Archives
Break
On Tuesday I am going here for 4 nights and I am really excited. 5 whole days without any demands on my time from anyone, except Hubby, and after the last few weeks that is a really rejuvenating concept.
Work has been very busy, called out every night that I'm on call and because we are so short staffed still having to work the next day is really taking it's toll on every aspect of my being, healthwise and emotions. Even days when I'm not on call something has cropped up and meant that I don't get home until 7.30. Tuesday's 'something' was one of my younger patients who phoned me during the day to say she thought she was in labour, would I go round? This young woman has quite a complex social history and at one point during her pregnancy she was homeless and due to the stress went into premature labour. Things have calmed down now but I was still happy to spread the TLC more thickly. When I visited her she was in labour, but still early on, I stirred things up a bit, and told her that I thought it would be early evening before she would meet baby for the first time, just carry on walking, eating etc. and go in when things had hotted up. As I left I heard her comment to the Grandmother, as another contraction came, ' Oh God, what has she done?'.!
When I returned to the hspital at the end of my day I went to Labour Ward and looked to see if she was there, she was, but what was written on the board indicated that they felt that she was less progressed in labour than I had discovered 6 hours earlier. Being an abject coward, I decided not to to go in and see her, I imagined they would be unhappy and have no confidence in me. Sitting writing some notes and a medical student appeared ' She wants to push', she announced. Looking around no one seemed to be impressed with the news, they were all doing something, so I plucked up my courage, and went in. She was pushing, and was also panicing. After a few minutes I managed to calm her down and encouraged her to breath rather than push with the contractions. I wanted to ensure that she was ready to push, if women in labour push before all the cervix (neck of the womb) has gone it can cause the cervix to swell and cause problems.
Got to go, unexpected visitors, back later.
Right back now, where was I? Oh yes, pushing Mummy. On examination cervix had gone, hurrah, push if you feel like it. Often I don't need to physically exam to know that the cervix is fully dilated (delighted) but with the difference in opinion on my previous findings, and once she had reached hospital, I felt that it would be advisable. Then we had to retrieve her partner, who had gone off in search of nourishment as opinion had been that they were in in for a long haul. He was tracked down just in time, we could just see the top of baby's head by the time he was back. He took one look, then looked up at me and asked if it was okay. I remember the first time I saw the first inches of baby's head and how worried I was that everything was normal, it looks rather like the inside of a walnut, all crinkled up folds of skin, bit like a brain. I assured him it was, then hastely sat him down, he was looking decidedly pale and sweaty! Half an hour after I had entered the room we had a little girl, 7lbs 1oz, Sky. Hugs with everyone, and off I went. Only two hours late home.
When we go into work we only have a vague idea of what could be happening that day. We know if we have a clinic, but we don't know whether it will last for 1,2 or 3 hours, my Friday clinic will often run for 4 hours. If we arranged to 'book' someone we have an allocated time in our diary, I always warn them when I arrange it that it is not unusual for me to run late, but that if it is over half an hour I will phone them and let them know. We then have postnatal visits and the number of these varies from day to day dependant on who has been discharged and whether we need to cover colleagues work if they are sick, attending a homebirth, or on holiday. Then the unexpected happens through the day, a rapid labour leading to an unexpected homebirth, someone needing an urgent visit. On Friday I was touring my 'patch', which has a large area where my mobile has no coverage, and suddenly my voicemail alerted me that I had 10 messages. I can't ignore them, they may be urgent, so I have to pull over and listen to them all. One of them was from a woman who had just found out during a scan that her baby had spina bifida and she was desperate to talk to me, another hour used. Why am I mentioning all this? Well, I've been reading this blog and have been disturbed to learn how little people appreciate the 'juggling' community midwives have to do with their workloads. On a good day it all runs smoothly, even so I never get time for a lunchbreak, but most of the time it is a question of trying desperately to fit it all in. They want evening clinics, actually that would suit me, I hate mornings, but where? Doctors surgeries close at 6pm, or the ones I work in do, Antenatal clinic at the hospital closes at 5pm. Anyway, other professionals I may need to contact during a clinic, scanning departments, physio etc. all finish at 5pm so it would be difficult to deal with situations requiring referral. To be fair I would say that 95% of the women I see are lovely, they are understanding that I am only human, that I do have a life outside midwifery, and that I have 170 pregnant women under my care so sometimes they have to wait, but those other 5% are the ones who make the most noise and cause me most stress trying to see that all their demands are met. I try not to take it personally, I rationalise it and tell myself that it's the shortages and cutbacks that mean we are under-resourced and overstretched, but when I read blogs like Emily's, and particularly one of the comments, I feel really frustrated.
The Hoff.
If anyone out there knows anything about Rheumatoid Antibodies and why a level might come back high (480) when it's not really high,i.e a false positive, please let me know.
'We would be grateful if you could meet with us on Friday 13th at 1.30pm in the Interview Room to discuss concerns from a managerial and supervisory perspective regarding clinical practice issues.' 'Us' being the Head Midwife and Supervisor of Midwives.
To say a cold sweat overcame me would be less than accurate as I was also shaking. I received the letter this morning, I go away tomorrow. I knew that this would overshadow my enjoyment of a much awaited break so I eventually suceeded in tracking down the manager. Well I never, I havn't caused any morbidity or mortality, what I have done is have a friend, who is also a midwife at the same trust, ask me to deliver her baby, and have a pregnant daughter. Apparently I do this 'sort of thing too much', this 'thing' being to have women/friends/colleagues/daughters ask me to care for them. Anyone who was reading my blog back in April 2004 will know how much trouble I got into then.
Oh well at least I can go away knowing that clinically there are no problems, it's just that I allow people choice.
Rome - The Eternal City
The break was everything I could have wished for, from a no hastle trip with Ryanair, made easier my my long-legged Hubby having a seat infront of a bulkhead, so he could stretch out, to the easy collection on our return from Luton to pick up my car. Our hotel was clean, the staff friendly, and we even had a small balcony overlooking a busy Via so we could drink in the sounds of The Eternal City. Sounds there are in abundance, cars hooting constantly and emergency vehicles endlessly roaring past sounding their sirens. Weather was fantastic, sunny and comfortably hot. We did all the tourist bits, Colosseum, Vatican, Forum, Trevi Fountain etc., walking miles in the process. In isolation they were all truly impressive, but then given the fact that just a few steps away there would be another monument, ruin or fountain deserving of admiration, it was awe-inspiring. There were thousands of other tourists everywhere, all the sites were very crowded, add to this the security measures at St Peters Basilica and the Colosseum and queues become an accepted part of the experience. Crossing the roads are an acquired art. They do have signals on the lights to tell you when to go, but the motorists don't seem to be aware of them. In return though drivers do seem to be alert to pedestrians so our attitude became 'go for it'.
Top Tips
- Wear comfortatable, thick soled shoes. Sightseeing involves loads of walking, even if you take a taxi or publc transport to the first place many of the sights then require treking skills. Much of Rome is cobbled streets, very hard on the feet and ankles.
- Have a bag that pick-pockets would have difficulty getting into, a draw-string seems favourite. Pick-pockets everywhere. Within 5 minutes of arriving at our hotel another guest came in having just had his wallet lifted on the bus. Sitting having a coffee I watched as two men approached the table near ours, the tourists had a rucksack on the seat, one suspicious man stood a couple of feet away looking around whilst the other bent down to talk to the unsuspecting traveller, being an interferring old busy-body just as the standing one moved to grag the bag I leapt forward and alerted the guy to what was happening. Hubby was angry, he thought I could have been hurt, and only half an hour later, seeing a guy resisting thieves be 'bottled', made me far more cautious the rest of the time. Having said this Italians themselves are welcoming and friendly.
- Invest in a good map, with bus numbers and routes on it. Rome's transport system, during the day, is amazing. Tickets cost 1 Euro from a kiosk or small shop and that entitles you to all day on the buses or tram, or one metro trip. In reality you don't need to buy one at all for the bus or tram, no one checks it so it is basically free, and crowded!
- Take a good guidebook with you. The descriptions at many sites are non-existant or leave many questions unanswered. If you have the money there are hundreds of tour-guides available and using one will often entitle you to avoid the queues for entrance. We were lucky and had the most amazing free tour of St Peters by an extremely knowledgable and entertaining American guy. I wish we could have afforded a tour guide for the Vatican museums and Cistine chapel as I know we missed out on a lot of the significance of much of the paintings, statues and history.
- Don't buy food, ice-cream or drink from the street vendors. They are real rip-off merchants, walk a couple of streets away and find a trattoria or pizzeria, much cheaper and you can sit and people watch. (They also have toilets, long queues if you need to go at one of the attractions!)
- Leave visiting St Peters and the Vatican Museums until the afternoon. Not nearly as crowded.
So many places we didn't go, not enough time. I know I will return though, as I threw a coin in the Trevi Fountain! My sightseeing highlights were St Peters Basilica and the Palatine Hill, the first because you have to see it to believe it, the second for much the same thing but a very tranquil place in a bustling city, for eating and a relaxed nightlife, Trastevere.
To read whilst away I took Dan Brown's 'Angels and Demons', like the 'DaVinci Code' there were many arid sections, but a great book to read whilst in Rome as it gives lots of interesting snippets of information, would recommend as a 'Good Read whilst in Rome'.
Junk mail
I have a cunning plan. Well, it's not really that cunning, infact it's puerile, but it will give me a sense that I am fighting back against Royal Mail and their cheek at, not only hiking up postage rates, whilst making a nice little profit, but also shoving unsolicited mail through my letterbox. Whats the plan? Simple, I'm going to post it all back to them. Alone, I will be annoying, if we all did it though we could cause them as much annoyance as they cause us.
Beyond belief
At a local maternity unit there are two lifts which are needed to transport women from the delivery suite and theatres to the wards, they are the only two lifts. For a while now there has been a sign stuck under the call buttons advising users that 'These lifts are faulty, please keep finger on button', this alone would be enough to stop me from using them, I have no desire to be stuck in a lift. A couple of weeks ago, when there was a torrential downpour, the basement flooded, which stopped the lifts completely, luckily this was fixed within a few hours. Today it happened again, but this time they have not been, and will not be, repaired until sometime tomorrow.
Picture the scene, today was Elective Caesarian day, all the women were marooned downstairs on the labour ward, filling it up. This was the situation until 4.30pm when the Ambulance Team were asked to come and assist, which they did, carrying all the women upstairs on chairs. Good solution but.........supposing someone requires emergency surgery, bleeding heavily, baby in distress, what will happen then, how will they get them down to theatre, dial 999? The mind boggles. If nothing catastrophic happens overnight this is one hospital who should really give thanks to some higher being for saving their arses. They have had weeks to sort out this problem, but as usual nothing has happened, they must have had more important things to concern themselves with like what should they order for the buffet at the Managerial Meeting.
The waiting game
Friend with cholestasis is being induced at the moment. Yesterday she was given two Prostin, a pessary which is used to 'ripen' the cervix and allow an artificial rupture of the membranes. As she is only 37 weeks her cervix was unfavourable and the first two prostins have done little to expedidite inducing labour. This morning she has been given another pessary, we are now keeping fingers crossed that this one does the trick, meanwhile she is plodding the hospital grounds and I am waiting to be summoned to go and break her waters and help her have her third baby. I was there for the other two, the first was all normal, no problems in pregnancy, but she developed cholestasis with number two and was also induced early but that was over in a flash, third babies are often difficult little babes!
My 'little bird' tells me that the lift situation continues, with no end in sight. The lift shaft is flooded and the water needs to be pumped out, they have already involved the ambulance service in this saga, why not call on the fire-brigade to pump out the lifts?