Adventures in Nursing, Part 3

For those of you that don't know, when I first got out of nursing school I decided to take a job with Parkland Memorial Hospital in Dallas. I was working in their Labor and Delivery, which delivers the most babies in the United States and second in the world (there is a hospital in India who delivers the most). It is a crazy place! I went there because it is also a great place to get experience, you will see things there in the first 6 months that you might not see in 30 years of nursing elsewhere. I am glad that I went there because it made me able to deal with whatever was thrown at me in my nursing career, but it was also very hard on me. I would work a 12 hour shift and realize on my way home that I hadn't been able to sit or eat the entire shift. I had 5-6 laboring patients a night sometimes, where most hospital will never give you more than 2. So, suffice it to say that I have a lot of crazy stories from Parkland. Today, I will treat you to two mini tales, one about myself and one about a friend that started at the same time I did.

Story 3A: INTERCOMS ARE NOT GOOD IN AN EMERGENCY!

I was in the midst of the 6 month internship at Parkland. It takes that long to learn all the info you need to be a functioning Parkland nurse. About 3 months in they start letting you out on your own, doing vaginal deliveries and taking care of laboring patients. You are not allowed to do c-sections or recovery room until you go through the second half of the internship.


So I was on one of my first days on my own and one of my patients is delivering. So the first year resident and I went back to deliver the baby. Deliveries at Parkland are very low key if they are routine, just you and a resident. So, I was busily getting my stuff ready for delivery, drawing up pitocin, getting my warmer ready for the baby and working on completing paperwork. You don't take a patient back for delivery at Parkland until the baby is mostly hanging out so the doctor can usually handle all the coaching once you get back to the delivery room. So I was not really paying super close attention as the baby is delivered, until the resident says, "uh-oh." I look over and the resident has the baby's head out but nothing else is coming. She states, "I think we have a shoulder dystocia here, call for help!"


For those of you who don't know, a shoulder dystocia is when the baby's head is out but the shoulder is caught on the mother's pubic bone. It is not really a party, and can be very damaging to the baby if not resolved in seconds. So, I ran over to the intercom, we had to press 510 to call overhead for help. This was an emergency procedure so everyone available on the unit would come running. But what I kept hitting was 5-1-0 then X to cancel. I did this like 3 or 4 times, 510X, 510X, 510X each time getting more and more frantic. Finally, I concentrated hard and hit 510 and then proceeded to scream "SHOULDER DYSTOCIA!!!!!" Little did I know that they were preparing for a twin delivery across the hall so when I yelled, I almost got knocked out cold with the door as people came rushing in the help. Luckily, the shear force from all those bodies charging in catapulted the baby out. I called the NICU and they came to examine the baby who was screaming loudly by that time. Both mother and child were safe. The resident and I came out a little worse for wear, I think.


Story 3B: A C-SECTION WITH A SURPRISE


This story involves my friend Tarsha. She was one of my fellow interns who had come all the way from Virginia to Parkland because she saw the hospital on Discovery Health. She was nice, although she was an inquisitive gal who liked all her ducks in a row. She was a great nurse, but didn't do all that well under stressful situation unless she had everything together. Tarsha, of course, figured out that you can't always have everything prepared. This episode helped her on that road.

I was delivering my patient on the Midwife side of Labor and Delivery. The births were usually low risk and midwives did most of them with the occasional c-section, so we kept a 2nd and 4th year resident on that side. Tarsha had been in another room pushing for a while when I went in to do my delivery. Apparently, they had decided to call for a c-section in Tarsha's room for a large baby. The patient had pushed for 3 hours with no progress. Unfortunately, the unit was very busy so the charge nurse, who is supposed to go back and help the nurse during a c-section wasn't able to. Tarsha told me later that the residents were in a big hurry and were rushing her. She told them that she had to get the drugs for the anesthesiologist and when she came back in the room they had started the c-section without her. Big no-no! Tarsha hadn't been able to get her warmer set up, call the nursery or anything. Back in my delivery, I was just finishing up when I hear over the intercom, "Undiagnosed twins in OR 1, UNDIAGNOSED TWINS!!!". Poor Tarsha, I thought. So, I finished up my delivery and recovery and had my patient transported upstairs. When I got back, the charge nurse tells me to go check on Tarsha because no one was able to go and help her. SHE HAD CALLED FOR HELP 45 MINUTES EARLIER!

Tarsha told me that when I walked into the OR it was like I had a halo and a beacon of light. She told me that she had walked back into the OR after getting her meds to see the baby being pulled out. She grabbed the baby and called for nursery. Tarsha began drying the baby and stimulating as she should when she heard "Baby B? Baby B?". She turned around and the other resident was holding up another baby! There was only supposed to be one baby in there and Tarsha didn't even have a second warmer. So she called the NICU to help with the babies, and then the patient started bleeding uncontrollably. By the time I got in the room, the anesthesiologist needed more drugs to sedate the patient because the spinal anesthesia only lasts about 2 hours. He put her under general anesthesia and the attending physician was called into the OR. We had to race down to the blood bank and get some units of blood. Meanwhile, it was total chaos in the OR for a while. They didn't end up having to do a hysterectomy on the girl which was nice considering she was only 18. Her babies did well and she recovered nicely. Poor Tarsha is still a little traumatized, I think, she still shudders when she thinks about that day. This story is not a good example of how to be a charge nurse or what a good resident should do but things happen and at a place like Parkland, sometimes if everyone comes out okay that is all you can ask for.

I am sure that I will remember some other charming stories from my days at Parkland, although some of the ones that did not end well I don't think I will share. Just remember working for county hospitals, in general, is usually like working in a war zone and you are just glad to come through each shift alive.