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 to walk around the halls with her husband for one hour 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) caused by 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 report to the day shift, 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 S.

“I asked you to come review a chart with me because a woman named Wanda S… is suing 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 capsules and discharge her home. Thankfully, he had cosigned it. It seemed strange to be reading my handwriting six months later. Attorney S 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. 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

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.

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Nursing Tour of China – Part 4

Beijing, Saturday, June 7, 1986

We flew to Beijing this morning so I was up early at 5 a.m. The propeller plane was pretty smooth until it made a roller coaster type landing which gave me severe motion sickness. I was so tired after lunch that I skipped seeing the Forbidden City and Tienanmen Square, but I sent my camera along with one of the nurses.

It was nice to be alone in this beautiful luxurious Holiday Inn where we are staying. Quite an upgrade from the cockroach infested hotel in Xian! After I slept, read my Bible, and wrote a letter, I ordered an American dinner from the menu of a hamburger, French Fries, milk shake, and wonton soup. I cringed at spending $8 (a hamburger costs me 62 cents in USA), but this was the first American food I have tasted in a week since coming to China. It sure tasted good! I think I’ve eaten more rice this past week than I’ve eaten all year. I hope my stomach feels better by tomorrow when we climb the Great Wall.

Mary is a delightful Christian nurse from Alaska on the tour and we have been enjoying sweet fellowship together. We are hoping to take a taxi tomorrow to visit a church. The Lord’s will be done.

Beijing, Monday, June 9, 1986

Yesterday was a full day! We climbed the Great Wall in 95 degree heat in the morning. It was quite a view from the top of the arid and rugged mountains. The emperor began building it 300 BC with thousands of slaves for defense to protect them from the Manchurians in the north. He made it wide enough so his whole army could march along the top of it. The wall stretches over 3000 miles from east to west in China. They estimate 400,000 people died while building it and were entombed in the wall.

Climbing the steep Great Wall in 95 degree heat!

Climbing the steep Great Wall in 95 degree heat!

View from the top of the Great Wall

View from the top of the Great Wall

I climbed a small ladder to  sit on a camel and had my photo taken with the wall in the background. As I climbed down from him, he tried to bite me!

My favorite photo of China as I sat on the unfriendly camel.

My favorite photo of China as I sat on the unfriendly camel.

After lunch, we went to the Ming tombs. My stomach still wasn’t too good, so I just sat in the garden and drank Coke. The others said they walked down five flights of stairs to a large underground empty cavern. Then we had a nice dinner at the Marco restaurant- western style! I felt much better after dinner.

Mary and I checked on the Protestant church, but they only had morning services, so we had our own service together outside in the hotel courtyard garden. We read John 21 and comments from F.B. Meyer on the life of Peter. I can’t help but think of the verses in John 21 when Christ asked Peter three times, ” Lovest Thou Me? Feed my sheep.” The three requirements for service are love, humility, and courage. May God give me all three! I have no idea what God wants me to do in relation to China. Mary and I then had a wonderful time in prayer together for the people of China to receive Christ as their Savior. It was so refreshing to both of us to worship the Lord together!

Today, we toured the beautiful Summer Palace built on the Hill of Longevity overlooking Kunming Lake. After being destroyed by fire, it was rebuilt in 1886 for Empress Cixi and became a public park in 1924. We enjoyed an excellent lunch including sweet red bean steamed rolls- just like the Korean ladies served me back home!

Intricate paintings in the Summer Palace.

Intricate paintings in the Summer Palace.

Some of the nurses had fun dressing up as the Empress!

Some of the nurses had fun dressing up as the Empress!

Temple of Heaven

Temple of Heaven

Empress Cixi's marble boat that does not float was being repaired.

Empress Cixi’s marble boat that never floated was being repaired.

The pandas at the zoo were comical as the parent pandas combed the fur of the baby panda as he played.

Mother panda with her baby. They were so cute!

Mother panda with her baby. They were so cute!

The Peking duck dinner was fabulous! They roast it in honey over a fruit wood fire for two days so all the fat drains off. Then they slice the duck in little pieces which we put inside a crepe with scallions and plum sauce, and rolled it up like a hot dog.

Fabulous Peking Duck Dinner!

Fabulous Peking Duck Dinner!

Tuesday, June 10, 1986

We visited a general hospital for adults this morning and had very friendly nurse tour guides. A neurology nurse gave me her address and asked me to write to her. I included a gospel of John and gospel tract inside my hospital’s magazine that I gave her as a small gift. I was amazed that the Director of Nursing offered me a job to teach there! But the whole atmosphere is so dark and depressing. I don’t think I would survive there alone for very long.

Xuan Wu Hospital

Xuan Wu Hospital

Friendly Neurology Nurse who was our guide.

Friendly Neurology Nurse who was our guide.

Hospital Grounds

Hospital Grounds

General ward with IV in patient's foot

General ward with IV in patient’s foot

Entrance to Intensive Care Unit.

Entrance to Intensive Care Unit.

Acupuncture Chart

Acupuncture Chart

Tour Group photo with hospital nurses.

Tour Group photo with hospital nurses.

Then they took us to a traditional pharmacy with dried lizards, snakes, essence of frog and antlers, etc.

Traditional pharmacy with dried lizards, antlers, and herbs.

Traditional pharmacy with dried lizards, antlers, and herbs.

I also walked the back streets alone for the first time. I was sad to see the poverty and smell the stench as the unfriendly people glared at me. I came across a market where they sold vegetables, live chickens, and roasted ducks. The average Chinese does not have a refrigerator, so they need to buy food daily.

We then flew to Guangzhou (formerly called Canton) and arrived about 7 p.m. We stayed at a beautiful hotel in the country by a lake and had our farewell Cantonese dinner which was superb! We said goodby to our Communist tour guide. He told us this hotel was formerly only used by Communist party leaders.

Canton beautiful hotel in the country

Canton beautiful hotel in the country

Guangzhou to Hong Kong, Wednesday, June 11, 1986

I still have about 15 Chinese gospels of John which I don’t want to take back home. After asking the Lord what to do, I decided to leave them in my hotel room. I pray the housekeeper will deliver them to people who have hungry hearts to know the truth. I am thankful that God’s word never returns void!

For as the rain comes down, and the snow from heaven, and returns not there, but waters the earth, and makes it bring forth and bud, that it may give seed to the sower, and bread to the eater, So shall My word be that goes forth out of My mouth; it shall not return unto Me void, but it shall accomplish that which I please, and it shall prosper in the thing whereto I sent it. Isaiah 55:10-11

After breakfast, we boarded the express train to Hong Kong. There is quite the building boom going on in Guangzhou as evidenced by bamboo scaffolding everywhere. I’m not sure I would want to climb those scaffolds as they don’t look too sturdy to me.

Bamboo scaffolding looked a little scary to me!

Bamboo scaffolding looked a little scary to me!

This southern China countryside I’m viewing from the train window is gorgeous! Brilliant green rice fields, water buffaloes, fishing ponds with men in their cooley hats who are holding fishnets and bamboo fishing poles. Farewell, China!

Green rice fields on the way to Hong Kong on the train.

Green rice fields on the way to Hong Kong on the train.

Dear Lord, Thank You so much for giving me the privilege of visiting this ancient country. How I pray that You would bless the believers, strengthen, and protect them as they give out Your good news of salvation through Jesus Christ, the Son of God. I pray that many will receive You as their Savior. Amen

Reflection

I thank God so much for allowing me to go to China after reading so many missionary books about it. The Lord was very gracious in that I didn’t have any further trouble with my eyes, and my mother did well with her cancer treatment while I was away.

The Lord opened the door for me to return to Beijing in 2004 to assist in caring for some orphans. During a break, I was able to tour Tienanmen Square and the fascinating Forbidden City that I missed in 1986 because of my motion sickness.

Next post I will tell you about the end of the tour in Hong Kong and my time in New York City on the return trip!

Nursing Tour of China – Part 2

Shanghai & Nanjing, China – 1986

June 3 – Shanghai

I was too tired to write last night and am weary again tonight, so I have a feeling this will be a short journal! Yesterday we went to our first hospital tour in Shanghai. We met in a large boardroom first where they told us about the hospital and served us loose-leaf fragrant Jasmine tea in china mugs with a lid to keep it hot. We learned to sip it through our teeth so we didn’t swallow the tea leaves! They told us some health statistics in China compared to the USA.

Nursing in China

Nursing in China

Xin Hua Hospital

Xin Hua Hospital

Entrance to Hospital

Entrance to Hospital

Then we toured the pediatric ward. They have a few pieces of new equipment, but it looks pretty antiquated otherwise – about 1950 era.

Pediatric patient with scalp IV

Pediatric patient with scalp IV

Rubber reusable IV tubing with glass drip chamber and glass bottles.

Rubber reusable IV tubing with glass drip chamber and glass bottles.

Baby under oxygen hood

Baby under oxygen hood

Infant nursery. Note oxygen tank against the wall

Infant nursery. Note oxygen tank against the wall

Nurse's station

Nurse’s station

English lessons for the older children.

English lessons for the older children.

I was excited to talk with Dr. X, a pediatric cardiothoracic surgeon, and give him a gospel of John tucked inside my hospital’s magazine. How I pray he would read the gospel of John and receive Jesus Christ as his personal Savior. He is going to Canada next month to study for a year.

Chinese English Gospel of John I gave Dr X

Chinese English Gospel of John I gave Dr X

Jesus said unto her, I am the resurrection and the life; he that believes in Me, though he were dead, yet shall he live. And whosoever lives and believes in Me shall never die. Believest thou this? John 11:25-26

Then they served us an elegant lunch at the Seaman’s Club overlooking the harbor. We had the unique experience of eating “1000 year old eggs”! They explained how they hard boil the eggs, remove the shell, and bury them in some type of mud until the egg turns black. It was OK, but one was enough! Then on to the Yu Garden with the zig zag bridge which was very pretty, even though there are no flowers in the garden. (I later learned the Communists think flowers are capitalistic.)

Zig Zag bridge to Yu Garden

Zig Zag bridge to Yu Garden

We then strolled through the fascinating old city before boarding our first class train car to Suzhou, the city of silk.

The train was so interesting with 2 seats facing each other with a small lace-covered table between us with a potted plant in the middle. There was carpet on the floor and overhead ceiling fans which made it very comfortable. We again enjoyed tea served by the stewardess.

First Class Train to Suzhou

First Class Train to Suzhou

Suzhou - City of Silk

Suzhou – City of Silk

Suzhou canals just like Venice!

Suzhou canals just like Venice!

Today in Suzhou we saw the silk spinning factory and embroidery factory and another garden. At the silk factory, they put the silk cocoons in very hot water and the women stand all day taking one thread from each  cocoon and threading it on to a large spool to unwind the cocoon. It was 95 degrees in the factory and the women are required to work 12 hour shifts.

Ladies unwind silk cocoons in 95 degree heat

Ladies unwind silk cocoons in 95 degree heat

In the embroidery factory, teen girls do this incredibly detailed silk embroidery which they copy from oil paintings. They showed us eye exercises they did, but there were no older women there because it caused such eye strain.

Young girls do intricate silk embroidery

Young girls do intricate silk embroidery

Then we took a 4 hour train ride to Nanjing. We had fun visiting on the train and getting to know each other better.There are 20 nurses total with 4 of their husbands who joined us. The new hotel where we are staying is very nice with an excellent dinner.

Chinese traditional instrument band

Chinese traditional instrument band

A Chinese band played traditional instruments. In honor of us Americans, they played Jingle Bells, Oh Susanna, and Elvis’ Love Me Tender. It seemed a little strange to hear Jingle Bells in June! Time for bed- my eyes are drooping.

Nanjing, June 4

It’s a sunny 80 degrees today which I thoroughly enjoyed. I slept well which gave me a little more energy. We started out by climbing up 392 steps to Dr. Sun Yat Sen’s tomb. Whew!  I made it without too much trouble. The view of the rolling green hills was so beautiful.

Dr. Sun Yat Sen's Mausoleum. "George Washington" of China

Dr. Sun Yat Sen’s Mausoleum. “George Washington” of China

nan6

87 year old friendly lady had just climbed 392 steps!

I met a very friendly 87 year-old lady on the way down who held my hand as we had our photo taken together. She had just climbed all those steps also! (I later found out that Dr Sun Yat Sen was a professing Christian who was the first president of China after deposing the last emperor in 1911. He is considered the “George Washington” of China.)

After visiting Ming tombs and drinking plum juice at the former summer home of Madame Chiang Kaishek, we had lunch at the hotel and then toured a second pediatric hospital. It was much like the one in Shanghai except our nurse guides asked us more questions. Their nursing research department was very impressive!nan hosp1 nan hosp8

Our friendly nurse tour guides!

Our friendly nurse tour guides!

Patient laundry hanging out to dry.

Patient laundry hanging out to dry.

We stopped for a few minutes at a tall drum tower where a class of 5 year old children were also touring. They were so cute as they walked hand in hand through the tower!

Children tour the drum tower.

Children tour the drum tower.

Typical Nanjing street corner.

Typical Nanjing street corner with “bendable” city bus in background.

Then we ate dinner and went to a variety show. It was lots of fun with a string quartet, singers, a kungfu demonstration, and a hilarious bird imitator. My eyes are closing fast.

Reflection

I still receive Christmas cards from one of the couples who were on the tour and from the Nanjing nurse guide who later moved to the USA. I have visited her twice in North Carolina. I was thrilled to hear how she went back to college to receive her BSN and is doing very well working at a major university hospital. Her daughter has grown up and has also graduated from college. Two of the nurses on the tour married the following year and I was invited to both their weddings. It was quite amazing how quickly our tour group bonded!

 

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.