So I've been asked lately by a few friends what my days are like now that I'm not teaching in the classroom but working on the Maternity ward. Today might not have been a typical day but it wasn't completely out of the ordinary either. Woke up at 5:30 prior to the pig in the garden behind my house, had some Bible time and then a quick shower, breakfast and started a load of laundry before leaving at 7:25 to go to Monday morning Hospital chapel service.
8:00 attempt to listen to change of shift report (spoken in Tok Pisin. English and PNG nurse acronyms) while counting heads to see if all 17 of the assigned students are present.
8:20 assign each 2nd year student on postpartum 4-5 patients and have them work with 1-2 of the 1st year students, assign two students to work in nursery, make sure the 2 students in the delivery room aren't doing a delivery by themselves, and make sure the 3rd year student charge nurse knows what he is doing for the day.
8:30 supervise the students beginning their daily care for the moms and babies, while Doctor rounds on patients. Begin signing procedure books for all 17 students for procedures done on Friday afternoon when it was too busy to sign then books.
8:45 check on students in delivery room, no one in active labor, one student starting an admission on a multipara.
9:00 continue working on procedure books- sign Sr. Staci approximately 150's times throughout said books, wonder where my coworker that is suppose to be working on postpartum is, so I can fully supervise in the delivery room.
9:20 continue to go back and forth between labor and postpartum, watching one procedure after another, point out some things in the chart for students to pay attention to, chat with a few patients
9:45 coworker arrives, inform him of students task on postpartum and then concentrate on patient in deliver room with 2nd year student Joshua. Time contractions (using hands and wrist watch and patient reports) review labor process, assist with filling out paperwork.
10:15. John now is beginning to admit his patient in the next delivery bay, go back and forth between both bays assisting both students.
10:30 remember I need more latex free sterile gloves to do these deliveries and go to central supply and find my stash. Place gloves in both rooms so I can quickly put on when needed.
10:45 while helping John, hear Joshua's patient make a noise that basically only means one thing on a delivery ward in PNG and run back over to them (10 ft away) and put the gloves on while making sure Joshua is ready for this delivery.
10:49 help Joshua delivery baby boy, try to prevent tearing, not quite successful, big baby
11:00 bleeding controlled, give assistance with suturing but realize this is over my head as American RN's don't suture and I'm still learning, so trade places with my coworker on postpartum
11:05 begin supervising 2nd year students giving scheduled meds after the medication prayer time, avoid 3 medication errors
11:35 switch places with coworker again and assist with breast feeding on Joshua's patient and them do assessment on John's patient. Now she is 7 cm dilated, amniotic sac still intact, and its her 5th baby in 7 years. Fully get her history, it's her first time ever to come to a hospital. Has not had prenatal care, last two babies died at 11 months and 4 months. Wants to avoid another baby dying (why she came to hospital this time) but also has husbands permission to get a tubal after this delivery. Has only had girls. Last baby born 13 months ago. Not the best history, not the most common, but I've seen many similar stories here before.
12:05 let hospital staff know of our patients status, tell John to run and get some lunch fast and head home to get a quick lunch and hang up my laundry! (We are allowed to take a one hour lunch, haven't done it recently!)
12:40 back at labor ward, John is already there and monitoring contractions and fetal heart tones as needed. Amniotic sac still intact. Talk with Joshua about things we could have done better in his delivery.
1:50 Joshua begins to admit another patient, help with assessment and paperwork. Check on John and his patient periodically.
2:45 John's patient remains unchanged. Contractions are not very close together, 7-8 minutes. Decide to break her water. John performs procedure. All is looking good. Contractions pick up.
3:10 Assist with Joshua's patient. All admission done, waiting for more orders as she had prior c-section is now post-dates, not active labor
3:45 John's patient is getting closer to delivery, 9 cm, but wants to keep walking around the bed, of course, right at change of shift. All midwives on ward are at a staff meeting (not located on ward) and all CHW (community health workers, somewhat like an LPN) are in change of shift report out in the postpartum area. We remain with John's patient.
4:15 John's patient suddenly makes the same noise that Joshua's patient made earlier, except she is still walking around the bed and isn't on the side that has the step to get up into the bed. She squats before I can get out any Tok Pisin that would have gotten her to get up into the bed and that motion was enough that we know have a baby coming and no way to get the mom up to our sterile field. Quick instructions to John and we have the field under mom and I have a baby head in my gloved hands (thankful I had them ready to go a few hours ago). I've never delivered a baby this way before and John was suppose to do the delivery but no way it could happen with where we were each located in the room. Baby boy safely delivered and placed on our clean field at 4:20, followed quickly by the placenta. John gets to help at this point, cord clamps and cutting, and we then get them both up into the bed to do continued assessment. I'm still amazed nothing bad has happened but that this lady came to the hospital to deliver safely and we end up delivering on the floor!!! She is smiling though, very thankful we were there to help and loving that she got a baby boy! Some more assessment and we control bleeding and discover a prolapsed cervix to add to all our fun. John and I keep on praying!
4:30 All the nurses return from their meeting in time to help us finish putting mom together and then get her and the baby cleaned up and assessed.
5:15 All paperwork completed, patients successfully moved to postpartum ward. We informed them we would see them in the morning and to keep a close eye on her bleeding. I head home to get my laundry off the line before it really starts to rain.
5:25 Second shower of the day with my lovely heated rain water!
So just another Monday on the Maternity Ward, Kudjip Nazarene Hospital. Love it and this life God has called me to.
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