Saturday, January 23, 2010

Rubber Chicken in Intensive Care Unit!

I am working the night shift at a large Catholic Hospital in a metropolitan area. I and another respiratory therapist are on duty for the night, and "Brad" who was well known for pulling off some good practical jokes to pass the time, had disappointed me this time. Best he came up with for the evening was the rubber chicken he brought with him to help pass the time. This was that common variety of chicken, plucked and portrayed as deceased with it's mouth gaping open. Brad figured we could hang him in a linen closet and maybe give a good scare to one of the Nurses.

The rubber chicken was hung by his feet and when anyone opens the closet, that is the first thing they will see. Several nurses visited the closet, but none reacted as we were hoping. "Oh, who hung this here", or "oh... that is really funny". Brad was disappointed.

Then Brad got a brilliant idea... "Hey let's take the bird down to the Cardiac Intensive Care Unit and find him a bed". There was only a couple of patients in the 14 private rooms, thus we should have no problem finding the chicken a bed. Bed 7, right across from the the Nurses Station will serve fine. Brad goes in like he is checking some equipment, tucks the little bird into bed with a sheet pulled up to his little chest, and head propped up on a pillow. He then turned on the pulse oximeter and left the room.

Now with the pulse oximeter not hooked up to a patient it will alarm in about 10 seconds. When the alarm goes off one the nurses looks up at the supposedly vacant room with a quizzical look on her face. In she goes to shut off the alarm and sees the little rubber chicken tucked in the bed. She starts yacking about how this is not right... We figure she is going to be upset with our little joke but instead she hooks the pulse oximeter clip onto the little birds arm, and silences the alarm. The other nurse joins in and applies a couple ECG leads to the little bird's chest and hooks it up to the cardiac monitor. The other nurse is busying herself with starting an I.V. on the birds free arm. They are now calling for Respiratory Therapy to set up a ventilator as they feel the bird is having difficulty breathing. I send Brad for a ventilator, while I intubate the bird with a 7.5mm endotracheal tube. Brad set the ventilator for around 150cc of volume to ventilate. I inflate the cuff on the endotracheal tube and get a perfect seal in the birds airway.

While Brad and I have been fussing with the intubation and ventilator, the nurses have started an I.V. drip, put in a foley catheter and hooked up a chest tube. We hook the bird up to the ventilator at 22 breaths per minute, and we all cracked up when the rubber chicken started inflating and deflating with the cycling of the ventilator.

We are all quite proud of how rapidly we were able to stabilize this very sick bird, and indeed proved not only to be a good way to pass some time, but also helped in building our team work.

An hour had passed and it was now about 3:00am and Brad and I are hanging out in the ICU talking with the Nurses. The bird has been very stable. Indeed... another slow night.

Then we hear the automatic doors swing open, and walking down the hallway, much to our surprise and horror, is the the Chief of Cardiac Surgery. We all stiffen in our chairs as we see him walking down the hall glancing in each room, obviously looking for a patient of his. He rarely shows up at this time of night, and what a night for him to choose to do a surprise walk through.

As the Chief of Cardiac Surgery approaches room 7, he comes to a stop and does a classic double take... At first it was if he was not sure of what he was looking at. As seconds ticked by, he was soaking up the full impact of what was going on in that bed. Then with an almost military about face he turned and looked blankly at the crew... "Slow night huh?" was all he said. Then without any expression on his face, continued on down the hallway. We were all almost dying trying not to break out in full laughter.

We left the bird on life support for the AM shift to see. It did not take long for the word to spread and several nurses and other staff had to come up to see our handy-work. I figured we would get called in before the Nuns for some counciling, for this stunt, but nothing ever came of it.

Ya gotta love the Night Shift in a hospital.

Sunday, January 3, 2010

Our Home Birthing Experience

It was curious in how I went from denying my wife any children for 9 years, to having 3 boys... and all were home births. My hesitation to having children, I am sure, was related to my (at that time) decade of hospital experience working as a respiratory therapist. Several of those years was with assignment in the Neonatal Intensive Care Unit. I enjoyed the work with the littlest of babies, but it did in the long run have an impact on how I viewed newborn infants. I did develop a fear or a certain view point that by and large, infants are born sick. This of course is far from the truth, but when you are immersed in that environment for 8 to 12 hours a day, for several years, it can indeed have an impact on your view of newborns.

I cannot even remember the name of the book now, but the overall thrust of the author/physician was to point out the many short-comings, errors, and other problems within the American health care system. This was in 1980. I am sure his writings would still ring true today. And of course there are a whole host of books today that are discussing that same issue.

The author had an entire chapter just on what he considered to be deplorable birthing methodologies in the American hospitals. I was quite struck by his words, and passed the book on to my wife... She also was a health care worker, and after reading the book, she also was intrigued by the statistics that the writer presented, showing that having a baby with home birth was many times safer than having a birth in a hospital. I would bet that although we are 3 decades since the writing of that book, that the stats are probably still pretty dismal for the birthing in the hospital settings. I will not take the time to quote birthing statistics, comparing hospital to home birth, as a simple web search will provide current information. Take the time to research!

The basic fact is this. Having a baby in the hospital increases the chance of injury to infant and mother, increases the chances of infection to mother and infant. Take note! I Do Consider unnecessary c-sections and episiotomies to be injuries to the mother. And I consider anesthesia or the many pain medications given during birth to be an injury to the infant. The amount of carnage related to these procedures is appalling.

With this stark information, I was slowly coming around to the fact that I should not and could not any longer deny my wife of her desire to have children. So I asked her if she would be willing to consider home birthing with either a midwife or physician present. Without hesitation, she agreed. And it was not much later that my wife was pregnant with our first child.

We started reading all we could about home births as well as going to the local Lamaze class. We were the only Lamaze students in our class that were considering home birth. We found a local physician that was willing to do home birth, but he bailed on us a few months before the birth.

We sought out a midwife and received excellent information and instruction from her, but as the time grew near, she too informed us that she would not be able to guarantee her being present for the birth due to travel time. She encouraged us to continue with the home birth plans, but to plan on managing it ourselves. She recommended seeking out others in the community that had home birth experience and see if there were any that would be interested in being present during the birth. We had some friends that lived not too far from us in the country. These two sisters had both had several children by home birth. When approached, they both were very excited about the prospects of attending the birth.

My wife of course had regular prenatal check-ups, we attend the Lamaze classes, and assembled the basic items together we would need for the birth. Again... I will not go into detail of what our reading and instruction and equipment consisted of, but I would say, we were pretty well prepared as one should be. Our physician gave a green light on the home birth as all looked very normal, and we should expect a normal birth with a healthy baby.

It was 4:00 am when she started into labor. I called the gals later in the morning to let them know that it looked like she was in labor. They would be standing by, but it looked like it might be a very long labor. We took walks up and down the drive and busied ourselves with making sure all was present. My brother and his wife would also be attending to provide assistance and photographic services.

The day drug on and it was not until late in the evening that my wife had started dilating, indicating that the birth process was starting to move along. Yes! I did the Pelvic Exams... Her contractions were getting strong, but the process was still proceeding slowly. The babies heart rate remained strong, and my wife remained strong despite the length of the labor.

It was about 2:00 in the morning that I started to question what the hell we were doing. My wife was working so hard, and it seemed that the moment of birth would never come. Yes... A true moment of doubt. I stepped outside into the cool dark air for a break. I flashed my flashlight into the woods, and there! Not 10 foot from me was an Owl sitting on a branch in the beam of my light. The Owl just sat their in my beam of light with an unflinching gaze as if he were imparting a message to me. I stood transfixed by this apparition, and after several minutes of me staring at the Owl and the Owl staring back, I slowly turned the light away and headed back to the birthing.

I had my resolve back and was indeed ready for our baby boy to be born into my hands. He was born with eyes wide open and without and distress or crying. I cleared his nose and mouth of mucous and presented the boy to the waiting arms of his mother. Within seconds he was contently nursing while a tearful mother stroked his head. I clamped and then cut the umbilicus, and we all gave each other great big hugs.

Without a doubt, this was one of my most intense experiences of my life. Not sure what to say about the visit from the Old Owl, but I will take that as a good omen. The sisters were wonderful through the process and assuring me that everything that my wife was experiencing was normal.

Our next two boys were born at home as well, but the stress level was less each time. We would have only one other person on hand to assist, and all went very well with the births. The most interesting aspect of the birth of the three boys was the alert wide-open eyes, and the lack of distress or crying. So many of the births I had attended in hospital settings were very different.

Now, I am not suggesting that home births are for everyone. Pre-natal check ups will identify most issues that would eliminate consideration for home birth. If there is a health concern, then the hospital is your best environment. If you do choose a hospital birth, seek out a facility that provides the best in natural child birthing methods. If you are interested in Home Birthing, there is a lot of information available on the Internet. The more prepared and educated you are, the more confidence you will have.

All the boys are grown now, and I await the day I will be a grandfather.