Katherine

Tan






October 8th. 2015



On my first day of Womens Health clinical, I was assigned to the labor and
delivery unit. I was shadowing Emily that day. Emily was only assigned to one
patient that day. The night shift nurse, Jen, warned us that this patient was a little
hard to work with. My patient was a 31 year old, G1P1, who had completed her
undergraduate and Masters education at JMU. She and her husband were both very
excited to have me spend the day with them, surprisingly. She also had a dula with
her. Emily and I both entered the room and the patient was getting induced. The
physician, Dr. Culver, was inserting the Cytotec into the cervix and the patient
tolerated that well. We kept a close eye on her and the fetal heart monitor
throughout the rest of the shift. Emily mentioned that our patient was IUGR so she
explained to me what that meant, why she was focusing on the fetal heart monitor
so closely and what we were looking for. My patient appeared very stressed and it
was due to the fact that she was in the process of selling her house. The day got very
interesting at around 10:00. She had been experiencing contractions but this was
not enough to stop her realtor from coming in with papers for her to sign to finalize
the sale of her house. She signed the papers through her contractions. After signing
the papers, she asked to go into the tub because it helped with the pain of the
contractions. Emily had assisted her to get in the tub. The fetal heart monitor was
still placed on the patient but Emily was having difficulties with keeping it on her
and in the right spot to get a good reading on the babys heart. We kept coming back
into the room to readjust it. About a half hour passed, and the patient was ready to
get back into her bed. We assisted her back to the bed from the tub. When the
patient was fully settled in bed, she was able to place the fetal heart monitor on
accurately and noted something on the fetal heart monitor. These moments are still
a blur to me since these series of events occurred so fast. Dr. Culver came running
back in along with another nurse that was on labor and delivery. They pushed the
furniture into the bathroom to make space to wheel her bed out. They lowered the
head of the bed, and off to the OR. I was mixed with emotions. At this moment, I was
so confused, excited, and worried. I had helped wheel her to the OR and it felt like 5
seconds later she was in the OR, and I was putting on PPE and getting ready to get
into the OR. At this moment, I was very excited because Ive always wanted to see an
OR and a surgical procedure, but I was very worried for my patient. I was still left in
the dark with what was going on. My patient was on the table getting ready to
receive anesthesia. She was unsure on what to do and what kind of anesthetic she
wanted to receive. Emily did an excellent job at getting her make her mind in a
timely fashion without pressuring her and being forceful. I hope to acquire a skill
like that during my career. It was just Emily and I in the OR for a short period of time
and then a flood of several other people came. Dr. Culver was incredibly calm and he
had seemed mentally prepared to do this c-section. The nursery team and a surgical
team shortly appeared and suddenly the OR felt so small. Shortly after the surgical
team arrived, the anesthesiologist began administering the epidural. The
anesthesiologist put betadine on the patients back with a technique that closely
resembled paint strokes. Next, she inserted the needle then the catheter. The

epidural was a lot different to read about versus actually seeing it in person. The
anesthesiologist was very good at describing to the patient what was going on and
what was going to come. Next, I remember them laying her down and my patients
husband coming in to sit next to his wife. He held her hand and sang to her the
entire time. The members of the surgical team and the nurses got her draped and
ready for surgery. Then, the physician very calmly approached the table and asked if
everyone was ready to start. I was very excited at this point because I was going to
see a surgical procedure up close and personal. The doctor began to cut and this was
the part that I was semi-nervous about. I was worried about how my body was
going to react but I tolerated it fine and found myself getting closer to the table to
see the abdomen better. Once the physician had cut deep enough, the rest of the
surgical team got the retractors and pulled it open even further. I was fascinated
with how yellow the adipose tissue was. I was also looking at the suctioning of the
blood. I noticed how it doesnt come out like water but it looks like little circular
droplets. It was not nearly as liquidy as I imagined. During the mist of my
amazement, the doctor said he was ready to take the baby out. He extracted the
baby and the baby had the umbilical cord around her neck and right arm. She had a
greyish appearance. She immediately went to the warmer and the nursery team
turned on the Apgar timer. The patient and the husband noted that their baby was
not crying and they began to worry. The anesthesiologist, who was situated at the
head of the bed, was the first person to adequately and calmly answered her
questions and acknowledged her concerns. The baby was very tiny. She was only 3
lbs and 11 ounces. I was really interested in how they were going to close up my
patient but I did notice that the baby was starting to pink up. My patients husband
followed the baby out of the OR. My patient started to get worried and scared but
the staff was really good at answering her questions in a calming manner without
saying anything indicative and falsely assuring. Once she was closed, they noticed
the bleeding from her vagina, which was a concept that I had learned in class. Next,
Emily and I took the patient to the PACU. I watched Emily assess her in the PACU.
She assessed to see if the patient could wiggle her toes or feels sensation in her legs
and exclaimed to the patient that this was a normal reaction and it will resolve. I
noted that this was another thing that we learned in class so I added some input in
as well. The patient was reunited with her doula, who was so happy for her. After
the assessment, Emily had explained to me what happened. Earlier in the day, Emily
explained to me what accelerations and decelerations were. When she looked at the
fetal heart monitor after we moved the patient back in bed before she noticed that
the baby was decelerating but not recovering and she said it was a concern and it
indicated that the baby was in stress. I was also lucky enough to briefly care for this
baby during my time in the nursery. It was a relief to see that this baby was finally
discharged even if it was 4 weeks after I watched her delivery.
This experience is something that I will hold close to my heart. I was proud of
myself for remaining calm in this kind of situation for not only my sake, but for the
sake of my patient. It introduced me to a type of adrenaline that I had never felt
before, how every minute and every decision needs to be worth it because there are
lives at stake. I will continue to describe this experience to all my colleagues for
years to come. Witnessing this situation so closely had reassured my love for OB and

sparked an interest in a possible career in the ER and dealing with traumas.

Although, I handled this event very well and remained as calm as I could, I would
like to be able to play a larger role the next time something like this arises.