So. I have neglected this blog.  A lot.  For a time it was lack of time, lack of initiative, lack of inspiration.  The last year has been from an over abundance of pain, sorrow, and soul breaking loss. In March of 2014 I was taking care of a dear friend in labor.  She delivered a beautiful baby girl, a baby she had tried for two years to conceive.  And then everything went sideways.  She started to bleed and nothing we did seemed to help.  All the experience I've had with high risk obstetrics, all the post partum hemorrhages I have been a part of, all of it meant nothing.  She fought a good fight, but it wasn't enough to tie her to this earth, to tie her to us.   She was my patient but she was also my coworker and my friend.  It's bad enough I couldn't save my patient, but to not be able to save my friend is devastating.  It has fundamentally changed me, not only as a nurse, but as a person.  Everything I knew to be true, is no longer true.  I feel as if I failed her.  Afterwards, her mother came to me and said "She told me she trusted you with her life." I know she meant that I did all I could, she wasn't blaming me, but I blame myself.  What didn't I know?  What should I have done differently?  Could advancing my education with an advance degree have helped?  There are no answers for me.  The hospital did a Risk Cause Analysis, and allowed us to review it.  After it had gone to Big Navy and the Joint Commission.  I read the review and was astounded at how the timeline was wrong, how events were out of order, how events were even completely missing.  So, not only do I have my own guilt, now it looks like I don't know my ass from a hole in the ground. Rage is also  something I am well acquainted with.

But, I keep going to work.  I keep doing my job, and fighting to be me.  I tell myself and others it's my way of honoring her.  Continuing to do the job she always wanted to do.  And it is. I don't think badly of those who could not continuing working where we all experienced such a horrifying tragedy; far from it.  We all have our trials, and we all have to do wheat's best for ourselves in any situation.  I feel like my life is a giant Jenga game; let's pull this piece from your foundation and see if you can remain standing! It's not my first rodeo with grieving, and I know the second year is always the worst.  When the bad times hit, they are really bad. I swing from incredibly high to crawling into a hole low.  Sometimes all I want to do at work is stay in my room and not interact with anyone but my patient and her family.  Then again, sometimes the last thing I want is to be anywhere near a pregnant woman.  My logical, critical thinking brain takes a hike if I see any tinge of blood in a catheter.  I know that it's the position of that baby's head on mom's bladder, but I am instantly thrown back into that labor room.  Was that the moment she went into DIC? Could I have changed to outcome at that point?  The logical answer is no.  I know that.  I have spent the last 15 1/2 months reliving March 9th over and over again, just trying to see if I can spot a point when we could or should have done something different.  If we could have gotten a second line in, if the art lines hadn't have failed, if the IO hadn't failed, oh my God, we stuck her everywhere. To no avail.  I have no way to reconcile what happened and why it happened.  I've seen worse hemorrhages and my patient lived; why was this different?  Why couldn't she stay?  I have no answers.

She was a beautiful, caring, loving, funny wife, mother, friend, nurse, and Naval officer.  Her name is Moani.  So, in respect for Mo and in her honor, I'm posting the song her parents sang at her memorial before she went home to Hawaii.

I have a raging case of insomnia.  Which is a little upsetting, since it's been so long since I've had to deal with it.  But, it's now 0200, I've been up since midnight, and my alarm goes off in two hours.  Awesome.  I even tried sending myself back to sleep with my good, old standby, self1induced orgasm.  No dice.  Well, hell.  That was a waste of battery power.  To make matters worse, I woke up singing "The Sounds of Silence." Yeah, that helps.  And, because my brain works this way, I began singing this to the tune:

Hello, Insomnia my old friend,
I see you're keeping me up again.
Now is the time I should be sleeping,
Not around the house creeping,
And I'm so tired
I can't remember my name
I'm going insane
With you, Insomnia.

Okay, so it's not great, but I could have done worse at this time of day on three hours of sleep.  And I should apologize ahead of time for the raging bitch fest that's coming towards my co-workers.  *sigh*  Sorry about that.

Will this make it better?

You want to know the absolute, worst feeling in the world?  It's when the most important and needed thing you want say to someone is the least wanted thing to be heard.  And then knowing that's the case.  And still wanting to say it every day, in every way.  But not doing it, so that no one is "uncomfortable."  Oh, well; fuck 'em if they can't take a joke.  My new(ish) philosophy.  Like the Ministy of Magic, I remain....strong.  (And, apparently, a giant nerd.)

This calls for some Tina.  

So much for my determination to blog more often.  Eh, life happens.  And in response to my shame at not blogging, here ya go:

Part two

I do believe I found the problem with my Ensign.  Anyone who knows me knows I like unmedicated labors or I like patient's who are almost circling the drain; give me a patient on Mag, Insulin, and Pit with a side order of pressor drugs and I'm one happy camper. I love me some adrenaline!  Don't get me wrong; normal, uncomplicated labors with epidurals and c-sections have the effect on me to a degree.  Seeing a family made complete, a new mom and dad enjoying this little person they've been wanting to meet for so long is amazing and humbling no matter how the kiddo comes out, or the circumstances surrounding the birth.  But day after day of induction, epidural, induction, epidural has a Groundhog Day effect and can leave me wondering if I need to change jobs for a little while.  Add in to this stew of ennui, a clueless Ensign who can't seem to grasp what the hell is going on no matter how many times I tell her, and I'm about to pull her hair out, along with my own, and weave a raft to paddle my happy little ass away from this Island of Frustration.

The other day I had her running triage with the understanding that the first patient through the door, in labor, was ours for delivery.  She needs to get the hang of the rapid changes that can occur during delivery and the need to multi-task with, sometimes, three different people asking you for something at once.  She's a very concrete thinker, and in high stress situations, tends to get ye olde "deer in the headlights" look about her.  Anyway, this young lady comes in to triage, it's her second baby, she is found to be 5 centimeters and she is adamant about not having an epidural.  Fine.  She "caved" (her words) during her last delivery and wanedt to avoid the word even being mentioned in her presence this time.  I told Ens. Getaclue that the patient and her husband needed to come up with a code word, known only to them, that, if she changed her mind and said it, would allow us to get her whatever pain management she wanted,  Otherwise, we would comply with her wishes and not talk to her about epidural even if she requested one.  (Some mamas, in the throes of transition, have been know to promise to give out the launch codes if they can just have an epidural.  This is transition speaking, not the mother's desire.  Unless she throws out the code word, like, say "chimichanga" and then her support person lets us know the patient is indeed serious about her desire to make this madness stop,)  We had been busier than a one legged man in an ass kicking contest lately, so we only had one room available and it had recently been cleaned.  The corpsmen were in the process of putting it back together and stocking it, so the patient was going to ambulate in the halls for a little while, unil the room was ready and then we would finish the admission process.  Which in this hospital meas at least IV access and labs for all laboring patients. As I am very territorial and have a definite "see a need, fill a need" mentality, I have not allowed myself to be in the room with Ens. Getaclue, unless she specifically asks for me.  So, I'm in the nurse's station, pacing back and forth (I hate not having anything to do) when I see this patient ambulating in the halls.  Then stop.  Get a death grip on the railing, bend her knees and breathe through a contraction.  "Shit, oh dear, " I think to myself.  I go to the room designated for her use and ask one of the minions if the room was about ready.  They only had linen left to stock in the room, so I said, "That can be done while she's in the room."  I urged the patient into the room and asked if she was interested in the tub.  She said, definitely, and since it takes roughly a millenium to fill, I started the water then went to tell the corpsman to set up a table.  The Ensign went in to start her IV, missed and asked me to come try.  I go in the room and wait while the patient signs her consents.  As I'm putting on the tourniquet she asks when she can get in the tub, and I told her if she wanted she could go right now and I could start her IV in there.  She jumps up, speed walks to the bathroom, and starts disrobing faster than a sophmore on prom night.  As she gets in the tub, she visibly relaxes and I say, "Awesome, right?" to which she replies, "Ten times better."  She has a contraction that she deals well with, kneeling in the tub surrounded by lovely water.  I
 put on the tourniquet to finally get this IV in, and she says, "You might want to wait...." So I release the tourniquet and she starts moaning, her eyes get the size of hubcaps, and she moves to where she is now sitting in the tub. I ask, "What are you feeling? knowing damn well what the answer is going to be, and she wails, "Lots of pressure!" with "pressure" being said on a gutteral growl that pretty much means "tape the windows, baby here comes the hurricane."  I, being much experienced and knowing that if I have a baby in this tub, the psycho doctor that's on the deck will make damn sure it's a blazing day in the ol' PacNW before a laboring patient gets in the tub if she's more than 2 centimeters, so I did the only thing I could; I shoved my arm into the water and stuck my left (and only gloved) hand onto her vulva, told her to blow and not push as I feel her perineum, and therefore the baby 's head, bulging into my hand.
I asked the Ensign to drain the tub and go get the doctor.  Then, as I felt her standing there looking at me, I looked her dead in the eyes and clearly stated, "Drain.  This.  Tub.  Go.  Get.  The.  Doctor."  This made some impact on her psyche, as she left the bathroom and returned with a physician.  By this time, the patient had enough clarity to say, "I'm ready, " flung her arms around my neck, I pulled her from the tub and she sprinted, literally sprinted, to the bed.  She crawled on it, about four seconds later her water broke, she looked at me and said, "What do I do???"  I told her to push her baby out, and voila!  Undmedicated birth, just like she wanted.  I was so stoked, you could have powered a small country with the energy I was feeling!  I was dancing around saying, "Oh my god, I DO love my job!"  And after this beautiful, natural, wonderful delivery, my Ensign came up to me and said, "I did NOT like that.  That scared the shit out of me."  And therein lies our problem.  Perhaps this is not the specialty for you, sister.  

Argh!  Just went to buy tickets for me and the boys for Brian Regan, coming to Skedaddle on March 23rd.  Figured it would be a fine way to help celebrate what would have been my 15h anniversary (March 21st), and what better way than to spend it with the boys, seeing a comedian that we all enjoy, as did their dad.  Yep, perfect plan.  I was on the website, ready to click "buy" when I said to myself, "Self, you should just double check that that is your weekend off."  Alas, alackaday, it is not.  Poop!  I guess that just saved me $160 bucks, but I'd much rather have gone to see him.

We just got back from Hansel and Gretel well, FB and I did, SoS declined. So, we took him over to Grandma's house with his brand new copy of Hotel Transylvania. And about three seconds into the start of our movie, I turned to FB and said, "It's a good thing SoS didn't want to come." To which FB replied, "Yeah, he'd have nightmares until he was forty." Needless to say, there were some elements of the film not for those of tender years or faint of heart. Despite the rather young children I saw in the theater. It was a fun film, with some serious action and some equally serious gore. Mwahahahaha! Of course, I wouldn't have cared what was happening as soon as Jeremy Renner took off his shirt. *sigh* This isn't without his shirt, but it has a nice brooding quality:

Also not shirtless, but you can see the potential:

And here, it just seems like my kind of guy:

Okay, so I have been slacking a tad, but I have good reason.  First, I actually started writing the previous post the second week of January.  And then my laptop ate itself.  I took it in to get it resurrected and, after three weeks of silence, called to see what the dealio was.  Hard drive trashed.  Not sure why this keeps happening.  Perhaps it's the porn.  I kid.  Why question mark because I love exclamation point.  Anyway, just got my new laptop today, and because I am incapable of waiting for anything, I bought it yesterday and had it overnight shipped.  Hey!  It was an option and only cost 45 dollars.  Seemed ridiculous to not take advantage.I have many posts floating in my head.  One would hope that I can actually get them out and they will be half as funny here as they are when I'm thinking of them.  And if not, I'll just post lots of man candy. Like, say, this one: