Tuesday, March 24, 2009

What We Take For Granted

Today sucked.
I woke up feeling ill and just got sicker as the day wore on.
I took myself in to the hospital well after the shift started. N had stayed for the "evening" shift which goes till midnight yesterday. I had gone to bed early and slept fitfully, drifting in and out of dreams of a birth that I thought might be happening. Early yesterday an induction was begun..
Unpleasant story alert. If you are pregnant and squeamish, or just squeamish, or just would rather not be exposed to tales of some of life's really shitty moments, leave this post now.

Last week it was discovered that a 17-year old, about 20 or 21 weeks pregnant, was carrying conjoined twins. They shared a heart and where connected at the chest/belly (thoraco-omphalo conjoined). The doctor discussed terminating the pregnancy with the family, which agreed. I thought I'd surely happen to miss this birth. But when we went in this morning, she was still there, and she was asleep. Her chart read that she was barely dilated this morning, and had been given morphine. A few hours later, however, her water broke and she was wheeled in to the labor room and was fully dilated. Niki and assumed our positions: far from the bed, with our arms crossed firmly across our chests, and no gloves on.

The birth occurred rapidly and without incident. The plan, such as it was, was to have the babies born and then leave them to expire. They were of course tiny, weighing in at 500 grams (less than a pound) total. They made no breathing effort, but the beating of the heart was visible for quite a while. The young woman made an effort to sit up and peer at the babies but she was urged to lay back down (I am typing “babies” though my head keeps thinking “baby”). In what was the worst taste ever, I thought, the doctor took photos of the babies immediately after birth, right there on the delivery bed. There was no reason that I could fathom why photos had to be done right then and there. The babies were moved over to the side of the room and various people paraded in to see. Not that I felt much better. I was there, for no good reason. I tried to give some comfort to the young woman, while she pushed, but she took no comfort. Nor did she show much outward emotion beyond the challenge of birthing.

After that, the day continued on. A woman came in and we led her to the “Admissions” room where we routinely hook women up to the CTG to get a 20 minute “strip” on the baby, i.e., fetal heart monitor tracing. N checked her first, and she was 2cm dilated. I tried to find baby heart tones, then N tried, then we tried up near the top in case it was breech (we were fairly certain it wasn’t but mistakes happen). Then we got a fetoscope and tried that. We found her pulse, going faster than normal, and confirmed that what we were picking up with the fetoscope was her pulse by feeling her wrist simultaneously. Two more midwives came in and went through our routine, including asking the woman if she’s been feeling baby movements. The woman said she thought she felt some in the morning but isn’t sure since then, as she’s been having contractions that have been occupying her attention. I jostled the baby quite a bit, asked it to wake up, show us where it’s heart was…Finally it was obvious she needed an ultrasound. It was now 12:30…technician was, of course, on lunch. Eventually we made it up there, and fetal death was confirmed. The heart showed no movement. This woman had no discernible reaction.

We all marched slowly back to the maternity ward where she was given a bed, and I wrote it up in her chart. There she would stay, to “await events,” as they put it here. I selfishly hope she delivers before I go back on shift.

I left early, my mounting nausea had worsened. I went back to my room and lay there for the most part, too pukey to do any work (business plan writing assignment) or even read. Hours later I am finally starting to feel better.

I miss home.