| | Mr S passed away. I only ever met him twice, but he was down to a tee the stereotypical Native Elder - spoke little but said much, warm in his weathered old smile, hobbled knees and wrists suggestive of a life lived hard, but rippled arms pumping his wheelchair along reminding you there's still a lot of life in there.
At least, until he fell short of breath, suddenly, this morning, in bed. I wasn't his doctor, but I overheard him talk to the lab tech - I think it was the cute one from Jasper, just in for a few weeks - coming in to take a picture of his chest. "Can you come back after lunch? I'll be up and you won't have to fight to get me sitting up then." Well, she didn't - he passed away, quietly, found two this afternoon.
The nurses were shocked. "Anyone but him, anyone but him." That means a lot when nurses and doctors feel that way when they lose a patient. I mean, we all feel bad when we lose someone, but to feel genuinely sad, to feel a loss like that, that's something special. Usually when patients die it's a relief - the sickest patients are usually the ones hardest to manage, the most depressing to see.
But Mr S was none of that. He was the patient the nurses would fight over, they would take him out for walks in his chair around the park. Again, not saying much, but having that presence you just wanted to be around. They talk about "heartsink" patients that drain you; but I guess he was the kind that reminded people why they got into medicine and nursing.
Now, they're negotiating who'll get time off to attend his funeral. I never knew him, but I might just go, just to get a sense of this man so dearly loved by everyone.
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Equilibrium in the world: one Masseter out... one Masseter in. It's our expectant mum, and it's showtime.
It's been hanging over our heads the past few weeks since she last came in - this mum going to deliver any minute, and bleed bleed bleed, on a doctor and nurses who haven't had obstetrics or neonatal experience in a very long time, in a hospital with no surgical or specialist backup. She checks in, it's kind of the feeling before a big exam: all those nights of late cramming and restless sleep are over, just get through the next three hours, and you can sleep easy tonight.
Take home message: Respect the grand multip cervix.
When a mum who's had 6 deliveries is coming out with number 7, it will be fast, and you'd better be ready. I wasn't. She came in with decent powerful contractions every minute and a half, with baby's heart rate totally normal each time. I checked her, she was only 4cm dilated, head nicely against the cervix, with a bulging membrane peeking through. "As soon as my water breaks he'll come right out", mum said. I believed her - six-time mums would know.
I stepped out to call my preceptor at home - I figured, if I could break her waters myself, then I would be sure I'm in the room when baby comes. Plus, if there's meconium (foetal faeces) in the waters, I'd know to take baby straight to the resus bay right away, instead of the usual letting dad cut the cord. (Of course, I knew the cord wasn't behind the bulging membrane - you don't want to pop that, or have baby press through it on the way out.)
Line's engaged. Oh well, only 4cm, plenty of time.
From down the hall: "Doctor they need you!!!"
Lesson learned: Respect the grand multip cervix.
Baby's head is already out, the nurse and doula are unwrapping the cord from baby's neck. I managed to get on a pair of gloves, and plop! That's the sound of 3 930g of baby boy catching on your hand. Weak cries, but pick up a bit when I hand him over to the doula to wipe down. They didn't have enough time to give mum a shot of oxytocin to help stop her uterus from bleeding; knowing that 7-time stretched womb is likely to bleed bleed bleed, I had my eyes fixed on watching for flow, hand on her belly.
They didn't have time to get the delivery tray out either. Cord clips please. And scissors, please. I find I always say "please" extraneously when I'm nervous and giving orders. Another nurse has to run out to get it. The doula grabs over my shoulder for suction and oxygen, but I don't notice - I'm still worried and fixed about that bleed bleed bleed I'm expecting.
A whole minute later another nurse brings in the two plastic cord clips. On they go, scissors to dad. Would you like to cut the cord dad?, I start, still watching for bleeding.
Over my shoulder, the doula - "Doctor, this baby needs resus now!"
Oh! Baby! Blue! Not breathing! But I could swear I heard cries earlier.
Clip and snip the cord myself, jump with baby over to the baby warmer. Feel around the belly button - no pulse. Mask goes over baby's blue lips, and I start bagging. Nurse swings round and feels the belly.
"No pulse." [Bag, bag, puff, puff.]
"No pulse." [Double check the mask placement, puff, puff, puff.]
"Sixty... One hundred... One forty."
Phew! I can breathe again.
Back to mum: just a wee trickle of blood. Oxytocin's in, and the uterus is doing its thing. Placenta comes out - no lab tech, so no cord gases, but we take a sample anyway - and I check the damage. Little wee tear, no stitches. And still, just a wee trickle.
And the uterus is hard as a rock. Not floppy. Not bleeding to death.
Nice.
He's our New Year's baby - first delivery of 2007! Can't even remember when the last one was. Kind of a neat feeling, signing off typewritten (!) template orders from a delivery pack over 15 years old. And what's more, likely the last ever delivery in this hospital, before the move to the new one next month. I fill in the "Notice of Birth (or Stillbirth)" - place of delivery, Masset Hospital - my signature a little mark on town history.
And I, and the rest of the nursing staff, and a happy mum and new baby boy, can sleep easy tonight. |
| | Posted 12/19/2007 11:45 PM - 66 Views - 2 eProps - 1 Comment
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