Move over butt cheeks

It was a rough night at work.

I started off in the recovery room, the post-anesthesia holding cell, where all women who have c/sections must pass through. In other hospitals...or maybe I should say better hospitals, there is never more than one patient per nurse during the recovery phase; vaginal or c/section. This patient:Nurse ratio is standard as the likelihood of a patient bleeding after they deliver the baby can be relatively high given all our ridiculous interventions. After a cesarean section, where a large incision is made in your low abdomen, that likelihood increases even more.

In true Methodist fashion, they staff one nurse per 1-8 patients in the recovery room. Of course it is a staffing issue but it has shown to be a standard practice as, even on well covered nights, only one nurse is in there. 

The range of patients is vast. Some of the c/sections are scheduled and planned because their previous deliveries were via c/section, or the baby is breech, or the baby is macrosomic (too big to fit the intended way) or the mother has HIV and her viral count is too high for a normal delivery. I have even seen a few cases where the mother opts for the surgery, not even giving herself the opportunity or possibility to labor. I thought that was illegal, but maybe just highly advised against? Most of them though are unplanned due to non-reassuring fetal heart tones, arrested dilatation or failure to descend (I hate that term...it is so defeating), or the doctor has dinner plans and wants to make it home for the basketball game. 

Some have been placed under general anesthesia, the process of putting the patient completely to sleep due to emergent factors that couldn't wait for an epidural to be placed. If this is the case, the recovery process can take much longer. Grogginess and a heavy head is what they wake up to. It is really funny to watch. They will lift their head, try to open their eyes, mumble something as off the chart as "Is daddy in that house?", and then slump back down. It repeats a few times, which I enjoy. 

When epidurals are used for pain management, it is the best situation. The catheter that sits in the little epidural spaces of the spine allows for constant medication to infuse providing longer lasting relief. The anesthesiologist can dose them up pretty quick pending they know what the hell they are talking about. Not to scare you people, but sometimes, they don't know what the hell they are talking about. Not too long ago, one of the anesthesia residents 'forgot' to administer duramorph, a strong narcotic that works like a charm. I found this out the hard way by trying to gently press on this women's uterus to check for bleeding. She slapped my arm hard enough that I was scared to ever check again. Maybe next time I will forget to administer his duramorph when he goes in for surgery.

Anyways, the other night I had three patients in the recovery room. This post delivery period should be, at most, 2 hours (in good hospitals) but the fear of bad post-partum care is high so we keep them longer to assure life after delivery. I was back and forth all night long monitoring the high blood pressures of two while pushing all sorts of narcotics in the IV for one. I was pretty tired when 6:30 came around. 

This is when I got a break from the recovery room for some action in the OR. And action it was. This patient had labored all day and finally made it to the grueling pushing stage. For 2.5 hours she grunted and bear-ed down to get that child out. No progress was being made. The head was stuck. So a c/section was called.

The woman was frantic. Feeling every contraction and bawling hysterically. When they would pass, she would smile and resume normal conversation. I swear, labor beings out the she devil in everyone.

We roll her back to the OR and gear her up for surgery. There is always the fear that after a patient pushes for an extended amount of time, the head of the baby will be so engaged in the pelvis, that an outsider will have to reach in and push the head through the belly...vaginally. I was not that person. Pam was. My job was to unfasten the safety belt that secured the patients legs to the table and position is just right so that an arm could comfortably make its move. As Pam gowned up, I squatted under the table to remove the belt and propped the leg for easy access. In this position, crouched down on the OR floor, I feel her Foley catheter bag (urine storage) rub against my arm. I set my knee down and realized it landed in a pool of blood. But the worst was yet to come.

In order to get a good hold and a sturdy position on the babies head, Pam (not a small girl) had to literally stand on her tows, shift her hips and SIT ON MY FACE. I am not sure if it was really all that neccesary, but as her butt cheek rubbed up against the left side of my face, I thought it better be. I am talking life or death. I was hearing some commotion, as I sit being sat on under the drapes and realize it must be a tricky grip. I couldn't retort as that would just be rude. I couldn't move or the sterile field would be tainted. I was helpless.

I am sure you could picture it...

 Almost time to go home. The clock reads 7:27 am. I have just been up all night, on my feet with a pain of what feels like a screwdriver slowly twisting into my heel. I am pretty hungry. But I know, because this is a change of shift delivery, I will be here way over my time. It smells a little bit like sour milk. My eyes are burning, my knee is sitting in a cauldron of someone elses blood, my arms are shaking because I am holding up the dead weight of a pregnant leg...and Pam's butt cheek just made long and direct contact with my face. 

Fun times.