(no subject)
I see it's been a very, very long time since I've posted anything at all, substantive or not. Aside from the fact that I've largely been ignoring the internet, things are delightfully the same in many ways--San Francisco remains beautiful, unsound makes me happy every day in ways big and small, the kitties are alternatingly infuriating and adorable as all cats are wont to be, and work in turns drives me crazy and fills me with joy.
I'm starting to feel more settled in at my job, and I think the doctors are beginning to understand that I know what I'm doing and can be respected and sought after for advice. I still deeply resent that it's taken so long, that it wasn't the assumption from the very beginning because of the culture of disrespect towards nursing that's so deeply engrained in some of the doctors here, but the change makes things much more tolerable. The charge nurses are learning my preferences for the Spanish-speaking patients, the sick pre-labor ladies, and the rip-roaring active labor ladies, so my patient assignments are becoming much, much more enjoyable. I've learned simply to tell the doctors what I'm going to do instead of framing things as requests or questions. Every once in a while I see a midwife, which is refreshing. I have great relationships with my patients. Things are better. They're not great, but they're better.
One of my patients last night, B., is one of the aforementioned sick pre-labor ladies--from Guatemala, with limited English speaking ability, 27 weeks pregnant with chronic renal failure, daily dialysis, rapid unexplained weight loss (several kilos over the past couple of days), and poorly-controlled diabetes. Last night I put in a naso-gastric tube to give her overnight tube feedings in addition to her regular meals in an attempt to fatten her up, and the whole time thought of nothing so much as fois gras. I can only hope that we succeeed, because without a big turnaround very soon, she won't live long enough to bring this pregnancy to term. She reminds me a lot of T., one of my last patients in Boston, who had end-stage cancer and died shortly after her baby was born.
This is B.'s second baby, and she was advised in the strongest language possible not to get pregnant again after her first child was born. She chose to do so anyway, because she says she doesn't want her son to be an only child. And, as an only child, I am baffled by the idea that it's better for someone to have siblings rather than parents. Oh right--I forgot that being an only child condemns a person to a life of selfishness, inability to share, inability to compromise, and a complete lack of empathy (insert eye-rolling here).
Still, I fear for her, and I worry about her when I'm not at work, I'll mourn for her when she dies, and it feels good to do that again. It's been too long, and it encourages me that these patients do, in fact, come here after all, and that finally I get to take care of them.
All the same, I keep looking around. I have an interview on the 16th at San Francisco General, a place much more in keeping with the safety-net, last-resort kind of place in which I'm used to working. It's for a position at the urgent care clinic, and I'm deeply ambivalent about the idea of leaving labor & delivery, even just for a little while to get my foot in the door at another place. Part of it is fear of the unknown, I'm sure--I've been an L&D nurse for my entire career, and there's a bit of me that's convinced that I'm simply not qualified to do anything else. Part of it is that I legitimately love caring for women during pregnancy, I love the wide variety of things I'm able to do as an L&D nurse, and I just don't know if I want to do something else even if the tradeoff is more time caring for the truly in-need populations and a more collegial relationship with the doctors. We shall see. I plan to ask very, very pointed questions at my interview. Expect a pros-cons post shortly thereafter and much gnashing of teeth.
I'm starting to feel more settled in at my job, and I think the doctors are beginning to understand that I know what I'm doing and can be respected and sought after for advice. I still deeply resent that it's taken so long, that it wasn't the assumption from the very beginning because of the culture of disrespect towards nursing that's so deeply engrained in some of the doctors here, but the change makes things much more tolerable. The charge nurses are learning my preferences for the Spanish-speaking patients, the sick pre-labor ladies, and the rip-roaring active labor ladies, so my patient assignments are becoming much, much more enjoyable. I've learned simply to tell the doctors what I'm going to do instead of framing things as requests or questions. Every once in a while I see a midwife, which is refreshing. I have great relationships with my patients. Things are better. They're not great, but they're better.
One of my patients last night, B., is one of the aforementioned sick pre-labor ladies--from Guatemala, with limited English speaking ability, 27 weeks pregnant with chronic renal failure, daily dialysis, rapid unexplained weight loss (several kilos over the past couple of days), and poorly-controlled diabetes. Last night I put in a naso-gastric tube to give her overnight tube feedings in addition to her regular meals in an attempt to fatten her up, and the whole time thought of nothing so much as fois gras. I can only hope that we succeeed, because without a big turnaround very soon, she won't live long enough to bring this pregnancy to term. She reminds me a lot of T., one of my last patients in Boston, who had end-stage cancer and died shortly after her baby was born.
This is B.'s second baby, and she was advised in the strongest language possible not to get pregnant again after her first child was born. She chose to do so anyway, because she says she doesn't want her son to be an only child. And, as an only child, I am baffled by the idea that it's better for someone to have siblings rather than parents. Oh right--I forgot that being an only child condemns a person to a life of selfishness, inability to share, inability to compromise, and a complete lack of empathy (insert eye-rolling here).
Still, I fear for her, and I worry about her when I'm not at work, I'll mourn for her when she dies, and it feels good to do that again. It's been too long, and it encourages me that these patients do, in fact, come here after all, and that finally I get to take care of them.
All the same, I keep looking around. I have an interview on the 16th at San Francisco General, a place much more in keeping with the safety-net, last-resort kind of place in which I'm used to working. It's for a position at the urgent care clinic, and I'm deeply ambivalent about the idea of leaving labor & delivery, even just for a little while to get my foot in the door at another place. Part of it is fear of the unknown, I'm sure--I've been an L&D nurse for my entire career, and there's a bit of me that's convinced that I'm simply not qualified to do anything else. Part of it is that I legitimately love caring for women during pregnancy, I love the wide variety of things I'm able to do as an L&D nurse, and I just don't know if I want to do something else even if the tradeoff is more time caring for the truly in-need populations and a more collegial relationship with the doctors. We shall see. I plan to ask very, very pointed questions at my interview. Expect a pros-cons post shortly thereafter and much gnashing of teeth.