey that's Pi!) 34 minutes.  Little bit of abs and arms, (had to finish off World's Strictest Parents, Madeline is convinced that we could be the host family on that show!)

Side benefit of Treadmill running.  Much less laundry.  No need for layers.

To the shower.

To the treadmill.

I hearby swear that I am going to get off the computer and go get on the treadmill and run at least three miles. I have been sitting on my booty all day in a obstetrical nursing class and need to move said booty so it doesn't get too happy in the sitting position. As much as I dislike the treadmill, it is too windy to run and I didn't get up at 5 a.m. to run so I gotta do it before church. Off to the treadmill. Hopefuly putting it out there publically will make me actually do it.

That beautiful day is deceptively cold!

Gorgeous day for a run. 33 degrees. Sunny. At 9:30 this morning I sat at the computer and noted that the trees weren't moving so that meant no wind. I was prepared for a perfect run...Then I stepped outside. Don't know where it was coming from but it was WINDY! Bitingly windy. Made your face numb windy. Overall though, still a GOOD run. Went 5 miles which has become my new normal for a run. For years I was a 2-3 miles was a normal run but since I trained for the last half marathon it seems that 5 has become my new normal to feel like I have had enough exercise. Last year that would have seemed unthinkable to just go out and run 5 miles on an average day. Now anything less seems like a waste of time! I even did 5 miles on the Disney cruise on Thanksgiving morning! (That's 15 laps around deck 4 for anyone who is counting.) Strange how things change. Now one thing that hasn't really changed is that I can't hack that far on the treadmill. 4 miles is the longest I've gone on the gerbil wheel, I mean, treadmill.

Need to find a race. Need a goal. Hmmmmmm.

72 hours, 12 hours of sleep.

Yes, my friends that night nurse that took such good care of you was probably working on an ungodly sleep deficit.  I started work on Monday night, so that was 24 hours awake. Went to bed Tuesday and only slept for 4 hours.  Wasn't happy about that AT ALL! Just couldn't sleep any more. Work Tuesday night. Really really tired. Got pretty flustered doing the PKU tests on my babies. You have to get six penny sized circles of blood on a little piece of paper that the state tests for 20 some genetic diseases. If your circles touch, you have to redo it, if your blood goes outside the circle you have to redo it, if your blood doesn't fill up the circle enough, you have to redo it. And you do the test with the baby under the warmer, great for the baby but if you are a sweating and nervous about doing the test and messing it up, you have the extra bonus of sweating because of the heat as well.  My babies survived. I survived but it was humbling for sure. Home Wednesday morning to find that hubby went out Tuesday night and bought me an electric blanket for my day sleeping bed!!!!!  (Do you hear the angels singing, "Hallelujah!!!!"???)  During the day I sleep in my youngest's room because it was the easiest room to make dark, one window, big tree outside.  But, I get home and it's cold in the house and I'm cold and tired and getting into a cold bed by myself (no one to cuddle with) was making it take about 2 minutes to fall asleep rather than the preferred 30 seconds.  So anyway, I get home and hubby has my blanket on the bed and warmed up.  Heaven. I slept for 5 hours.  I was a new woman. I tell new moms that when the baby sleeps for 5 hours straight you will begin to feel human again. It works for night shifters too! Work Wednesday night. VERY BUSY. Didn't have time to be tired. Seriously. I like being busy so I am not complaining. Give me a busy shift anytime over one where the time crawls from 1:30-4.  Oh and did a PKU on the first try.  Thank you sweet baby for sleeping through it and not kicking at all and being a chunky thing that didn't need the warmer on the whole time and helping me get my confidence back!  Home Thursday. Slept for 3 hours, knowing I wanted to sleep that night too so 3 hours was fine.  Let's add that up shall we... Monday morning to Thursday night: 85 hours total, 12 hours of sleep.  Amazingly crazy but it wasn't as bad as it sounds in actuality. I think I will survive night shift. But I'm really glad that next week is more classes and I get to work days!!!!

Week two, I hope this gets easier.

LAst week was great in some ways and like torture in some ways.  I really like working and taking care of people and learning new skills.  I even like charting and learning to remember what has to be done at what times.  But the sleeping is really hard.  Three days up all night with less than 5 hours of sleep during the day.  Yowza. That's just HARD!

Things I learned:
1.  When the body thinks it should be asleep, digestion just about stops.  So anything you eat just sits in your gut and ferments.  Thus that lovely feeling of having eaten a bowling ball.
2.  Despite the truth of item #1, you will get hungry, starving even, at 1 a.m. and eat too much and make #1 even worse.
3. Caffeine is an amazing drug. You really don't give it enough credit until you have a cup of coffee after staying upall night and sleeping for five hours. I went from headachy zombie to perky in 30 minutes. Madeline even said i was "acting really weird" when I picked her up at school!
4. The family will survive without you.  Shocking really!
5. Daytime sleep is elusive even with blackout curtains.
6. YouTube videos, particularly Chad at the Dentist, take on a whole new level of hilarity at 3:30 a.m.
7. Even though 5 a.m. feels like the morning of the next day you still have 2 hours to go.  That's longer than you think!

First payday Thursday!!!!!!!!!  Can't wait for that.
Working tonight and Tuesday. 

I hope this staying up all night thing gets easier.

I was REALLY exhausted this morning coming home.  I took the wrong exit off the freeway and seriously had to concentrate to not get that fuzzy drowsy feeling.  Little scary.  I think I will call Teri on the way home tomorrow.  Surely, given that it is a matter of my surviving the drive home, she won't mind if I call her at 4 a.m. Vegas time! (just kidding!!) 
The night went well though.  We had a baby come down from Labor and Delivery without mommy.  She was recovering from some scary complications.  Normally the baby would go to the NICU because we aren't staffed to care for babies in the nursery.  But since I was there, they gave me the baby which was fun and made me feel like I was really doing something meaningful.  And because I think newborn babies need a lot of lovin', he spent most of the evening in arms while I worked on new hire stuff on the computer! 
I did my first heel stick and both me and the baby survived.  My technique needs some work.  But I guess that's to be expected.  Let's just say the baby required a new blanket afterward or momma would have thought I was part vampire!
On to night three.  Caffeine is your friend!!! Will look forward to the bed tomorrow morning that's for sure!!!!!

First night! First day of sleep.

Well, the first night went very well.  No real drama.  Everyone was very nice.  There's something different about the way nurses treat a new nurse they know they will have to work with for the next couple years versus the nursing student that will only be on the floor for a couple weeks!  While I like that part I still feel very much like a nursing student!!!!!!  Came home, went right to bed.  Slept for almost 5 hours.  Wish it had been more but I was all slept out at that point.  Woke up to the air raid/emergency siren going off.  That's a starting and disorienting was to wake up from your first daytime sleep effort.  Apparently the test is the first Wed of the month but  I was considering whether I was going to have to get out hubby's arsenal to defend the homestead!  I feel a little like I just got off an airplane after flying to China.  What's a little anxiety producing is knowing that in the next 48 hours I'm going to fly back to the U.S. and then head back to China again.  I like China a lot but that's a lot of traveling!!!!!

Have no fear! I can crack your ribs while saving your life!

Today was CPR day.  Got re-certified because I let mine expire.  I figured that taking the class would cost me somewhere around $50 and if I waited until I had a job I might get someone else to pay for it AND pay me while I took it.  So today was the day.  Quote of the day, "Remember, your patient is DEAD!  You can't make it any worse.  If they aren't breathing, do it for them.  If they don't have a pulse give 'em one." OK, I can do that!  But new mommies aren't supposed to need CPR so I probably will attend my next CPR certification class and raise my hand AGAIN as a person who has never done CPR.  In April I get to go to a three day class on neonatal resuscitation.  That should be pretty interesting.  Also hopefully not needed (but probably more likely to actually need it!)
And if you come upon a person not breathing and with no pulse the newest recommendations are that bystanders do not have to give mouth to mouth any more.  Just push hard and fast on their chest.  If you hear ribs cracking you are probably pushing hard enough.  Also if a bystander can feel a pulse in the victims neck while you are compressing you are probably doing it hard enough.  The compressions are hard enough to force air into the lungs. And when people don't have to deal with the yuck factor of mouth to mouth they are much more likely to actually give CPR.  And when people who are DEAD get CPR they are more likely to end up as people NOT DEAD.  (Just considering DEAD as a viable possibility because the cracked ribs hurt so much!)