Twenty Four Hours

Late nights. Early mornings.

It’s been a long week.  Critical Care and Pediatric exams in the past week on top of an already packed clinical schedule.

Breathe.

The past two mornings, I’ve been dragging myself out of bed, doing my best not to wake Phil (he doesn’t care for waking up at 4:30am when he doesn’t have to), and self-medicating with two shots of espresso and steamed milk. 

We take report from the night nurses at 7am and get the scoop on any incoming Labors for the day.  There are a few surgical cases on the floor (reproductive health patients, mastectomy’s, hysterectomies, etc.) and one (that we know of) woman in active labor.  The floor is relatively quiet. 

Morning meds are administered, I disconnect an IV on a mom who is being discharged along with her healthy baby, listen to an infants heart and lungs…what’s that?  that extra sound, I hear? Oh, I’ve got a murmur.  Awesome.  Not to worry, most infants’ murmurs resolve on their own.  This kid’s murmur may even be gone before lunch. 

Document. Document. Document.  If its not written (or entered into the computer) then it’s not done!  (Nursing 101)

We discuss breastfeeding and childrearing in the down-time before lunch.  Over lunch, we quiz each other by presenting case studies with made-up Health Histories and Physical Exam findings, lab values, diagnostic results, etc.  We give our differential and diagnose and treat the ‘patient’. 

How else would we spend lunchtime?

Back to the floor and it’s quiet.  Very quiet.  We were considering calling it a day and getting in some extra study time before our Peds exam just when we hear a code be called. 

What is going on?! 

I ask the charge nurse how I can help, she says ’Woman in her 20s coming in from the ER. Gestational age is unknown. Find the family and get a history’.  I’m on it.

I called out her last name in the waiting room (Not to be repeated here.  Your welcome, HIPAA) and up stands the young woman’s mom and sister.  Both were pale and crying.  I explained that I would take them back to see their family member and that she was in a triage room with A LOT of people and confusing equipment (code was called because we knew nothing about this mom and baby…NOTHING) and that I had some questions to ask on the way.

How many weeks pregnant is your daughter?  Is this her first child?

Blank stares followed by more tears and the stuttered phrase…”We didn’t know she was pregnant…She doesn’t know that she is pregnant!” 

Omg.  Is this really happening?  What do you mean, she doesn’t know that she is pregnant! This is not some TV show?  How can she not know she is pregnant! This is what is going through my head and I’m sure they could see on my face.  Think quick, Sam.  Don’t scare them more…insert ^ words of comfort here^!  Oh Geez.  

I take in as much information as possible in the short distance from the waiting area to the Triage room.  I get the sister a box of tissues and water and step back to see nurses running this way and that, OB/Gyns and Pediatricians coming out of the woodwork.  Respiratory team is entering and the NICU has been contacted and a team is on the way.

Breathe.

Mom screams for maybe three good pushes and then we all hear the most wonderful noise.  The noise every mom wants to hear in the slow motion moment after the baby is out.  CRYING! Vigorous crying! 

Much more transpires over the hour that follows.  APGAR 9 and 9. Baby is stable and vitals are normal.  Baby measures TERM.  This is a TERM baby (greater than 37 wks!) and no one knew!  How does this happen?

In a matter of a few terrifying hours, this woman’s life is changed forever.  She has a beautiful, healthy baby girl and both she and baby are going to be ok.  Right? 

Shift ends.  I wave goodbye and smile at the family on my out.  I pray they will be ok. 

Leave the hospital, go to study group.  Review my notes.  Life keeps going. I have an exam in the morning.   

An exciting and exhausting day.   Sleep overtakes me like an afternoon ocean fog. 

Alarm. 4:30am.

Another Day.