The hardest shift of my nursing life (young as it is)

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:bluecry1: This is a continuation of the story of my best friend, pregnant with twins, twin B diagnosed with oligo at 15 weeks. A dye test for ROM was negative, and fetal anatomy was all normal. Serial ultrasounds had tracked both babies' weights right on target, and unresolved oligo for twin B.

She called me on Fri on her way in to the hospital in preterm labor, 24.1 weeks. She had been complaining of increased discharge over the last few days, and I figured we would see her soon in L&D. By the time she got to the hospital at 1700, she was contracting every 3 min. Subcu Terb was given in triage, to which she did not respond. I was on that night, so I got there a little early to sit with her in triage. When the decision was made to admit her, I clocked in and took over her care. Looking back, I'm not sure this was a good idea, but I had promised her way back when she found out she was pregnant that I would take care of her in the hospital when the time came. This was before she found out she had twins, and long before B was diagnosed with oligo, so I gladly made that promise thinking that since most pregnancies are uncomplicated I could take care of my friend no problem and it would be all just a lovely experience to be a part of. I had no idea things would turn out as they eventually did.

We started Mag with a 6gm loading dose, and then 3 gm/hr at 1800. Her cervix had been a fingertip in triage. We turned her up to 4 gm/hr when she did not slow down after 2 hours. The Mag eventually spaced out her contractions to every 5 minutes and she looked like she was getting more comfortable. I sent her husband home to shower and get her things. Suddenly she was complaining of increased pain with her contractions that only palpated moderately and I was having a hard time tracing B. She said she felt like she had to have a bowel movement and my stomach hit the floor. My charge nurse came in the room, I told her what was going on, and she went to call the doc for me. He came a few minutes later, checked her cervix, and said, "She is about to deliver the first one now." My charge nurse ran and got the ultrasound and strangely enough, she was delivering B first. She had somehow slid around A and was coming first, breech. The plan had been for a c/s, but the baby was already too low. We usually deliver twins in the OR, even lady partslly, but she would have delivered in the bed on our way there, so we called the high risk team to the room and just stayed there. The doctor told her that she was about to have her babies, that we would not be doing a c/s as there was not time, and that he had been told by her OB and the perinatologist that the one baby was not expected to live. Magged out as she was, she said she understood and was silent.

I felt absolutely paralyzed. Luckily we were not that busy, so every nurse that had been out at the desk was in my room, just doing. My charge nurse told me to stay at mom's side and hold her hand, that that was exactly where I needed to be. Within three minutes, baby "B" (but now I guess "A" because she delivered first), whom they named Samantha, was born breech with a nuchal cord x2. It was obvious at that time that she was ruptured because there was puss and stuff around her, so now everything made sense; the chorio explained why we could not stop her labor, and now we finally knew for sure why she had oligo. The doc said he was amazed that she had made it to 24 weeks before getting an infection.

When B delivered (Reagan), the team left the warmer where Samantha was and concentrated their efforts on Reagan. I knew then that Sam had not made it, or at least would not. The neonatologist came over in the midst of all this and told mom that the first baby was dying and there was nothing they could do for her. He said they had attempted to intubate her but could not and said something very vague about her getting hit with a lot of contractions and something about her jaw. I really just wonder if they went through the motions because they knew she would have pulmonary hypoplasia from having the oligo for so long . . . I guess it really would not have made that much of a difference. I started to cry at this point, though I already knew before he had even said anything. I asked if she could please hold the baby, and someone finally brought her over. I was furious, and I swear if I could have gotten to her I would have gotten her in mom's arms sooner. I just did not want her to die alone. She took a few little sighs after she was in mom's arms and she was gone. She lived for a total of 7 minutes. I didn't know what to do but to tell mom that I loved her and that I was so sorry. We cried together as we looked at her tiny little body and hands and feet and her sweet little face. Reagan was whisked off to NICU and the whole thing was over in a blur. I had had one of the other nurses call her husband and tell him to come back before she delivered. He arrived after the whole thing was over, and the three of us sat there and all cried together.

I had to remember that I was her nurse and I had to take care of her, so I made myself go into nurse mode, and that helped. My coworkers all helped me with the paperwork and everything; I would cry off and on once her family got there, and every one of them thanked me for being there with her and said how glad they were that I was on that night. Everyone said their hello's and goodbye's to Sam; mom dressed her in her clothes from the memory box, and after all of her family left we went to NICU to see Reagan and my charge nurse and a couple of the other girls made Sam's footprints and got her ready to go downstairs.

By the time 7am came, I was completely fried. The whole night took so much out of me; that would have been hard had I not known the patient - I really don't know how I got through it. I am so lucky to have coworkers that were so supportive and helpful. I feel guilty because so much of my work was done for me; I was not at my full capacity as a nurse and this is why I say maybe I should not have taken care of her. All of that being said, I am glad that I could be there for her and with her through everything, hard as it was.

Mom went home yesterday so that she could be with her family for the holidays. She and her husband said that they had kind of done most of their grieving 6 weeks ago when the oligo was diagnosed. The doctors had all been very up front and honest with them about the prognosis for Sam from that point. She has a two year old at home and lots of people that love her - a great support system. Reagan is in NICU and doing well at this point - or at least today. We know how rocky it is for 24 weekers. I really believe that she is a miracle baby, understanding now the why's and wherefore's of the pregnancy.

Thanks for reading.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Dear Rae,

What a wonderful moving story. You were a friend and a nursing advocate for this patient. Through this experience, you will use the wisdom you've learned to help hundreds of other women over the coming years. Glad to hear you had a supportive group of colleagues too.

Thanks for sharing and caring...the epitomy of nursing.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

OH Rae my heart goes out to you. You have a heart and soul for nursing, that much is clear. We are kindred spirits. You will find through the years, the MOST challenging, emotionally-wrenching and difficult patients and cases are also often the most rewarding and best learning experiences. You changed lives, trust me.

NO matter what the outcome for her precariously-premature baby, that patient will remember so much about you. Your words, your touch, your eyes, conveying true compassion and empathy and even how you smelled---she will remember details that would probably surprise you. It's amazing how people remember these small things during the crises of their lives.

I have some special nurses, still in my mind years later , who helped me through losses and pain---as well as shared the joy of the births of my two kids. THESE are the people who inspired me to enter nursing and continue to inspire me to do my BEST always. I hope I never lose that drive to care and touch others the way I was touched---and the way you obviously touch others, too.

You are a beacon in nursing---a shining star. DO NOT let situations like this ever dampen your spirits or pain your heart too much. They do drain you and exhaust you---but they can also inspire you. Just know this: You have a touch---a knack that tells me you are doing exactly what you should be.

You made a difference in someone's life today. Trust me and let that bring you some some well-deserved praise for your amazing spirit and caring. ((((Rae))))

PS if you hear, will you let us know how the baby and mom do?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Also remember this:

No nurse is an island unto herself. The others jumped in to help and that is how it should be.

I had an emergent case the other day--- where a patient presented as a "rule-out" who turned into a stat csection due to fetal distress. You should have seen that room fill up w/my coworkers, one helping start the IV, other shaving patient, and the other helping me push her bed back to OR.....and all the people buzzing in OR helping w/pt prep, instrument counts etc.

I don't think they did my job FOR me---they helped me in a crisis. They all know it takes more than one pair of hands to make these things go smoothly and safely. So yea---it takes TEAMWORK in times like this---to get the job done. My primary focus was on my patient and keeping her calm so her baby would not tank (her bp's were on a dangerous climb)---she and I had a bond. I had to help her through her crisis of going from routine walk-in to emergency surgery.

The rest of the nurses moved in and did the "nuts and bolts" that got her ready for surgery. This is how it is supposed to work-----be glad you work in a place where people do this and you need feel NO guilt. But do remember to thank each one specifically for what she did to help you in that crisis.

That is what it's about----nursing these types of patients is never easy and we can't do it all. Team work is necessary to make it complete! So no more guilt about "others doing your job" hear me????!

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Wow, Deb, you're gonna make me cry again!!!!!! I think we are kindred spirits of sorts :wink2: Of course I will give you updates on them - the mom is my best friend, after all, and she has given the NICU permission to allow me to visit Reagan without her present. I appreciate this honor very much. I am Godmother to her first child, so she and her family are like my second family. I will certainly keep you abreast. As of today, Reagan is doing fine; still on the oscillator vent and under the bili light (she had some bruising on her little head and leg from delivery.) There is a memorial service tomorrow for Sam that I will be able to go to.

Thank you girls so much for your kind words and support. It really means a lot.

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I will be praying for Reagan. Reagan sounds like a fighter and we'll be hopeful for a wonderful outcome.

Rae, you did a wonderful job. I know that you had some doubts on taking her as a patient once the oligo was diagnosed, but I can tell you that I know that she appreciated your presence. It is so tough to go through that, and while we have wonderful nurses, there isn't much that can beat having your best friend by your side at a time such as this.

As we say in Oklahoma, you done good. :)

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As a mom who lost 23 week twins, I want to say thanks for being such a great support. It's nice to not feel alone in that loss. I want to encourage you not to forget Sam and to let your friend know that you remember him through cards and kind words on his birthday and other special occasions, or just when you happen to think of him. A lot of people don't want to mention the lost babies because they think they'll bring back bad memories, but trust me, the memories are constantly there anyway -- it's wonderful to know someone shares them.

I will be praying for Reagan, too.

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Nurses who care like you do, Rae, are a true blessing when things go bad in our happy land of L&D.

We had a mom come in today ... 27 week fetal demise. Her wails as we got her settled in and labor started won't leave my head tonight no matter how hard I try. I don't think I've had one sob so hard in a long time. Most of our patients grieve quietly, waiting to go home to deal with the bigger pain. This patient was crying from the depths of her soul and we all felt it. It's gut wrenching to listen to when you know that the only thing that would make her stop is the one thing you can't give her. She kept asking why ... she went to a funeral yesterday and she somehow thinks that's why this happened. All we could do was administer meds and hold her hands and let her cry. I hope that was enough.

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When I logged on tonight I read so many negative threads about becoming a nurse. I was so discouraged until I got to this one. Thank you for sharing this experience and for being a hero.

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When I logged on tonight I read so many negative threads about becoming a nurse. I was so discouraged until I got to this one. Thank you for sharing this experience and for being a hero.

I couldn't of said it better myself. It is nurses like you who make the profession what it was meant to be & give hope to students like me. Thank you for sharing. I send all my love, prayers and thoughts to you and the family.

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Specializes in Case Mgmt; Mat/Child, Critical Care.

Rae,

I just read your post, I have tears in my eyes. I am so sorry for your friends loss! This is a subject near and dear to my heart, and I want you to know that you did a wonderful job as a nurse and as a friend! We all work together in these situations in L&D, that's one of the reasons I love this area so much...we may be crazy busy running all over the place, but the minute one of us has an emergency, we are all right there.

Anyway, may your soul be eased with the knowledge that you made a difference that day; and I will pray for little Reagan.

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It is good to hear of good nurses like you and nurses who stick together to really help others out.

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