P. taylor Cover

Zero to Ten: Nursing on the Floor
Patricia Taylor

Synopsis:

 

 

What’s your pain, from zero to ten? How fast can you run on the floor, from zero to ten? How soon will you have burnout, from zero to ten? Over forty years of experience in nursing inspire all these stories, from joy to frustration to devastation.

 

 

 

 


ISBN: 978-1-60489-309-0, trade paper, $18.95

ISBN: 978-1-60489-310-6, Hard Cover, $29.95


Binding
About the Author:

 

Tricia Taylor based these mostly fictional short stories on over 40 years of nursing experience in four Southern states in the U.S. She received her BSN, RN at FSU in 1976, and MSN at USM, in psychiatric nursing, in 1992. Her experiences included cancer nursing, hospice, med-surg, pediatrics, newborn nursery, teaching psychiatric nursing in a nursing program for twenty years, and then a return to med-surg, ER, quality-control nursing, and finally psychiatric nursing, until her recent retirement. This collection highlights a career that was usually exhausting, sometimes tragic, frequently infuriating, occasionally funny, and consistently rewarding. She now lives with her husband Joe Taylor, writer and publisher, and 12 rescue pets in rural Alabama.



  Exerpt:

Something New


“Just stay here and offer yourself,” says Mrs. T., my nursing instructor, as she blesses me with her crooked, exaggerated smile and bounces out of the birthing room. On the way down the hall, heading towards this room with her, I had told her I was scared. She had chirped, “Everything new is scary.”
This is something new all right. It’s our first day of O.B. clinical in the hospital. I’m dressed in scrub top and pants that are two different shades of faded green and are big enough to hold another person in them; the pants legs are rolled up several times and keep falling down. I feel very vulnerable, like I’m walking around in my tackiest p.j.’s from home. I no longer have the protection of my stiff white student uniform with the red stripe and school patch that make me feel important. And all we’ve studied so far in class are the signs and symptoms of a normal pregnancy. Certainly not anything to do with the scene before me now. I’m alone in the room with a beautiful young dark brown woman whom Mrs. T. just told me is in active labor. Like, in going to have a baby.
The woman is lying on her back with her head to one side and her eyes closed, her arms and legs limp. She has long braided hair that whips over her forehead and pillow. Her knees are bent and flopped to each side of her body with her belly protruding under a white sheet. She’s wearing a bright blue hospital gown that has fallen off her shoulders and exposes the top part of her large breasts. A bag of clear intravenous fluid is flowing into a site on her right forearm.

Two long brown wires are hanging from under the right side of her sheet and hooked into a monitor that looks like a TV set. Wiggly lines run across the screen and a light that looks like a red heart is blinking along with numbers that change constantly but seem to stay between 145 to 150. The bed is shorter than usual, ending just below her feet.
I approach the right side of the bed slowly and then stop suddenly as the woman opens her eyes, grabs her belly, arches her back and starts to scream. I’ve never heard anyone scream like this before. I run to her and say, “What is it?”
“Lord have mercy,” she murmurs between gritted teeth before she lets out another wrenching scream. I reach out to hold her hands, and she yells, “Don’t touch me.”
I think about running out to get Mrs. T. or a nurse. But should I leave my patient? Mrs. T. wouldn’t like that. Call the nurse? I grab for the call light. But then the woman calms down as suddenly as she started up. Her limbs fall back to her sides and she lets out a relieved sigh. She looks at me as if for the first time and smiles.
“Hi. I’m Patti, a student nurse. I’ve been assigned to stay with you. Is that OK?” I’m afraid of what she will say.
“Sure, it’s bad being alone,” she says as she closes her eyes again. I inwardly sigh with relief. I didn’t want to get kicked out of my first patient’s room. “Can I have some water?” she asks weakly. I don’t know if she is supposed to have anything to drink or not, but there is a cup of crushed ice with a spoon on the bedside table, so I scoop up a few small pieces and say, “Here’s some ice.” She opens her eyes and mouth as I spoon the ice into her mouth. She murmurs “Ummm,” and chews on the ice, while I stand with the cup preparing to give her more.
“Oh shit,” she blurts out, raising her arms and knocking the cup out of my hand. The cup plummets over the side of the bed with ice scattering over the floor. Perspiration is popping up on her forehead and she’s writhing back and forth holding her abdomen. She’s hollering again, “God bless, God bless,” and then starts with ear-shattering screams. She pulls at her gown roughly and reveals a large hard mass across her entire abdomen. That must be the baby. How weird. There are two straps across her belly to which the black cords I saw earlier are attached. I lean over her, tense and anxious to help, but afraid to touch her. When she stops rocking and screaming and pulling this time, I relax my whole body along with her and sit down on the stool beside her bed.
“I can’t take much more of this,” she moans as she relaxes back into the bed, legs sprawling with knees bent and arms loose again. I don’t know how much I can take either. I see that her abdomen is no longer so tight and strained. One of the lines on the monitor beside her has made a large upside-down u-curve. I go to her and pull down the gown and arrange the sheet neatly over her, and she smiles weakly. “How much longer will this be?” she asks. As if I have a clue.
“I don’t know. Have you ever done this before?” I reply, hoping that she knows more than I do.
“Yes, four times. But it was never this bad before. I want this baby out!” She exclaims, adamantly pushing her braids behind her head.
“Yes, you seem pretty miserable,” I say helpfully, remembering how Mrs. T. always stresses using empathy whenever possible. I wonder why she would be doing this for the fifth time if it was even half this bad before. I pat her hand and then leave her to go towards the bathroom to get a cool cloth for her wet, hot-looking forehead.
“Don’t leave me,” she blurts out as she tenses and starts to rock again. I run back to her just as a woman enters the room and walks up close to the bed beside me. I see her pink and blue scrubs and know she must be one of the nurses. I make out ‘Carol’ on her name tag. She is a petite brunette in her twenties; she looks a lot like me.
“Lakisha, take slow deep breaths like we practiced,” Carol instructs her patient. Lakisha. I didn’t think to ask for her name. Carol starts to model how Lakisha needs to breathe, and I join in: deep breath, in through the nose, out through the mouth, faster as the contraction progresses, fast, fast, fast, then slow down, slow, slow, slow, deep cleansing breath, and relax. Lakisha takes a few breaths and then stops breathing with us and lets out sharp yelps between phrases of exasperation, “Lord have mercy.” Carol keeps trying to get Lakisha to focus on breathing, but Lakisha won’t do it.
When Lakisha does settle down, she looks exhausted; her gown and sheets are rearranged again and her face is covered with perspiration. She just lies still with her eyes closed. “I don’t know if I can do this.”
Carol says, “Yes, you can,” and then tells me to go ahead and get the cool washcloth. She helps Lakisha to turn to her left side. “The baby gets more oxygen this way,” she says, cheerfully. She rubs lotion over her patient’s back and straightens her sheets and gown. I put the wet cloth on Lakisha’s forehead and then rinse off her face. She lies still again while Carol introduces herself to me and then helps me to understand what is going on.
“Patti, Lakisha is having uterine contractions that are forcing the baby into her pelvis. She’s getting close to delivery.” She points at the TV-like monitor. “This lower line that looks like a lot of small hills is recording the contractions: They are doing just what they are supposed to do. And the top line is showing the baby’s heart rate and how it is responding to each contraction.” I notice again that the numbers read around 145.
Carol smiles at Lakisha, “The baby’s taking the contractions well. If not, the heart rate would be dropping.” There’s a lot more to this than I thought. In the movie it looks so quick, a few ladylike yelps and it’s over.
“What should I do?” I feel overwhelmed. I hope I’m not responsible for monitoring any of this.
“Just stay—” She doesn’t finish the sentence because Lakisha starts to groan and balls up on her side around her large hard tummy.
“Damn,” Lakisha blurts out. Carol takes my hand and shows me how I can massage Lakisha’s lower back with lotion in slow rhythmic circles. I take over, and it does seem to calm her a little and she doesn’t seem to mind me touching her there. She is calmer now that Carol is here too.
Carol goes to the other side of the bed and imitates correct breathing technique for Lakisha again while Lakisha seems to do her best to follow. I breathe along with them. Deep breath, in through the nose out through the mouth . . .
* * *
After the third go-around of back rubbing from an awkward angle and deep breathing, my back and neck hurt, and I feel dizzy. I want to cry out with Lakisha, “How much longer?” as she’s done several times. Between contractions, we hear a soft knock and then the midwife comes in, smiling at Lakisha. I know it is the midwife because Mrs. T. introduced us earlier. She goes by the name of Judy and is attractive, 40-ish, with auburn hair. She wears blue scrubs and a spotless, starched white lab coat. Mrs. T had told me that Judy used to be a nurse on this unit and then went back to midwife school. I doubt that is something I’d ever want to do. It is all too new, and strange, and scary.

Lakisha looks at Judy with great hope and expectancy, and Judy says, “I’m here to check you.” Check what, I wonder. But Carol and Lakisha obviously know because Carol starts to help Lakisha roll over onto her back.
I must look confused because Carol tells me, “Judy’s going to see how far Lakisha’s cervix is dilated.” I nod back, not sure what that means, but I feel safer now that there are two experts here with us. I’ll bet Lakisha does too.
Judy sits at the end of the bed, pulls the sheet up over Lakisha’s knees, disclosing a large swollen vulva. She tugs a sterile glove onto her right hand and with her left hand she picks up a tube of lubricant and smears it over her right fingers. She tells Lakisha, “I’m just checking now,” and inserts the first two fingers of her right hand into the vulva. Lakisha tenses a little, but Judy reassures her by rubbing her left hand over Lakisha’s abdomen, and saying, “It will just be a minute.”
Judy’s right hand twists a little inside Lakisha and then Judy announces with a big smile, “You are at ten. It’s time to start pushing.” She just beams as she withdraws her hand. You’d think she just found gold. She leaves the sheet up over her patient’s knees, exposing all the lower part of her body. Lakisha doesn’t seem to mind. I guess modesty doesn’t mean much at this point.
“Thank God,” sighs Lakisha, and then closes her eyes.
“Ten. What’s that mean?” I bravely ask.
“Her cervix is completely dilated, it’s open ten centimeters and big enough for the baby to be pushed out,” Carol says to me. Then as Lakisha starts to tense with her next contraction, Carol tells her, “Lakisha, you need to push.”
Lakisha arches her back, holds her breath, and pushes on the bed rails toward the foot of the bed. “Lakisha, don’t hold your breath,”

Carol directs, but Lakisha only takes a big gulp and then holds her breath again. Judy washes her hands, and with one more encouraging smile she heads toward the door. She can’t be leaving. She can’t be leaving. And out the door she goes. I look back at Carol and Lakisha, but they haven’t seemed to notice Judy’s departure; they are busy with Lakisha’s contraction. Why did Judy leave? Does that mean Carol might leave soon too? And leave me here alone with Lakisha?
During the next break, Carol instructs Lakisha, “You’re not going to get the baby out this way. You have to stop holding your breath, arching your back, and pushing away from your body.” Carol demonstrates in the air how to pull on the side rails towards her and to expel air like blowing out candles.
Lakisha watches her and says with angry tears, “I can’t do that.”
“Yes you can, you have to, Lakisha,” Carol replies sternly now.
On the next contraction, Lakisha does the same wrong pushing again, though Carol is telling her what to do. It’s almost as if Lakisha has decided to deal with this by being as rebellious as possible. She’s like a two-year-old in Wal-Mart who won’t come to her mother when she’s called.
* * *
Two more contractions, and Lakisha looks weaker and is even more irritable. “I can’t do this. You have to get the doctor and get this out.” She has slipped down in the bed, her buttocks almost to the edge. The sheet has fallen on the floor, and she barely still wears a gown. Carol looks between Lakisha’s legs during every contraction and then looks disappointed. I guess she’s looking for the baby. I’m at the end
of the bed watching too. Is the whole baby just going to come out on the floor? Shouldn’t someone be there to catch it? Someone besides me?
“Lakisha, if you just hang in there and push like I told you, it won’t be that much longer. The way you are arching your back is just pushing the baby back up in to the birth canal,” Carol explains with exasperated patience.
“I want you to get the doctor for surgery now,” Lakisha insists loudly, and then another contraction hits her. She doesn’t even seem to try to really push this time. She is holding her abdomen and crying out like she was before. When the pain stops she is adamant again, “Damn it, I can’t do this. I want this baby cut out now.”
“Lakisha, you’ve done this before, you know you can,” Carol reminds Lakisha which just seems to make her more angry.
“It’s never been this bad before. I can’t stand it. You have to get the doctor,” she cries.
“If you had surgery, you’d have a lot more pain tomorrow than you ever thought about having now.” Carol says in a calm but deliberate, low, voice. “Now watch me. You need to sit up and pull towards you. Then push down on your pelvis like you are going to have a bowel movement,” she says as she holds out her arms and then brings her wrists and hands towards herself in demonstration.
“Would it help if she was up farther in the bed?” I ask, not sure if it is a good time to make any suggestions. She is lying flat and not really in a good position to push like she is having a bowel movement. And the floor looks dangerously close to Lakisha’s naked bottom. “Good idea, help me pull her up.” Carol says. We both grab an arm, and on the count of three pull Lakisha up while she pushes with her feet. Then Carol raises the head of the bed and positions Lakisha’s hand on the end of the short side rails so that it would be easier for Lakisha to pull towards herself. I wipe her head again and say, “You can do this, the baby’s so close.” I don’t know if this is true or not but it sounds encouraging to me.
Lakisha sighs, but with the next contraction she does pull up some and lean forward. Carol and I both take an arm and pull on it towards her body to remind her what to do. She takes a deep breath and pushes. “That’s good, “ we both groan with relief. It will be a real problem if she can’t push the baby out. I guess she would have to have surgery, which sounds scary.
When Lakisha rests again, her eyes close, and Carol seems to relax too and is in a lot better mood. She asks her patient, “Is the daddy here?” Lakisha nods her head silently. Carol continues, “Do you want Patti to go find him?”
“No, I never want to see his ass again,” Lakisha pronounces severely, continuing to close her eyes. Carol smiles at me and I assume this is a common reaction of women in labor. Though if I ever have a child I’ll expect my husband to be here suffering along with me. If he’s present at conception he can darn well be at the delivery.
Carol checks the monitor strips and makes notes on a clip- board as she’s been doing all along. I sit on a swivel chair on the side of the bed feeling tired but too excited to rest. It doesn’t seem possible that we are really waiting for a baby. It just seems like this will go on this way forever.
Judy comes back in, but Lakisha doesn’t open her eyes until she sits up suddenly with the next big pain. Carol tells Judy, “It won’t be long now.” Judy uncovers the large sterile tray near the end of the bed, that contains all the equipment she will need. She puts on gloves and a gown. Carol helps her to tie it in the back while I stay close to Lakisha and offer supportive words.
Another woman whom I haven’t seen before walks in with energetic steps, turns the lights on over a high table with plastic sides that has been up against the wall near Lakisha. She is Aretha Franklin dark with a Doris Day haircut. She stands behind Judy as if on call. Her name tag says ‘Angelic.’
Judy sits on the stool at the foot of the bed and checks between Lakisha’s legs. She says she is massaging the vulva to help prevent it from ripping during the birth. I peep to see what she is doing and see the vulva bulging and red from the pressure. Rip? The skin can rip?
Then Judy joins Carol and me to encourage Lakisha to push. “Push, push, push. . . . Hold it. Don’t let go. Don’t breathe. Don’t breathe. Focus on your bottom. You are almost there.”
Lakisha bends forward, pulling on the armrests, holding her breath. Her face is bright red.
Suddenly another nurse with wild red hair runs into the room and screams at Judy, “The woman next door is crowning now. You have to come.” Crowning?
Judy seems to freeze a second. Then she turns to the redhead, “Couldn’t you just make her pant until I can get there?”
“It ain’t gonna happen,” pronounces the wild redhead. Do nurses talk like this?
Carol says, “I’ll work with Lakisha until you can get back.”
“OK. Lakisha, stop pushing till I get back,” instructs Judy as she takes off her gloves and gown. What? Stop pushing? Not push? After all we’ve been through? I can tell from the horrified look on Lakisha’s face that she is thinking the same thing.
Judy rushes off after the redheaded nurse. Angelic does the same, to leave the three of us alone again.
Lakisha’s next contraction starts before she has time to say anything. Carol reminds her, “Don’t push anymore right now. Just pant to slow down the baby until Judy gets back.” She demonstrates for Lakisha again, this time panting, quickly in and out. Lakisha mimics the pant unenthusiastically at first, while glaring at Carol and me. I join in panting. It’s the least I can do. We pick up the tempo and act like three large dogs after a long romp in the forest. Carol nervously checks between Lakisha’s legs as we continue to pant throughout her contraction.
After two more attempts at panting, Lakisha is verbally angry again. “I can’t do this anymore. I want this fucking baby out of me now. Get Judy or grab it yourself, it’s coming,” she pronounces. I can’t say I blame her.
Sure enough, this time when Carol and I look down, not only is the vulva open, but there is a large dark mass edging out between the lips. “It’s the baby’s head,” Carol says as she grabs the phone off the wall. Lakisha looks satisfied until the next contraction, and then she screams out and then sits up and pushes with all her might. Carol demands, “Don’t push now,” but Lakisha ignores her. I grab my hair and grit my teeth. Is this what nursing is all about?
Carol grabs the phone and yells into it, “We need Judy ASAP.” I do know that this means, like immediately. After a pause she says, “She’s crowning. We can’t wait.” She hangs up the phone, grabs a pair of sterile gloves and sits in the chair between Lakisha’s legs. Lakisha starts to rest again and what is apparently hair recedes from view. Carol mumbles, “Judy has just got the other one out and is cutting the cord. We have to wait a few minutes.”
Carol implores Lakisha to pant and not to push next time. Lakisha has sunk back down to the end of the bed again, so it is harder for her to push, but she is also dangerously close to the floor once more. I assume it’s not all that unusual for nurses to have to catch the baby, but Carol still looks nervous, like she’d rather not do this herself. I hope she doesn’t have to either. Because for one, she looks
real nervous, and for two I’ll probably have to help.
Angelic trots in the room and stations herself near the high table. She puts a pink and a blue blanket and two small hats, one pink and one blue on the table under the lights. I guess she’s going to help with the baby. That seems positive anyway.
Finally, Judy shows up. Carol jumps out of the chair and Lakisha cries out with relief.
Judy pronounces, “Now we’re gonna get this baby out.” Judy puts back on her sterile garb while Carol and I pull Lakisha back up in the bed and we each grab hold of a bent knee. Lakisha sits up and grabs hold of my hand. With the next pain, she pulls my hand backwards towards the rail. I’m in severe pain and my hand has turned white, but I’m not going to try to make a big deal of this. After all, the woman’s having a baby. During the next rest I disengage my hand and massage it while I move to the end of the bed. I need to see what’s going on anyway.
With the next contraction Lakisha gives one more big push and the baby’s head comes sliding out.
“Thank You, Jesus! Praise God!” yells Lakisha.
I can’t believe it’s a baby’s head, but there is hair and there are eyes, ears, and a little nose and mouth. I want to be happy, but the head looks so weird: it’s pale and looks like it’s covered in green hand lotion. It’s not moving at all. And there is a lot of blood and green fluid coming from around it. Judy pronounces, “We have light meconium.” I don’t know what this means but in the movies there is no green fluid. Angelic hands Judy a clear plastic device with two tubes extending from it. One’s short and the other’s long and attached to a bottle on the wall. Carol whispers to me over the bed, “The baby has had a bowel movement because it is getting tired of the pushing. It’ll be OK. It’s just important that it doesn’t breath in the meconium.”

Judy sticks the small tube in the baby’s mouth. With a sucking sound, greenish fluid is pulled back through the contraption and towards the bottle on the wall.
Then the body slips out behind the head. It’s a girl. But she’s all so pale and still not moving. Judy continues to pull fluid from each nostril. I’m scared. Is she dead? No one else seems particularly worried; they are just watching Judy with expectant expressions.
Sure enough, the baby suddenly starts to cry, a truly loud wonderful cry. And she starts to pink up. It’s a little, pink, tense, moving, alive baby. Everyone smiles and laughs, and Judy holds the baby up for Lakisha to see, saying “It’s a girl.”
Lakisha is smiling now, calm, and laughing. Judy cuts the cord, and more blood spurts out. Then Angelic takes the baby and puts her under the warmer and dries her off, wraps her in the pink blanket, and places the pink hat on her little curly dark head. Then she hands the baby to Lakisha.
The mother holds the bundled baby up to her face, and says, “I love you, girl.”
While Judy delivers the after-birth and cleans up, Lakisha turns to Carol. “Thanks Buddy,” she says shyly. Carol smiles back and winks. I sit down.
This was just another routine event for Carol and the fifth time for Lakisha, but something mighty new for me. A few minutes ago I would have said that this was definitely not for me; it was all too much. Now I wonder. Maybe, just maybe, this is something I could get used to.