[Mermaid4]

Nighttime briskness slapped me in the face as I climbed into the car for the trek to work. It was my third scheduled night shift but only the first I had felt half way healthy enough to attend. I had called ahead to prepare myself for the pace of the shift, and was already exhausted at the prospect of a wild and crazy night. So were the words of the evening soul who breathlessly answered the phone and my query. She even threw in the info that at ten pm, she had not yet had her dinner.

“That’s just WONDERFUL”, I mused, but kept the thought to myself as I readied myself for whatever chaos loomed ahead.

Body ache upon body ache piled generously and generally around me. It took a concerted effort simply to walk up the hill and into the hospital. My husband had provided me with a plastic container of soup so I wouldn’t be hungry overnight. I didn’t have the heart to tell him that if by some miracle I was able to get to a point in my night that dinner became possible, just looking at the mixture made my poor abused tummy do radical flip flops. I tried to ignore the aroma.

I wasn’t disappointed on arrival. Or, at least not surprised. At least one night nurse had been called in early and already looked as though she had put in a full shift. She seemed so pooped that I wondered how she was going to get through the night. Not five minutes into report I was informed that the night before, because I had called in, two evening nurses had been mandated, because three night nurses had the audacity to call in sick. I was still sick enough that I didn’t care, but didn’t tell THEM that. I apologized on behalf of everyone.

Hey, one has to keep going….

Perusing the board, it became readily apparent that it wasn’t going to be the quiet night I had hoped for. And, there was a repeat C section scheduled for the morning which meant that we had to prep her (in our spare time). Another nurse, relatively new to our unit, took me aside and whispered she had a patient that she thought I should take. Apparently my “emotional support” skills were needed for the case, which was a fifteen week fetal demise. The alternative was a drug seeking, needy, poly substance abuse fresh Csection currently lobbying the staff to take her out for a cigarette. For the first time in quite awhile I wished for a labor to immerse myself in. Two or fully with no distress. That’s how I like them…

But, twas not to be. Following a cursory dialogue with the inexperienced nurse which included the fact that many nurses are reluctant to care for fetal demise patients because it hits so close to home. Sometimes it takes awhile to figure out that the discomfort is not so much because of the quality of patient, but instead, the quality of discomfort the nurse has.

That said, I told the charge nurse I would do whatever she wanted. The look of relief in HER tired eyes made me glad I had given her the option.

I dragged myself out of the chair and prepared to meet the unfortunate couple, who appeared to be shell shocked. They had gone to their regular office visit and discovered by ultrasound that there was no heart beat. There had been some spotting previous to the visit but she hadn’t thought much about it because it was sparse and she had had similar experiences with each of her other two pregnancies.

She didn’t want to talk. Ok by me since I wasn’t in the conversation mode either. Nubain is a wonderful thing and she had recently been medicated. Her husband was snoring on the couch and I noticed, both she and I were annoyed by that...

I introduced myself and informed her I was to be her nurse for the night. She grunted something in reply and faced away from me towards the window. The evening nurse had mentioned that this couple didn’t want to deal with the staff. They were in a room at the end of the hall to minimize the interaction with babies. We could both hear the cries of the infant next in the room next to them, and she gave me a brief penetrating glare that signaled I close the door and get out. I did exactly that.

Ten minutes later I saw the husband come down the hall to the kitchen. A tall grizzly bear type, he breezed past me. I quietly introduced myself and told him I wanted to respect their privacy, but I would be looking in on them from time to time. He nodded, shook my hand, turned and went back.

Two minutes later their light went on. She wanted something for pain as the cramps were getting more intense. I immediately called the doctor, an old fashioned elderly gentleman who just could not understand why I would bother him barely two hours after her last dose of nubain. He didn’t care about my opinion that the patient should get more. Even the argument that people in labor received many doses of pain med at frequent intervals didn’t faze him. Finally he allowed me to offer her some vistaril, but emphatically ordered that she not be given more nubain until four hours from the first dose. So unfair was MY thought. After all, we aren’t protecting a baby here and losing one was already mind numbing. Why not medicate this poor woman to the hilt? Every night it seems, I realize a moment when I become a patient advocate. This was it.

She wasn’t happy with me. Anger blazed across her face. I told her it was perfectly acceptable to take any anger she had out on me. I even encouraged it. Her features changed and she eyed me silently. I told her the vistaril might sting but promised to bring the nubain in as soon as it was due, giving her the option of accepting a heated body massage to help her relax. To my surprise and relief, she took me up on my offer.

Five minutes into the back massage the first full sentence from her to me. “I just don’t want to leave without a baby.” Then, “This is the most horrible thing that could ever happen to anyone.” Laced with a few appropriate expletive deletives, I silently agreed. She continued to talk and then cry as I gently massaged her back, legs, feet, hands and arms. As she relaxed her wall came down and the tears flowed. I could tell her husband wasn’t sleeping and listening, so I made a point to mention that often the husbands can feel left out, or helpless since they can’t fix it. Sometimes it can seem that they don’t care when in reality they care quite a bit. I noticed that he came over and sat by her bedside as she cried. I finished the massage and encouraged them both to rest, promising that I would be close by and readily available. She seemed somehow comforted about that.

Two am was the appointed time for pain medication so I gave it. Five minutes after that she rang for more medication and it killed me not to be able to give her any. I sat with her while she cried, screamed and swore. I said nothing but stroked her cheek as she let out some of the pain we couldn’t touch with any medicine... She reached out and grabbed my hand as her poor husband sat helplessly by. I took his hand in my other hand and with a silent glance that somehow spoke louder than any words I might have said, he acknowledged his gratitude.

The older doctor had forbidden the patient to get out of bed and wanted her to use a bedpan. Something about dislodging the cytotec. Another tidbit left over from the dark ages I would have to figure out how to discuss with him.

When the patient begged to go to the bathroom I told her I certainly couldn’t refuse, but stayed close by due to my suspicion that delivery was imminent. I had been told she was five centimeters with bulging membranes just five minutes before she received her nubain. I asked if she felt vaginal pressure and she angrily yelled she wasn’t sure. She refused to allow me to check her underwear. I think I knew what might happen so parked myself just outside the bathroom door.

“Oh my God!” “Oh my God!” I heard not three minutes later. I helped her to bed and summoned the troops. I needn’t have since, having heard her screams of dismay, they assembled rather quickly.

My heart sank as I looked into the toilet because I knew what I would find; what I would have to retrieve. Suddenly the soup that made my stomach perform flip flops seemed totally benign. I took a deep breath and reached in to gently bring the baby back home, all the while trying to put the wails of grief coming from the bed, out of my head. This had all transpired in the short five minutes the husband had left the room.

Fetus was intact, enclosed in the amniotic sac with an intact placenta. I called the doctor and told him we had a delivery. He came in and was actually very good to the patient.

He didn’t want me to rupture membranes so I took him aside and gently told him that as a mom myself I would want to hold my baby and looking at him through the amniotic fluid would not be way I would want to remember things. Crusty and old fashioned with a reputation for eating nurses for lunch, he softened and asked simply that I note the fetus was intact and I was the one to break the water. He walked down the hall a few feet, turned and motioned me to him. “You are a good nurse, you know...” “This lady needs you.” Suddenly I didn’t feel so poorly.

She didn’t want to see the baby at first so I gently suggested she hold him while I stood behind the curtain close by in case she didn’t think she could do it. She agreed to that and, as all moms will do, unfolded the blanket and checked to see if he had all his fingers and toes. Behind the drape, my tears flowed as she said to her husband, “look at his long fingers and he has your chin.” I wondered if she would take my suggestion that he be named but she refused.

As I was preparing to leave, she was already dressed. I brought in a memory box with a card with the tiny footprints I had taken. Silently she undid the ribbon and more tears flowed between both of us. No words…Just tears. She reached up and gave me a hug, thanking me for everything. I couldn’t imagine what she could possibly have thanked me for. In these instances I learned long ago that palliative care is really all one can do, and to not feel badly when people in their situation want to get as far away from the hospital and nurse as quickly as possible. After all, the nurse is as much a reminder of their loss as anyone else.

“George Richard,” she whispered. “After my father”, she said. “That will be his name.” “It’s a strong name,” I countered, and promptly made a card in calligraphy for her.

She was gone before my paperwork was done. Next week I may not even remember her name. Next year I hope if she remembers me it will be because she is back in labor either near or on her due date. If she doesn’t want me to be her nurse I will understand completely.

Until then, she now has an angel in Heaven, and however sad I am, I am also grateful and graced that I was appointed to share this experience with them. George and Martha…Who knew?

Written by…Martha J. Crowninshield O’Brien RN Copy right 12/02/04

[SmilingBluEyes]

.....it is the hardest part of what we do.........the hardest thing to see families shattered by tragedies like this......I can so relate to the things this nurse had to do to help this family accept and begin their grieving process. Been there quite a few times myself. It's so hard.......


you are amazing at telling stories....just amazing.
thank you for that.

[nursemary9]

Martha,

Thank you. That was beautifully written.

Mary Ann

[SmilingBluEyes]

You should be published you know.......................you write like stories like the ones I see in some amazing nurse story books, like Echo Heron.... Here I thought that was a published story at first! You have a knack!

[Mermaid4]

You're welcome..I had this family the other night and just fininshed writing it since their experience affected me so much. Deb, you must have read something else.....The nurse , in question, is me......Sometimes it just has to come out.....I thought we could all identify with the experience..Some patients and their experiences just touch us to the core....

[Mermaid4]

Ok you guys....I have been approached by an author friend of my dad who has implored me to attempt to publish..He tells me to self publish and put the book up on ebay...Maybe my nurse friends could buy it and say they knew me when......What do you think? I just want nurses to have a voice and have others know what we deal with every day, evening and night....Maybe I will give it a try......

[directcare4me]

Have you submitted your work for publication? There's not a thing wrong with self-publication; but you might also consider submitting some things and see what happens. You write very well.

[Averykat]

You write beautifully and your caring and empahy come out with your words. Please do keep writing - I think the self-publishing would be a wonderful idea if it's something you want to do. There are many who would be touched to read your work.

-Kate

[Mermaid4]

Well then, I guess I had better get to it! I think we all have wonderful stories. Amazing stories....

[SmilingBluEyes]

NO I corrected myself, Mermaid. I could see this was written by you...I have read so many nursing stories...many about fetal demises that I made the mistake of thinking it was one I read. It's that good. I hope you took that in the spirit intended. Have a good weekend now.