The Nursing Student and Baby Rosebud

My maternity rotation in nursing school was during the heat of a Mississippi summer. It was a relief to spend it indoors in a cool hospital.

Maternity was an exciting rotation full of life and promise that everyone had been looking forward to. Who does not love babies? The hope and wonder that permeate the labor and delivery makes it a joyous place. Most of the time.

With six more months of clinical’s to go I was competing with four other students for class valedictorian. And my nemesis was ahead of me with her GPA so I knew I had to knock it out of the ballpark with post clinical conference grades. So when we were all lined up with our instructor and she asked who wanted to scrub in on a “special C-section” I jumped right out of line with my hand raised. THIS was what I needed to get ahead in post clinical’s!

To my surprise our instructor just glared at me. I looked back at the line of students staring at the floor and thought, “I was the only volunteer, I should get extra points for this!”

My instructor grabbed me by the arm and waved the others off to the nurses lounge. She continued to glare at me and said, “Are you SURE you want this assignment?”

“oh yes Mam! I will do a great job!”

“This is not a ‘JOB’, your patient is a very dedicated nurse who happens to be a friend of mine.”

My stomach did that flip-flop thing that something was wrong but Professor X continued, “Her baby died in utero two days ago. There is no obvious reason why. Her doctor wanted her to labor and expel the baby naturally but she refused and is here today to have a section done.”

She paused and my heart began pounding, joining the party with my flipping stomach.

“You up and volunteered for this so here is your assignment. You are to provide comfort to her and her husband. Stay with her and provide physical and emotional care pre-surgery, during surgery and post op. After she is settled in her room you will be providing post-mortem care for the baby and taking the baby to her family for them to say goodbye. The grandmother has provided a christening gown and you will bathe and dress the baby in this gown to take her to her family.”

I was now in complete shock and GPA or not, I wished I had joined my peers and kept my big mouth shut.

Professor X continued glaring at me. “You asked for this. Life is not a game or even fair.” She looked down at her spotless white shoes and continued, “You do this and do not add to the family’s sorrow. It was a unique gift for them to allow a student nurse in on their personal tragedy. They are in room three. I will be watching you!”

I made my way to the OB nurses locker room to change into scrubs, I was in shock and decided my best approach was to be as professional as possible and keep quiet and stay out-of-the-way.

I went to room three and after taking a deep gulp of air and knocked on the door. To my surprise I heard laughter coming from inside. I was invited in and found a very pretty woman sitting beside the bed with her husband. “Oh you must be my student nurse! I am so happy to meet you!” I was completely taken off guard by how nice and how cheerful she was along with her husband. We all shook hands and introduced ourselves and I asked her if she was ready for me to help her with her hospital gown and getting ready. While I assisted her, she kept talking, cheerfully.

“I believe you know that our baby is not going home with us?”

“yes Mam, my instructor told me that you found out two days ago?”

I helped her get in the bed and to a comfortable sitting position. Then I pulled up the bedside table and laid out the supply’s to start her IV. Students were not allowed to start lines at this private hospital so I pressed the call light for the staff nurse to come in.

“Yes.” Mom continued, “we did a sonogram two days ago to confirm she had died…” Mom looked down and sighed, “There is nothing to indicate what happened, the placenta is attached and in place, the cord was not around her neck…She is just gone.” Another sigh from Mom. “my doctor wanted me to wait and labor naturally, but I told him I was not going through all that and not getting the prize at the end! No way!” she laughed now, “So here we are.” She looked at me expectantly.

I could not help myself. I blurted out, “I am so sad for you! How are you dealing with this? You and your husband?” I looked at him but he just shook his head. I noticed then that he rarely took his eyes off of his wife’s lovely face.

“I do not know. All I can tell you is that I was screaming at God that this is not FAIR! I cried till I could not breathe, then even though He did not answer me I felt peace.”

I just nodded as I felt tears welling up. I did not know what to say. Twenty eight years later I type this and still don’t know what to say…

The moment was broken by the staff nurse coming in to start the IV. After she expertly popped it in she surprised me by leaning over and kissing Mom on her forehead. I realized then that this woman knew the entire staff and they were all friends. What I didn’t know was that they were all sisters, in the society of nurses that one day I would join myself, but at the moment was still an outsider.

We are supposed to comfort, not need comforting. We are the one’s who care, not the one’s who need care. Role reversal is uncomfortable. The staff nurse swiped angrily at a tear sliding down her face and glared at me, “take good care of her!” she hissed at me on her way out the door. “yes Mam.” I whispered.

All we could do now was wait. I got Dad his scrubs for the OR and showed him where to go change and then I just stood there, scared, afraid to say anything. It seemed Mom felt my angst and she started talking to me about her three-year old son and what a joy he was. I smiled and nodded and tried to look less miserable for her sake.

Then it was off to the OR. Mom cheerfully chatted up the anesthesiologist as he put in her epidural. “Give me some extra!” she joked, ” I am not willing to feel any discomfort today!” But despite her joking the mood in the room was subdued and sad.

Mom’s OB doctor came in and shook his head. “It’s okay J.” she assured him, “lets just get this over with. Please be quick.” The doctor nodded and the surgery began. I was on the right by the anesthesiologist and Dad was on Mom’s left by her head. I heard murmured prayers and “I love you’s” Mom then popped her eye’s open and said, “Its okay, I am okay.” She then demanded her doctor take down the screen that prevented her from seeing her belly. The doctor refused and she sighed and glared at the ceiling.

In what seemed like seconds the baby was out and handed to a nurse who wrapped her in blankets and set her in a warmer. Mom  was sewn up, cleaned up, curtains down. I was to wheel her back to a room. My instructor was outside the OR and directed me to a room away from the post partum unit. “We don’t want her to have to hear or see the new baby’s. This will be quiet and peaceful.”

Again, I could only nod. It seemed I had developed a growth in my throat that prevented me from talking but wanted me to start crying. I could not do that, so nod I did.

We got to the new room that was a nice suite just off of post partum. Mom and Dad’s family were already there, with beautiful flowers arranged on the table. I got the bed locked, call light in place, checked the IV, pump settings, fresh water, coffee for Grandma…Then it was time for me to complete my assignment.

I took Mom’s hand and told her I was going to the nursery and I would be back with her daughter.

She bit her lip and squeezed my hand and smiled at me.

I trudged back to the nursery. My instructor was waiting by the door and put in the top-secret security code for me. The warmer with its still wrapped bundle was off to the side, away from the window where new family’s were smiling, pointing and taking pictures. I picked up the silent bundle and followed my instructor to a side room with a large sink.  Professor X had a beautiful white lacy gown in a plastic wrapper she laid to the side. “Bath her and dress her in here, then take her in your arms to the family. Since she is deceased there is no need to push her in a cart of supply’s that won’t be needed. This is a more personal and caring way to do it.” She fixed her mouth in a straight line and glared at me, “Are you okay?” I barely managed to croak out, “Yes Mam” over the painful lump in my throat.

I saw the nursery nurses watching me in the side room as I unwrapped the bundle. In the blanket was a perfect little baby girl. It did not seem possible that she would never open her eyes, cry or grow up. She was so beautiful…I was thankful for the water coming out of the faucet to mask my gulped sobs and the tears that were now pouring down my face. I bathed this gorgeous baby in warm water, put a diaper on her and then the christening gown. I brushed her scant brown hair to dry it and it curled on top of her little head. Her skin was as white and soft as alabaster and there was not a mark on her tiny body. What I could not stop staring at was her mouth, it looked like a perfect rosebud in miniature.

Her lips were a perfect deep dark pink, almost scarlet. There are no words this side of heaven to describe the perfection of her lips, the shape of her mouth and the extraordinary color that seemed to grow deeper the more I looked. Rosebud, what a perfect name for lips like that…It seemed to me that her lips were perfectly shaped for an eternal smile, even as her eyes were eternally closed in an expression of peace.

Finally I was satisfied that I had her hair perfect, the gown just right and was ready to go. I picked up Rosebud in my arms, got her positioned and fluffed out the gown so she looked just right. I grabbed a scratchy paper towel and swiped at my tear-stained face then headed out into the nursery.

The nurses seemed to be standing at attention waiting for me to walk out with her. The curtain had been pulled down so visitors could not see in and every nurse inspected the baby in my arms. I felt the silent approval that I had done a good job. Rosebud looked like an angel doll. One of the older nurses patted me on the shoulder as I left the nursery.

My instructor was waiting. She too, inspected the baby doll in my arms and nodded. We walking silently down the hall to the room where the family was waiting.  Professor X knocked for me then pushed the door open but did not enter with me.

There was a collective gasp as I walked in and Mom, who had been so stoic, so cheerful, so accepting of this horrible situation threw her arms out towards me and finally started to cry…

I laid little Rosebud in her arms and she wept. “She is so beautiful and so perfect… OH God! She is perfect…”

I had not been dismissed so I just backed up a few steps and stood there. I honestly did not know what to do. Then a man in a suit came forward from the corner and said, “Let us pray.” Everyone grabbed hands and gathered around the bed. Now I really did not know what to do, this was a very personal, private family moment, do I disturb it by trying to sneak out? Do I flatten myself against the wall and try to be invisible? My dilemma was solved by Dad who grabbed my hand and pulled me into the family circle. I held hands between him and a grandmother as the Pastor led this lovely family in prayer. I do not remember what he said, I do not remember feeling comfort, but I do remember feeling confident and sure Jesus was present and listening.

After the Pastor prayed and Mom had stopped weeping, everyone was exclaiming how perfect and beautiful Rosebud was and taking pictures for keepsakes. I still had not been dismissed but the clock on the wall told me I was already late for clinical conference. After a few minutes of indecision I decided to slip towards the door.

“WAIT!” cried Mom.

I turned and ran back to the bedside, crying opening now. “I am so sorry for your loss. I don’t know what to say, but I will always be grateful to you for letting me be your student nurse today.”

Mom hugged me, tears rolling down her face. “Thank you, you took wonderful care of my daughter. You will be a good nurse.”

Still crying I hugged Dad and the grandma’s and slipped out. In the hallway I could actually let the sobs out.

I still could not go to clinical conference without giving report to the staff nurse so I went to the nurses station, let them know Rosebud was still in the room with the family, Mom was stable, left to claim on her IV.  The staff nurse gave me the “nod of approval” and I headed to the conference center.

I did not bother to change back into my uniform, I was already late so what difference did it make? All I wanted to do at this point was get out of there, go to my mother’s house, let her comfort me and have a good cry.

Professor X saw me slip into the back of the auditorium and glared at me then the clock. “I’m doomed,” I thought, “she’s going to give me a clinical U for sure.”

After all the other students finished presenting their patient’s and care plans for the day I heard my name. “Alana had a very interesting case today, come up here and present please!” Professor X bellowed.

I walked to the front hanging my head. I had no notes prepared, no care plan, no idea what to say.

I looked out at my fellow students who stared right back at me. I was a mess in OB scrubs that were wrinkled and still wet in spots, what little makeup we were allowed to wear had long since been cried off and my eye’s were red. I took a deep breath and said, “I took care of a mother today whose baby died in utero. She elected to have a C-section rather than labor with a stillborn.” I wanted to go on about how beautiful Rosebud was, how perfect. But I needed to present the facts of the case and the nursing care involved, but at that moment the tears started again. With no thought to GPA or valedictorian or even a clinical U I just said, “And I learned it’s okay to cry with and for your patient’s.”  Sometimes that is all you can do for them.”

 

Blessed are they that mourn, for they shall be comforted.  Matthew 5:4

 

The Rhythm of Life

 I have always had a fascination for EKG tracings. My desire to know what the little scribbles on graph paper meant led me to take a critical care certification class at my hospital so I could work in CCU if needed, and the step down unit Telemetry so I could play with these fascinating items at work. I learned a lot in that course but it was  dry and I did more memorizing than actual learning. I got signed off to take Advanced Cardiac Life Support after this and I decided to take it with an outside company rather than in the hospital. The in-house instructor had the reputation of failing everyone during the “mega code” including doctors.  At that time, ACLS was extremely difficult and a feather in the hat of anyone who could pass it.

I took the course under Dr. David Doernbach, a fascinating and funny man who had the knack of making the technical funny and a discerning that clinicians who understood what they were doing and why made for much better patient outcomes than patients who were treated with memorized algorithms and protocols.

I sat with my mouth hanging open as Dr. Dave presented a slide show that showed some of the first EKG machines, monstrous contraptions that took up entire rooms with the patients sitting with their feet in buckets of salt water and nurses with bat wing starched hats rolled out soot tracings onto paper so the scribbles could be studied.

But if you think that is archaic, consider this: In 1838 Carlo Matteucci, a professor of Physics at Pisa University invented what was called a “rehoscopic frog” where the nerve of a dead frog was used as the electrical sensor, causing the dead muscle to twitch to show electrical activity! How gross! Don’t you appreciate your cardiologists nice clean office now?

That was it for me, thanks to Dr. Dave, I will forever be hooked on graph paper with scribbles on it. And we have come such a long way from the 1788 report of the Humane Society: ” An Essay on the Recovery of the Apparently Dead” in London, to Augustus Waller demonstrating EKG’s on his dog, Jimmy, standing in four jars of saline for the show at St. Mary’s Medical School in 1889. The first portable EKG, a “Holter Monitor”, was a 75 pound backpack invented by Dr. Norman Holter in 1949. I mean seriously, if you can handle trudging around with a 75 pound backpack your heart is probably fine. At least for now!

So that brings us to a modern EKG– this is a normal rhythm strip.

You have your first little “bump” called a “p-wave”  is the electrical activity going down the heart muscle to stimulate the heart to action, the large “wave” after that is the “QRS” that shows the ventricles contracting to pump blood out of the heart. The last little bump is your t-wave as the heart depolarizes to perform this miracle all over again. The boxes on the graph paper show time, going horizontally, and measures voltage, or strength of action, horizontally. This is an extremely SIMPLIFIED explanation but to me it speaks to much more than the cardiac cycle. We have an idea, a thought, that leads to an action then a resting period, and we get ready to do it again. impulse- action- rest -repeat-impulse-action-rest-repeat…

This is the rhythm of LIFE.

What can happen when your rhythm is off?

Well on an EKG if you have no p-wave, you have atrial fibrillation and your ventricular action is often rapid and irregular. In your life if you have no plan your actions are thoughtless and often irregular…

Think about it!

And there are so many variations to consider, apply them to your life by name: premature atrial contractions= premature thoughts we may react to with unplanned actions OR premature ventricular contractions, an action with no thought to guide it. These can become more frequent and lead to very dangerous rhythms/actions. If you have a proper p-wave then too much time before action from the ventricle you have a heart block. Depending on how long the interval is between p-wave and action shows the severity of your heart block.  Are you blocking an action you need to take in life? Consider and treat this now before it ends you. Bradycardia or tachycardia describes a heart rate that is either to slow or to fast, either one can decrease cardiac output, or measurable action in your life. Is your life moving along at the correct pace? Why or why not? What is causing the slow down or acceleration? Better get with your cardiologist and find out.

This one is familiar to anyone who has ever seen a medical drama on TV.   V-TACH! or “V-TACH! Charge the paddles!” and the gorgeous TV doctors and model nurses slap the defibrillator on the patient, yell, “CLEAR” and the patient dramatically arches off the gurney, everyone looks at the monitor and see’s a perfect sinus rhythm, everyone smiles and the patient smiles too. Especially if the patient is a female and the TV doc is VERY cute! This never fails to make me laugh!

In real life, this is an extremely serious situation with scant minutes for correction. The heart muscle is “fibrillating”, in other words it is moving, but the action is not producing any cardiac output. The heart is “quivering” but not pumping blood, there is no life-sustaining action here at all. This often has tragic outcomes…

Socrates stated, “The unexamined life is not worth living.” We can look at our lives like an EKG tracing, do we have a p-wave, a plan, take only the correct amount of time and have appropriate actions? Then do we rest and repolarize so we can do it again?

I like to sit down with my journal and think on paper. This helps me focus and see what is going on in my life, what is working, what is not, what I think should be going on and what I think I should be doing. In this way I can follow the advice of the Apostle Peter: “Seeing that ye look for such things, be diligent that ye may be found of Him in peace” 2 Peter 3:14. My way may not work for you but I encourage you to find a way that does. Then do it!

Take good care of your heart and it will take care of you.

 

*** Nothing in this post is intended to replace medical advice from a doctor! Educate yourself on the signs and symptoms of a heart attack or stroke  http://www.heart.org/HEARTORG/Conditions/911-Warnings-Signs-of-a-Heart-Attack_UCM_305346_SubHomePage.jsp       IF you even think you are having a problem– call FIRST, call FAST, call 911!  (line stolen from Dr. Dave!) Believe me the ER is full of doctors and nurses who can’t wait to take care of you. It’s what we do– even if our doctors are not that cute or the nurses don’t look like models at the end of a 12+ hour shift! ***

If you are a medical professional who is tired of boring ACLS classes or dry EKG lectures I can not recommend Dr. Dave’s programs highly enough. He is simply the best, and funniest! http://www.vsu.com/

You could also work through this book and really show out at work parties! Just don’t forget the real life mantra, “treat your pt. NOT the monitor!”

https://www.amazon.com/Ecg-Workout-Exercises-Arrhythmia-Interpretation/dp/0397550553/ref=sr_1_1?ie=UTF8&qid=1491774961&sr=8-1&keywords=DAvid+Doernbach

(comment if you know this one)

xx00- Alana

 

Life lessons from an Unwanted Teacher

Lessons we need to learn are often taught by the most unwelcome of teachers. We have all been schooled in time management by Professor Procrastination, crushed by Coach Chaos, and a lot of us have  been instructed in the art of love and war by Dr. Divorce…

I had an incident last year and have been under the tutelage of chronic pain. She is the most miserable instructor I have ever encountered, she will not be getting positive feedback from me! But I am slowly learning lessons that are helping me in this situation and are applicable to other area’s of life.

DO NOT GIVE UP!

Whatever your situation, do not let the pain, the injury, the illness define you. You are more than a symptom, more than a diagnosis. YOU ARE MORE! There are still many things for you to enjoy and take advantage of. Focus on those things.

Keep a pain log. Use this tool to effectively communicate with your doctor so you can graduate this class as soon as possible! But keep it simple, and short. Use adjectives to describe the pain type: burning, stinging, moves around, pressure, throbbing. This will help your doctor help you.

Do not focus on the log! What you focus on becomes your world. You do need to keep track of what is going on but keep it short and simple. A sample entry may look like this: “Sharp, throbbing pain in hip after PT, lasted all afternoon, used ice after PT with minimal relief.” That’s it! Don’t write a novel, jot a note and move on!

ALLOW YOURSELF TO REST WITHOUT GUILT.

Take advantage of this time to do something most of us never really do, rest. Before I was wide open 23 hours a day. I loved every crazy minute of it. I did not ask for this “break” nor did I want it, but here it is, so I’m using this time to catch up on quiet activities: The stack of books on my bedside table, movies I never went to see… And much to my surprise, deep restful sleep is actually good for me! The world continues to spin on its axis without me running at top speed. And that is ok.

PAINT BAD PICTURES WITH GUSTO!

Distraction can be very effective therapy for pain. So what soothes you? What activity would you like to try? If you love to read and are a social person you could start a book club from your couch. If movies are your thing, put together a watch list and arrange for all your favorite movie snacks to be available. You could have a “junk food list” and “healthy snack list” and invite friends to join you. I have always wanted to paint magnificent watercolors. I am currently using watercolor pencils to create the most awful seascapes! It’s fun and it takes my mind off of negative things.

MUSIC HAS POWER!

Music is a great distraction and way to relax, re-focus or get yourself moving. William Congreve wrote in his play, The Mourning Bride, “Music has charms to soothe the savage beast, to soften rocks, or bend the knotted oak.” When the pain makes me feel like a savage beast or knotted oak I lay down and listen to “WholeTones” by Michael Tyrell.

Music also has power to energize the body. Make a playlist that includes all the music that makes you feel like a million bucks! My energy playlist includes; “All Fired Up” by the incomparable Pat Benatar, “Keep the Faith” by Bon Jovi along with many others. “Defying Gravity” from Wicked inspires me to fly above whatever is trying to pull me down!

ALLOW OTHERS TO HELP YOU…

This may be the most important, yet hardest of all. I have always been a giver, not a receiver, but I know how much pleasure I get out of giving and doing for others.

Are you going to be selfish and deny that pleasure to others?

If you need help, take it. My daughter now pushes the grocery cart and loads and unloads everything for me with a smile on her face. It seems insignificant, but it’s a big deal right now. For both of us. If you can’t drive accept that ride! You can write thank you notes from your bed while eating your neighbor’s amazing peanut butter brownies!

PRACTICE GRATITUDE FOR THIS TIME, THERE IS A GIFT IN EVERY SITUATION.

Use these tips to move up your graduation day. Take the time to rest and so something new and you will triumph over this course! Then take what you have learned and help someone else who finds themselves in this class.