Scrub Scrub…

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March 23, 2012 saw me being wheeled to the operating room for my fourth and most difficult operation ever. Even though I had two more ten hour surgeries after this, that one would remain to be the worst.  I went in at seven AM for a wash out and most likely loop ileostomy, and came out around seven PM in severe pain with the awareness that things did not go exactly as planned. The doctor was unable to close my fascia, the tissue beneath the skin that works to attach, stabilize and separate muscles and internal organs.  She attached clips to my stomach with elastics that would have to be changed everyday to help things close and had a plastic surgeon insert synthetic skin to also help with the close. I did not know this at the time, but the doctor was pretty sure I would never work as a labour delivery nurse anymore, or any kind of nursing that required any kind of physical activity.  Even weeks after the surgery it was very hard to get up, and I was not allowed to do anything without a hernia band. Never mind nursing. I was pretty sure I would never be the same person again period. Walking down the hall was an ordeal; how was I suppose to push a bed down the hall at top speed for a crash section? The next couple of years saw two more surgeries to get rid of the infection and all the organs it spread to. They took everything they could.

Even though I had a revision of my ostomy since then, I still consider that date the anniversary.

March 23, 2015 saw me scrubbing in for my first c-section since I got sick, more or less four years after that last one I was ever involved in as a scrub nurse. I can’t really remember when my last section was before this.  I remember scrubbing in from time to time leading up to my illness, but they are all fuzzy. I might have paid more attention if I knew what was to come.  I was nervous scrubbing in for the first time in so many years, but I was so excited because for me this was truly the end of the long journey. I loved scrubbing in for sections and had even considered applying to the OR course or ped’s OR before I became sick. It wouldn’t be very workable these days since my ostomy can be unpredictable, but I was happy to be able to do these simple short surgeries. I was even in for a three hour long one with no issues the other night.  I don’t know if I will stay on the birth unit forever, but the draw and excitement is keeping me there for now.

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Immunizations and the Recent Measles Outbreak…

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This morning I was watching last nights news as per my usual routine, and one of the headlines had to do with the recent measles outbreaks. Some children in Toronto caught the virus because they had not been immunized against it.  Unlike the recent outbreak that originated at Disneyland, these were all independent incidences with no connection. Except the fact that they had not been vaccinated.

I get very passionate about this subject, especially since I live in Canada, a country where health care is universal and we are not required to pay for things like provincially scheduled immunizations for children. Our healthcare system is usually in a sate of turmoil due to government funding (or lack of) and our hospitals are not always equipped with the best and newest equipment (or working equipment for that matter…three of our labour rooms have lights that will not turn on) so this makes prevention of diseases all that much more important. Third world countries cry for vaccinations and proper treatment for preventable diseases and would probably line their kids up for blocks and blocks to receive just one dose of the vaccinations that are given to our Canadian children at 2, 4, 6, 12, and 18 months. At 5 and 15 years old. So with this in mind, while watching the news this morning I posted on facebook my outrage that kids in Canada had measles because their parents chose not to vaccinate. What I didn’t expect was the debate it would spark. My privacy levels on facebook are set so only my friends can see what I post so I figured I was safe from sparking any huge debate by posting my feelings about vaccinations. I knew most of my friends were of the same mindset as I was and figured I would get the usual “likes” and random comments.  I was wrong!

I love a good debate, and vaccination is a hot one right now. As a nurse I am required to not let my views show in the hospital room. The patients views are what matter, and like them or not my job is to make sure these values are respected and known to all the healthcare team. I must be accountable for my patients safety, advocate for them and maintain my continuing education to ensure I am providing them the best care. I don’t really know what happens after I take my patients up to the family newborn unit. There are children out there whose deliveries I was present for and I have no idea where they are or what they are doing now. I have no idea if they have been vaccinated or not, and it is not my place to care as a nurse.

As a person who has been through many illnesses and has actually had, or seen family members have some of the preventable viruses (even though we were vaccinated) I cannot understand how a parent would choose not to do everything possible to protect their child from preventable diseases.

When a patient decides to decline a treatment we are offering I tend to google it so I can get an idea of what they are learning by declining. I don’t tell them what I’ve learned from this search…that is not my place. I just like to know where they are coming from. Some of the most common things that are declined in my line of work are continuous fetal monitoring when it is indicated, antibiotics when they are indicated, induction of labour when it is indicated, and the vitamin K injection we give the baby to prevent hemorrhage.

Our policy on fetal monitoring is based on the Society of Obstetricians and Gynaecologists of Canada, or SOGC guidelines. They can be found here.  These guidelines are there for the safety of a patients unborn child, plus the safety of the healthcare team caring for the labouring mother and fetus.  It offers a solid communication that allows us to capture exactly how the fetus is responding to contractions and what interventions were taken to aid fetal wellbeing.  We provide continuous monitoring for all patients who are receiving induction, are attempting a vaginal birth after having a c-section, when there is meconium present in the amniotic fluid.  There are other examples as well.   Fetal monitoring is not perfect. I have seen cases where it looked like we were capturing a perfectly healthy fetus, only to find it was the mothers heartbeat. I have also seen cases where we caught an issue on time because of the monitoring. I have seen people flat out refuse the monitoring and be lucky enough that nothing happened during the labour. A doppler can only tell us so much.

When a patient is positive for group b strep and their water breaks it is our policy to induce labour and start antibiotics so the baby does not get infected during delivery. You can read more about it here.  Again, I have seen people come in as soon as their water breaks, receive the antibiotics and still develop a fever during labour. I have seen patients decline the antibiotics and the baby has done fine. I have also seen babies of patients who decline the antibiotics become sick and require antibiotic therapy after birth.

How does this relate to the vaccination debate? The point I’m trying to make is that as healthcare professionals we make decisions based on research, education and life experience. Sometimes things can happen that we can’t explain and might never be able to. They don’t follow the norm.  There will always be a small percentage of people who do not react to a treatment the same way as most can. The same can be said about vaccinations. Lately people have been talking more and more about vaccine injury, which you can learn about here.  People are using this as a reason not to vaccinate, along with fever, seizures and other known side effects. They are saying they do not want to subject their healthy child to something that does not have guaranteed safety. If you continue to read the above link to the CDC you will see that they even admit it is not known to be 100% safe. However, nothing in the medical field is. Chemotherapy is not 100% safe. Surgery is not 100% safe. The birth of a child is not 100% safe. We do the best we can based on what we know and what we have experienced.

No, we do not know how every single person will react to the vaccinations. We do not know how a pregnant woman and her baby will react to the flu shot. The flu shot is based on a guess.  Experts try to determine what strains of influenza will be prevalent in the upcoming season based on the season that just past.  Sometimes they get it wrong. They did this year. The reason we don’t know how pregnant women will react to certain medications until they are given them is that ethics prevents scientists from conducting tests on them. Testing for medications are conducted on healthy people of a certain age group. Ethics boards were created to avoid situations like this. Before we had any sense of ethics, a man named Edward Jenner discovered inoculations by scraping a spore of cowpox and injecting into a healthy young boy. He based this on his observation that milkmaids were not catching smallpox plus the observation that people who survived the disease never caught it again. You can read more about it here.

Some of the arguments surrounding when to vaccinate your child seem to have scientific background and could be legit, such as the fact that breast milk can help the child’s immune system. We know this is true for the first couple of months for sure. Maybe it’s true for longer, I don’t know. Again, who would want to do the study to find this out?  Do you want to skip vaccination on the off chance that your milk will protect your child? When would you suggest starting vaccination if this is the case?  And what about those parents who, for whatever reason, can’t breastfeed?

I am all for informed decisions, and if you have done your homework properly and still do not want to vaccinate your children that’s fine. But you could at least make sure there is not an immunocompromised child attending school with your child. You can make sure you are receiving the proper information. Google searches do not provide the proper information without some serious digging (I found all the above articles on Google after scrolling through blogs and obscure websites that are usually sponsored. And please don’t complain if your child develops and (heaven forbid) dies from an otherwise preventable disease.

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The Fastest Year

I feel like it must have been at least a year since I’ve written in this blog. I don’t remember posting at all in 2014. I remember starting posts and saving them in my drafts, but never getting back to them after that.  This was mostly because I was attempting to blog from my ipad and would get fed up trying to type such a long post with two fingers. I would usually get the urge to type during a nightshift so that was all I had with me and I didn’t feel like doing it on the work computer where people were coming and going. I would get home and think about posting but do something else instead. Needless to say I didn’t get a lot of writing in this past year, even though a lot has happened.

I suddenly find myself in the beginning of 2015, back to working full time and sometimes forgetting I was ever in the hospital as a patient at all. What I carry with me are the things I’d hoped to carry: more compassion and patience for the women and babies I take care of and a better understanding of how it feels to be in their shoes.

Sure I’ve felt it before as a kid, but the last time before this that I was in the hospital was fifteen years ago. It lasted a week and I remember very little about the whole thing. A surgery, a few days of pain, a quick recovery. Much more like the last surgery I had this time. Much of the reason why I went into my first surgery so smug; I went in with the belief that I was strong, that I would come out of that surgery quickly and be back to work by Christmas that year.  If you’ve followed the rest of this blog you already know that I was wrong…very wrong.

I wasn’t wrong about my strength, although I questioned that quite a few times as well. I went to hell and back a few times. I spent a total of two days under general anesthetic when it’s all added together, not counting the days I was so drugged up to control pain I even sent text messages without realizing it.  Or the number of times I was put under conscious sedation for a procedure. I learned what it feels like when a large amount of narcotics leaves your system. In the end it took me a full year to rid my body of opioids.  So when I have a mother who thinks she is in pain even though she hasn’t learned just how bad that pain can get I take her seriously and do everything I can to help her deal with it (without getting an early epidural). When I have a patient taking methadone because she was on drugs prepregnancy or even during the beginning of her pregnancy I can understand how it feels to her. I can understand why someone would have a hard time coming off drugs.  Weaning narcotics after an extended use is a feeling like no other. There is no real way to make it easier. I remember nights where I would just hold myself as tight as I could to stop the pain in my arms and legs. If I was cold at the same time it was worse. So the two nights I floated to NICU and cared for a baby who was born to a mother who was on methadone I knew exactly how he felt as well.

I’ve learned that after all this I am still strong enough to be a nurse in a high paced environment.

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A quick update…

I am sitting in a clinic with what looks like a lot of time to kill but only 15% battery so I thought I would do a quick update before it runs out.

I have been back to work for six months now, and on twelve hour shifts for four. With the exception of a few little things it’s going really well. The two biggest things are the aches and pains I get from my body trying to get use to working in such a fast paced environment again, and the number of colds I have caught since I returned.

I guess I should have expected the colds. I have basically lived in a bubble for two years and had not caught so much as a sniffle. This was a godsend at the time…I didn’t need a cold to further deplete my sad little immune system. However, it also meant that when I rejoined society every cold I caught knocked me on my ass. What use to cause a bit of discomfort now caused weeks of fatigue , something I didn’t need when trying to return to work. But I pressed on and made it through. I seem to be doing better on that front now and have started taking immunity boosters whenever there is something going around.

Getting use to the hospital environment took some time as well. You would think I wouldn’t have a problem with this, having lived in the hospital for so long, but our floor is the driest in the hospital. The nicu and OR units are all there so they keep it extra dry to try and keep the bugs out. Therefore, I spent months sounding like Patti and Selma and looking like a toad. This also went away with time as my body adapted to the Sahara.

The rest of it…remembering how to be a nurse, enjoying being a nurse, delivering babies…that came back like it was no time at all. I love being back on the job and making a difference in people’s lives. I love facing each unique situation that a labouring mother and her family can bring to the table and I love helping other nurses when I can.

So for the future I am going to work on getting back in the operating room and high risk pregnancies. I haven’t decided if I am going to continue on the flight nurse path, but I might. We also have a resource position now that allows people to work in all the units serviced by women’s and newborn health: NICU, family/newborn, birth unit and prenatal special care. I love variety so I think I would really like this option and might think about it for the future.

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On the mend

So I wrote a post about this a while ago, saved it as a draft and then went to finish it later.  For some reason it wouldn’t let me post it from draft mode. I was doing it on the iPad so that might have been the difference, but I decided to just re-write it so I can add more recent stuff to it.  

I had my surgery on October 24 which means I am now seven weeks post op and feeling fine.  The surgery was very long (ten hours) but that’s nothing new to me.  The initial wake up was much less fun than usual.  I think they tried to avoid the NG tube only to have me start vomiting and so they seemed to have to put it in quickly and last minute because I was still retching from it as I woke up and my throat was very sore as well. I think they might have put the wrong size in. It was also quite apparent that I was used as a pin cushion/practice subject for the arterial line and central line. My left hand looked like it was bitten by a vampire and was numb and my right was very bruised around the art line site.  The right side of my neck was also bruised and it looked like someone tried to choke me and I was full of blood.  Apparently it took them three hours to get me ready for my surgeon.  

This time they did a hysterectomy, got rid of the most recent abscess and a muscle flap to help prevent any new abscesses from occurring.  As far as the hyst went I didn’t really feel any different except for the headache I had for the first three days afterward until they were able to start the hormone replacement.  I don’t miss anything connected with that part of my body at all and nothing has changed.  And that’s all I’m going to say about that without getting too personal (I can talk about my ostomy until the cows come home, but I don’t think you need to hear about what hasn’t changed since the hysterectomy). 

As for the flap, it’s still healing but very well.  The actual flap site is completely healed, but there’s a small spot in the incision that is being tended to by the home care nurse.  I think this is a combination of two things: it’s very hard to move around and do things without aggravating that area (picture a cut on a joint that keeps opening when you bend it) and I’m pretty sure I’m allergic to whatever sutures they used.  I broke out from something and that’s the only thing I can think of that might have caused it.  My leg is also kind of rejecting sutures (literally pushing them to the surface, but not causing any kind of trouble other than that).  

As far as the leg incision, that’s been the worst part.  It runs from my groin to my knee and since they also took a muscle out of there it has needed the most rebuilding of strength.  they also used my dominant leg (my right one) so I have had to get use to using my left leg for things like bracing myself or getting up on a chair to hang christmas decorations.  The other day I took the dogs for a walk and they barked at the mailman.  I went to brace myself in case they took off, but used my right leg.  It gave out and down I went.  It was more embarrassing than anything else and gave me a good idea of how much strength I have to work back up in that leg.  I have started using a stepper to help and will probably do some swimming exercises as well.  The strength will come back in time so all is well in that department.  

My ostomy has been find through all of this. I am sticking with my convatec supplies as they seem to work the best and stick the best as well. I like the added benefit of not needing scissors with the mouldable ones.  All is well there. 

I’m hoping to get back to work mid january and also hoping to get back to outdoor things this winter. I miss downhill skiing the most since I did go skating last year.  The best part will be going back to work and being me again…that me I have been searching for these last two years is back even though I will always have this new experience under my belt. I hope to turn it into a positive thing and be a better nurse as a result of it. 

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Surgery update…meeting with Dr VanEyk

So I can’t really remember the last time I posted about my upcoming surgery. I had been putting it out of my head a lot as I am not looking forward to it. Needless to say, the consents are signed and in a month or two I will be back under the knife.

This time there is an interesting twist. A doctor and co-worker will also be operating on me as I will most likely be getting a hysterectomy.  So yesterday I went to the IWK Health Center, my place of employment, to meet with Dr Nancy VanEyk.  I had my choice of who to see in the gynaecology department, but I figured it would be strange no matter who I saw.  I have worked with Nancy quite a bit on the birth unit and have also scrubbed in with her for c-sections, so I knew she was good at what she did.  She is very smart and very nice as well.  Dr Williams, my colorectal surgeon, also approved her as her husband is a fellow coworker and has been consulted to provide me with a second opinion on several occasions.

I was still nervous about going to my place of employment for this appointment.  I already had such a hard time being a nurse and a patient at the same time, and I didn’t want people I work with treating me like a patient with no knowledge.  I was scared she would think my surgeon and I were overreacting in thinking a hysterectomy would be the best choice for the issues my chron’s is causing my uterus via the fallopian tubes.  I was worried the nurse would know me and treat me poorly as a result, or not know me and treat me poorly as a result.  I guess I have spent too much time at the VG, because I had forgotten that most nurses who work at the IWK are there because they want to be there.  Most nurses who do not like what they are doing do not last long.

The IWK is a combination woman and children’s hospital, the best in the Maritimes, maybe even Atlantic Canada.  It is referred to as a “magnet hospital”.  Since there are no private hospitals in Canada, magnet hospitals are the ones that are considered to be the best in the country to work at; providing employees with a wonderful sense of educational security and the best technology.  I was first introduced to this hospital as a child when I was transferred here for my first two surgeries.  At the time the technology was not really up to snuff compared to the brand new hospital I came from, but the staff were amazing and you could tell that each nurse was there because she wanted to be.  In such a specialized area of nursing, you would not survive if you hated your job.  It was at that time that I knew not only that I wanted to be a nurse, but I wanted to work at this very hospital.  I still get a sense of awe that I am here, getting paid to do such an amazing job, and yesterday as I made my way to the clinic I took the same route I would often take to get to work in the morning.  I missed it dearly.

The nurse who came in to assess me walked in and said, “I thought it was you! I saw the name and wondered if it was our Beth”.  It was so nice to be recognized, not for being a frequent patient, but for my identity outside of this sickness that it put me at ease right away.  Nancy arrived a while later and spoke to me as if we were downstairs discussing a patient.  She was in agreement with the plan and was able to answer any questions I had without making me feel like I was no longer a part of her team.  It was nice to be treated this way as a result of being a known coworker instead of being seen as a patient who happens to be a nurse.

She also wanted to make sure I was really ok with the plan at hand.  This, of course, will mean I will not be able to have biological children.  However, even before I became sick I wasn’t sure if this should have been in the cards for me.  I was worried about fourth degree tears, blockages, emergency c-sections leading to more problems down the road.  Now, after everything I have gone through and many discussions with Dr Williams and Jessie, it has pretty much been decided that there will be no babies coming from this body.  And that was before the most recent issues.  I had wondered if I would feel differently if I was in a heterosexual relationship, but on reflection I am thinking not.  There are so many children out there who need parents that I think it would be selfish to put myself in a potentially dangerous situation just to say the child has my eyes.  Plus, I wouldn’t want bring a child into a world where I am always sick.  I want to be able to have enough energy to have fun with my children, and right now that would not be in the cards.

So I signed a consent that will allow her to do whatever she thinks will be best for my recovery and return to work.  I have one more doctor to see and will hopefully be entering the OR in late October/early November.  I am hoping this will be fast and successful and that my post-op recovery will be as well.

My previous self, two AM and just help bring this baby into the world.

My previous self, two AM and just helped bring this baby into the world.

A baby I delivered when the doctor didn't get there in time.

A baby I delivered when the doctor didn’t get there in time.

A whole summer waiting for surgery. Might as well enjoy it!

A whole summer waiting for surgery. Might as well enjoy it!

Swimming with Reese

Swimming with Reese

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Update on the convatec mouldable…a few days later

So a few days into my trial with the new product I had a leak and thought “great…”

However, upon removing the wafer I found the leak was actually caused by my not clicking the bag on all the way after adjusting the position of the bag. Under the wafer it was clean as can be, and my issue with skin breakdown was completely gone. And I don’t have to cut the wafer anymore! Anytime I can cut sown on steps to changing the equipment is a good day for me!

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