Saturday, November 22, 2008

Progress report (now with random photos)

Well, my to-do list still looks a bit sick. (I've taken a leaf out of Frogdancer's book and illustrated with holiday snaps- the photos are from the Italian leg of our trip last year, on the theme 'Rome wasn't built in a day') Catch more babies - Nope - not a one. Despite the best efforts of my colleagues to fling all multiparous and other quickies in my direction.

I had a day in the assessment unit - where it is frowned upon to catch babies unless you genuinely have ZERO time to whizz them around the corner.
I spent a shift with a delightful young primip who spoke minimal English (my French was fairly rusty, oui, c'est vrai). Her trace looked like crap (she was on the trace due to augmentation of labour) and the baby heartrate kept bottoming out, so needed to go for CS. Bummer. Near perfect gases. Cord only around the kid once, but had been in a spot that got squashed a lot and made the trace look crappy. The heartrate did take time to recover, more each time, and can only do that for so long, but it was disappointing for everyone. Baby came out squawking. Happy Maman and Papa. (Hopefully happier than this Maman below, Michaelangelo's finest work, the Pieta. Forget the Sistine chapel. This is it. Oh, and his David - who is also utterly magnificent.)
Today I came on to two delivered women. One was asking about circumcision for her new son - she wasn't too fussed whether it happened or not, just thought it was what you did. "In the olden days: we know better now, why cut something off when you can just wash it?" I told her. Thats the way God makes 'em, might as well leave them alone! Besids - he'll be the odd one out, it is so rare to find a circumcised boy under the age of 20 in Australia. (and thats a good thing) She was most relieved, it was one less thing to accomplish, and once I gave her the script to brush off enquiries from old-style pressure groups she was very happy to leave him as nature intended. We had a brief discussion about how to care for it (self-cleaning mostly, or just a swish until it pulls back fully and needs to be gently attended to by the fella himself) and then talked about Sci-fi fantasy books! (these look a bit like bookends to me)I was then sent to collect a multip who was a sure thing for a catch. A nice couple with a good history of spontaneous easy birth, including a multiple birth. Nix. Nada. Bupkiss. I even stayed behind nearly two hours after everyone else from my shift,but she went off the boil, even after rupture of membranes. I have just phoned - she had her son two hours after I left. I'm pleased for her, but sheesh. What does a midwife have to do? No-one else was scoring any babies either today, it was uncharacteristically slow, and two rooms were closed for water leaks! But I will be heading to the ward this week, and not be rostered back on LBS for a long few months. My catches remain at 45!
My perineal repairs remain at zero. No catches, no repairs. Easy equation. Not much call for it on the ward either (one hopes). Even less in clinics or VMS!

K2 CTG training remains unfinished - I have had no time to complete it at work this week, but can access it from home and will apparently be paid for the time I take from home. It is very interesting to do, I am refreshing and building on my knowledge. Its great.

The mentoring is all sytems go. We will meet soon, but had a brief catch-up at work, during which she beamed when I said Yes. A good sign. I have a few things planned to start with already. She is an interesting woman and its a good challenge for me professionally.
I have had a pretty definitive NO about getting some temporary work in the birth centre, more's the pity. Ah well, when one door opens another may open. I'll keep my ear to the ground for suitable continuum opportunities.
At home - I have been struggling a bit with a sore throat this week, along with an unwell hubby with a viral illness. Its not like him to take time off work, let alone go to the doctor and he has done both this week. He's not sleeping well, but I think it is starting to lift, and he is finally accepting that pain relief IS a necessary part of coping with sinus pain. He does allow a bit of cossetting every now and then.
I saw my Mum - who was not terribly cheerful or positive following her trip. We went out to a rose nursery near her place to get some rose bushes struck from a cutting I had taken of a stunning climbing rose 'Chrysler Imperial' with a heady fragrance. It was a favourite of my Dad's - I'm sure I've posted about it before. However the nurserywoman was most blunt - nuh, wrong time of year. Nuh, got no root stock to graft it onto. We finally dragged the month of January out of her as a good time to try again. Customer service training surely can't cost too much can it? Heavens above, at least be forthcoming with information - we were the only customers in the whole enormous place - it can't be too hard. To top off our frustration the nursery cafe where we had planned to have lunch was also not open on the day of our visit. I could feel a Mum-shaped meltdown coming on, so we wandered out to distract her and bought some new roses instead. Sigh. They also had some very pretty decorator pots which made a lovely advance birthday gift for Mum. Another gift off the pressie list.

Oh yeah, make a list, check it twice....that was on my to-do list. DONE!!!! Yay! Now to get to the shops and achieve the purchasing, or do the making......
Minimal crafting achieved this week, apart from... oooh I lie! I made two little button bracelets on Wed night at swimming. And I altered a polo shirt for work by appliqueing some pretty bright rose print cutouts over a very unattractive logo on the breast of a new white polo shirt, and adding a matching trim around the collar to cover up an orange stripe. I don't do orange. It doesn't suit me. But the alteration worked out well, and I wore it to work successfully (successful in the fashion stakes, not the baby-catching stakes, sigh). I even sold a bag this week! Which inspired me to stitch a few more. I may join Calamity Kim and make a craft pledge to make 3 small items a week in 2009. Just competing with myself, but also for etsy stock. (shop still empty, I'll blow the horn when its open). Its not like I don't have the stash!

Speaking of which...House still a tip? Check!

Purchased Xmas tree? Nope. The hunt continues, I seek them everywhere I go.
(BTW - we have absolutely NO idea what this item above is. They were fixed to the walls at regular intervals in many places in Rome, Siena and Florence and are at about head height to me. But we took a photo, and I love it 'cos it shows Don's hand. I love his hands)

More op-shopping. I found a blue cowgirl + tiara hat! I need it. Truly. The theme for our staff Xmas party is Country and Western! See - I DO need it. And the matching shirt, which hubby will claim when I'm finished with it. We also found some gorgeous Bally shoes for Steff. $10. Worn once. Very stylish black and cream loafers with sedate tassles. Di-vine. Italian leather designer shoes. We were suitably stoked (I bet Kelley is very jealous - do you have teeny-tiny micro feet? Cos Steff does!) And a sassy tote bag for fun. It is a rare day when our local Vinnies doesn't give some sugar!

Enough rambling on .... Be good.

Sunday, November 16, 2008

Moving on

Suddenly I have only one more week on LBS!
(the photos are from a funny email sent to me this week entitled "When your Dad is a graphic designer...what do you expect?)

I have so much on my to-do list!

  • Catch more babies myself. (myself, do you hear?) It has been very noble of me to find and foster 25 catches for a very nice resident doctor in the last 2 months. She got her 25th last night - 3 in one night. Good thing she runs fast. She owes me chocolate. And LOTS of it.

  • Stitch more perineums (current total = 0)

  • Sort out whether I can be a mentor to someone who has asked for me (I am pretty junior, and I'm moving on, and around. Alot. But am flattered to be asked. And it may just work despite all that. Stay tuned)

  • Finish my K2 CTG training (item one may interfere with this notion, decisions, decisions)

  • Finishing said K2 training may make me more defensive in my practice. I hope not. Its all about perspective, people. Small percentages. (Do I sound like I had a frustrating shift last night? How could you tell? What were the signs?)

  • Swap a shift so I can attend a meeting on Thursday night, seeing as I am the secretary and all, and I was an apology last time. And I am rostered to work a late shift on that day. And if item one happens, there is fat chance of me getting away for an extended meal break to attend.

  • Did I tell you I have seen TWO true knots in the cord in two shifts running? Wow? One born vaginally, no worries, one who went for CS not even in established labour. Rats. I've been seconding a lot, so I've seen lots of births, but I'm missing the hands on (poised, actually) (thanks to Google images for this pic)
  • Enjoy my last week (for now) with a great team, who have made me very welcome. I have spent 7 1/2 months with them in the last year- the longest I have ever worked in one place.
And at home:

  • Make a Xmas list, start shopping/making/planning. 5 weeks you say? Eeek!

  • Figure out the family meal arrangements for Xmas - given that I have just agreed to work night shift on the 23rd and 24th into Xmas morning. And will therefore be asleep until lunchtime. Oops.
  • See my Mum, who is back from gallivanting (in an unrelaxed fashion) around Europe.

  • Make some more stuff, to clear my decks a little, and just for fun.

  • Find a nice plastic Xmas tree - why are they all scratchy, dull and spiky? WTF? Our previous tree - which I bought in 1983- had semi-glossy authentic looking cypress branches. I paid $21 for it. It was terrific. Last year I was determined to replace it (getting a bit shabby), and spent $85 on a truly horrible tree (dull, scratchy, too dense). Which we all hated so much I didn't bat an eyelid when hubby tossed it this year. Even a silver tinsel tree would be better than some of the ones I have seen recently.
Considering my lack of interest in Xmas last year, I may just enjoy the lead-up this year. This is not set in stone. I reserve the right to regress into anxiety attacks. Or boredom.
Please - don't write too much of interest on your blogs, dear friends. I spend way too much time attached to this Bloglines. The above lists will take time to achieve. Take pity on me.

Now how do you spell s-e-l-f d-i-s-c-i-p-l-i-n-e?

Wednesday, November 12, 2008

Quick update

Someone in the universe knows how to do this booking holiday time much better than me.

She is my manager. I sent her a balanced, insightful, self-deprecating (and only slightly whiny) email about my plight. And how I love my job, and want to further my career. About how it wasn't fair to move me to the ward just to get holiday out of them.

"Don't be ridiculous!" she said. "Everyone does it. So...first two weeks of February? Done. Sign here. We'll use the same method for June - you're first in line. Tell us when your dates are sorted."

Sheesh. (insert pic of blushing, sheepish and relieved look here)

Thanks for your sympathy and tolerance for my inexperienced whining. I wonder when I will be a real grown-up and understand the workplace better?

Now ... I wonder if Eagle Bay is available?

Tuesday, November 11, 2008

Exercises in frustration

I am new to working.

Apart from one year in 1985 I have not worked full time in a regular job until I started work as an RN in mid 2005. I have had the utter luxury of being a stay-at-home wife and mother (albeit with considerable voluntary commitments by choice) for most of my children's lives. I worked one day per week for money from 1996. It was pretty good.

Since I gained my qualifications as a registered nurse I have been employed at the hospital nearest to my house. Because its easy and I'm a bit lazy. And we only have one car. Besides, parking is appalling and I walk to work. And my husband and I prefer to be near to our places of employment and we were able to buy into the area in 1984 (when we still paid 2-3 x what people were paying to live in suburbs further away). My employer is also a specialist in women's health and maternity care. My field.

I relish my work. I find it very absorbing. I think about it alot. I have plans to experience a wide range of areas, with my eye on a longer term goal of being community based. I like to see people in their own environments. That's where health (or a lack of) impacts on people. With respect to maternity care, childbearing is not an illness for most people but it can be a challenge to the health systems of some with underlying conditions, or poor health and nutrition. I like to understand how a pregnancy fits into someone's LIFE.

So I am working about 3/4 time. And fitting work into MY life. I still feel I am a beginner at this. Because of the way I work I move around between areas, 2 months here, 6 weeks there. Mostly with around 2-3 months notice of where I am going, in broad terms.

I am coming to understand that while this is intellectually and professionally stimulating, it has a downside. Namely that my family gets the leftovers. Of me. I am frequently not home for evening meals, weekends, sporting events. Or if I am at home I am sleeping. Or wishing I was asleep. Or mentally exhausted and needing to unwind in front of the TV. Or at the computer. I spend more time communicating with YOU, readers, and others whose blogs I read even if they are unaware of my attention to their whimsy, than with those I live with. This is not always ideal, or appreciated by others in the house.

So to get some time to spend with said others in the house I apply for leave. That I have accumulated. That I am theoretically entitled to. That must fit in with the needs of the organisation. That comes on a first in best-dressed fashion. With advance notice an advantage. Major planning required. Others always ahead of me in a queue. Because I don't (can't, not always) get much notice. Do you see where I'm heading with this?

I am becoming frustrated in my attempts to achieve a better work/life balance because of planning. I am not used to planning this way. The problem is largely mine. I chose to work in this way, to gain experience across a lot of areas. I hadn't anticipated the pitfall of leave planning. And major short-staffing issues - which means that the employer has need of labour and doesn't have the capacity to replace any more staff if they are on leave. Which sucks for the employer as much as the leave-deprived staff. Morale drops because people are not able to recharge their batteries. They feel flogged and overworked, constantly taking extra shifts to meet the shortfall of staffing. I am by no means an island in feeling advance planning pressure. It must be dreadful for the managers to try and fill the rosters with a decreasing number of staff. Almost no-one works full time. Days off are breathing space for the weary. For the sleep deprived with constant body-clock changes.

I don't know how systems can be sustained in this environment. I've only been working for 3 years and I'm getting frustrated. There is no leave available in one of my key areas until mid-2009. And there are others ahead of me in the queue. I can't apply unless I know where I'm going to be. By which time I am never near the top of the queue with a chance of 'getting' the leave.

Many have resigned permanent contracts over the leave issue, and now work as casuals - picking and choosing the days and shifts they want to work. They have to be organised, but it seems to work for them. Of course they rarely want to work night shift, so the bulk of night duty falls to permanent night staff, supplemented by other permanent staff taking turns to work night shift. 2 weeks on nights, 4 weeks on days. It is not easy. I can't see that managers have much choice. But it would be nice to think it will change for the better sometime soon. I could always follow suit and resign and go casual - but that would mean that I lose access to some of the areas I have yet to gain experience in (i.e. I have NO chance of being rotated through those areas if I am a casual) and hence I will never get those brownie points on my CV. Which I'm not building just to take to heaven. I need those experiences to move into the community. Therefore casual = serious career limitations.

My family are resigned to my shift work. They, of course, don't get the rewards that each particular shift gives me in terms of my contact with people, the buzz of a birth, or the camaraderie with work colleagues. I do love my work. But I don't think my family are finding my absence endearing, for all that they are pleased that I love my work. My husband works really hard, and our kids are not the most forthcoming houseworkers or cooks. He is entitled to be somewhat cross when he comes home at 6-45 to a wife still asleep after an interrupted day of catnaps and another night shift ahead, and a dinner not even underway, and adult kids lounging around waiting for the fairies to pop dinner in front of them.

The reality of life as a midwife, being on call (not yet but one day), shift work including lots of night shifts will continue to take me out of their sphere. And return me tired and in need of space and solitude to recharge myself. Which is clearly lacking currently.

As I have alluded to before, this is the first year that I haven't had a kid in school. A reliable 9-3 timeslot where I can have the house to myself. For creating, thinking, reading, sewing, playing bingo - whatever! Where I can just pick up my keys and go out without answering to anyone, or stay in my jammies if I want to. No-one draping themselves over my neck and hassling me to 'do that thing [insert needs of others here]'.

However loved or needed I am by others, I need myself too.

I suppose I am also struggling with the idea of ambition. Of ego. Of stepping deliberately (a little) away from family ties that have been so strong, and at a time when children are usually becoming more independent, ours are not. (For various reasons. Some of them too difficult to go into.)

But I want to strengthen my professional self now. I work hard and happily, in a high-ish pressure environment, and need to re-charge to sustain this. Some regular hours alone, and definitely some time with just my husband would be just what I need. I am planning and applying to all and sundry, while taking my place in the queue (sigh).

Pray for a solution from this seemingly insoluble mess, that will continue to provide the range of experiences I need to build a career doing the work I love.

In other news...

I do apologise, in the public domain, to all those behind me in the queue at a large office supplies outlet yesterday while I insisted, implacably, on a refund of the $50 difference between the price of a new laptop and the slightly higher price of the laptop LEMON that my daughter purchased only 3 months ago, which was being replaced after 2 lengthy delays for major and unsatisfactory repairs. It was the least they (the company) owed us after all the inconvenience. Bastards. We received the refund. Only after I assured him I was quite happy to stand there for the next hour and explain the principles of customer service obligations to him while his potential customers streamed out without their purchases. I am a largish woman and can block an aisle quite effectively. His junior staff were all hissing at him to do the right thing, don't be ridiculous, pay her because it truly is an absolute dud. I even insisted on it being recorded on the electronic comment section for the register "Product exchange - DUD". Take that large corporation whose after sales service sucks.

And finally, I am overwhelmed with joy at the wisdom of the majority of American voters. Intelligence and integrity is welcomed back to the White House.

Tuesday, November 4, 2008

Back to night shift

Just a quick check-in before I start night shift again tonight.

I worked last weekend and had two very different days!

On Saturday I met a young couple having their first child. In spontaneous labour, not wanting any pain relief, very private, from a non-English speaking country but they spoke very good English, which is always a help because my Arabic sucks (I have three words). She declined the opportunity to have her baby caught by a male resident doctor, so I was actually in with a chance at catching this baby myself!

She laboured really well, steadily and stoically. It was such a breath of fresh air to see her. No drips, no CTG, no drugs, just massage and movement. Gripping our hands and calling to God to help her. Membranes intact, walking well. I offered the shower, or a bath for pain relief, she chose the shower, but she didn't seem to want to be away from me for too long. So I stayed, and talked soothingly to her, encouraging her, applying counter-pressure to her back with the pains. The room was fairly quiet, the day drifted away.

Earlier we had talked about the usual progress of labour, how she was smiling now at 3-4 cms dilation, contracting 3-4:10, but things would heat up and get intense and she may feel desperate and out of control and restless. That was all normal, I would welcome those signs and she should trust her body and allow it to function in this way. She looked a bit nervous but secretly determined, and a bit excited at the prospect. Sometimes I will explain that the intensity feels a bit sexual, and this is when they can reach for their partner and focus together, as they complete the activity that started 9 months ago. It is really intimate, and often noisy in a similar way. My job is to hold that space for them, and help establish their confidence to get through that intensity together.

And so it unfolded. She did so well. He did so well. In the last 2 hours or so I barely left the room, as she entered transition, trying a bit of gas briefly, then throwing up and getting back in the shower. She was just beautiful, unveiled, naked at times, breathing hard, reaching for us and accepting our assurance that this was exactly right, prevailing, pushing through, napping between contractions then rousing to focus again.

At 8pm her waters broke in a gush. Could she feel a baby in there? Have a feel! No, she wouldn't but I could if I wanted to. I could feel him quite close. I guided Dad's finger gently in, he gasped in delight, his jaw dropped! Go ahead and push. By 8.10pm there was suddenly a head well on view, and I laughed and scrambled to another pair of gloves. Their son was born at 8.16pm, with one hand tucked up under his chin, and a full head of hair, and an intact perineum for Mum. What a triumph for her, what a delight all round. All 3kg of him. Just beautiful. So clever. Baby Mohammed tucked in for a feed quite quickly, Mum lying on her side and resting after her efforts, both of them relaxed and sleepy after a big day. What a natural she was, she should definitely do that again!

Noting his birth later at home I realised that he was the first baby I had caught all by myself (no midwifery or medical student, doctors, intruments by docs, or gone to CS) since 12th August. There was a second midwife present, but I was the only one to lay hands on him to birth him. I am quite fussy about calling a baby 'mine'. I must be the primary accoucheur. There are many, many babies that I suppose I could call half mine, where I was gloved up and guided hands, then someone else 'got the catch', with me as secondary accoucheur. Even for the babies I have seen through to CS lately after long labours, where I am listed as witness to the birth and I have signed the birth certificate forms. But there is something pretty special about seeing and feeling their wrinkled scalp appear, watching the face emerge and blowing bubbles or mewing a bit on the perineum. I love that bit the best I think, when they are just head out - poised between worlds, a soul hovering in transit. Then to guide a baby's shoulders out after waiting for their dear little head to turn, then placing them in their mother's arms, or helping Mum or Dad to bring them the rest of the way out that is, oh, just sooooooo amazing. There were 3 people in the room, and now there's 4 people in the room. Yay!

So full of the joys of Spring I waltzed into work on Sunday morning. It looked like I was going to get another one, a young primip at 8cm, labouring all night, but no. Her progress was really slow, really slow, and she was unwell, febrile, tricky epidural, offensive smelling liquor. She was a big girl, and quite immobile, a bit passive. She ended up having a CS mid-morning, baby a bit flat, needed some resus, really whiffy, probably with sepsis, but not doing too badly really. Poor love. Lovely family, that little baby boy P, will be well loved and cared for. He was a big'un too! When we took him down to SCN he weighed 4.220kg (9lbs 5oz). I saw his Mum in recovery and she was just relieved it was all over, and couldn't wait to get down to see her son.

I returned to LBS gasping for a cuppa (11am) but no - I was sent straight back to theatre with another woman who was opting for a CS due to a big baby. She was another really big girl, we used special lifting equipment to move her safely onto the table. There were delays for one reason or another and by the time the baby was born at 1301 I was getting really cranky for some nourishment! Further delays in the ward receiving the baby, and I finally took baby S to the ward where she weighed in at 4530g - (10 lbs) with an enormous head - 40cm (av. = 34-36) - the biggest I have ever seen on a baby - her head looked like a bowling ball. Good decision on the CS! No wonder that head hadn't entered the pelvis!

By this time I was feeling quite vague and trying not to cry (I really ache when I'm standing in theatre, and being hungry and thirsty too, boo hoo, woe is me). I got back to LBS at 1355. I fell on the nearest spare meal from the patient trays and wolfed it down, with my feet up on a chair. I couldn't even talk, but after 20 mins rest I was feeling more human. I finished my paperwork as quickly as I could, weighing the smelly placenta with a student to show her the probable chorioamnioitis, and tracking down small details from the two births I had witnessed that day, plus a form from the previous day that the ward had lost (I found it, they had been having a 'boy's look' It was there all the time). By 3.25 I was off home, I actually walked home after my earlier exhaustion! The exercise will do me good.

So now I am starting 4 nights tonight. I have a social weekend planned in between sleeping, and hope to catch up with the girls for a pseudo-camp weekend. It should be great.

I look forward to hearing about an Obama win in the USA elections - the alternative is just unthinkable!