MEPN Reflections.

Those are my hands. We're doing a small art installation at our graduation ceremony and they will be part of them.

Today I finished my final hours of clinical instruction, and it still hasn't hit home:
I'm done.

Monday there is a class, but I'm headed to a wedding, and I was okayed to go early in the quarter.
So really, I'm done.

This year has been very short, but jam-packed. We were talking about some heavy stuff at lunch, and I thought I'd post some of the stuff I've experienced this year:

Poop is just not a big deal anymore. Period. Cleaned up a lot of it this year, and there's probably more to come.
Was present with a patient who watched her husband slip away more and more neurologically as cancer took over his body. And cried with her.
Learned that yes, I *can* take care of four patients at once on a med-surge floor, but it's hard and I can't do it and be doing a good job.
Learned I have a ton more to learn.
Started an IV on someone who was scared of needles, first try.
Missed on a few people who were scared of needles, first try. Didn't go for a second.
Watched one of my favorite patients go through acute rejection of a transplanted liver.
Watched the team of doctors and nurses pull for her to get a second transplant, and I watched her go home happy and healthy from that second surgery. That was a miracle.
Sat in the ICU with a woman who was too sick to be transplanted, and had been begging us to "let her go home." I held her hand as she was dying, intubated in the ICU, and she turned her head toward me for a moment when she was supposedly "unconscious." And the next day I held her daughter's hand.
Watched the acute distress of a young man who had his last bit of hope dashed when we learned he was in acute rejection of his lungs. I don't know the last outcome, but it was not looking good.
Sat with that memory intensely when my friend, Anne, died following acute rejection of her lungs at age 33.
Helped take care of a 3 year old boy who was dying in the PICU.
Helped care for an 11 year old developmentally delayed girl on dialysis with spina bifida who was in pain and spoke only Spanish. And helped her family get in touch with translators.
Laughed with an old woman who was incontinent after being in the ED for 3 hours (I had just showed up). Her remark, "Well, if you guys had actually checked on me, you might have noticed earlier. What do you expect? I'm old!" She watched us running around like busy bees.
Listened to a 12 year old with Lupus who had been in the hospital for a month, and who told me that all she wanted to do was go home and hang out with her brother and her cat. And have a piece of pizza, for once.
Charted with a 4 month old in my arms who would cry unless he was held by one of the nurses. He'd turn blue if he cried: Tetralogy of Fallot, and he would sleep if I sang to him.
Cried from anger while taking care of a pre-teen girl who had been hit by a bullet while playing, and was decerebrate. She would make noises that seemed like frustration or pain, and the reality of that situation broke my heart. I was overwhelmed by the love of her family, and still feel sick over the way violence destroyed her life. When I saw her picture from her soccer team, taken a week earlier, I nearly vomited because I was so angry, and the change in her was that drastic. I will never, EVER forget her.
Had a frank, genuine conversation with someone who was diagnosed as a paranoid schizophrenic, who told me, "Wow, you calmed me down!"
Had a patient tell me he loved me, in a really sweet way, and I could not tell him that I loved him back, because how do you explain platonic love to someone who is in a locked inpatient psych ward? I mean, really, how?
Held the hand of a spouse who discovered her husband had been rejected for a transplant, and has a year to live....
and still haven't emailed them.
Held my tongue when a precepting nurse chided me for holding the hand of a woman in labor.
Auscultated - and played with - a girl who had two hearts. Yes, two. Heterotopic heart transplant if you want to look it up. Imagine the ECG.
Failed on numerous attempts of trying to do something good. Fortunately it didn't hurt anyone.
Made a little girl cry by not taking out her IV fast enough (don't prolong the bandaid removal).
Faced some of my own prejudices, especially in psych.
Let go of some fear of TB.
Saw a multitude of vaginal births, and a few crash C-sections. And a few scheduled C-sections.
Relied on friends. Including professors, who were really supportive in all the loss I experienced this quarter. Sheila and Lynn and Pam, thank you. Seriously- thank you all.

And I made some great friends.

The Cycle Continues

I'm backdating this blog entry, mostly because I like having Anne's sunshine smile at the top of my blog.

Friday, the 10th, I spent my first rotation in Labor and Delivery. Here's a summary of the experience:

My brand-new clinical instructor is moving very quickly towards us, somewhat breathless.
"Okay, Nicole, you and (male MEPN) are in the delivery rooms, and everyone else is in Post-Partum. Go change into these scrubs. And the women in those two rooms are pushing. Hurry!"

My cohort and I look at each other, high-five, and nod. Neither of us even had time to register nervousness- I mean, I had never seen a vaginal birth, only a C-section, and we have had about three lectures on pregnancy. New scrubs on, we stepped out, ready for the day.
For about ten minutes the nurses we were working with hemmed and hawed about the number of students allowed in one room, and I told him to go ahead- as a male, I know it's more difficult for him to be accepted into a delivery room. Not today. He merged right in to the room, needed and accepted. He had only been in there two minutes, when I hear a call for, "Hey can I get another person in here?!"
So I stepped in.
"Um, I'm a student, what can I do?"

A nurse looks at me, "Grab that towel and go hold her leg so I can hand tools to the doc."

The patient is in a traditional hospital-birth supine position, her husband is at her side. They are super cool, and very calm, all things considered.
"Hi, nice to meet you. I'm Nicole." Contraction.... "Okay, breathe deep with me, ready?"
And that was it. Off and running. It's 7:15 am, and I am helping hold this woman's legs open for a difficult birth, trying to remember what I can about fetal heart rate decelerations, next to her husband (who is also totally rad), watching the doctor work, realizing that this baby is in a little bit of trouble. And I'm watching the baby's head crown.

Holy Shit.

And I thought, silly me, that the head would be way smaller than it was.
The OB was very calm, and grabs the vacuum to help get this baby out. I see the FHR (fetal heart rate) is about 70.
Not so good.
Doc, very slowly but firmly. "Get Peds in here. Now."

A team of 3 superhero nurses emerge from the ICN, ready. They're setting up oxygen support, and the warmer.
The woman pushes again.
"Call Dr. XXXX. Get him in here." I realize that she's calling for the attending.
"Okay, now push. Hard. We need him out of there."
Attending arrives, steps back close to the ICN nurses.
Our laboring mama listens. Another nurse is pouring mineral oil and olive oil on the crown of the baby and on mama's perineum.
And all of a sudden, I realize just how huge that head is, because it's coming. Fast.
And just like that, there's another person in the room.
"Floppy baby."
Not a good thing.
He's blue and floppy, and the cord was wrapped around his neck, twice. Not 2 seconds into the world, this little guy is under a warmer, being rubbed down, suctioned, and bagged with oxygen.
The trio of superheros is working, hard.

It's almost too much to absorb. I look at mama, I look over at baby, and then I look down at mama and she asks me (and the doc), "Did I tear?"
It took every ounce of my consciousness not to look incredibly shocked.
Um, yes.
The OB: "It's not that bad."

Apparently, it's not that bad, but I have never seen a vaginal birth and I could not believe what a "not-that-bad" tear looked like. And the amount of blood that was associated with this process I was NOT prepared for.

I keep myself together, "Yeah, not that bad. How are you doing?"
And then I look at dad. "How are *you* doing?"

We start bantering, like we had known each other for a while. I glance over at the busy trio and the once-blue baby. He looks pink, to my relief. It's been almost 10 minutes.
Then we hear it... He cries!
I sighed, audibly. Everyone in the room noticeably relaxes.

They bring the little guy over to mom and dad, and let them say hi, but he was on his way to the ICN to be watched for a little bit. Both mom and dad are medically savvy, and they nod. Mom looks tired. Baby looks pink, warm and dry. He looks a little mad after being suctioned, and he's probably a little dazed.
"How long were you in labor?"
She looks at me. "31 hours."
My male MEPN companion and I look at each other and our jaws drop.
"Um, can I get you some juice?"
She laughs, and nods. "Yeah, that'd be great."
The OB is busily sewing up the tear. This mama had an epidural, which she relates is what helped her make it through. It's not even 8am yet.

And that was the beginning of the day. Literally, 2 hours later, I'm watching a C-section, then an hour after that, I'm holding the legs of another woman who didn't get an epidural because her baby was on the fasttrack into life. First baby, and she only pushed about 5 times. She tore, too. And let me repeat, NO epidural. Her baby came out with a loud cry, pink, and feisty. Good sign. The doc was trying to numb her up to sew her back together. Again, not a bad tear, but on my first day, it was pretty shocking.

At that point, I thought to myself, "Is there a third option?"
If I invent anything, it's gonna be a baby transporter beam, a la Startrek.
And I had a hell of a lot more respect for all the women I know who have gone through this process.

I then spoke to my Godsister, who is a NICU (ICN) nurse, and she relayed to me that usually women with epidurals tend to tear more often because they can't feel pain, so they don't allow themselves to stretch enough. Makes sense, naturally, when it gets too painful, you stop, take a breath, relax, let yourself stretch, and then begin pushing again. Huh. I am going to ask my prof about this (not that I don't trust my godsister, I just want to ask my professor).

L&D started with a rush of emotion.

So on the same day that I was there for 3 new people coming into the world, someone I really loved transitioned to another one.

Which is a wild head trip for me.

In the past few weeks I've lost a lot of people I've known. See my prior post about one group, but I also lost Shane McConkey, who was a trick skier filming in Italy, and fell. One of his skis didn't pop off, which screwed up his balance and from what I understand, his parachute was tangled in his ski. So he fell. 400 feet. He was only 39, and he was the most bitchin' landlord I ever had- he used to come over and drink beers with us, and his wife Sherry used to come visit as well. I remember how excited she was when she told us she was pregnant. Shane was awesome- he knew I was trying to improve my skiing and offered to ski with me, which floored me. Shane was a legend- he was Squaw's guy, and he was a friend to so many, and so down to earth yet nutty and fun. Total prankster, and totally loveable. He leaves behind his wife, Sherry, and Ayla, his daughter.

Too much.

It's a cycle. I haven't confronted death in a long time, and I've never seen birth like what I saw on Friday, so I guess it's time for reflection.