Cowboys and Emergencies in Obstetrics

June, 1982 – Jackson Hole, Wyoming

After flying all day across the USA to get here, the airport van dropped me off in front of the picturesque hotel where they were holding a week long conference for doctors and nurses on Emergencies in Obstetrics. I was thrilled that my director gave me three educational days and paid for this national seminar as long as I agreed to give an in-service to the labor and delivery nurses when I returned. I was on my own to pay for airfare and hotel. I could not afford to stay at the hotel where the seminar was held, so I booked a room at a cheaper motel down the hill.

The van driver told me there was no taxi service in Jackson Hole. As I was wondering how to get my suitcase down the hill to the motel, a pickup truck pulled up. A cowboy got out and asked, “Howdy, Miss! Do you need a ride somewhere?” I explained how I just needed to go down the hill. He said, “I’m going that way, so hop in! No problem at all!” And he swung my big red suitcase into the back of the truck. I thought to myself, “He seems like an honest friendly guy, so I guess it’s OK.” He promptly drove one block down the hill, put my suitcase on the little porch, tipped his hat, and wished me a good day. I tried to give him a few dollars, but he absolutely refused and said it was his pleasure to help me out. Folks sure seem friendly here!

The cowboy politely dropped me off at my motel. No taxis in Jackson Hole!

The cowboy politely dropped me off at my motel. No taxis in Jackson Hole!

Since the next day was Sunday, I looked in the yellow pages of the phone book for a church to visit. I found the name of one and asked the motel owner for directions, which he wrote down for me. I took off walking to church with my Bible and finally arrived in time for time for morning worship, 5 miles later! I didn’t realize how far outside of town it was, but God richly blessed me with the Bible message. During the welcome time, the Pastor asked any visitors to stand. I stood and a married couple also stood. We introduced ourselves to the small congregation, and I discovered they were a doctor and his wife from the Midwest who were also attending the seminar!

God blessed me at the church I walked to 5 miles outside of town.

God blessed me at the church I walked to 5 miles outside of town.

We became better acquainted after church was over. When they heard I had walked so far to get there, they happily offered me a ride back to town in their rental car.  Then we went to lunch together in a log house called “Jedediah’s Original House of Sourdough”. The history of Jackson Hole on the newsprint menu about Jedidiah Smith’s adventures in the Rocky Mountains in 1829 made for enjoyable reading.

Jackson Square has an archway of elk antlers on each corner!

Jackson Square has an archway of elk antlers on each corner!

The seminar was excellent during the mornings which left the afternoons and evenings free for sightseeing. Dr Earl and his wife, Patty, adopted me for the rest of the week, and we had great times of fellowship as we explored the Grand Tetons, Yellowstone National Park, went hot air ballooning in Idaho, and took a rafting trip. As I drove their car during the week for them, Dr. Earl read from the Psalms to Patty and me. It was so refreshing to meet a doctor who fervently loves the Lord!

Jenny Lake in Grand Teton National Park

Jenny Lake in Grand Teton National Park

Jackson Lake - so beautiful!

Jackson Lake – so beautiful

Fabulous balloon ride in Idaho over ranch land!

Fabulous balloon ride at dawn in Idaho over ranch land!

One afternoon, I took the ski lift gondola to the top of the mountain overlooking the town of Jackson Hole. I gazed off into the distance and saw mountain after mountain as far as I could see. As I thought about some low points of a year ago when I had to switch jobs, and then had the severe back pain in December, I just praised God for this week of oasis and renewal.

Still lots of snow in June in Jackson Hole!

Still lots of snow in June in Jackson Hole!

I will lift up mine eyes unto the hills. From whence cometh my help? My help cometh from the Lord, who made heaven and earth.” Psalm 121:1-2

On our final day, we took a covered wagon ride through the woods. As we ate our delicious chuck-wagon dinner of barbecued beef, cowboys serenaded us with songs from the Old West. It brought tears to my eyes as they sang “How Great Thou Art” in perfect harmony. What a great finale to the week which began with a friendly cowboy!

Fun covered wagon ride to our dinner in the woods.

Fun covered wagon ride to our dinner in the woods.

Cowboys serenaded us with songs from the Old West

Cowboys serenaded us with songs from the Old West

When through the woods, and forest glades I wander, And hear the birds sing sweetly in the trees, When I look down from lofty mountain grandeur and hear the brook and feel the gentle breeze,

Refrain: Then sings my soul, my Savior God, to Thee; How great thou art! How great Thou art!

And when I think that God, His Son not sparing, Sent Him to die, I scarce can take it in, That on the cross, my burden gladly bearing, He bled and died to take away my sin. Refrain

When Christ shall come with shout of acclamation, and take me home, what joy shall fill my heart! Then I shall bow in humble adoration and there proclaim, my God, how great Thou art! Refrain

Reflection – 2015

Numerous times God has taken me through a difficult trial in my life, and then graciously blessed me with a time of refreshing like He did in Wyoming. Even though I went to the seminar alone, He gave me sweet fellowship with Dr Earl and Patty the remainder of the week. I never would have met them if I would not have walked those 5 miles to church! I know God saw my heart and longing for fellowship with other believers and brought us together.

By the way, I also learned quite a bit about how to handle Emergencies in Obstetrics and received my certificate verifying the 24 hours of lectures I attended. And I shared my new knowledge with the other nurses in labor and delivery when I returned 🙂

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Nurse Burnout Prevention

Labor and Delivery- April, 1982-11:30 p.m.

We only had one lady in labor tonight, so we all pulled out our various needle crafts and Theresa went and made a huge pan of popcorn for everyone.

popcorn

POPCORN! Favorite labor & delivery snack.

The resident doctors and med student pulled up a chair also to chat for awhile. Anne and Susie like to do counted cross stitch and taught me how to do it, so I am working on a strawberry clock. I find it quite tedious on my eyes to count all the tiny stitches and use the right color thread according to the pattern, but I’m determined to finish it! Bonnie likes to crochet and volunteered to teach me how to do it after I finish my clock. It’s fun to feel creative in between patients and on breaks!

My 1983 Strawberry clock still hangs in my kitchen!

My 1983 Strawberry clock still hangs in my kitchen!

No matter how busy we get, Mary Lou, our assistant head nurse always makes sure everyone takes 30 minutes for lunch. She knows how essential it is to fuel our bodies and to take a break from the intense speed at which we sometimes have to work. I thank God that I can work with such a pleasant group of hard working nurses. Since I started last summer, they have been so kind to mentor and teach me. Most of them have many years of experience and absolutely love labor and delivery!

Reflection – 2015

I think job satisfaction was the highest among the labor and delivery nurses than any other group I ever worked with over the years. They all loved helping to bring babies into the world and found their needle crafts to be a good stress breaker and use of their time when we were slower.

Nursing is a high burnout profession since it tends to be very stressful mentally, emotionally, and physically. I searched online to see what other nurses were writing about preventing burnout, but none of them approached it from a Christian perspective, nor had they worked very long as nurses. It is purely by God’s strength and mercy that I have been able to work for 38 years as a nurse. So I decided to make my own list of how God has led me to cope with the stress of nursing.

1. I start my day with Bible study and prayer before I go to work. I ask God to teach me from His word and commit the day to Him, ask for His wisdom, and that I would be a good testimony for Him. I write down a Bible verse from my quiet time and put it in my lunch box to think about later on. Today my verse was Psalm 94:19 “In the multitude of my thoughts within me, Thy comforts delight my soul.”

2. I always eat breakfast before I go to work and pack my lunch. I try to eat whole unprocessed foods, lots of fruits and vegetables, and drink lots of water to stay hydrated. The main cause of headaches at work is from dehydration.

3. Exercise. I do some stretches in the morning and ride the stationary bike and lift weights in the employee gym at work. It really helps to get rid of the kinks from sitting at the desk and boosts my energy. On weekends I walk outside or do an exercise DVD inside.

4. I love to learn new things totally unrelated to nursing. Art, music, and travel are my favorite ways to unwind. Last year I went to a weekend fiber arts retreat for Christian women. As we knitted and crocheted all weekend, I discovered that over half the women were nurses!

Knitting and crocheting are favorite stress breakers!

Knitting and crocheting are favorite stress breakers!

Over the years, I have taken oil painting, glass painting, cake decorating classes, mountain dulcimer, and violin lessons.

Monochromatic winter oil painting I did in class.

Monochromatic winter oil painting I did in class.

Painting on glass is fun!

Painting on glass is fun!

Cake decorating class.

Cake decorating class.

Last year, I began hosting a group of guitar, violin, and dulcimer players from church for a monthly night of playing hymns together which is great fun!

My mountain dulcimer is great fun!

Mountain dulcimer

Playing my violin and dulcimer are great stress busters.

Playing my violin and dulcimer are great stress busters.

Over the years, I’ve learned German, Chinese, Spanish, and a little Hebrew. I’m far from fluent, but it feels good to stretch my mind and comes in handy when I travel. Many times I have trouble finding someone to travel with me, so I was happy to discover Road Scholar a few years ago (www.roadscholar.org). This is not a Christian organization, but they have interesting educational trips all over the world. Often the single supplement is not too exorbitant, so I get a private room, and enjoy meeting many new interesting people at mealtimes and during the educational activities. Usually, there are quite a few who are traveling alone like me.

4. I find it interesting and thought provoking to read biographies and about history. I discovered I can check out free books from my public library on my Kindle through the Overdrive app!

5. I buy myself fresh flowers a couple times a month, especially during the dreary New England winter.

Cheery primrose in the winter!

Cheery primrose in the winter!

6. To change it up, I drive home by a different route  and notice everything along the way. When the weather is nice, I stop at a park and take a walk before arriving home.

7. I LAUGH, SMILE, and SING praises to God as much as possible, because it always lifts my spirits. “Then was our mouth filled with laughter, and our tongue with singing.” Psalm 126:29.

8. I do deep breathing exercises with visualization of my favorite scene. I tend to hold my breath unconsciously when I become tense, so I put a little sign on the wall above my phone, “TAKE A DEEP BREATH, PAM!” It helps when a patient starts yelling at me for something over which I have no control.

9. Whenever I have been in a very stressful job situation, I ask the Lord to deliver me in His time and His way. Sometimes He does it by changing my attitude or the people around me, or He moves me to a different job. It is so wonderful to trust Him! “Casting all your care upon Him, for He careth for you.” I Peter 5:7

10. I do something spur of the moment for the sheer fun of it!

11. I avoid negative people and gossipers.

12. When asked to do something extra, I ask God if He wants me to do it before I answer. I need to guard against spreading myself too thin and getting overly exhausted. “Redeeming the time, because the days are evil.” Ephesians 5:16

I would love to hear about your stress breaker tips and how you prevent burnout. Email me at pamela.aprn@gmail.com

Surprise in Labor and Delivery – Part 2

March, 1982 – 12:50 a.m.

I glanced at the white board after we transferred the surprise twins to Neonatal ICU for observation (see Part I of previous post). Bonnie, the health tech, had put a new admission in my other room named Wanda. Bonnie handed me her blood pressure and temperature on a piece of paper, and warned me, “Pam, she is extremely overweight, so I think she will have a difficult delivery.” I walked in the room and introduced myself to Wanda who was accompanied by her equally large husband, Martin. She told me she was 23 years old and this was her second pregnancy. She had a miscarriage at 14 weeks last year. Her last weight in the office was 305 pounds. She said her contractions began about 5 hours ago and were now 5 minutes apart, so her doctor told her to come to the hospital to be checked. I had brought the doppler stethoscope with me which was a very sensitive electronic stethoscope that is more sensitive than the manual fetoscope.

Manual Fetoscope to listen to baby's heartbeat. Curved part is placed on nurse's head for conduction.

Manual Fetoscope to listen to baby’s heartbeat. Curved part is placed on nurse’s head for sound conduction.

Electronic doppler to listen to baby's heartbeat

Electronic doppler to listen to baby’s heartbeat

I placed ultrasound gel on the end of the doppler and began trying to listen to the baby’s heartbeat on her very obese abdomen for an entire 5 minutes. I couldn’t hear anything through the layers of fat. Wanda grimaced and said she was having a contraction as she looked at her focal point and started Lamaze breathing. I placed my hand on her abdomen to feel the contraction, but felt nothing. After she said the contraction ended, I did an internal exam and felt her tightly closed cervix with the baby’s head up high in the canal. I did not have an elastic band long enough to go around her abdomen for the external monitor, so  I asked her and her husband to get up and walk around the halls for 60 minutes and then I would recheck her. This was our standard procedure if we were unsure if the woman was in labor.

After an hour, I rechecked her and there was no change. I called the resident MD and gave him my assessment. “Give her one seconal now and another to take at home if she is not asleep in one hour.” I went back in her room and told her that since her cervix had not changed in an hour, she was having false labor pains (Braxton Hicks) of her ligaments stretching and gave her the seconal. She was NOT happy to be going home and told me so.

I finished that busy night, and as I was walking out the door at 7:30 a.m., Barb, one of the day shift nurses came up to me. “Pam, they just brought Wanda back up from the emergency room. The ER doctor delivered her baby in the parking lot! She is furious with you for sending her home and said she is going to sue you.” My heart sank and my eyes filled with tears as I walked out the door. Sometimes, nursing is a very tough job….

When I arrived home, I opened my Bible to Psalm 46 and asked God to comfort me.

God is our refuge and strength, a very present help in trouble. Therefore will not we fear, though the earth be removed, and though the mountains be carried into the midst of the sea…Be still and know that I am God; I will be exalted among the nations, I will be exalted in the earth. The Lord of hosts is with us; the God of Jacob is our refuge.

I prayed that Wanda and her baby would be healthy.

October, 1982 – 7:30 a.m.

After we gave day shift report, my head nurse came to me. “Pam, the hospital attorney wants to speak with you in the legal department at 8 a.m. about a law suit from one of your patients.” I took a deep breath and asked God to give me a quiet heart. I entered the office and a tall thin gray haired man greeted me and introduced himself as Attorney Steel.

“I asked you to come review a chart with me because a woman named Wanda S is sueing the hospital for emotional trauma, inaccurate assessment, and negligent care of her when she was in the labor and delivery unit. You were the only one who examined her,  and then she came back later that morning and delivered the baby in the parking lot. Please look at your charting and tell me about what you remember about Wanda.”

I opened her thin paper chart and read my brief notes. I read the verbal order I wrote from the resident to give her 2 seconal and discharge her home. Thankfully, he had cosigned it. It seemed strange to be reading my handwriting six months later. Attorney Steel said, “Did you forget to write any other assessment or do you remember anything else about what happened with Wanda that night?” “No, she was only there an hour. She was very difficult to assess because she was so obese. My charting is complete.” He thanked me for coming and I went home.

I never heard the outcome of the law suit. But it was a good reminder to me to chart completely and accurately immediately as things occur, especially in a place like labor and delivery where things change dramatically in mere seconds.

Reflection – 2015

One of the huge problems in medical care in the USA is the cost which is driven up by exorbitant malpractice suits against medical professionals. When I took a nursing tour of China in 1986, I was amazed that each patient only had a single piece of paper on a clipboard hanging on the end of their bed! I looked with longing at that little clipboard, wondering what it would be like to only have to write a few characters on each patient each shift. The head nurse explained that since it is a communist nation, the people were not permitted to sue any doctor or nurse for malpractice. Each patient has their personal health notebook that they bring to the clinic or hospital and then take back home. Therefore, there are no departments for medical records or malpractice attorneys.

Minimal charting in China in 1986

Minimal charting in China in 1986

Much of the charting we do is to prove we are practicing nursing according to the standard of care and to cover ourselves if we are ever sued. My college nursing instructor drilled into us, “If it’s not charted, it’s not done.”

The following is an exerpt from “Make Your Nursing Care Malpractice Proof” – January 2012, Vol 7, No. 1 by Deanna L. Reising PhD, RN

Six categories of nursing malpractice claims have been identified:
•failure to follow standards of care
•failure to use equipment in a responsible manner
•failure to assess and monitor
•failure to communicate
•failure to document
•failure to act as a patient advocate or follow the chain of command.

As I thought about the situation with Wanda, thankfully I did not commit any of those “failures.” Babies simply have a mind of their own, and they don’t read a book about how or when to be born! Expect the unexpected in obstetrics.

Surprise in Labor and Delivery! Part 1

March, 1982- 11 p.m.-Labor & Delivery

Mary Lou, our assistant nurse manager, wrote our assignments for the night shift on the large white board at the nursing station after we listened to report from the evening shift. We only had 5 women in labor so far, so she gave me Helen in the birthing room and the first admission.  Helen had 2 children at home, was 28 years old, and was dilated 5 cm (halfway). She was at 37 weeks gestation, which was technically 3 weeks early, but typically the baby would have mature lungs and be over 5 pounds in weight.

I walked into the birthing room and introduced myself to Helen and her husband, Mike. Helen was a pretty blond lady with large blue eyes. Her dark haired handsome husband seemed quite attentive to her. She looked exhausted from labor and being pregnant. As a contraction began, she began to do her Lamaze breathing as Mike held her hand. I placed my hand on her swollen abdomen to feel the strength of the contraction.

After it let up, I asked, “Do you know if you’re having a boy or a girl?” Helen replied, “No, Dr. J. doesn’t believe in doing ultrasounds if the pregnancy is normal. We already have a boy and a girl at home, so we’re ready for either.” I checked her blood pressure which was normal,  and then did an internal exam. The amniotic sac of water around the baby had not broken yet, so we were not yet monitoring the baby’s heart beat internally. She was further along now.

I looked at the external monitor strip which recorded a normal heart rate and variation at an average of 130 beat per minute. I wrote my assessment and initials on the monitor strip, and said to Helen and Mike, “I’m going to call Dr. J at home and tell him to come in. You will probably deliver in the next hour.” Helen groaned and began her breathing as another contraction started. I left the room, wrote my new assessment on the white board, and called Dr. J. and then assessed another patient in labor whose nurse was in the delivery room.

When I returned to Helen’s room, I found Dr. J with her. He was in his scrubs, and said he just broke her water. Since she was fully dilated, he told her to start pushing. As this was her third baby, she would probably deliver quickly! I pressed the call light and asked the tech, Theresa, to come in and assist. I removed the bottom of the birthing bed, put Helen’s heels in the stirrups, raised the head of the bed, and gave her the steel handles on each side of the bed to grip. Theresa wheeled the sterile table out of the closet and uncovered the instruments so they were all ready for

Helen gave 3 pushes, and the baby’s head crowned, covered with blond hair. Dr. J told her to push gently, and a perfectly formed baby girl slipped into his hands. He suctioned out her mouth, she grimaced, and let out a nice cry! The beautiful sound of that first cry never ceased to amaze me! I pulled the Apgar cord and wrote down the birth time: 11:50 p.m. Her one minute apgar was excellent at 8/10 as Dr. J. placed her in the warmer. She appeared to weigh about 5 pounds, which is slightly small for 37 weeks. I congratulated Helen and Mike on their new baby girl and rubbed her dry with the warmed blanket and put a cap on her head to help her retain her body heat.

As Dr. J massaged Helen’s abdomen to deliver the placenta, he said, “You have another baby in here, Helen! You’re having twins.” Helen immediately began to cry and said, “Oh no, how will we ever pay for another baby?” Mike turned pale. My heart quickened as twins are always a high risk delivery, especially surprise twins! I had never delivered twins in the birthing room before, but it was too late now to move her to the delivery room! I pressed the call light and told the tech at the desk what was happening and asked her to get the resident in here and the Neonatal ICU nurse stat! The room quickly filled with extra staff so we barely had room to turn around.

Thankfully, the second baby was also head down and came out equally as easily 5 minutes later. She was also a girl! Dr. J placed her next to her sister in the warmer and we quickly dried her off. She also had excellent Apgar scores and appeared to weigh around 5 pounds. We handed one girl to Helen and the other to Mike to hold, and they both seemed to relax a little as they began to get over their shock of having not one, but TWO new babies!

Surprise twin girls!

Surprise twin girls!

I silently prayed that Helen and Mike would realized that God could give them His love, strength, and finances in Christ Jesus if they would only trust Him. I thought of how many childless Christian couples who would absolutely love to raise those beautiful twin girls in the nurture and admonition of the Lord! Children are so precious to God because He creates all of us.

Lo, children are an heritage from the Lord; and the fruit of the womb is His reward. Happy is the man who hath his quiver full of them… Psalm 127:3, 5

The father of the righteous shall greatly rejoice, and he that begetteth a wise child shall have joy of him. Thy father and thy mother shall be glad, and she that bore thee shall rejoice. Proverbs 23:24-25

After I woke up the next afternoon, I was glad it was my day off, giving me some extra time to think and pray. I continued to pray for the new twins to be healthy and receive Christ as Savior at a young age. Sometimes it’s difficult to be content and be single since most of my friends are married and having children. I wonder if God will ever give me a husband and children? I know His will for me today is to simply fix my eyes on Him and be content. I opened my Bible and read,

Not that I speak in respect of want; for I have learned, in whatever state I am, in this to be content. Philippians 4:11

It always encourages me to read this and think of the great Apostle Paul who God used to write these words. Apparently he was single, or a widower during the last part of his life and had to learn contentment also. I decided to get out my cassette tape on “Social Relationships” by Dr Stephen Olford to review Biblical principles of companionship, comradeship, courtship, and singleness. I always feel better after listening to it! Especially when he says, “You dear young people, if God wants you to marry, He will NEVER allow you to miss meeting your life partner!”

Dear Lord, Help me to rest in You in sweet contentment and just live one day at a time. Thank you that I am single today and that Your ways are so much higher than my ways and that You make no mistake! Amen.

Reflection – 2015

I was thrilled to find Dr. Olford’s message at the following link:

http://www.sermonindex.net/modules/mydownloads/viewcat.php?cid=426&min=20&orderby=titleA

I think every single person and parent would greatly benefit and be encouraged by this message! The Lord has allowed me to continue to be single as I near my sixth decade of life. I no longer fear being single as I did when I was younger, because God has been so kind and gracious to me over the years, and provided for my every need. I praise Him for His precious gift of contentment!

Some years ago, God guided me to the wonderful verse in Isaiah 54:1

Sing. O barren, thou who didst not bear; break forth into singing, and cry aloud, thou who didst not travail with child; for more are the children of the desolate than the children of the married wife, saith the Lord.

After I read this verse, the Lord showed me that there was no limit to the number of spiritual children I could have! How wonderful!

Next week I will continue with the next surprise of that very busy night in Labor and Delivery!