Personal Identity In Nursing

Personal Identity Paper
College of Saint Elizabeth

Personal Identity Paper
On a normal day on the Labor & Delivery floor it can be slow--until it's not. I work on a unit that averages 5-10 deliveries in 24 hours. I have worked shifts with only one delivery and others where the nurses are running around the entire day with no breaks. I've even worked shifts where there were eight cesarean sections in 12 hours. I've had shifts where we have started the day with one room full and only had one room empty four hours later, and vice versa. It's so hard to compare L&D to any other type of nursing; the closest comparison would probably be Emergency Room nursing. There are no scheduled meds, and we are often looking
up policies and procedures to learn how to deal serious situations (i.e. withdrawing from alcohol who had retained product and a general anesthetic followed by IV push sedatives to keep her from seizing). A medically risky person can deliver with no complications, and a perfectly healthy young woman can hemorrhage after a quick and easy labor and delivery and lose her uterus. You might care for both these women in one day, and then resuscitate a baby who had a perfectly normal fetal heart tracing. You have to be prepared for any or all of these situations to occur within minutes and act quickly when they do, all the while reassuring dad and grandma and staying connected to mom so she feels trust, even if you met her five minutes ago. You will learn to mistrust full moons, yell at people who say the “Quiet” word and firmly believe that pressure changes cause waters to break. You will teach more than you thought you knew and grieve with perfect strangers when something perfect goes wrong. You will learn to hold your tongue and put your judgment, on the back burner. You will learn to trust your intuition sometimes over your experience or common sense. You will never let a first or even second year resident check a patient without checking after them just to see how good they are.
As nurses, we can function with an almost divine ability to help in an emergency. We have constant training with endless practices, drills and scenarios. And when something goes down we get tough and do what is necessary to save mother and baby. On that very day I think the staff from the Emergency Room found a new found respect for the staff on Labor & Delivery. I think they finally understood why this unit is classified as a critical care unit and not every experience is beautiful and uncomplicated.
Unfortunately, July 29, 2013, was no ordinary day on our unit.
I walked onto the floor to find out I was the charge nurse for the day, often referred to as the “unit gofer”. To hospital workers, day shift charge nurses will usually take a small load of “easier” patients and assign other patients, do various paperwork, and help with admits. That day had been business as usual until about 6:00 pm when I received a frantic phone call directly from the emergency room of a 24 year old eight month pregnant Hispanic woman being brought into the resuscitation room of the emergency department with an estimated time of arrival of eight minutes. The ER nurse reported that she had an established cardiac arrest of ten minutes and was found unconscious; no other history could be obtained. Full basic life support had been present since arrest; initial application of advanced protocols had not re-established circulation while in the field. Immediately, it had become an all hands on deck situation. I called for my coworkers to have our operating room opened and prepped. The resuscitation cart was ready for the neonate. The neonatologist, anesthesiologist and attending obstetrician as well as our resident were informed of their arrival. Just as I hung up the phone, I heard the sirens from the ambulance coming and the pages over the intercom for the Labor and Delivery team to report to the ER. Without hesitation, I ran down with surgical instruments, sutures and lap sponges to a room filled
with chaos. The woman was unresponsive, intubated and chest compressions were being administered. The attending obstetrician made the decision that an emergency cesarean section would be performed. I wondered myself whether an emergency caesarean section would be life saving for either the fetus or mother. The team, which consisted of obstetrics, anesthesia and emergency room personnel, surrounded the lifeless body and the first incision was made; there was no time to put a foley catheter in her bladder, no time to initiate aseptic techniques. I was the scrub nurse for that section, (which entailed handing instruments and anything else requested by the physician) while focusing on the task before me, I watched everything. It was as if everything in the room was happening at lightning speed and I was in slow motion. One of the anesthesiologist was screaming that he thought she had an aneurysm due to her dilated pupils while the other kept on asking the surgeon if the patient should be placed under anesthesia. Her blood pressures ranged from 145/95 to 150/120, several medications were being pushed through her intravenous to keep her stable. I watched the frantic movements of the emergency room staff, who were not used to saying pregnancy and cardiac arrest in the same sentence. Two minutes after the incision was made, the baby was delivered through meconium stained fluid, lifeless like his mother. The neonatologist and nursing staff were standing by and neonatal resuscitation began. Medication was pushed through his tiny veins and he was immediately transferred to the Neonatal Intensive Care Unit. As for the mother we sutured her uterus and safely closed every layer of tissue. She was hemodynamically stable at this point. The radiology department was then called as there was not time at the beginning of the surgery to count instruments or lap sponges; the x-ray machine would take care of that. The patient was then transferred to the Surgical Intensive Care Unit, where she would be observed closely for brain activity. As I looked around the room, I wondered about the patient’s family and whether she had children. I had hoped that if they arrived at the hospital, they did not see the chaos that had ensued. I wanted to make sure that if they were there, someone updated them on her condition. After all, as a nurse, you are the advocate, the educator, the mercy-giver; you are the one the patient depends on.
I returned to my floor feeling overwhelmed and unsure of how all of us handled the situation. Hindsight is always 20/20. I tried not to beat myself up looking back over all the actions that took place, knowing the outcome, and I thought, did I do everything I could? Did I follow hospital policy? Did I follow my heart?
Later that day, I went down to the Intensive Care Unit to speak to the nurse taking care of the patient.
She had informed me that she had an extensive neurological history, which included a craniotomy, a past aneurysm, and several other procedures. I saw the family in the waiting room and felt it was my duty to introduce myself and tell them how sorry I was. I visited the NICU and was present for the transfer of the newborn to another hospital for more specialized treatment. I found out two days later that the baby had died but I felt given the circumstances we did everything we could for him. I visited that family and patient for many weeks to follow. In the end, she lived, but with what quality of life? She had left sided paralysis, a feeding tube and had a tracheostomy tube. Though she listened to commands, I wasn’t sure how much she could comprehend. When I went to go visit her one day, I saw that her room was occupied by someone else. The worst had come to my mind. I asked the nurse what happened she informed me the patient was transferred to an acute rehabilitation center for further
care.
Sometimes miracles occur in such dire situations reminding us that among the bad in this world our small victories seem a little more significant.
When I went home that night I looked at my family and thought of a quote I once saw “Life is short, live it. Love is rare, grab it. Anger is bad, dump it. Fear is awful, face it, and memories are sweet so cherish every one of them.”, so live your life to the fullest because you never know what is going to happen.