Katy, RN, writes:
I am a two year RN who works in OB, though I only do post-partum and well-baby care, not Labor & Delivery. Tonight I baby-received at my first C-section where we had to transfer the baby to our level 2 nursery (we call it Special Care Nursery). The young mom had all ready lost a 23 weeker and this baby was 36.6 wks. This is the point of pregnancy where being off on your dates by two weeks can make a big difference and that may have been part of this baby’s problem, though he didn’t really look premature. She had to have a repeat C-section due to having a classical incision the first time and had gone into labor, which is why we sectioned her when we did.
It took a long time to get through all the scar tissue so we were waiting around forever. Once the baby was born they put it in my charge nurse’s arms and she ran with it to the table. He was blue, floppy and making no respiratory effort. I was rubbing his back and face and body as hard as I could and begging him in my mind to breathe while trying to appear calm so the dad wouldn’t freak. The other nurse asked the dad his name, and we called him by it while we told him to cry for us. We were about to ambu bag him (same concept as mouth to mouth, but with straight oxygen and more sanitary) when he started weakly crying. We kept rubbing and suctioning him and giving him blowby O2, and he was very slowly pinking up centrally, but his tone remained completely floppy. He was also flaring his nostrils and retracting with each breath.
We then tried to get an O2 saturation level on him but couldn’t find the sensors in this particularly infrequently used OR, then when I ran and
got one from another OR had a horrible time getting it to pick up. This whole time we are giving him oxygen and stimulating him (we were by then scratching his feet and being quite rough to get him to cry more). I had to check his heart rate and listen to lungs several times and once got my stethoscope all tangled up in my OR hat and it felt like HOURS till I could get it untangled and out so I could listen. After 10 min of this we called Special Care Nursery down to evaluate him. By then our O2 sensor was working and he was satting anywhere between low 70s without oxygen to almost mid 90s when I would cup my hand over his face with the oxygen tube in it to increase the concentration of oxygen he was getting.
We put him in the transporter and the level 2 nursery nurse pushed while I kept my hand inside it with the tubing in his little face. After I passed along what information I had, I returned to the nursery. At that point I started shaking and was near tears for a couple minutes while I relayed the story to the nurse who’d been watching the nursery for me. Even though I’d been gone for about an hour, she still told me to go sit down and take a break.
Shaking and still near tears I called my mom. I was just going into how scared and dumb I felt when I looked up at the greaseboard in our break room. We often leave general messages to the staff there and someone had written:
“Kudos to whoever had the great idea for putting a cut-down hat under the bili goggles.” And someone else had written in my name above it. It was an idea I came up with several weeks ago out of frustration with the little goggles our babies under bililites wear to protect their eyes. The dumb things never stay in place and we are constantly adjusting them. Now, I don’t actually think it is that big a deal if the things are slightly off for short periods of time, but it REALLY bothers the parents of these babies. One night I got the idea to chop off the top of a hat (since overheating is a concern with these kids) and put the soft band of it over there eyes and the goggles over that. It keeps the goggles in place a lot better. It has met with a really positive response from the other nurses and the parents, as well.
So, just when I was feeling really low and crappy and scared I got a major pick-me-up. A night nurse mentioned to me the other night that I had written her a little note wishing her a good night a few months ago as she was starting what promised to be a rotten shift. She told me that it had meant so much to her that night and that she had taken it home and put it on her bulletin board.
I guess what has struck me tonight is how you never know when something that seems small to you can mean so much to someone else. I hardly even remember writing that note, but it really touched that nurse and helped her through her night. It probably took the nurse who wrote the message on the greaseboard less than a minute to write it, but it made the difference between feeling really rotten and feeling okay to me. It’s like that book, “The Five People You Meet in Heaven” which is excellent, by the way.
I don’t know how the baby did.
At our hospital, we have Wow! cards. These are cards kept around the unit for us to use – we usually write one out and give it to a coworker who has done especially nice or helpful things for us. I’ve written them to nurses who have started IV’s for me on my patient when I was unable to. I’ve received them for being able to get especially difficult ABG’s on another nurse’s patient. (For some reason, I’m great at hitting the artery, but I suck at threading veins.) There are a zillion more reasons to give and receive these cards, but it’s always really nice to come to work and see a Wow! card in my mailbox from someone who has appreciated me. :-)