I was assigned to the NICU Wednesday. It was pretty boring because for the most part you just let the kids sleep so they can rest and grow. We do assessments every two hours, alternating doing a hands-on assessment and just taking vitals off the monitors. You want to disturb them as little as possible because it’s stressful. We had a little girl born at 27 weeks (her mother was getting sick fast with high blood pressures) who was on her second day in the NICU. She was under 1 pound. She looked more like a fetus than a baby since she hasn’t put any fat on. Just a large head and skeletal body with frail muscles you can see under her skin. She was getting her nutrition through a central line in her umbilical vein and was breathing on a ventilator. We had to suction her trachea a few times for fluid build-up. She was also hooked up to an ECG, had a pulse oximeter on her foot (that you have to switch feet each day because the little light can burn their thin skin), and a temperature probe stuck to her belly. It must be frightening for parents to see their kid like this. She was on a bed under a radiant warmer and pumped in moist air to keep her from drying out. They use saran wrap over the bed to keep the air in. I guess the fancy “giraffe isolette” was being used by another preemie who was not so badly off but was born first. I loved taking care of the little girl. She was so completely helpless. When she cried it was soundless because of the intubator. Kind of surreal.

Thursday I was assigned to Labor and Delivery. First I did a transition for a newborn c-section just before I started my shift. I gave the baby its first bath and took vitals every 15 minutes. I also gave it the vitamin K shot and put in the eye ointment – those little guys can screw their eyes shut really tight! I saw a beautifully easy birth at 10 am. It was the second in the family. The mom had an epidural and just breathed out her boy in less than 5 minutes once she started pushing. The umbilical cord was crazy long. The midwife was so impressed that she had someone get a tape measure. 44 inches! They’re usually 14-18 inches. I helped a spanish-speaking only (SSO) patient who was having a natural birth. Nooooo thank you. Compared to that gorgeous epidural earlier it was clear which way I should have my first. I really have no motivation to try natural. I hoped to stay through her birth but it was taking much longer than planned (she was already fully dilated) and I wanted to see the c-section at noon. I heard it took another hour and a half after I left before the birth. The c-section was great. I love watching surgery. When they take the uterus out to sew it up I thought it looked just like a roast chicken with its neck sewn full of stuffing, with drumsticks/fallopian tubes on either side. Like I said before, I spoke with the first assistant RN who assisted with the surgery. She told me all about the surgery, the tools, the healing, and her education to get to that role. I tooled around after lunch following a nurse on an antepartum patient. I dropped in for another vaginal delivery, seeing just the end of it up to stitching up the mom. I have to admit by that point I was getting kind of bored with deliveries. I feel the same about c-sections. It was a cool experience, but you’ve seen one you’ve seen them all.

One week to go and I’m done with OB.

Ben has taken up his blogging pen. That’s a link to his new site and I updated the link on the right side of this side as well. Please add him to your usual internet browsing!

This week in clinicals was great but I’m pooped and don’t want to get all worked up writing about it on this here blog. My legs are moaning with ache – I’m not sure if it’s because I couldn’t find my compression socks this morning or because it’s the end of two 12 hour days. I was ravenous and exhausted when I got home a couple hours ago. Now my tummy is full of tacos and my veins are coursing with happy diet coke, my legs up propped up on pillows and I’m catching up on two days of internet hoo ha (whoa, 700 BILLION?). I hope to write up my experiences tomorrow, but I may not get to it. Then the weekend will be here and I won’t every get around to it. That happens. Basically I’m writing now to at least say hello, so I don’t feel too bad about myself for not writing later. If you’re a bored passer-by on my blog, entertain yourself by figuring out what this is – I talked to a Certified First Assistant RN today (she was so cool!) and she talked about this:

Did you know that fish, stage make-up latex, and dog butt musk share the same unpleasant scent?

My hoodie stank so I washed it. It still stinks. It smells like alkaline chemical, like the stuff I used in darkroom. I haven’t been in a darkroom in 8 years.

Question posed on another blog: What are your most re-watched movies? In no particular order:

The Princess Bride
Star Wars Return of the Jedi
The Lord of the Rings (all three, plus bonus features when I’m sick)
Singin’ in the Rain
Rushmore

TV shows?
Arrested Development
Seinfeld
Friends
Family Guy
Spaced

LD was very slow today with only 4 laboring patients, and mine was the only one who looked like she would deliver during our shift. The other student and I faced off with rock-paper-scissors to win the patient – I was lucky to get her. She was very sweet and pregnant with her first child. Supportive family was there the whole time. She delivered vaginally with an epidural and episiotomy. The pushing was only 20 minutes long and not nearly as gross as I expected. I followed her the rest of the day until she went to the post-partum unit.

I got to check her cervix (or attempt to – it’s very gooshy and confusing in there), remove her foley catheter, and assess the newborn after an hour. I helped her get the baby latch in order to breastfeed. I even got to put in a straight catheter to empty her bladder just before she left the unit. So even though it was a super slow morning and I sat around waiting for a long time I got to do a lot of fun things in the end. (Yes, inserting catheters is fun!).

The birth was totally exciting and happy. We were a little worried about the fetal heart rate, lots of decelerations during contractions. My nurse surmised that the cord was wrapped around the baby’s neck and she was right. We worried that having all that trouble would exhaust the baby before she could be pushed out. But pushing labor went fast enough (20 minutes) so there weren’t any real problems. The placenta came sliding out quickly with a waterfall of blood behind it. The placenta had a marginal cord insertion site so that was cool to see. I would have liked to look at it closer with better lights, but I decided it might be inappropriate for me to sneak off with the tub and poke and play with it. They might think that was weird 🙂

America’s Best Contacts and Eyeglasses rocks. As I said before, my light purple glasses I’ve been wearing for 7 years broke. I was able to hot glue the hinge back together to wear them during class but clearly this is not a long term solution. I started looking for a cheap way to replace them – cheap because I have no eye coverage with my bare-bones health plan and because we’re living on a student budget. Here’s the breakdown of what I found:

Eye exam:
Target = 55
Lenscrafters = 65
Walmart = 62
America’s Best = free with purchase (40 without)

Frames:
Target = start at 99
Lenscrafters = start at 99
Walmart = start at 19
America’s Best = start at 49, but buy two for 69, lenses included

Lenses:
Target = 100+
Lenscrafters = 125+ but had a half off deal through November
Walmart = 69+
America’s Best = basic lenses are included in the two for 69 deal. Upgrades start at 69.

So really no comparison. Any other place would total 255+ for the whole package, or just 69 from America’s Best plus you get a second pair. I figured if they didn’t have good frames then I would get the cheap exam and take my prescription to an online shop like zennioptical, where frames + lenses start at $8. But they had decent stuff and at least I could try them on. I’m glad I got some new ones ordered so quickly – not so glad I have to wait 7-10 days for them to arrive.

Those are the two pairs I ordered, but the one on top is purple/pink (I could only find a pic of the blue version). Miranda graciously accompanied me to offer much needed advice. She was very direct and honest and made me feel really good about my purchases. I’m pretty excited to have two pairs because I frequently leave my glasses in my school bag or my purse, and then when I get to the movies or lecture I realize I left them in my other bag. No more!

By the way, remember my shoe conundrum this summer? Just wanted to let you know how awesome my dansko clogs are. I would wear them everyday if that wasn’t so boring. They feel great on my feet and offer the most support I’ve felt outside of a pointe shoe. Amanda has been converted to the dansko love as well. If you need some good shoes I whole heartedly recommend them.

By the way, I got another A on my OB test today. So far I’m rockin’ the 4.0.

Studying pre-eclampsia and other pregnancy/labor complications.

Watching It’s Always Sunny in Philadelphia and Burn Notice.

Shopping for new glasses. My frames broke yesterday 🙁

Snacking on Fruity Pebbles leftover from my fro-yo for cooking club.

Loving the cold weather turn. Bring on the sweaters and long sleeves!

Knitting a lovely project that will be secret for now.

Desperately needing a haircut. A color job wouldn’t hurt either.

Contemplating getting my ears pierced.

So what am I still interested in?

• General Med/Surg (but not rehabilitation)
• medical or surgical ICU
• Wound care
• OR nursing
• ER (I at least want to try it, I’m not sure it would be a match)

What have I nixed?

• Postpartum/NICU
• Long term care (especially Russian speaking Alzheimer’s units)
• Hospice
• Mental Health
• Pediatrics (I’m pretty sure, but I won’t know until my peds rotation later in the year)

I can cross OB off my list of possible specialties. I had two days of clinical this week at our local hospital. The first day was spent following the lactation consultants. Boooooring. Boobs boobs everywhere. We visited postpartum moms to make sure they are feeding well. We had an open group session where 5 moms with babies of various ages up through 3 months came for assistance and weight checks. The rest of the day was private appointments of the same thing. Mom and sometimes Dad came in. Undress baby and weigh him. Change the diaper. Weigh him with the dry diaper. Nurse for 20 minutes on one side. Weigh him. Nurse for 15 minutes on the other side. Weigh him. Hmm, he could go for more. Nurse and weigh for anothe 30 minutes. Chat while they dress him, say good bye, and another couplet comes in. All. Day. Long. My eyes were drooping by 2 pm.
Yesterday I was in the postpartum “Mom Baby” unit. I had a good nurse who explained a lot of things and let me pass out all the medications. Unlike my med/surg unit we weren’t allow to access the pyxis drug carts or log onto computers to chart. So I spent a lot more time just observing. I did one newborn assessment and one mom assessment in a 12 hour shift. I had a whole hour where there was nothing to do so I studied class notes. I was lucky. Another student in a different MB unit read a novel for 3 hours. We’re all packing reading material now. It seems that aside from the labor and delivery unit everyone just needs to rest. I hear that Special Care Nursery (their NICU) is even more boring because you’re SUPPOSED to leave the babies alone as much as possible so they can rest, feed, grow, and be unstimulated. Even the girls in LD yesterday were bored. One was assigned to a nurse whose two patients wouldn’t let a student in. What was she supposed to do all morning??
I talked a lot to my nurse in MB about what specialties to go into (she had a marvelous Boston accent, I suppressed giggles all day). She said OB was always pretty quiet. Even in LD you just don’t get much experience. It’s just uteruses and boobs in and out all day. It would be hard to get another unit to accept you once you’re done working there. She said it was great while she had kids in school because it was so mellow, but it wouldn’t be good for new students. I noticed that most of the nurses were more laxed, doing wimpy assessments and chatting an awful lot. A bit more bumbling, forgetful, and slow. Most have been working in OB for 20+ years. I got the feeling that OB was looked upon as the easy nursing specialty. Kind of like how psychiatry is at the backend of the MD specialties (not that there’s anything wrong with psychiatry! They just don’t get much respect).
So I haven’t had my LD days yet, but I’m pretty sure OB is not for me. I want more exciting critical care.