hospital

Raising Roo: Birth Story (Part 2)

/ jonathanrobb / Leave a comment

I meet the midwife on shift, a friend of our midwife, who explains that Christina had rang ahead and ensured Alex was hustled off the ward and into the birthing suite as soon as possible. I thank her profusely for reducing our apart time, and reflect that, once again, in Austria, it’s all about who you know.

The midwife explains the current options, all of which boil down to different ways of waiting, and Alex goes with the most comfortable sounding: a bath. The suites are fitted with a private bathing room containing a circular tub the size of a spa. The midwife gets the water running, provides some towels and shows us the adjoining bathroom, and then leaves us to it.

Alex disrobes and eases into the water, her tight pregnant belly glistening, and it still doesn’t feel quite real, even here and now, that a baby is ready and waiting inside.

‘Do you want me to get in with you?’ I ask, winking.

‘I don’t know how the midwives would feel about that. They’re used to dealing with naked women, not men.’

I sigh. ‘All the perks go to the pregnant lady.’

‘Damn right.’

We talk, conversation broken regularly every time Alex has to focus on another contraction and I get to practice my encouraging breathing instructions. She says that the warm water is helping, but it feels as if they’re getting stronger. 

I bring out a bluetooth speaker and we listen to George Ezra strum his brand of upbeat pop, Alex soaking in the bath and me on the floor, one hand dangling in the water, waiting for our baby to arrive. 

After an hour, the contractions step up a notch and the discussion and laughter starts to thin out. The pain has increased to the point that she cannot keep talking, cannot keep the thread of conversation. I default back to a string of reassurances but can see their effect lessening with each new spasm. 

At a little before seven, Alex is towelling herself off when Christina arrives. We both soften a little with relief. The hero is here to make everything better. Which, of course, is an unfair expectation as a baby still has to pass through my wife’s genitals and there is little Christina can do to bypass this. Nevertheless, her presence and positivity is a comfort.

Half an hour later and that comfort is dissipating under the ceaseless strain each new contraction is demanding from Alex. She’s hunching now, all efforts directed towards taking long slow breaths through this latest wave of squeezing pain.

‘Any reason they’re coming so fast?’ I ask Christina.

She shakes her head. ‘The body is in charge, and every body is different.’

Christina suggests an examination to get a gauge of where we’re at. Alex lies down on the mattress, once again dressed in an oversized black t-shirt, and I sit at the head of the bed. I hold her hand and give a hopeful squeeze that all her efforts will result in good news. Alex squeezes back, but I think it’s more due to pain than optimism.

‘One centimetre,’ Christina says, and the announcement hits me like a splash of cold water.

I think of all that Alex has given already and multiply that by ten, the magic number before anything can start happening, and feel a heaviness in my gut. I catch her eye and force a bright smile.

‘Progress,’ I say. ‘Only nine more to go.’

She gives a weary grin but the expression is cut short by another contraction.

Once she is breathing normally again, Alex sits up. I’m watching her closely and see the colour drain from her face. She purses her lips and lets out a long stream of breath.

‘I don’t feel so good,’ she says.

‘Do you want to lie back down?’ I ask.

‘No. I want to go to the toilet.’

She stands but pain ripples through her middle and I grab her elbow for support. We shuffle out of the room together, Alex’s weight pulling more at my arm the further we go. 

‘I really need to get to the bathroom,’ she says, a touch of panic in her voice.

‘Almost there.’ I pull open the heavy door and guide her past the round bath and towards the bathroom.

She shambles out of my grip and stumbles against the toilet door, banging it open and dropping to her knees. The sound of retching follows, deep and guttural, the type of heaving that seems determined to scrape away her insides. The contents of Alex’s stomach erupt out of her and continue to do so until she is rung out.

‘I missed the bowl,’ she says in a croaky voice.

I look over her shoulder from where I was rubbing her back and note that the bathroom contains a sink, a bin, and a toilet, and that she had managed to miss all three. I decide not to share this observation.

‘Why don’t you go sit down. I’ll clean this up.’

Alex gives an exhausted nod and pads back towards the bath. I find a cup and fill it with water from the sink and carry it to her, then get to work with some paper towels and disinfectant left on top of the cistern. By the time I’m done, a little colour has returned to my wife’s face, but pain lines have set up camp around her eyes and mouth.

‘Are you okay?’ A pointless question I can’t help but ask.

She shakes her head, the formation of words proving too much.

We get back to the birthing suite and fill Christina in on what she missed, and she suggests we try walking around the ward to ease some of Alex’s discomfort. Alex concedes with a worn-out nod. The three of us venture into the large open space between rooms, Christina on one side and me on the other, with Alex hunched over between us. 

We don’t get far before Alex stops, fingers tight around our arms, trying to breathe through the iron grip of her uterine muscles. Christina and I garland her with praise and encouragement, and try to coax her further, but progress is slow and it’s not long before she is waving us off, silently pleading for a rest while she hunches against a work desk, arms crossed against the smooth surface and head hanging in between. 

The contractions come back-to-back without any respite to allow Alex to catch her breath and detense. I squat beside her, trying to look up into her face.

‘You are doing great, babe. That’s perfect. Long breath in and long breath out.’

I enact my instructions, breathing with her, and she follows along, face scrunching up and cheeks ballooning as she exhales. She opens her eyes and looks so very tired. She has become increasingly non-verbal and it’s making me nervous. My brain feels like a bird flapping up against a cage, wanting to shout out that something is wrong, that my wife is in pain, but everyone is behaving as if it’s normal so I have to believe that it is. I attempt to quiet the manic bird and smile and rub Alex’s back and prompt her to take a step.

We manage to cross the length of the ward, a weird shambling six-legged creature letting out a jarring combination of painful moans and upbeat assertions. Alex is wrecked by the end of this journey. She leans into a sink mounted on the wall and I ask if she is going to be sick again. She only shrugs and sags lower.

Christina spots a physician and excuses herself. We are alone in the hallway and I want to do something to make the situation better but my options have shrunk to cheerleader and backrubber. I have never felt more useless to my wife. She is bearing this physical burden for us and I am repeating the same sentiment I’ve been saying for the past hour. I’m amazed she hasn’t asked me to shut up yet.

Christina returns. ‘The doctor said he’s been watching you and believes you’re ready for an epidural.’

I feel a flush of satisfaction that Alex’s painstaking parade has been good for something.

‘Is that something you’re still wanting?’ Christina asks.

Alex looks up with dark hollows under her eyes and breathes out, ‘Please.’

We start-and-stop our way back to our suite, moving with the tide of her contractions, until Alex finally collapses onto the edge of the bed. I expect to see relief in her face, but sitting hasn’t eased the waves of pain squeezing her body. Her entire focus is committed to enduring.

‘Just a little longer, beautiful, and then they’ll numb you right up. You won’t even know you have a uterus by the time they’re done.’

She gives a fluttering smile at my weak attempt at humour then returns to her ordeal. 

It takes another forty-five minutes of deep breathing and moans trickling from pursed lips before the anaesthesiologist and his resident arrive. I am given blunt instructions to leave the room; COVID restrictions separating us again. My caveman side wants to thump my chest and tell him ‘Make me,’ but I concede after giving Alex one more pep-talk and a kiss to the forehead.

The door slides closed and I stare at the white surface for a while, picturing my wife exposing her back for the needle, before turning to the open ward. 

I stay within a five metre radius of the room, wandering out to my self-imposed limit and then snapping back. I lean against the wall beside the door, and then the door itself, and then stride out again, restless. From my nursing experience, I know the procedure should take around twenty minutes, providing all goes well. At the forty minute mark I feel like a shaken up bottle of soft drink with the lid on tight. I bite back the urge to hammer on the door and demand they let me in. I pace my small circle and wait.

Five minutes later the door slides open and the anaesthesiologist and his resident step out, glancing at me before striding away. I rush the room and find Alex sitting up in bed with her latest accessory — IV pole, pump, and tubing snaking under her shirt — erect beside her. She smiles at me and I breathe again.

‘How are you doing?’ I ask, sitting on the edge of the mattress.

‘Better,’ she says.

‘The contractions?’

‘They tell me they’re still there, but I wouldn’t know it.’

Tension is draining from her features and her shoulders have relaxed. It’s good to hear her voice again.

‘Took them long enough,’ I say.

‘I don’t think the resident knew what she was doing.’

‘Just what you want when someone is shoving a needle into your spine.’

She leans forwards until our foreheads touch and we each exhale. The respite feels well deserved.

With the pain under control, we find ourselves unsure what to do next. The morning has been swallowed in a haze of agony for Alex and a fog of anxiety for me.

‘So, what do you feel like doing?’ I ask.

‘I could eat.’

I laugh and know I have my wife back.

(To be continued…)

HOSPITAL BED PERSPECTIVE

/ jonathanrobb / Leave a comment

My previous post detailed how I found myself turning twenty-six in a hospital ward. Happy birthday (Can you hear the slathered on bitterness and irony? You can? Good).

The experience was unanticipated and has been disorienting, but made even more surreal by that fact that I’m normally the one standing over the hospital bed rather than laying in it. I guess I should thank rhabdomyolysis for allowing me a patient’s perspective. I should, but I’m not going to.

When I chose nursing as a career I had only been inside a hospital three times: when I was pushed out into the world, visiting a sick cousin, and saying goodbye to my dying great-grandmother. Except for my birth, of which I oddly have little recollection, my other visits were short and superficial. I was there to be with family and largely ignored the hospital as a whole.

Therefore, when I came to nursing I came with virtually complete ignorance of the hospital system. This ignorance only became apparent during my first student placement; until this point I presumed the various television shows and movies I’d watched that had taken place in a hospital would have adequately prepared me. This was not the case. Apparently, liberties had been taken when writing those scripts.

My first placement consisted mostly of me learning where to stand so as not to be in the way. I soon mastered this skill. Eventually, I saw the overlapping cogs of the multidisciplinary health team and what my expected role was within them. A hospital can seem a chaos of doctors, nurses, pharmacists, physiotherapists, occupational therapists, cleaners, PCAs, patients, and visiting family members. But there is a pattern in the chaos and it wasn’t long until I knew where to go, what to do, and who to speak to; basically, how to be a nurse. Prior to this I had the skills – I could take blood, hang an IV, administer injections – but now I had the knowledge of how and when to apply them.

By the time I graduated and started working as a nurse the wards were a familiar place. I could recognise people by their roles, I knew what to do when a buzzer went off, how to placate a distressed patient, and the perfect place to stand so as not to be in the way (This skill still came in handy when a herd of doctors descended on one of my patients). Like any well worked in workplace, the hospital became commonplace and I could navigate its walkways with ease.

This did not prepare me to be a patient.

The first thing I noticed as I was lead into the emergency department with a patient name band around my wrist was the casual condescension of the staff. There was no intended insult in this; they’re used to speaking to people with little health knowledge, and often, with limited knowledge of the English language. However, with both medical knowledge and a strong grasp of the English language, the small and simple explanations I was given seemed only to patronise. I immediately scanned back to the multitude of conversations I’d had with patients, and prayed I didn’t come off so bad.

I received descriptions of my condition in language usually reserved for five-year olds. I itched to interrupt and explain that I knew all this, that I was a nurse and the equal of them. I didn’t, as I figured the intrusion into their well-meaning explanation would only serve to paint me as arrogant. However, when the natural segue presented itself, I quickly slipped in the fact that I was a nurse. The change was instantaneous. Suddenly, I was a person again, not a patient.

The next insight was of dependence. Even in my state of physical competence, I was dependent on the whims of the hospital. Food came when it came. If I wanted a shower I had to wait for towels. Doctors and answers appeared on their own schedule, not mine. And I waited.

Working as a nurse is a job of hectic tasks, a never-ending to-do-list that begins when you step onto the wards and ends when you handover with a breath of relief to the new nurse taking over. For a patient though, it’s one long day of boredom. You stare at the same four walls, bounce between the same time-wasting activities, and wait. You get excited when the food tray comes, not because the food tastes particularly good, but because it gives you something to do. You watch everyone rush, and you sit, and wait for the moment when they say you can go home.

In here I’ve seen how miscommunication between staff and patients serve to add to the cloud of confusion and unease. Patients don’t quite know how to phrase their questions and staff have no time to decipher their desires. Presumptions are made, things are missed, and the patient settles back and waits.

The other side of this coin however is how vital and appreciated the staff become. Whether the dependence is enforced or genuine, a helpful nurse is a godsend. A doctor who takes an extra minute to explain what the blood results mean gives a patient an afternoon free of anxiety. Simply having a friendly face and a quick laugh to break the tedium is a gift worthy of a bear hug.

What I hope to gain from this enforced role reversal is a better insight into what my patients are experiencing, and what I can do to ease their pain/anxiety/discomfort/boredom. I’ve been shown the other side of the looking-glass and the details reflected back have shown me the importance of small mercies and kind words.

Hopefully, being a patient will make me be a better nurse.

Thank you, rhabdomyolysis.

THAT WON’T HAPPEN TO ME

/ jonathanrobb / 7 Comments

This post comes to you from inside a hospital.

I turned twenty-six yesterday.

This was not how I foresaw my twenty-six birthday.

As a nurse I’ve come to terms with the fragility of health. When you see a patient die from a fractured hip, or a previously healthy twenty-eight year old women yellow with jaundice, you quickly realise sickness isn’t just for the old.

Most of us, understandably, fool ourselves into the mindset of, ‘That won’t happen to me.’ We watch documentaries of people just like ourselves come down with cancer, people of the same age, gender, socio-economic status, and race, and we still tell ourselves, ‘That won’t happen to me.’ We mentally scan our body for aches and pains, and when we find nothing we relax in the knowledge that we are, at least temporarily, invincible.

And despite my apparent insight into the illusion of health, I was still shocked when three days ago I stood over the toilet and watched as brown urine trickled out from me. I did the right thing and saw a doctor who took samples of my bloods, but I felt confident the results would be minor; that I would be fine.

Because that sort of thing wouldn’t happen to me.

And even when I got a call from the pathology clinic testing my bloods at eleven forty-five on a Sunday night telling me to go to emergency immediately, I still couldn’t shake the notion that it was no big thing. Sure, I’d go to hospital, and maybe they’d keep me for a few hours, but then they’ll send me home telling me to keep my fluids up and to take it easy.

Because that sort of thing wouldn’t happen to me.

This was three days ago and I’m still tucked away in my little corner of the hospital.

Let me back up and tell you how this happened.

A week ago I was talking with my brother who was telling me of an exercise boot camp he had enrolled into. Five weeks, three hours a week, improved fitness at the other end. It sounded good, and I signed on. Thursday afternoon found me grunting and swearing as I worked through push ups, sit ups, pull ups, planking, tyre lifting, squats, and a light jog. The workout was hard, my arms shook, my stomach tightened, and I felt a little sick. But you’re meant to, aren’t you? That’s how you know you’ve pushed yourself.

I wasn’t concerned despite the fact that for the next two days my upper arms and chest ached. I struggled to lift my arms higher than my head, groaned when I had to reposition myself in bed, and trembled when attempting to take off my jumper. I figured this was the repercussions of a very thorough workout.

Consternation came when urine the colour of cola-flavoured cordial streamed from my body. I opened my laptop and typed ‘brown urine, excessive exercise’, into Google, and quickly learnt a new term. Rhabdomyolysis.

Essentially what I had done was damaged the muscle fibres in my arms and chest to the point that the muscle cells died. Upon the destruction of these cells, proteins are released into the bloodstream. This is not where they’re supposed to go. What I was seeing when I looked down into the toilet bowl was the dead matter of my muscles.

The risk of rhabdomyolysis is that the kidneys are not used to filtering these proteins, and one, creatinine, can build up in the kidneys. Potential consequences: decreased urine output, kidney damage, renal failure.

Let me reassure you that at this point it doesn’t look like I will suffer from any of these afflictions. Although, for the record, the specialist told me he had never seen creatinine levels so high. I’m marking this as an accomplishment; you have to take wins where you find them.

So here I am, on the other side of the looking glass. From nurse to patient. From the lands of the invincible healthy to the wards of the acutely sick. From twenty-five to twenty-six.

And they say exercise is good for you.