DAY 3
I’ve just finished taking off my coat and boots when someone comes bursting through the doors of the health centre. “Someone’s not breathing!” There’s a flurry of activity as a few people haul a backboard outside to bring this person in. The four of us nurses head into our emergency room to make sure we have what we need.
The patient arrives a few minutes later, stumbling, held up by her mother and boyfriend. Breathing, walking, has a pulse. Check, check, check. She mumbles her name when I ask, but won’t answer anything else as I check her vitals. She refuses to open her eyes.
“She supposed to fly out next week to deliver, but she hasn’t been coming to her appointments with me,” Sara, who manages the prenatal patients, says. Only now do I look down and realize that this girl is heavily pregnant. Sara tosses me the fetal doppler. “Gen, can you check the baby’s heart rate?”
Yikes. I don’t do this much. Luckily, my work mom had let me practise on her just a few weeks before I’d left. I’ve just pressed the doppler against the patient’s belly when I see her eyes roll back and she starts to seize. Her mother starts to scream hysterically beside me.
And so begins our first day on call.
Seizures are always a little scary and unpredictable, and never have I had to deal with one in a pregnant woman. I’m used to having a bunch of other nurses to call in for help, at least one doctor, a respiratory therapist, and a code blue button to get all hands on deck if things go terribly wrong. Here, I have these three other nurses, and the doc on call, who is taking his sweet time to give us medication orders over the phone. There is no more back-up for us to call in.
“Can you ask him if we can draw up some ativan?” I ask Sara, still on the phone with the doctor. I have no idea if it’s safe to give in pregnancy. Judging by how long it takes him to answer her, it seems that the doc – obviously not an obstetrician – is looking it up himself. The patient starts to seize again and I grab an oral airway, but there’s no way I can get it past her clenched teeth. She’s managed to rip out her IV, so the doc gives us an order to inject the ativan into her buttocks. She finally settles for a minute, and I take this chance to put a new IV in. But I’m an idiot and don’t realize that the ones here don’t have the fancy vacuum seal that I’m used to at home, so the moment I put it in, blood comes spraying out like a hose. Whoops. At least we have IV access again.
The doc finally gives us an order for a continuous infusion of mag sulfate, and luckily, this keeps her from seizing again. But she’s so confused and agitated after her seizures that she won’t stop trying to climb out of the stretcher, and it takes three of us to continually hold her down as she swings and swats at us. When she’s finally willing to lie down, we get her boyfriend to climb in and spoon her in the stretcher. Who says you can’t get creative with restraints?
It takes a few more hours before she’s medevac’d out. The front desk staff have been sending all the walk-in patients away since all of us were tied up with the seizure, but now they’re all trickling back in. No one, it seems, is willing to stay at home with their cold symptoms, and I swear we see half of the kids in the community in one day. We scramble to see all of them, but they keep coming in. My preceptor and I, being the ones on call, finally go home at 2AM, almost eighteen hours later.
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It’s a week later, and I’ve finally fallen asleep after an awful coughing fit when my phone buzzes at midnight. It’s a text from my preceptor, who conveniently lives next door.
BB having a seizure. Meet you outside in 5 mins.
Shit.
The baby arrives at the health centre just a few minutes after we do. He’s a teeny-tiny thing, less than a week old. It’s the baby of the girl we saw a week ago. We check him out and he’s completely fine.
“Look, he’s doing that thing with his eyes! He’s trying to have a seizure,” his grandma shows us anxiously. We inspect him, and my preceptor laughs. “No, he’s just looking around. They can’t see much when they’re so little, so their gaze looks unfocused.”
We spend a few more minutes providing some reassurance and teaching. Grandma is understandably nervous after her daughter’s seizure last week. We help her bundle the little guy up, and tuck him underneath her coat. “If you’re worried about anything, just call us. We’re always here.”
We head home, hoping to catch a few more hours of sleep before our next morning at the clinic. But we detour to the edge of the town to see if we can see the northern lights tonight. Nothing. There’s too much cloud cover. Oh well. I think our non-seizing baby has already been our lucky moment today, and I’m happy to leave it at that.
The patient arrives a few minutes later, stumbling, held up by her mother and boyfriend. Breathing, walking, has a pulse. Check, check, check. She mumbles her name when I ask, but won’t answer anything else as I check her vitals. She refuses to open her eyes.
“She supposed to fly out next week to deliver, but she hasn’t been coming to her appointments with me,” Sara, who manages the prenatal patients, says. Only now do I look down and realize that this girl is heavily pregnant. Sara tosses me the fetal doppler. “Gen, can you check the baby’s heart rate?”
Yikes. I don’t do this much. Luckily, my work mom had let me practise on her just a few weeks before I’d left. I’ve just pressed the doppler against the patient’s belly when I see her eyes roll back and she starts to seize. Her mother starts to scream hysterically beside me.
And so begins our first day on call.
Seizures are always a little scary and unpredictable, and never have I had to deal with one in a pregnant woman. I’m used to having a bunch of other nurses to call in for help, at least one doctor, a respiratory therapist, and a code blue button to get all hands on deck if things go terribly wrong. Here, I have these three other nurses, and the doc on call, who is taking his sweet time to give us medication orders over the phone. There is no more back-up for us to call in.
“Can you ask him if we can draw up some ativan?” I ask Sara, still on the phone with the doctor. I have no idea if it’s safe to give in pregnancy. Judging by how long it takes him to answer her, it seems that the doc – obviously not an obstetrician – is looking it up himself. The patient starts to seize again and I grab an oral airway, but there’s no way I can get it past her clenched teeth. She’s managed to rip out her IV, so the doc gives us an order to inject the ativan into her buttocks. She finally settles for a minute, and I take this chance to put a new IV in. But I’m an idiot and don’t realize that the ones here don’t have the fancy vacuum seal that I’m used to at home, so the moment I put it in, blood comes spraying out like a hose. Whoops. At least we have IV access again.
The doc finally gives us an order for a continuous infusion of mag sulfate, and luckily, this keeps her from seizing again. But she’s so confused and agitated after her seizures that she won’t stop trying to climb out of the stretcher, and it takes three of us to continually hold her down as she swings and swats at us. When she’s finally willing to lie down, we get her boyfriend to climb in and spoon her in the stretcher. Who says you can’t get creative with restraints?
It takes a few more hours before she’s medevac’d out. The front desk staff have been sending all the walk-in patients away since all of us were tied up with the seizure, but now they’re all trickling back in. No one, it seems, is willing to stay at home with their cold symptoms, and I swear we see half of the kids in the community in one day. We scramble to see all of them, but they keep coming in. My preceptor and I, being the ones on call, finally go home at 2AM, almost eighteen hours later.
--------------------
It’s a week later, and I’ve finally fallen asleep after an awful coughing fit when my phone buzzes at midnight. It’s a text from my preceptor, who conveniently lives next door.
BB having a seizure. Meet you outside in 5 mins.
Shit.
The baby arrives at the health centre just a few minutes after we do. He’s a teeny-tiny thing, less than a week old. It’s the baby of the girl we saw a week ago. We check him out and he’s completely fine.
“Look, he’s doing that thing with his eyes! He’s trying to have a seizure,” his grandma shows us anxiously. We inspect him, and my preceptor laughs. “No, he’s just looking around. They can’t see much when they’re so little, so their gaze looks unfocused.”
We spend a few more minutes providing some reassurance and teaching. Grandma is understandably nervous after her daughter’s seizure last week. We help her bundle the little guy up, and tuck him underneath her coat. “If you’re worried about anything, just call us. We’re always here.”
We head home, hoping to catch a few more hours of sleep before our next morning at the clinic. But we detour to the edge of the town to see if we can see the northern lights tonight. Nothing. There’s too much cloud cover. Oh well. I think our non-seizing baby has already been our lucky moment today, and I’m happy to leave it at that.
And then you got sick. :'(
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