I left work at 9:45 last night - nearly fifteen hours after I had punched in. Last week we were totally dead - it seemed NO ONE was having a baby. The charge nurses were practically doing tribal dances to drum up business.
And as per usual, the floodgates opened and now the whole HOSPITAL is filled to capacity, staffing is tight, charge nurses are begging you to work more...life is back to normal. I was pulled from postpartum to the special care nursery early in my shift for the past two days and ran my tail off the whole time.
I've missed the NICU - I miss the challenge, the busy-ness, the tough cases where you're constantly on the move, attending to minute details, calibrating machines, pushing meds, focusing on one very sick little person. We don't get that at Holland - we might get a really sick or tiny baby every once in a while, and they get shipped as soon as they're stable. I've convinced myself I'm really glad to work in different environment and that this is a good thing. I don't WANT those sick babies anymore. I don't WANT to come home an emotional wreck wanting to rip off the face of the next person I see (poor Matt).
We had one urgent c-section after another yesterday afternoon. I was in Special Care, and the nursery nurse was pulling her hair out (the nursery nurse has to "catch" the baby at the c-section and admit it, and is up to her elbows in paperwork because we're the first to lose a clerk when things get busy). There's a reason most people work an 8-hour day. By the time 3pm rolls around, I feel DONE. I'm tired, I want to get off my feet, I'm hungry. But no...there are four more hours to go! Having a lot of stuff come up in those last four hours is just tough. Then you come up close to the change of shift, and if you're flying back and forth between the nursery and the operating room still, those last four hours become four and a half or five. You're waltzing out of work at 8 or 8:30 at night, and still need to eat dinner, take out the dog, throw in a load of laundry, etc. Twelve hour shifts are beautiful and cumbersome all at once.
So we get c-section after c-section after c-section. I'm caring for my skinny preemies in Special Care and playing secretary for the nursery so we can all get out on time. A lady rolls by on a gurney at 6:45 from the ER. Char (nursery nurse) and I look at each other. No. If that's going to be another c-section, hold it off until after the change of shift at the very least. The night shift is starting to wander in, we're so close.
Our pagers all collectively go off. STAT c-section for heart tones that are in in the toilet. Ummmm....Char, you keep admitting that baby, I'll go. That'll give the night shift a chance to change into their scrubs and get clocked in. Linda (my relief), there's my report sheet, I'll be back in a few. Back to the OR. It sounds like a busy cafeteria with the instrument table being quickly opened and arranged. Mom rolls in and she's bawling. No time for a spinal so anesthesia puts her under general. The pediatrician delegates to me and the nurses who have appeared out of nowhere (praise God): he has the airway, I have the heart, Char has the lungs and the monitor, Sarah's recording. Baby's out, no respiratory effort, no color, no heart rate. Six minutes later, we've done CPR and he's intubated and is minimally stabilized. It felt like an hour. Get him into Special Care, call the Big House, get lines in, remember S.T.A.B.L.E.!! Sugar, Temp, Airway, Blood pressure, Labwork, Emotional support. Set up the line tray - did anyone get a sugar yet? Is the transport team on its way? Where's the transport paperwork? Katie, copy mom's chart, call xray. Is that the right dose of heparin for this kid? Check it in Neofax. Ummmm....do we have a line yet? Get a blood pressure - do we even KNOW this baby's weight? Go talk to the mom because no one else has time (like I do). Back to the nursery. His blood gas is awful, sugars are high so he's stressed, and crud, he has a collapsed lung. Umbilical line placement was unsuccessful and his vasculature is too collapsed to draw labs or place an IV. The team from the Big House is here and taking over, praise the Lord. Hugs to the transport nurse - I used to work with her.
Debrief, fill out the resuscitation record, change my clothes and leave. My car's covered with snow and I have a parking ticket. Fabulous. My husband made me dinner, I crawl into bed, get up and start washing dishes - because at least THAT brings some semblance of order that was missing last night and it's something I can fix. Sit in the bathroom and cry and remember God has a purpose for this kid's life too. And this was nothing - NOTHING - compared with the disasters we had in the NICU.
I'm so glad I don't work in the NICU.