And Now for a Word from Our Sponsor...

From reading other blogs of L&D nurses, I’ve begun to realize that things are pretty much the same all over the country. So, instead of attempting to rewrite what has already so elegantly been done, I now turn this blog over to my online friend at At Your Cervix… L&D nurse extraordinaire, future midwife, and all around “Good-ole-girl”. These are her words…I could only hope to be able to so clearly depict the realities of this “Love it, but Hate it” job

“Which leads me to some of my gripes and concerns about coming to L&D triage.

• Don't ask for food immediately - it's not happening - think about it - you're here
• because of pain, leaking fluid, vaginal bleeding, preterm labor, n/v/d, or for whatever reason. You will NOT be automatically given food upon arrival, and chances are good you won't get food while you're here on L&D. The best you can hope for is some clear liquids, unless your doctor allows you to eat. And if you can eat, chances are you don't need the level of care required on L&D. (Ed. Note…and no, we can’t provide a meal to your mother, your boyfriend, or your kids…I’m sorry they are hungry and you didn’t have time to feed them. I’m hungry because there are six more women here just like you, a dozen more sitting in the waiting room, we’re understaffed, and none of us in L&D are going to get a meal break tonight.)
• Triage means: you will be evaluated, and seen according to severity. Your stomach virus is a lower priority than the preterm patient who is ruptured.
• If you're not in active labor, expect to be sent home. Home is more comfortable than a small stretcher in a room with 4 other women who are also being triaged.
• I'm not here to cater to your every whim. I am caring for multiple women, with multiple problems. I have to prioritize, so do not be upset if I can't get you that cup of water immediately. There is only one nurse in triage. I cannot be everywhere.
• There are no TV's in triage on purpose - to discourage you from staying any longer than needed. Plus, I also need to be able to hear all 5 EFM monitors simultaneously. I cannot do that with 5 TV's blaring at full volume.
• Each person may have ONE visitor with them. The triage bays are too small to accommodate your entire family.
• Speaking of which, just WHY did your friend/family member drag your 1 yr old child out to the hospital at 10pm? (ed. Note…or 2:00 A.M., tired, fussy, hungry?)
• I really don't care about how tired you are of being pregnant when you're 32 weeks along. You won't be admitted and induced because of this. In fact, you're here because we're trying to STOP your preterm labor. You really want a baby subjected to being in the NICU for weeks?
• If you can't urinate on your own for the urine sample I need from you, I can easily use a catheter. But you don't really want that, right? Because I don't want to have to catheterize you unless I absolutely need to. It hurts too much. So please drink the fluids I've given you to help you produce urine for the specimen.
• I'm glad you have signed your tubal ligation papers, but I'm not worried about that right now.
• I'm going to keep my mouth shut when this is baby #4, and you're only 21. And the father of this current baby wants 10 more babies, because "they're so cute." And he doesn't work. Neither do you. Great.
• I'm also going to keep my mouth shut when you presented to prenatal care only 1 week ago at 38 weeks, and you're in active labor today. Oh yeah, and you have 3 different STD's to boot. And the baby has a cardiac defect. And this was NOT your first pregnancy, so you knew better. But I will keep my mouth shut, even when I want to lecture you about good, early prenatal care.
• Don't expect an epidural upon arrival - when your cervix is closed/thick/high, and your contractions are every 20 minutes. You're going home, because you're not in labor!
• Please don't bring in your suitcase when you are the above patient. You're just going to have to lug it back to the car when you leave. Besides, it also takes up precious room in triage, and I need to be able to get to the fetal monitor to care for you and your baby. (Ed. Note…ditto the car seat…your not-yet-born baby’s car seat belongs, duh, IN THE CAR!!!!!!!!!!!!!!!!
• Thank you for bearing with me when I've made you wait for that drink of water. I appreciate the "thank you" that you gave me when I was finally able to get it for you. I apologize for it taking so long.
• Thank you for not arguing with both your doctor and then myself, when your doctor has discharged you home. Thank you for realizing that you don't need to be admitted today.
• Thank you for listening intently to my discharge instructions, and asking intelligent questions to clarify any concerns. This shows that you are actively listening to my teaching.”
• (Ed. Note…and thank you for looking at me with suspicion every time I make a request, perform a treatment, relay information to you from the doctor…I really am here to help you. If you distrust us so much, why are you here? We’re not the only L&D in town…
• Ed. Note continued…yeah, yeah, I know, you’re gonna sue _________Hospital, because they were so stupid as to tell you that you are not in labor…guess you’re gonna have to add us to that claim, because YOU’RE NOT IN LABOR!!! Fine, drive on over to ________ Hospital, five miles further up the road…they’re going to tell you the same thing…and I just LOVE knowing my tax dollars are paying for your waste of hospital resources for absolutely nothing! By the way…don’t you have better things to be doing at 3:00 A.M. in the middle of the week than shopping for some hospital that will admit you because you are “tired of being pregnant”?...like, perhaps, SLEEP?)
• Ed. Note, continued, one last time…for one of my personal favorites…

L&D RN…”When did your vaginal bleeding start?”

Answer…”About an hour ago”.

L&D RN…”Did you soak more than one menstrual pad?”

Answer...”Uhm…I didn’t use a pad…but there’s this spot on my underwear…

[L&D RN squints to see the pin-sized, pink dot on pts underwear, which patient happily whips off and holds up in the air].

L&D RN “When did you have sex last?”

Answer (giggling, looking up at snickering boyfriend…”About an hour ago”.

Here, another gem from At Your Cervix (catchy blog name, isn’t it? Wish I had thought of it, but that’s just how clever this writer is).

“Abuse of the"taxi" service

She arrived via ambulance. 18 years old, pregnant with her first baby. This was by far not her first visit with us, nor was it the first time she utilized the ambulance service to grace us with her presence.

"What brings you to L&D tonight?" I ask her, my standard opening line.

"My water broke."

Hmm, ok. I do my usual assessment and evaluation. Chief complaint of large gush of fluid x 1 at 3pm. Not wearing a pad on arrival, nor is she currently leaking any fluid. She's also smiling. Started having "contractions" while in the ambulance on the way here, now rating them 5 out of 5 on the pain scale.

(You haven't felt pain at a 5 out of 5 yet honey, I think to myself. Note that she's still smiling.)

She also mentions to me that the doctor in the clinic "broke my membranes" today. Hmm, at 9am, the time of her appointment? And she's just now coming in with c/o ruptured membranes at 3pm? I don't think so.

I try to clarify things with her a bit, "The doctor today must have stripped your membranes in the clinic, because she would have never broken your membranes on purpose in the clinic - it's just never done that way. Also, if she broke your membranes, it would have been accidentally, and she would have sent you over to us on L&D immediately for monitoring."

But no, she insists that the doc "broke my membranes" in the clinic at 9am, then then her "water broke" at 3pm. We're not talking about the highest on the genetic chain of life here, if you get my drift.

"So, why did you call an ambulance?" I question her.

Her mother answers, "well, we couldn't find anyone to drive her here. And besides, her insurance pays for the ambulance." I note "medicaid" under her insurance company in her demographics paperwork.

I try REALLY HARD to bite my tongue.

When later letting her doctor know that she's arrived, her doc even mentioned that the doc the patient saw in the clinic that day told the patient POINT BLANK - DO NOT CALL AN AMBULANCE, call for a taxi if you can't get a ride in to the hospital.

Oh yeah, and the doc stripped her membranes in the clinic that morning. For which, I wanted to verbally lash said doc, because this patient was only 37 weeks gestation.

In the end, the patient's membranes were intact, and she was sent home - without the luxury of a taxi - I mean an ambulance - to bring her home.

+++

Comments re: taxi/ambulance service abuse

Recently, in the comments section regarding use and abuse of the "taxi" aka ambulance services, there was this comment:

Thea said...

"What, no room at the inn tonight? It's sad when someone's career slowly strips them of compassion. Have you ever tried to get around without a car for any decent amount of time? Do you know what it's like, truthfully? Have you been 18 and pregnant? Do you have a clue?"

And here is my response:

"Thea - actually, I do know what it's like to be pregnant as a teen - twice. I had my first child at age 15, and my second at age 18. I wasn't bashing her for being pregnant as a teen, because I've been there myself twice. I was, however, upset - and rightfully so - that young women like herself will abuse the ambulance and hospital services like this. I had yet another ambulance abuser come in last night at work. It happens almost every single day! They don't care, because their "insurance" pays for it - well who pays for that? We do - the working class.

I have also been on state aid - for my pregnancy at age 18, only because my then husband did not have health insurance at his job. I knew the importance of prenatal care, and went to a clinic to receive it. Did we abuse services? No, absolutely not.

What really, really pisses me off, is the fact that after the ambulance brings the patient in, her entire entourage of family and friends DRIVE IN BEHIND HER! Or, like last night, the family members arrive BEFORE the ambulance does!

Add up the costs - ambulance ride: bare minimum of several hundred dollars. Eval time in triage at the hospital - minimum $750 for basic services, double that when we charge for an NST as well. That's a total of close to $2000 (including ambulance services) that the taxpayers pay. And 9 out of 10 times, the patient is sent home.

Now, multiply that by numerous instances by the same patient. Now multiply that by numerous patients who abuse the system the same exact way.

And that's just ONE hospital.

And people wonder why the health care spending and industry is out of control????"”

(Ed. Note…[but then, you knew this was coming, didn’t you?...You know, if you are pregnant in this town, and you call the squad to your house, they have to transport you…even if your husband/fiancé/boyfriend, who has a perfectly running car sitting in the driveway, didn’t want to be bothered because he just got off work, and he was too “tired” to drive you in, or your mother (who also has a decent car sitting in the driveway) was cooking dinner and wanted to finish her meal before driving you in…so there they sit, in the recliner in the living room, or at the kitchen table, watching nonchalantly as the medics load you up on a cart and take you out to the squad. I sure hope there isn’t a serious problem going on in your neighborhood right now…like some one having a heart attack, who just might die because your significant other was too tired or your mother didn’t want her Rice-A-Roni to get cold! And, since you are not in labor, and you are not truly sick, and neither is your baby, we are sending you home, and no, we aren’t going to give you a taxi pass…CALL YOUR MOTHER!)

END OF RANT (with mucho thanks to ATC)