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August 20, 2008

Yawn, Otherwise Entitled My First Graveyard Shifts

I was always one of those lucky ones during nursing school, getting scheduled for the posh daytime, clinic hours during my clinical rotations. The latest I can remember staying at my post was during my OB internship, when at eight o’ clock in the evening a patient I’d been caring for since seven in the morning finally delivered her baby. Naturally, I wasn’t going to miss out on the reward after a long day of pain and waiting, waiting and pain. But, I never had to work through the night ...

When I accepted my present job back in Spring of this year, I knew that I’d be working a combination of day shifts and night shifts ... And last week, I got more than a taste of overnights. I worked forty-eight hours of overnights. In celebration of my achievement, I’ll offer a brief list of insights, should you ever find yourself working overnight on a Mother-Baby unit.

1) You can deliver safe, effective patient care without caffeine. Yes, Friends, it’s possible! I drank my last carbonated, caffeinated beverage one week ago today! I was concerned about the amount of caffeine I’d been taking in since starting work back in July - my daily average was at least three cups of coffee and two cans of Diet Coke with Lime. So, what better way to nip a bad habit in the bud than on the night shift when everything is weird to your body anyway? (For the record, I have been enjoying one modest cup of coffee on my days off ...)

2) You can sleep successfully during the daytime ... If the lights are off. And if Adelaide’s voice isn’t ringing through the house. And if the fan is on. And if Nine is in the basement. And if the air conditioning is on. And if our next-door neighbor isn’t working on his lawn, his motorcycle, or his roof.

3) You can subsist on two meals per day. I found that eating a big supper with Joel and Adelaide and then having a big breakfast in the morning (before trudging off to bed) was the best for me ... Eating a giant “lunch” at 2:30 in the morning is bizarre. Perhaps I’m in denial about my job or working the night shift, I refuse to have “lunch” in the middle of the night. I do think “midnight snack” is a more appropriate moniker and way-of-life for me - I will not forget the fact that I am not a nocturnal creature, and so lunch is a daytime thing.

4) You will not find time to sleep on your shift. Before I’d attempted a night shift, I foolishly believed that I might be able catch a cat-nap working overnight. I was wrong. In fact, it’s a bustling, busy place with babies coming into the world at any time of day or night. And, what’s more, new Moms and Families will send their babies to be cared for in the nursery more overnight than during the daytime. Moms seem to need that precious shut-eye to handle the barrage of doctors, residents, paperwork, and visitors that show up during the daytime, so nighttime is the best time to be that nurse who coos, cuddles, feeds, and rocks new babies. But, that’s typically not me so far ... Nope, there’s been too much charting, too many antibiotics, too many fundal checks, and too many admissions for that sort of soothing work.

5) You will not be able to do this kind of work without a Joel. If you ever find yourself in my position, will not be able to work your scheduled hours and then sleep your sleep without help from a Joel. He will help you by getting your kid dressed and to daycare in the morning, working hard for his own paycheck (and personal sense of accomplishment, of course), getting supper on the table at night, taking care of your kid’s cries through the night, getting up the next morning to do it all over again and giving you a bouquet of flowers to keep you going ... Yes, you must have a Joel.

So, we’ve got three more night shifts this week before I’ll be back on days for more than a month ... Being a night owl isn’t so bad, but I am a little sleepy ...

August 6, 2008

Spawn of Big Head

I took Adelaide to see the doctor a while back. She needed a physical for day care, which I'm sure is required by the licensing body of Iowa child care facilities or something, but still seemed kind of ridiculous to me. On the other hand, thanks to my giant and shiny health care benefit, it was free, and we thought it'd be a good thing to get Adelaide "in the system", healthcare-wise.

Plus, I've always kind of enjoyed well-visits with Adelaide (especially those that don't involve injections). She's very easy-going about being poked and prodded, all the nurses and doctors get to praise her for being healthy and smart, and a lot of that praise gets reflected back upon me and my genes.

It was different, here in the "big city". The first and most obvious difference was that we were seeing a pediatrician. Both of Adelaide's doctors in Vermillion were family doctors, one of them helped deliver her, both of them went to our church, and both knew our family from school, work, and the community theater. They liked us and were very easy-going in the office. The pediatrician that saw Adelaide here, on the other hand, was very serious about ferreting out illness, starting with Adelaide's growth chart: 37th percentile for weight, 69th for height, and 97th+ for head circumference. She's been skinny, tallish, and large-headed at every checkup since she came into this world, I assured the pediatrician, but the doctor wanted to know more:

Doctor: Has her head always been above the 95th percentile?
Me: Um, no, I don't think so. Sometimes it's more like 90th, and sometimes it's higher. I think it depends on how the nurse wraps the tape around her head.
Doctor: Has she ever had any imaging done on her head? For instance an ultrasound?
Me: No...
Doctor: Has anyone ever been concerned about her development?
Me: No.
Doctor: Do big heads run in the family?
Me: Well... I'm not sure. My dad has a pretty big head.
Doctor: And how about you? Do you have a big head?
Me: Hmm... maybe. I mean, I don't know where I'm at compared to the average, but when I look in the mirror, sometimes I think, "Wow that's a big head."
Doctor: And as a child? Were you big-headed?
Me: I don't remember any doctor mentioning it, but there was a kid who used to call me 'Toe-head' because he thought my head looked like a big toe. And in kindergarten they had this song they'd sing that went something like "Joel is a mole with a big fat bowl", which I always took as making fun of my head.
Doctor: Do you have trouble finding hats that fit?
Me: No! Oh, well, yeah. My wife bought me a school baseball cap when I matched here, and when I told her that it was a little tight; she said it was the biggest one in the store. And in high school we did My Fair Lady, and I was Professor Henry Higgins? And in the first scene the costumer had this great hat for me to wear, but it was too small, so I wound up with a lame one.
Doctor: [Nods. Types something about "big head" in the computer.]

No praise was reflected upon me and my genes. To the contrary, I had clearly passed down to Adelaide the curse of my giant cranium. As the pediatrician struck "big head" indelibly into Adelaide's medical record, a diagnosis that will follow her for the rest of her life, I imagined her fate. Already we sometimes struggle to find a shirt with an adequate neck hole, but what indignities will she suffer in the future? Despite her excellent audition for the class play, she'll be cast as Humpty Dumpty. When Adelaide goes to college, her freshman roommate will remark on how much space her giant pillows require. She, too, will have trouble finding hats.

As the doctor turned back to Adelaide, I desperately tried to salvage the situation:
Me: Still, she doesn't look... you don't think her head looks disproportionate, do you?
Doctor: No, I suppose not.

As a coda to an already long entry, a few words about professionalism. I struggled writing this entry because I am, subtly, criticizing one of my colleagues at my institution. While I haven't mentioned them by name (or indicated gender), and on this page I don't identify where we're living, someone with access to Adelaide's electronic record could figure out who I'm talking about. It would, of course, be unethical (and grounds for termination) for them to do so, but it's still possible.

Doctors are like office workers anywhere: they occasionally indulge in bashing each other. I've often felt that doctor-on-doctor bashing is an unprofessional habit, especially when it's done publicly (it's in all of our best interests that patients trust doctors, isn't it?), so let me emphasize (and get myself off the hook) that I'm criticizing my colleague as a patient reacting to their poor interpersonal skills. My colleague was perfectly appropriate as a clinician conducting a well-child exam. Kind of a pinhead, though, if you know what I mean.

August 2, 2008

Saturday Afternoon: A Garden View

Down by the riverside ...

Some Saturday afternoons, when the sunlight is just so, you realize that there will be plenty of time for updates about the things you've done and seen the first month in your new home.

Sprinklet

Sometimes you realize that the most important thing on the day's agenda is just to enjoy fresh spray of water, the angle of the light, the song of the birds, and the laughter of your family.