R(etired)N

True story.

She walked in casually, nicely dressed and makeup - immaculate.



Random photo from an ad

 No heavy breathing, no stopping to have a contraction, nothing.  She smiled at me - and plopped her little suitcase on the floor by the bed.

"So what's going on?" I asked her as I welcomed her to the assessment room.

"I think I might have started labor" she replied.

"Are you having contractions?" Trying to get a take on what's happening.

"I think so." Still smiling.  " I kind of felt a little pressure and thought I would come in to get checked"

That little key word: Pressure.   She didn't look in any way distressed.  Didn't look like she was in labor - yet she felt "pressure".

I quickly put her on the monitor to do a short strip.   "Would you like me to check to see where you are at?" I asked.

"Why not? I am thinking it won't be long"  It wasn't her first.

The thing about mom's in labor, you never really know what you have.   I always believe the mom.  I listen to her.    That word "pressure" triggered something in my head - even though her behavior was nothing like that of most women in labor.  You just don't know.

I checked her.

"Wow - congratulations! You're fully dilated!"

She laughed.   " I thought so.  I was really quick the first time!"

Moral of the story:  Always listen to what the mother says.   Never discount anything she tells you - even if you think otherwise.  Although there are similarities generally speaking - there are always the exceptions.  Pay attention to the mom -  the monitor won't tell you the whole story in labor.  Let the mom be "Queen of the Room" and allow her to dictate what she wants and needs.  Every mother is unique in her needs and wishes - so listen to her!

You just never know.

One thing you don't often see in the Delivery room is a crowning head of BRIGHT RED HAIR.  That little bit of light in a darkened room, shining on the head as it is coming out is like a glowing ember of fire......

Wow. That is impressive.   I have only seen it a couple of times, it is so rare. Usually, the red hair evolves later....but when it comes right at birth in it's full glory....it's amazing.   I love red hair.

The other thing I found amazing was the couple of babies who at birth -  had TEETH.  Their poor moms.  As if it isn't painful enough starting out breast feeding .........

Ouch.

I've written stories about my Dutch Gramma and Grampa on my mother's side.....and their stories are quite interesting and well documented in Gramma's diary for posterity.

But my dad's side of the family also has a few stories - albeit passed on by word of mouth which may make them suspect for accuracy since my uncles - when they all got together - could really weave some yarns.  I am thinking that's the Irish blood in them.

Family photo - Jim and Charlie, Grampa on top the cart

My Grandfather rode out from Orangeville Ontario Canada first by train and then continued on by ox and cart.  I can't imagine what kind of a trip that would have been.   Jim and Charlie - the two oxen - were the main means of power around the farm.

  It was the boys' chore to take them to the river to drink every day.  In the fall, trips were made until the river froze over.   They would then just melt the snow for water.

One day, early fall, the river had frozen on the shoreline and Jim the Ox slipped and split his legs (when a heavy ox or cow did 'the splits' -it is not possible to mend ) and they had to shoot him.
Grandma sent them a letter telling the rest of the family the bad news - that "Jim slipped and split his legs and had to be shot".  Of course, everyone she wrote this piece of news to, thought the "Jim" she mentioned was one of my dad's brothers - "Jim".  It caused quite the stir amongst the family.

I am not sure what kind of medical care they had access to on the prairies - that they actually would think that someone would have to be shot for the sake of a broken leg that couldn't be fixed.

Speaking of which, my father was born on the farm on the Saskatchewan prairies as were his brothers and sister.    He was born at home in the middle of winter, under circumstances much like those my Midwife Grandmother had attended in Alberta. 

He came into the world on New Years Eve -  fireplace going....water boiling on the stove.   Celebrations put on hold as they all waited for the news.   There were no hospitals anywhere nearby if anything were to go wrong. 

I don't have to tell you, he made it ok.

Delivering at home was, as was with everyone living in remote Canada,  the only option unless you had the means to drive miles and miles to the nearest city....and since Grandma and Grandpa didn't have a car until they moved to Vancouver  in the 1940s, that wasn't going to happen.   Even the nearest store, a little general store where they would buy the necessities, was 10 miles away.

Because they lived on a farm, the only items they needed to buy was sugar and a little flour, since they did grind some of their own coarse flour on a grinder rigged up out of  an old car motor.  Everything else would come from the land - vegetables, fruits, berries, nuts.  Saskatoon berries (I have at least 12 shrubs growing in my yard here in BC - they grow wild in the Okanagan Valley) were plenteous, and the gardens would reap bushels of strawberries.

A type of coffee was made from roasting, then brewing - coarse ground barley.  I suppose this is similar to Ovaltine - a "coffee substitute" which uses malted barley for one of it's main ingredients.

Canning for winter was a must.  Every sort of vegetable grown was canned.  Jams made.  Potatoes were gathered and stored in a cellar, unwashed, so they would keep.  Turnips, carrots - all the root vegetables would be squirrelled away for the winter months.

 It didn't matter how old you were, if you could walk around - you could work.

As little kids they would go to school in their one room schoolhouse, but also would have their chores to do at home when their classes were finished for the day - or early morning before walking to school - milking cows, gathering eggs, feeding the pigs and chickens....

My uncle told me that one day they were sent to the neighbor's to help stook the oats so the hayracks could pick them up and take them to the thrashers.  As 8 and 10  year old boys, my dad and my uncle would walk the five miles to the neighbor's and do work in the fields, then after, would sleep in the barn, then come home again after the next day's work.  No thought was given as to whether this was safe to walk there and back or whether it was even work that little kids should be doing.

Their sources for amusement were varied.  Fishing, swimming - all things kids do nowadays but with variations.   My dad would tell me how they would set snares for the groundhogs or gophers.  These animals were a nuisance for the farmers - making holes in the field where horses or cows could catch a leg in and injure themselves.  The boys would get once cent for each tail they could bring in.

At the young age of 12 or 13 - the boys would take their rifles and check their trapline for weasels or coyotes or the occasional rabbit.  They would take along sandwiches - usually jam - which became frozen stiff and difficult to eat in the sub zero winter weather.  My father tells of the time they were gone so long - they missed supper.  Darkness falling by 4-5 pm, Grandma was worried, and by the time they got home, Grandma was crying - thinking they were lost and frozen somewhere.


Anyway, every Christmas, it wasn't really Christmas unless Grandma, and later on - my mother continued the tradition - made Mennonite Fruit Soup "Plumamousse"....... Grandma would make for her now Irish family....

Here is that recipe.  It is as delicious as it was back then, full of flavor in it's sweet goodness, and great if you have any problems in the area of regularity. You could actually blend it and freeze it and use it for a "Prune Whip" in lieu of any laxatives.

Please go to this site for a slightly different recipe

Plumamousse

1 package of Prunes
1 package of dried apricots
1 package of raisins
1/2 cup sugar
2 (or so to thicken) Tablespoons Flour

Optional:
You can add a can of cherries, or dried cherries, apples or peaches - or to make it really easy, instead of separate bags of dried fruit - use a huge bag of mixed fruit that you can buy at Costco.  You can also add cinnamon.

Cover with water or apple juice (then you can leave out the sugar)
Let sit overnight to soak
Boil mixture to soften fruit but leave intact - approx 15-20 minutes, and add cornstarch or flour to thicken
Add milk to thin and eat!
Can serve cold or hot.

Here is a similar recipe on a great Mennonite Recipes site using Tapioca pudding

The only benefit that I can see for having the American Thanksgiving so late -  after the Canadian Thanksgiving (October) ....is perhaps that one can learn from mistakes made in the decor area....

This is either my cousin's idea of a centerpiece FAIL or an experiment by his kids gone wrong.
I can just hear the turkey screaming......

Not a very good Thanksgiving centerpiece idea for your table. Kids - don't try this at home.

My mother used to tell me stories of how she and her sisters would walk all the way from their house in Vancouver during the 1940s to the downtown which was at least 5 miles.  They would take the trolleys part way but there was still a lot of walking, since they lived a little out of the way from the main thoroughfare routes.   In the middle of winter, at times this could be a very wet and bone-chilling proposition. Or snowy.

They would make the time pass quickly by singing all the way. Music was a huge part of their lives - after all, that's how Gramma and Grampa met. 

There was always a concert put on at the local Catholic Church, and even though they weren't Catholic they would go to the Christmas Mass on Christmas eve,  and attend the local Christmas Concerts, especially when there was music.

Her favorite was Handel's Messiah.

I made a point of attending a Concert put on by the Vancouver Symphony Orchestra and the Vancouver Chamber Choir (or the Cantata Choir or the Bach choir - which ever one's turn it was that year)  in 1973 at the Queen Elizabeth Theatre when I was in my first year of college.  I will never forget it.   The music swelled throughout the building - reverberating in the rafters - leaving an echo after the last notes were sung.  I closed my eyes and imagined my mom as a young girl - with her family - listening to the same thing years ago.

My very favorite part, of course, was the  Hallelujah Chorus.

 And now, almost 40 years later, here it is - the same song - still as fresh as it was back then - sung via "flash mob" in  a mall in Welland Ontario - near Niagara Falls - just 10 days ago.....

It still brings a smile to my face....and I must admit...a little tear to my eye.

The part of the news story that I found interesting was the death of the 51 year old grandmother who, at the scene of the explosion, was going in and out of consciousness - but was responding to the gal who attended to her initially. 

What happened after she was picked up by the ambulance is unheard of here in Canada. 

Apparently, as the story goes, en route to the hospital, the ambulance ran out of gas and the family members were asked to pay for the fill up at the pumps before they would continue on.

So now, in my head, I am picturing a severely injured woman in an ambulance  -stopped at a gas station....taking the precious minutes to fill up.   According to the woman's brother, she was also taken to three different hospitals - and it was 3 hours before she was even attended to.  Her daughter,  an R.N., also noticed that the paramedics were using life-saving equipment incorrectly.

The care given may or may not have had an influence on her survival.

Now, I have spent many winter vacations in Mexico since the late 1970s and have never had the misfortune to require any sort of medical care while there.  There is such a thing as the unexpected - such as what happened above  -  but -   what if you chose to have surgery done elsewhere?

There is controversy about having procedures done in another country. 

I have actually chosen to have surgery done in the USA (Radial keratotomy in 1984-when it was not offered in Canada) but I would say that the delivery of care in the USA is comparable to here. Safe enough. Doctors easily researched.  In English.

With Medical Tourism in underdeveloped countries, how do you check out the credentials of a surgeon or the staff?  How do you do research on a facility that you can only go to the website - and not see it in person prior to the procedure - and no reports you can rely on from reputable sources?

How dependable is the accreditation??  How do you assess the quality of care within a country that may not be forthcoming with accurate statistics or information? How do you differentiate the quality facilities from the opportunists?   Can you believe the edited "testimonials" you read? How do you understand any reports if they aren't in English?

Would you choose to have surgery done in a third world country?


Now I get to tell you a sad but true story:



Linda was a fun gal...very pretty, and laughed all the time. As a co-worker she was dependable, efficient and an all-around great nurse.   We spent many shifts exchanging stories and laughs... she was the perfect person to be working alongside - always smiling, always ready to help out or offer a friendly critique.

Her personal life was a tragic one, her husband had died several years ago from an MI - suddenly and shockingly - leaving her to raise her 17 year old daughter on her own.  But - she would come to work and would always be the life of the unit.    We both liked the same area to do our charting and it would be a constant challenge to see who would get to the space first.

Once Linda got her life together - bought a new condo and decorated it *just so*.... the next thing on her agenda was self-improvement. 

She decided to secretly go for some cosmetic surgery.   She never told anyone.   Due to finances... she decided to have the procedure done in Mexico.   Last minute arrangements were made and she flew down south ... the start of what she thought was the beginning of her new life that she had carefully planned out.

Once again - the care given may or may not have had an influence on her survival.

No one at work ever heard from her again. 

The first news we heard of her passing was a phone call to work from her sister back east...  to say she wouldn't be back - that she died in a Mexico Hospital after successful completion of her surgery. 

No other news or explanation was ever given to us.

No news about what happened to the 17 year old, now not only fatherless but motherless too.  No news of what the details were - or even funeral arrangements - if they were made.  Only the last entry on her Facebook page to her daughter,  "I love you sweetie...thanks for feeding kitty for me"....


Occasionally now, I will run across her signature in charts and her face will flash through my mind.... then a wave of sadness......

I miss her.

But then, I am only her co-worker.

What about her daughter....?

I found a couple of old concert tickets in my drawer today and it got me thinking of all the concerts I have gone to.... and then I read over at Albinoblackbear that she went to a Chieftans concert (so jealous!)
So I thought I would try and remember which concerts I have gone through in past years - from the 1970s through to the last one in 2005 or so...
So here we go..... (by the way, this doesn't include pub concerts and what have you....!)

In no particular order:

1. Jesse Colin Young - then and now
2. Trooper 
3. Jethro Tull
4. Little River Band
5. Jim Messina
6. Kenny Loggins
7. Tom Johnston (Doobie Bros)
8. Good Brothers (twice - friendly guys!)
9. Hoyt Axton (twice! Darn, I had dreams of being his backup singer! Sadly, he's passed on - MI) OMG this was my all time favorite song of his!!!  I think I knew how to play and sing every song he ever did.
10. XTC
11. Young Canadians
12. SuperTramp (Breakfast in America Tour)
13. Chris DeBurgh - before he was famous....
14. Doug and the Slugs  (R.I.P.)
15. Burton Cummings (twice) (from The Guess Who)
16. Valdy  (saw him perform up at a ski hill)
17. Juice Newton (at a country fair in East Bay S.F.)
18. Wynona Judd (Concord Pavilion)
19. Take 6 (Concord Pavilion)
20. Oakridge Boys - one of the guys fell off the stage while singing.....
21. Emmy Lou Harris
22. The Highwaymen (Willie Nelson,Waylon Jennings, Kris Kristofferson, Johnny Cash) Amazing!
23. Bryan Adams (twice - a relative got to sing with him)
24. Neil Diamond
25. Harry Chapin (I got his autograph - He met people at his concerts and would give autographs for donations to his charity.  Sadly he has passed on - MI while driving on the freeway back east)
26. Journey (one of the band members handed me a pick with their name on it while performing onstage - unsolicited! - i have since given it to my nephew)
27. Liona Boyd (now if I could only play guitar like her!)
28. Randy Bachman (from BTO ) - here is a different version of the same song-bothe with Neil Young
29. Blue Rodeo (twice - those guys are good)
30. UB40
31. Great Big Sea (Great concert! I was dating a pediatrician at the time - dumped him soon after)
32. Patti LaBelle
33. Long John Baldry (I had a couple dates with one of the members of the band whom I met in a bar accidentally, didn't know at the time who Long John was - met him backstage pre-concert and wasn't impressed.   Also met Kathi McDonald who, by the way, is a fab singer. It's a funny story)
34. Amy Grant  (in the early 1980s and then in 2005)
35. Farmer's Daughter (later met their parents on vacation - chatted with them - very nice)
36. 1998 Lilith Fair: which included -  Sarah McLaughlin, Bif Naked, Sixpence None The Richer, and other assorted musicians.
37. Shania Twain  wasn't overly impressed but I still like her music
38. k.d. lang (before she was popular -- performed in a nightclub)
39. Joe Cocker
40. Loverboy (Mike Reno) - and met him a million years ago in the hospital and no he wasn't the patient...
41.  Chuck Girard - now this is a good story....I will have to tell u this one at a later date....
42. UK  (1970s) - a member went on to join the band YES  - here is YES in later years
43. White Stripes

There could have been other bands that I happened to see, either accidentally or so long ago I forget who they are.   I know I am related by marriage to a Famous Country Singer.  Oh ya. And I used to be married to the lead singer of a band of which I will not name that used one of the members of another well known band - and that's ANOTHER funny (or not-so-funny story) -ended up ditching him.  

Geez. Are there any normal (male)musicians??

I guess I have not had much luck with Men of Music.  I've never been a groupie.  Definitely never been one to chase after someone because they were in a band.  Actually tried to avoid them.  They all just seemed to appear - and introduce themselves and assume I wanted to go out with them. 

At one point before going into nursing, I had been invited to sing in a local band in my hometown....tried it out one night and didn't really care for it.  Too much smoke and too many drunks for my liking.  And -  I was also much too practical.  I couldn't see any future in music.  Nursing won out in the end - and I continued with my RN training.

I did go in 2 singing contests when I was younger - early 20s....quite a large one in the city nearby - won 2nd (someone singing and playing  "The Rose" (urp!) on the piano came first! I sang Hoyt Axton's "Billie's Theme" while accompanying myself on the guitar), and then won 1st in the little local one  .....then won first in a province wide song-writing contest a few years later (won some cash and a chance to record - but declined..) ..........then promptly ran away to East Bay S.F. to work as an R.N.

 Everyone thought at the time I was moving to try and get into the San Francisco music scene, but I had no intentions of doing anything but nursing and was quite surprised and amused when I heard the gossip on a trip home. ( although, I secretly hoped I would have the time to go to Art Institute, but didn't)

 If I was going to do anything creative that didn't make me money - it would be art/painting.  So - I regretfully declined any forays into the music scene.  Besides - if you want to do well in music, you have to want it....and I didn't have that kind of passion.   I still enjoy music (and my acoustic Ovation with a pickup that my band buddies gave me) and have written a few more 'tunes',  but I love art so much more...and that is what I would pick as my "retirement career".


So there you go.

Music. Art. Nursing.

And I picked Nursing.

When I moved back to Canada from the USA - it was a bit of an adjustment to what you can and can't get off the shelves at the drugstore.

I remember in the early 80s, telling the MD I saw in Hawaii on vacation, that I would just go to the drugstore to buy the benadryl for my swollen eye  - and he looked at me like I just told him I was a drug abuser. 

"You can't get that off the shelf - you need a prescription for it" he told me. 

That was news to me - in Canada, at that time, you could just get it off the shelf, just as you could the ibuprofen.

Same with codeine. You can still buy acetaminophen with 8 mg of codeine over the counter without an Rx.  Mersyndol is one of my favorites.....it has an antihistamine in it as well as the codeine. Expensive at $23 a bottle of 100's but a very good medication for migraines.

So,skipping back to the move home to Canada:

 I was in the local pharmacy, and after waiting the 2 or 3 persons ahead of me in the lineup to speak to the pharmacist - I asked the ill-fated question:

"Where on the shelves do you put the Monistat?" - not realizing that it wasn't available except by Rx in Canada at that time. 

I had spent a good half hour looking down every aisle for that life-saving medication.

Loud enough so the entire drugstore could hear, he announced:  

"Dear - you need a doctor to prescribe you Monistat - it's NOT an OTC..."

I was humiliated.  I started to back away, embarrassed to the point of wanting to run.

 Then - He stepped forward.

"Hi" He said. " Would you like me to write you a prescription?" 

I looked over at the kindly face and recognized him instantly as one of the docs that occasionally came to do deliveries and must have recognized me from the Labor Delivery unit.  He had been in the lineup behind me, and -  along with the rest of the crowd - overheard the conversation with the Pharmacist.

"Uh. Oh sure! Thanks so much! " I was relieved and mortified at the same time.

Later, back on the Labor Delivery unit at work,  I asked him if he was taking on new patients. 

"Certainly - for a colleague " he replied.

And so our relationship began.

He was the best MD.  You couldn't ask for a kinder and thoughtful MD.  He was soft-spoken and meticulous in his practice.  AND - his deliveries were always so quiet and relaxed. 

We called him "the Midwife Doc" because the deliveries he attended were so lovely.

I can still picture him sitting on the lowered foot of the bed as he was getting ready for the delivery of a baby on our L&D unit.  The lights in the room were off - except for the soft glow of a portable lamp next to his elbow.  

There was a warm quiet  in the room.  He spoke softly and encouragingly to the woman as she pushed in her own style -  lying on her side on the unbroken bed, husband next to mom, holding her leg during the little pushes.   Midwife Doc patiently waited, supporting the perineum as the baby's head slowly pushed it's way through - crowning ever so slowly. 

Each 5 minute interval Doppler tone had a reassuring - *dop*dop*dop* - as we encouraged the mom. 

No loud noises. 

No counting. 

Just mom and quiet words........

He never panicked. He didn't see the need for an episiotomy.   He looked up me and then over at mom and said casually, "Well, nurse, how is everyone doing?"  Twinkle in his eye.

I looked at the mom - face glowing with sweat, but a serene smile on her face.

"Perfect.  Just perfect" I replied.

In the next few minutes,  the baby easily slid out.....






A month later - it only took one little mistake to change everything.

On the way home from attending a delivery, Midwife Doc was talking on his cell phone as he drove along one of the little town's streets.

He didn't see his red light at the intersection. 

His sturdy car was T-boned, and he was thrown half a block away, through the side window and out of his car - unconscious.

As talk in the town would have it - his GCS scoring on arrival in ER was the lowest it could be.  There wasn't a person in the entire hospital that didn't feel sick about the accident.   

He had little kids - and in fact, I still had the thank-you note from when I had attended at the delivery of his baby that same year.

People that had never prayed before, prayed fervently for this kind doctor. 

Miraculously he did recover, but unfortunately, never to the point where he could go back to his practice. 

I saw him in passing in the community several times.   There was a blank look in his eyes.  Not even a little sparkle.  No recognition of me, or anyone else.  Still the same kind face - but no longer the man I knew.

You could tell he was trying to remember, but he just couldn't quite get there.

His entire life - as he and his family knew it - was destroyed. 

He no longer had a means of employment. 

He was alive, yes.  He still recognised his children and wife....but he no longer had the same joy and was no longer able to follow conversations or remember ..... and definitely all knowledge of his medical training had disappeared.

What are we teaching our children?

I have actually removed 2 of my stories from my blog.   They weren't "bad" stories, and in fact were more on the informative side, positive stories from more than 20 years ago, but unfortunately, our professional body doesn't have much tolerance for anything that appears to be "breach of confidentiality" and thus I have withdrawn them, just in case. 


I had laundered them and then reposted after removing them the first time this past summer - but having looked over the "new" rules, I have come to the conclusion that an ounce of prevention..... 


So, you might notice the only two stories involving *actual* patients (besides myself, relatives, friends and random people out there on the street or neighborhood)are removed - the stories about Amniotic Embolism and the Vanishing Twin Syndrome - because although they had educational and informative value -  it may also fall into that grey area of confidentiality and the last thing I want to do is get in trouble with my Professional Body - even though I don't feel that I have given enough identifying elements and have changed the stories significantly - for my peace of mind, I have removed them.


I do know that our professional and licensing body does troll the blogs, and since a recent email was sent out informing all of the change in the Standards of Nursing practice as it relates to modern day technologies - I will comply. 


Here is in part, some of their Q&A about modern technology on their site:

I have expressed caution re: some gadgets and  their usefulness in the hands of the general public and how they can be more of a liability than beneficial.

Here is one "invention" that is so wrong that the Canadian Government has actually issued a warning and now has pressured a recall.

The "Breastlight" was supposed to be a health and wellbeing product, used to illuminate the breast so you can "see" any changes in your breast.

Problem is - there is a chance that people will use this as the sole method to check their breast and actually forego the monthly breast exams that are supposed to be done or skip follow up post cancer tests/exams with their MD .

It is not an effective screening device for breast cancer.

From the health Canada site:  "It is important to note that there is no clinical evidence that the Breastlight can be used effectively as a screening device for the early detection of breast cancer. As such, it may present a potential risk to women relying on it for early detection of breast cancer."

WARNING:  The "Breastlight" not authorized for use as a screening device and anyone who has one of these instruments should follow up with their MD for any further testing.

Occasionally there would be another mom in labor and there was an extra room just in case, that was set up for deliveries if need be....in a pinch.  It had everything needed for a delivery - but due to the population numbers....it was rare that you would have two deliveries at once, although it has happened.

The small town I worked in had a good number of moms that were what the nurses in the hospital I worked in in California called "Berkeley types"(....and hey, if you are from Berkeley - no disrespect meant, that is just the way they referred to the sandals/long hair/au naturel types down there).  They seemed to deliver their babies with no problem and little effort.  It was amazing.

There were several GPs that did anesthesiology that would come in to put epidurals in.  Now, some RNs  might not be familiar with GPs having the training to do epidurals and give anesthesia might give pause at that bit of info, but the truth is, this is a commonplace thing in rural Canada where the access to anesthesiologists is limited.   It has been shown that it is quite safe to have an epidural put in place by one of these GPs and in fact studies have shown there is no difference in complications and no life threatening incidents occurred when compared to a university affiliated hospital. (these GPs do not do complicated cases - only ASA class 1 or 2)

We did not have obstetricians at this small town hospital.  I looked at that as a positive thing.  Coming from a hospital in California that only had OBS specialty docs and Midwives, I was suspicious at first.   But, I was soon to find that the GPs in Canada are quite competent and usually -  if they knew you were an experienced nurse - they would treat the nurse as a peer rather than someone beneath them.

The GPs I worked with were very capable and did lovely deliveries with less intervention than in the larger hospitals I had worked in - and in fact - were comparable to the midwives I worked with in California.  Mind you, most of the moms were low risk types.  Anyone complicated would go to the next town over.

It was interesting to work at night. Alone. There was a float RN available at home that you would call in if you needed help - if a second laboring mom walked in, or if delivery was imminent.   Of course, not really knowing when a mom was going to deliver had it's challenges.   After the multitude of deliveries I had done up until that point which was in the thousands....one has a little bit better idea as to the timing.  It is just something you *know* after a while....based on a combination of the behavior of the mom in labor, mom's delivery history and intuition..... and somewhat on the dilatation, believe it or not. 

It was nice to have the woman in charge of her labor as opposed to the MD or the nurse.  She was allowed to mobilize at her leisure and only have intermittent monitoring with a Doppler.   I saw very few care plans because there was really no need for any.  Everyone just knew that whatever the woman wanted, or requested, we did our best to fulfill.  There were never any objections to anything that I knew of.    The birthing beds were rarely, if ever, broken down.  I never saw a scalp electrode or a pair of forceps the entire time.   Sometimes babies would go home without the "newborn bath".

I find it interesting that when you google "laboring moms" they are all pictured in a supine position......

I can remember one winter night one of the GPs phoning up to let me know that she was going on a cross-country ski Christmas excursion put on by the town.   She told me she "might" be out of range with her cell at certain times, so if one of her patients went into labor and she doesn't answer right away - don't worry, she would pick up the message at some point.  As luck would have it, one of her patients did come in and, sure enough, I wasn't able to get a hold of her for a good 2 hours.  I almost had to deliver the baby myself, which wouldn't have been a panic at all, really.

When a laboring mom came in, the practice was to wait until approximately 1 hour before she delivered (!) then have one of the other nurses from another ward would call the "2nd pair of hands" to assist with the birth and I  would pick up the phone in the delivery room to notify the GP to come in. 

Most of the time they would get there in time.   Like I said, you develop a 6th sense after a while, and at that point I was at 4 to 5 thousand births and counting.    If they or the backup nurse didn't get there on time, the RNs from the Med/Surg side of the hospital would come and "help out".  Mostly all they did was stand at the door with eyes wide open - they all hated L&D.  Most of them wanted nothing to do with the deliveries - and when they asked if all was OK....and they would give me an expression of relief at my "no thanks" - and run off.

By the time I had worked at the country hospital, I had been fully conditioned to the way most hospitals delivered babies in BC.   It was easy to orientate to the new place -   the same "Partogram" or delivery record is used for monitoring labor and immediate post partum throughout the province.  It didn't matter what hospital you worked at  - the charting was all the same.   Basically, it was just getting used to the MD's routines and where stuff was kept.   Being alone on nights had it's advantages in that I could develop my own routines without interference.

The nursery was another ball of wax entirely.    There was a room beside the nursing station that the moms could wheel their baby into if they wished.  There was no nurse - just a baby monitor that would have the other listening end at the nurses station.  My problem with that system is that sometimes there would be no nurses at the station if it was busy on the Med/Surg side.

 I always encouraged moms to keep their babies with them at all times, and if I did have a baby between feeds if a mom was desperately in need of a rest and wouldn't take "no" for an answer,  I would take the baby with me on my break - I couldn't ever bring myself to leave a babe unattended in the "nursery". 


All in all, a great experience.  I would work there or at any other small hospital again in a minute.   Anyone contemplating working in a very small hospital such as this....I would advise that you be very secure in your OB skills.

The one other piece of advice? Listen to the mom.

She knows her body better than you do.  If she tells you something - listen!  I don't understand those stories I hear that some moms have told me: "the nurse didn't believe me when I told her I felt like I was going to deliver....."

The one thing I can predict about L&D ?

                             - it's unpredictable.



(all photos googled and borrowed from "wikihow" and employment sites)

Occasionally we would have residents come through that had other interesting occupations.   This is a story from 2002:

I happened to be chatting with one of the residents in my course of arranging care for one of my laboring moms, and I could see that she was excited.  She mentioned she had just come from  Los Angeles this past weekend. She explained she had attended the Oscars.

"Wow. That must have been a spectacle" I offered, only minimally impressed but not wanting to dampen her enthusiasm.  My old roommate in California had turned down an invite to go to the Oscars as a date with one of the Big Kahunas at Fox Studios, and had heard of some of the shenanigans that goes on with all the activity around the function.

 "Well, I didn't get to see the whole thing.  I was one of the performers". Matter of factly, as if she was discussing a case presentation.

 I looked at her in surprise.

She seemed to be an ordinary, slightly-built, petite young woman who seemed average in every sense of the word.  And - a darn good resident to boot.

She handed me a photo of herself standing arm in arm with a fairly tall man all dressed in black.  She was flushed with excitement.


I suppose some might be impressed with meeting Sting, however I was too busy what with being in awe of her as one of the troupe members for The Cirque.

  Pretty cool.


The Cirque's Performance at the 74th Oscar in 2002:


Sting's Performance at the same Oscar's:

One of my favorite songs for Remembrance Day was written by a man, Terry Kelly, who wrote it after an experience in a drug store when over the intercom shoppers were asked to observe 2 minutes of silence in memory of our fallen soldiers - on the 11th month at the 11th hour on the 11th day - and the one man who didn't.  Here it is in French.
It is at this time Canadians pause to remember - where ever they happen to be - for 2 minutes....remembering those who have made the ultimate sacrifice for our country.





Then there is a band "The Trewes" who wrote this song when one of their friends from Nova Scotia died in 2006 in Afghanistan.

In Ontario, when a Canadian soldier dies for his country in Afghanistan they touch Canadian soil at Canadian Forces Base Trenton in Ontario. From there, a funeral procession leaves the base and heads to Toronto, taking our departed heroes to the Centre for Forensic Sciences.

 Along the 172km path of Highway 401 -  people spontaneously line the overpasses to show their support, waving Canadian flags and signs or standing at attention,  paying their respect to the fallen and their families.

This portion of Highway is now called the "Highway of Heroes".

All proceeds from this song goes to a fund that awards scholarships for the children of the fallen soldiers:

Holiday Sales.

It is something every store chain has every holiday in the USA - at least -  if what I see on every American TV channel is any indication.

But try it in Canada....on a certain holiday.....and all that store gets is bad press.

As the story goes,  Eddie Bauer needed to dump some of it's merchandise in this "recession" market - so this past Friday, they geared up with their newly minted "Remembrance Day Sale".  Now,  I can see how a company that is based in the USA can make an error such as this - assuming that Canadians are similar to Americans - because after all, we do like a good sale just as much as our southern neighbors do!

An immediate outcry ensued - demanding that Remembrance Day should be a day of commemoration, with "admiration, respect and honour for our veteran" and is not meant to be treated as "just a holiday".  Veterans voiced their displeasure and Canadians quickly -  via Twitter and Facebook - took up the hue and cry to preserve this day as sacred and to denounce the intended Eddie Bauer Remembrance Day Sale as "disrespectful".

 As a result:

"Eddie Bauer president Neil Fisk issued a statement saying the Canadian sale was based on a similar promotion held in the USA.
The Remembrance day sale was meant to be the equivalent of the Veteran's Day promotions held in U.S. locations, he said.
We appreciate the sensitivity around this holiday and the feedback we have received.  We have tremendous respect for Veterans across Canada and the U.S. and will adjust our marketing accordingly," Fisk said. "***

 Going to their website, I see that they have withdrawn it's Canadian campaign, but I still see them advertising their "VETERANS DAY SALE".......

Which leads me to deduce -  according to what Mr. Fisk says - the company either only has respect for the Canadian Veterans....or they are really only responding to the pressure from their target shoppers - and there is no *actual* regard for any Veterans - whether they be Canadian or American.

I will let you decide......



$Cha-ching!$





***TheChronicleHerald.ca (Canadian Press)

Our paper money is known to be quite colorful. 

One of the most common denominations of our paper currency, the $10 bill is a commemoration of those who have sacrificed their lives for our country.

On the far right you can see Robert Metcalfe - a British soldier during WW2 - pictured standing at attention at an Ottawa Cenotaph.

Amazingly he survived the German Blitzkrieg on the European mainland albeit wounded in the legs with shrapnel.  En route to the hospital, his ambulance was ambushed by a German tank.   He was evacuated via Dunkirk - and out of the 3 ships that sailed, his was the only one that survived a severe hit by the enemy. 

On his recovery, he was sent to fight with the allies in Italy and North Africa.  En route, his ship was chased by the Bismarck.  They made it to North Africa and he served under General Montgomery, fighting against the "Desert Fox" Rommel.  It was there that he met and married a Canadian Physiotherapist.

After the war, they moved to Chatham where he was involved in politics, then retired to Ottawa.

For the next 60 plus years he volunteered - raising money for Veteran's causes, speaking for the Royal Canadian Legion to high school students, and acting as a volunteer guide in the War Museum bringing to life the sacrifices made by the Canadian troops.   He hosted trips (often at his own expense) by veterans and their families to the different cenotaphs, battlefields and cemeteries in Europe.

When he was 80 he wrote a book about his experiences.

I was over at the Man-Nurse Diaries reading some of his past blogposts. I ran across this one - "Dad's Prefer Breast Feeding" and had to chuckle - especially when I looked at his pie chart on why....

It reminded me of a story my mother told me once a while back (she would kill me if she knew I was repeating this, but, uh,  oh well - there isn't anyone I know reading this anyway, except for my girlfriend Jan- and she knows everything about my screwball family so it's gonna be no big news to her!)

 It is one of mom's own breastfeeding stories.

My mother breast fed all of her children - all five of us - in an era that encouraged bottlefeeding - the 1950s.  Or - should I say - actively discouraged breast feeding, so I am quite proud of mom for doing what she thought right when there was so much pressure around her to give it up or made to feel somehow that it was wrong.  It seems that milk production was not a problem for the women in her family.  She took to it really well.

So well, it seems, that at times she sometimes had too much milk - if there is such a problem. (which I don't believe!)  What to do when there was no baby around to feed and there is a little bit of excess and she isn't (for some unknown reason) wanting to pump and save?

So - fast forward to many years later when mom was in a group of women from her church who were discussing breast feeding.  The Pastor's wife had just had her baby and it seems that she had the very same "problem".

Of course she asked my mother, being the experienced and wise sage in the women's group,  what she did when the milk was overflowing and there was no baby to put to the breast.

Mom paused, slightly embarrassed.

"Oh, my husband took care of that" she replied sheepishly with a little smile.

 Way to go Mom.   Not the visual I really wanted.

I often listen to CBC (Canadian Broadcasting Corp) radio in the car as I am driving places..... and there is an MD that comes on regularily that gives interesting talks on various subjects.

Here is the plug.

I enjoy listening to his program when I get the chance.
For example - here is an interesting programme on "Healthy Design" from November 5th (repeated Nov 6 and 8th).   You can listen to the sound bite - which expands on the actual intro  by clicking on the audio beneath the article introduction.

It discusses errors made due to electronic devices to the design of hospitals that require RNs to take more steps than they should in the course of a shift to the changes made in psychiatric facilities.

He presents medical topics in a way that is clearly understood and interesting.

Check it out.

Emergency Blues made a very good point in this blog entry.

 I came to a similar conclusion - that your employer may throw you under the bus to save themselves -  with my blog entry in October - Murder in the Hospital.


Listen to this free advice from a Lawyer:






And now the police - agreeing with the lawyer, by the way:

I found Digital Catharsis via Emergency Blues.....
He is a Nurse working in the United Emirates.  His site is worth checking out.

He posted this Youtube Video, which I loved:




It got me thinking about what nurses do.....and what a difference we can make in the lives of others.  I suppose in the past I have taken for granted what people in the "world out there" experience, and although it is all "routine" to us - to those we come in contact with - it is more than routine....it can be  life-changing -  the height of joy and the depths of despair - depending on where you work and who you are taking care of.

The older I get, the more I appreciate my calling.

When I was younger, I have to admit that I did take it all for granted.

Being a Nurse.

There is nothing more reassuring to a patient than a Nurse that is passionate about his/her profession.

I was wandering around on the Internet and I stumbled across a Workshop Presentation by  Perinatal Services BC in May 2010.

 It's a great presentation by an RN and 3 MD specialists - one of which I knew as a Resident when I was working as an L&D RN at a particular Hospital.  She was fabulous and when she decided to go into Obstetrics as her specialty....we were all thrilled (Yay Jen!).  The hospital that has her practicing there is very lucky. 

Also, in the audience, I recognized at least 3 of my former co-workers.  

Here is the presentation.

  It is at least 3 hours long, if you have the time - it is well worth a look.  Hopefully, if you are in the USA, you are able to view it.  It is a great presentation for student nurses as well as RNs.  I would use a little caution if you are a pregnant mom and have no medical background because some of the things discussed, you may not want to hear.

The first part by the RN was a bit of a snooze - but a good refresher nonetheless - the physiology of a Normal Delivery.   Following her are 2 Obstetricians and a Neonatologist giving very interesting presentations backed by numerous studies.

  Here are a few of the highlights in case you are interested : 


- You don't need to do an episiotomy to deliver a shoulder dystocia.  It is not a 'muscle' or 'tissue'  problem but a bone on bone problem.  You also don't need to do an episiotomy for an assisted delivery.  Studies have shown that increased peritoneal trauma occurs with routine episiotomies.  Be patient!!!  Allow the perineum to stretch on its own!

-  Mom pushing on all fours is desirable and is helpful in a dystocia and also with malpresentations.  Delivering on all fours is generally a good idea.

-  Second stage starts when a woman is fully dilated AND has the urge to push.  Take care when diagnosing prolonged 2nd stage -  2nd stage is diagnosed incorrectly if woman is pushing without the urge to push.

-  Physiologic pushing is best and we should modify how we encourage moms to push.  In other words, shorter pushes without breath-holding  - which the mother does instinctively -  until the very end.   We need to do away with those 2 hours of 10 second-breath-holding-counting-to-ten pushes with each contraction.  All it does is exhaust the laboring mom.

-  "Rotisserie" of mom is a good thing.  In other words....keep changing positions throughout labor.  Moving and mobilization is desirable and is proven to be beneficial to mom and the delivery of babe.  There is a drop in interventions in labor when a woman is allowed to mobilize.

-  Mom is the best incubator if you have to do a transfer to another hospital.

-  With careful case selection  and management, it is reasonable and safe to deliver breech.  Vaginal breech delivery is now an option for some Canadian women.

-  Low dose asa is being revisited as a treatment for prevention of preeclampsia.

-  It is beneficial to delay cord clamping.

-  IV oxytocin should not be given IV push post partum unless mother is on a cardiac monitor.

-  Treat a mother presenting with intrauterine demise (IUD) as a DIC unless proven otherwise.


Most of the information above doesn't surprise a lot of us L&D RNs....except that it is coming from Obstetricians.   In BC we are lucky to have a Perinatal program that seeks to optimize Neonatal, Maternal and Fetal health care throughout the Province.

While we are on the subject of  Real Life Travel Horror Stories,  our Canadian Government has a couple of stories of Imprisonment on their website.   They don't sound real to me...but there is one story of a nurse "Lucie" who smuggled drugs.....     www.travel.gc.ca/truestories   not that anyone would do something as foolish as that.

But - you don't have to necessarily be doing something obviously illegal to be detained.  There are countries where you can be imprisoned for the most minor infractions of local customs.  The statistics below show numbers but they don't show any breakdown or explanation.

Doing time abroad: Foreigners filling prisons

So beware, for even a friendly kiss or texting explicit messages can get you into trouble.

And then, as if that isn't a cautionary tale as it is....there are other things that can go terribly wrong.

I have done a lot of travelling in my day,  but I will tell you one thing..... I do my homework before going anywhere. 

She was a  Nurse Manager on a unit I worked on at one time, back when we called them  "Head Nurses".  Most of the nurses on the unit didn't really care for her....she was *old fashioned* - and not in a good way, or sensible way.   But - she did have her "posse" that she hung out with and were her "faithful few".

She ruled it MANDATORY that all nurses on her unit were to wear caps! (I didn't even own one)  Also - It was mandatory to wear pantyhose with the uniform-even pant scrubs. Her reasoning? -  to "catch the pubic hairs" when you had to go into the OR - it was a "hygienic" thing she said (although I have no idea what she expected would happen when the alternate-gendered nurses and MDs(both sexes) didn't wear their pantyhose). **

Pink see-through scrub dresses were her choice of scrubs for the unit (crawling up on the bed or bending over was problematic, never mind that one's slip would always ride up and bunch up around the waist with these scrubs-revealing everything).

 She would look down her nose at you if you weren't "somebody" or "wealthy".... although she herself spent money she didn't have like it was water and barely had a pot to piss in due to her extravagant expenditures.

 


It could possibly be that this enormous debt she piled up with all her outrageous spending caused her to look outside of the country to get her finances in order.

From what I hear....it was a nightmare.

I am thinking she would have carried the same attitude with her as an expat in Saudi Arabia.   I am certain she would not have made very many friends with the way she treated people.   

Apparently she did have one friend there....because it was the friend and herself that got into a whole lot of trouble.

When I travel anywhere, I tend to find out what the laws are and then lay low -  following those laws to the letter.  I also avoid doing anything rashly stupid either.  When in Rome,  they say.....

If one is going to a land that actually punishes the smallest of infractions with cutting off the hand and/or public flogging and quite possibly putting you to death,  sensibility might tell one to refrain from going to that country in the first place.  Especially if one has Attitude and No Common Sense.

I am afraid common sense wasn't a strong suit with this chick.

As the story goes, this nurse and her friend got in trouble for taking photos that they shouldn't have been taking.***  Whatever it was they took photos of,  the "authorities" arrested them, confiscated their cameras and detained them.  


 One of the first things they do when you go to  Saudi to work - they will take away your passport and hold it for you.   So, sans passport and sans contact with the outside world, they were imprisoned. 

They were not allowed contact with anyone.  They did not have access to consulates or other friends or nurses.   They were kept separately in a prison stripped bare of any necessities save maybe a sink and a hole in the ground for a toilet, which to this nurse, was quite an inconvenience I am sure.

For several weeks they were kept in prison - probably one that was a step up from your regular Saudi prisoner but devoid of any niceties.   It was the not knowing what was going to happen to them that ate at them.  They must have been well aware of the possibile consequences.

When you travel to another country, there is only so much that our government can  and will do.  I just got my new passport sent to me from our government and some of the cautions they sent along (an information pamphlet included) are:

1. Your Citizenship offers no immunity
2.  Consular officials do not intervene in private legal matters, do not provide legal advice, do not post bail or pay fines or legal fees.  They do not investigate a crime or death, they do not ask local authorities to give preferential treatment to Canadians.

Peeking through the opening through which dinner is served at a Riyadh prison

Basically, they were at the mercy of the Saudi Government.

Luckily for them, due to the Saudi Government's good graces, within a couple months, she was sent home to her country - tail between legs - and unfortunately was given her old job back.  (Question.  Why do they always seem to do that?)

In her absence there was quite the shakeup and major changes made at the hospital back at home.  No longer was it mandatory to wear the white caps.  The pink scrub dresses were still around, but most nurses had switched over to the greens.   She had lost control of *her* crew.  

It didn't take long.....she was ousted quietly from her position....and put in charge of some innocuous area in the hospital where she could do little damage (why do they even bother?).


  I was never so glad as to leave that place for good. 

***************************************************************

**note her evidence based nursing decisions here.....(no need to ask - I am being sarcastic)
***As an aside here, though - I have a couple other nurse friends who have worked in Saudi,  and neither of them say they had any problems whatsoever....and they had taken many photos without incident.   Let's just say that someone ruffled a few feathers of someone with influence....