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Archive for May, 2008

Countdown

The nails are varnished, the eyebrows are shaped, legs are smooth, hair is tamed and now I’m planning my dance moves for Son’s wedding. First comes:-

Perhaps a little

definitely some

hopefully

[

and, if no one suspects I’ve requested it (and I’ve had a little alcohol)

That’s my Saturday night sorted!

What would you choose to dance to?

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Premature babies

I’m just hoping that the link I’ve just posted will show all about prem babies and plastic bags.

Yes!!! It’s worked. Well this is the American version of what we are now doing. We are doing virtually the same thing. The theory is that it stops the baby becoming too cold and helps to protect their skin.

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Euphoric

I am on a high because I passed the drugs calculations. I have been so worried about this and had managed to convince myself that I was going to muck it up so now I’m really relieved that I beat my demon. I was just speaking to son and told him the good news, he rather poured cold water over my joy by putting it into perspective, ” well really Mum I would hope that you would be 100% correct when calculating drug dosage”. I know, I know, he is absolutely right.

They decided to spring another surprise on us, a practical and theoretical test on newborn resuscitation. We usually just have an update once a year, now though many of our mandatory days also incorporate ‘tests’ to prove that learning has taken place, apparently it’s a CNST requirement. Every time we have an update something has changed slightly, today’s new facet was placing a premature baby into a plastic bag as it enters the world. These are not specialist plastic bags, oh no, any old bag as long as it is suitable for use in a microwave, not that we have the intention of putting babies into microwaves, it’s just the bag has to be heat-proof. I am pleased to relate that I also made the grade on resus skills, good job really as I’m a community midwife attending homebirths.

Long day, but ultimately reassuring and productive. The relative isolation is one of the downsides of working constantly in the community, it’s easy to get into a rut so these mandatory days are good as they pull you up, make you re-assess and update your practice and provide an opportunity to interact with your hospital based colleagues.

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My brain hurts

Tuesday is the day I might stop being a midwife. I haven’t won the lottery, a national newspaper hasn’t offered me a post as a journalist, no, nothing so positive is going to happen on T-Day, what will possibly (probably) happen is that I will fail my drugs calculation test.

I have been desperately practising my calculations courtesy of this Lanarkshire NHS web-site, I have an 80% success rate, unfortunately our pass rate is 100%, whoops. It’s the 80kg men requiring mcgms that I can’t get my head around, I seem to underdose them, it’s the mg/kg/hr that gets me every time, too many variables.

I know we have to be 100% correct with drug calculations. I am also aware when I am unsure and, we always have to check IV, IM and controlled drugs with a colleague. I know, I’m just trying to defend my shortcomings and excuse my inability to make sense of number sequences but, give me a prescription chart and the medication with it’s advice sheet and I can work out what the patient requires. There is obviously some vital component missing in my brain which should facilitate successful ‘mock’ calculations.

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Listening

A Pinard

Salutary day today. Clinic first, not too bad. One of the pregnant women, 39 weeks with her second baby, told me that after she had last seen me baby had done some massive movements, spending one day lying across her womb, a transverse position. When I palpated I really wasn’t sure what I was feeling. It was obvious that baby was in a posterior position, baby’s back to Mum’s back, but was it head down or bum first, breech, I really wasn’t sure. Out came my Pinards, often that will help me solve my dilemma, not today though, wherever I chose to place it I could hear baby’s heartbeat clearly. Obviously a case for a sonographer. After much bargaining with the hospital they gave in and invited her to go straight there. I phoned her tonight to hear the result, head first, cephalic, with the head deeply engaged, explains why I couldn’t feel it!

After clinic I had a couple of routine, 5 day postnatal visits, weigh and PKU, aka the Guthrie, heel-prick or newborn screening test. Then 2 pregnancy booking home visits. The first was a woman who has now moved to another area but wanted me to book her as I had seen her last year when she had an IUD, intra-uterine death, at 34 weeks. After her loss I stayed in touch until after the post-mortem, during all the process she was well supported by the bereavement midwife so I never heard the full results, just that a syndrome was involved. Today we recapped the whole experience again, so very sad but it is important that K and I are able to communicate well. All her hopes and fears through this pregnancy, which is bound to be sometimes beset by doubts however much screening of baby is done, should be shared openly with me.

Next came a booking where I knew that the woman was booked for a CVS, a chorionic villus sampling. There was a healthy, young boy at home with her and, since she was young, I was interested to learn why she was having this invasive form of screening. Her second child, a girl had been born healthy but by 4 months old had started to exhibit physical signs that she was unwell and a genetic abnormality was diagnosed. Over the next year she deteriorated and a bone marrow transplant was tried, with initial success. Unfortunately the little girl died aged 2 years. There were many photos of her, from a healthy newborn to a toddler showing the hair loss, emaciating effects of the drugs used prior to a bone marrow. It was another emotional chat, the Mum discussed all aspects of her daughters life, graphically describing her last few days, I thanked her for sharing her daughter’s story with me and wished her well with the CVS.

So I had visited 2 women who had previously lost babies, both girls due to abnormality, then came my final visit, a newly discharged Mother of 5. Terrible, a disgustingly filthy house. N greeted me with complaints that the house should have been fumigated whilst she was in hospital but ‘ the f*****g social have only done a deep clean. At least it cost the w****rs 3 undred quid’. Good start. No children, no baby, I had been told that there is an ICO on the newborn. Hmmm. Dare I? Here goes. ‘N. Can you tell me about things. Baby, you, the birth. Why you stayed in hospital so long.’ Out it all came. Baby is with foster parents. 1 of the other children is in hospital following an attack by a relative. 2 others are also in temporary care and 1 is being adopted following physical abuse. I sat and listened to a distressing tale of ‘lost’ children, husband in hospital following an assault, inability to care for children and a total lack of understanding why the baby and 2 of the children had been taken away by social services. She is resigned to never having one of the children back but is fighting for the return of the others. She has the services of a barrister and is going to ‘show them social workers what a**e h*les they are and what they can do with their ICO.’ Whilst I was there a friend phoned and she revealed how desperately distressed she was, how she didn’t know how she would cope. By the time I left I was concerned for her mental well-being and was beginning to feel that they were being unfair, I wanted to speak to her social worker, she gave me the number. Once in my car I phoned the social worker, unfortunately she had left for the weekend and wouldn’t be available until Tuesday. The person I spoke to was not really that interested in the information I wanted to share. Next I went to the surgery and spoke to her G.P, I’m not sure what I expected him to do, I just wanted to share my concerns with someone. I returned to the office and ensured that all my concerns were noted and accessible to N’s midwife who is working tomorrow.

Hubby says that I have had an interesting day, I have found today distressing. My final visit has me behaving like a schizophrenic. I am full of a middle-class ire that this woman and her husband leech off the system, off me the taxpayer. They don’t work, have numerous children they are incapable of caring or providing for. Have a house so filthy that it requires deep cleaning which is paid for by the public purse. Then I just see the person sitting there, bereft, desperate to have her children back, children that I’m sure she loves, and I want to help her. I’m so pleased that I’m not a social worker.

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First exhibition

Jack’s design for the wedding menus which shows Son, DIL and their dog, Mabel. Hmmm, perhaps more Chagall than Cezanne.

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Nuptial News

Ten days to go until my little boy gets married. I’ve ordered the balloons, the ribbons for the wedding car are safely stored with the ‘pull bows’, must try one so I know how to do them, my hair and nail appointments are made. One daughter is making the table centres, Jack has drawn the picture that will be used on the menu and he and Amy are in training for handing out the ‘favours’ ( I am extremely doubtful about Amy being given a large basket of sweeties, son obviously has more faith in her than I do!). I have been depriving myself of carbohydrates and calorie heavy foodstuffs for weeks now hoping that I can shed some flesh and the skirt that I use to gauge if my efforts are successful is suggesting that I have gone down a clothes size. Yeah! Unfortunately I think I need to buy a different pair of shoes. I had bought a pair with open toes, then the other day my toe experienced a close encounter with the stairgate, the nail is now black, no concealing it in those shoes. A cover-up is needed.

Mother has put a spanner in the works, I want to strangle her. When son first announced his wedding plans she said that she didn’t think that she would go as it is a civil ceremony and, being a rabid catholic, she couldn’t condone it. “Up to you Mother”. Then she thought about it and decided that she would condescend to go. A week ago she phoned me to say that she wouldn’t be attending as my step-father would be going on an annual walk that weekend. I would like to say that I was speechless but that would be untrue, I was eloquent in the extreme. “Stop right there Mother. You said ‘annual’, it’s a annual event this walk. Right, that means that it happens every year. Your grandson is getting married for the first, and hopefully, the only time this, or any other, year. Now, let me get this straight, you feel that an annual walk is more important than an invitation to the most important event in your grandson’s life?” Her response was to ask me to tell son that she wouldn’t be going to his wedding. I declined the offer and this is when she started explaining that stepdad doesnt even know about the wedding and she doesn’t want to stop him going on his walk because he is ‘bi-polar’ and it might ‘tip him’. Bi-polar my a**e. If there is anyone with, or causing, a psychiatric disorder it is the mother from hell. My poor sister was immediately alerted to Mum’s calumny, I think I was mostly intelligible whilst relaying the essence of the conversation. I was so angry I was shaking. Last I heard mother has decided that she will come without her husband. Pondering about tipping someone over the edge, by asking them to make a choice, has me questioning about whether not telling him there is a choice could be equally destructive if, or when, he finds out.

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