The WHOLE nine yards

Sorry about the gap. I seem to be falling behind in the blog.

Anyway, I have some stuff worthy of reporting to my loyal readership (up to 7 entire people, by now!)

I will first talk about the great mini weekend that my mom treated Karen and I. We had ourselves a much needed evening at the spa, and dinner out. I have talked about spa before in the Philippines, but it is really affordable and quite soul reclaiming. I went for the native foot massage, followed by an epic sauna. Karen got a bunch of other stuff, then we had a nice pasta dinner overlooking the city. What a great little place. THANKS MOM!

The preceding was followed by a week's hospital duty in Abatan, about a 4 hour van ride towards Sagada. This place is "on top of the world" in terms of the Philippines, and as compared to anywhere else. The wind and rain and fog rolls through here pretty violently, but it makes for some breathtaking scenery and of course, as green as it gets. We had the 12-8AM shift, and that was crappy, but somewhat tolerable. We had very "toxic" patients in the wards. My last day, I had a 11 year old kid with acute renal failure (glomerular nephritis). He was swollen like a balloon, with a BP of 180/110. Headaches, nausea, vomiting and of course, no peeing. Poor kid. I talked his mom into going to Baguio General, and did my best to help him out, but really, all I could do was administer IV meds and monitor his vital signs. I though he was going to have seizures, but lucked out. He was in an ambulance that morning and hopefully on his way to better (read:advanced) care. He needed a lot more than this district hospital could provide. He was my first patient that I thought might not make it during my shift.

On the much more positive side, I delivered a baby. We had a 17 year old girl and her family (and the father) in when we started our shift, and I was up for the delivery (my group rotates the procedures among us) . As a typical overenthusiastic rookie, I ran and put my scrubs on. She was a nulliparous, so This was to be a long night, in actuality. We walked her up and down the halls for about 2 hours, then brought her into the DR. Though she was fully dilated, she wasn't effaced, and her membranes had not ruptured. Myself, the midwife and the soon to be mother hunkered in for about 3 hours of regular contractions. then it seemed that she backed off a little. The midwife ruptured the membranes manually, but it seemed like there was not a lot, and it did little to accelerate the process. Then, the contractions came back with a vengeance. She poked the membranes again, and this time a good spurt of amniotic fluid came out. I foolishly thought this was what all the hubub was all about. I was wrong. Also, I thought that my role as "Actual delivery nurse" was merely to assist the midwife, I was REALLY wrong about this. The good midwife basically handed me the steering wheel, and talked me in like a corny pilot passed out/control tower movie ending from 1972. Then I was instructed to dilate the cervix. I will spare the details for the uninitiated. After 3 minutes of the longest 3 minutes of my life, the contractions where coming in like crazy, and though she was not a screamer, she was obviously in a lot of pain. The midwife went in with an episiotomy and then all hell broke loose. First, the REAL bag of water burst. And I am not talking about a little fluid here, I am talking about 12 ounces or more of a giant white explosion (this is the "mucus plug" that I was not really looking forward to). I performed a matrix like maneuver to avoid the discharge, and was mostly successful. Then, with a huge yell (hers, not mine), the head came out. I was then instructed to grab on and pull her out. We got over the shoulders after a short time, then I caught her. (real fast). I passed the clamps and scissors to the MW, and we got a cry as we held her upside down for a few seconds to drain. We passed the baby over to the just arrived Doc and the cord tie/assist nurse. Then, (far, far, from over) I delivered the placenta. At this point, I was in a surreal world of all kinds of fluids and an incredible amount of blood. Oh yeah, and this is normal. We got her uterus to fully contract finally to slow the flow of blood, and then sutured the episiotomy/ repair (this procedure would be birth control if we taught it to our children). After some time, we were finished, and the mother and baby went to their room to their family. I was in a euphoric daze for about an hour afterwards. (similar to my total hysterectomy case a month before, but more profound)

Shockingly to me, I am actually looking forward to my next delivery. I doubt if I will have another great "hands on" experience like I did again, as most facilities do not allow students to do what I did. The experience was amazing.