The majority of days I work, I leave feeling exhausted, as if every ounce of energy has been drained from my body. My feet throb and my scrubs feel heavy with sweat and hard work. My legs ache from all the running around and constant back-and-forth movement from room to room, but somehow, my baby-weight from last year has not managed to melt off. Sometimes I'm short with my husband for no reason at all. Sometimes I'm short with my daughter. And even though I spend more time at work with my patients than I do with my family, when I'm home and have five minutes of quiet time, I inwardly groan when my baby wakes up early from a nap and takes away whatever stretch left I have of "me-time." All of this leaves me in a constant state of "I'm-so-tired" and feeling like a candidate for the worst-mom-of-the-year award.
And work never gets easier. Every day I feel as if we're delivering more babies and I feel like moms are coming in with more problems. Even though the information is out there, so many women are misinformed about inducing their labor. Every week I work, there seems to be a near-miss of someone who comes so close to having the worst possible outcome. And when we walk off of our unit to go home, no one knows what kind of day we had. We can't talk about how great or how hard our patient was, we can't detail how great or how bad our day was, and we can't mention how great or how difficult the providers were who we worked with that day.
Recently, I was laboring a mother who was progressing nicely and the provider on call was in no hurry. I couldn't have asked for a better start to my day. I didn't feel rushed to get anyone delivered, the provider was content with letting labor progress naturally. Because the patient was contracting adequately and making cervical change, Pitocin hadn't even been mentioned. I had actually eaten breakfast and was planning on what to order for lunch with all of my coworkers. I walked out of my patient's room trying to decide between burgers and Mexican food to hear a scrub tech say that she was going to go open up the OR. I could feel the sense of urgency in the air.
I was working with a handful of new grads that day, so I tried my best to stay calm and collected. I walked into the only other room that had another mom in labor, ready to ask my coworker if I could do anything for her. The patient's partner was standing at the head of the bed, holding the patient's hand. The patient's mother and sister were seated in the corner, ohhing and awwing over a swaddled baby in their arms, completely unaware that a pool of blood was collecting below the bed. The provider was seated in between the patient's open legs, sewing up some sort of perineal laceration. Laps soaked in blood were scattered around the physician. She called out orders for labs, she called out orders for medications, she called out for instruments, but she never stopped trying to repair the bleed. I didn't end up asking my coworker if she needed anything. I walked out of the room, called for the charge nurse, grabbed an 18 gauge needle, grabbed more Lactated Ringers, and went back to start a second IV. I barely had time to flush it before the patient was gone, taken to the OR less than 10 minutes after delivering her baby.
I picked up the laps, heavy and saturated with blood, and tidied up the room the best I could. I knew that if time went by, her family would come back and see the delivery room for what it really looked like: a trauma scene. For now, the patient's family did not ask many questions, they did not know to be concerned. For just a moment, I watched her family as they held the baby and I prayed that the patient would make it out of the OR to see her first child.
When I got to the OR, I saw that it was full of nurses and scrub techs. Two nurses were hanging blood, another nurse was giving the physician Cytotec, scrub techs were holding different parts of the patient and handing different instruments to the physician, and another nurse was writing everything down. The anesthesiologist was diligently monitoring the now-intubated patient and her vital signs. Seeing "the dance" already in progress, seeing that everyone was already performing their role, I stood back in the corner and waited for them to need a runner for more medication. Everyone was so calm and focused. Everyone moved with purpose. And when I finally left the OR, the patient was alive, but had narrowly escaped a hysterectomy and a worse fate with an EBL of 3500mls.
When the patient was transferred to ICU, her family came back-and-forth from ICU to labor and delivery, since we were now caring for the baby. Every time we saw them, they thanked us. They were so happy over the birth of their first baby, their first granddaughter. But every time I saw them I wanted to tell them the truth. I wanted to tell them the secret. I wanted to shake them and whisper in their ears...you don't know, but your wife/daughter/sister almost died. Did you see her eyes roll into the back of her head and did she see all that blood in her bed? Did you know that things were so bad and that came close to being the only baby she ever had?!? I wanted to tell them that if it weren't for her physician, if it weren't for the nurses and the scrub techs, if it weren't for that anesthesiologist, they would be leaving the hospital trying to figure out how to raise a baby without its mother. But I couldn't tell them that. I couldn't acknowledge all of the secret good work that we did that day, or how well we all did it.
So if you've ever been the patient or the family member who watched as a nurse's step quickened, or if you've ever seen a nurse magically get help, even if you never heard them ask for it, know that every single thing we do has a purpose. Know that your health is always our top concern.
Until my next delivery ♥
And for any maternal-child nurse other there...Quantifying Blood Loss ...because 500mls is sometimes 800, and 800 is sometimes 1200... (right?!?)