Placenta Lasagna

So, I get an uneventful report from Dayshift Nurse. She then pulls me around the corner and half whispers "I have to tell you what's going on."
Ok.
So, it seems FOB (Father of Baby, not to be confused with SOB) wants to keep the placenta.
Fine, I say, some cultural thing? Expecting to hear he's southeast asian, or some sort of uber-hippie who's trying to complete the cycle of life by planting a tree over the discarded organ.
But no.
"He's white. He just wants to eat it."
She wasn't kidding.
She goes on to say how she asked further "is this some cultural thing?" and was totally unprepared for his response:
"No, you see, I have this fetish..."
He says he has always wanted to eat another human being, and figures this is his only chance to do it legally. He's actually done the research, and there are no laws that say you can't eat your kid's placenta.
"Like, Hannibal Lecter-style?" Dayshift Nurse asks, half bemused, half bewildered.
"No, I don't want to hurt anyone..." replies FOB.
She really wasn't kidding.
So, I went about the patient's care and delivery - apparently patient and her family know about the placenta eating and are just as grossed out as the rest of us. But he persists, willing to buy a new pot so he can cook it because his wife doesn't want him using her pots to cook up a placenta omelet. Or lasagna. He calls a friend after the baby is born "wanna eat some placenta?"
I suppose that a placenta is actually very nourishing tissue, being full of blood and vascular tissue. I'm sure there are nutritional benefits out there, and really, we eat chicken placenta, why not human placenta?
Because it's gross, that's why. Can you imagine forking off a mouthful of mushy lobe? Would the calcifications make it chewy? Would you save the cord for dessert or snack on it first for an appetizer? Would you dry it like jerky? Soy sauce? White wine, or red? Amnion soup? Salad with pecan-encrusted artery? Do you like your placenta broiled or fried?
Gross.
I dutifully packed up the placenta in its yellow-and-white pathology bucket and bagged it for him to take home. I got the impression he wasn't so sure about the whole thing, after seeing and smelling it, but he took it home, despite loud protests from his wife.
I have no idea whether or not he actually ate it, but I hope he did, and I hope it tasted like chicken.

TMI

My poor, darling husband.
He is a wonderful man, we'll call him Perfect Husband, and a really good Family M.D. Other nurses who take care of his patients go out of their way to tell me how wonderful he is. How caring of his patients, how respectful and kind to the nurses and how pleasant he always is. (And how disappointed they all are when they learn he's married... He's a hottie!) When I worked in the local carcass dump (read: medical floor), I took care of his patients occasionally, and was frequently curbsided by other RNs to decipher his hurried handwriting. When we shared patients, they sang his praises to the heavens. They stop us in the grocery store to tell me how much they love him. I think he's great, and it's really nice to hear other people think so, too.
So, when I went into nursing, and was thinking about my life and my career and my future plans, I decided I didn't want to talk about medicine all day, and so didn't want another medical professional as my partner. I met Perfect Husband outside of work, and it took me months to figure out he was a medical professional. You see, he's an excellent chameleon and takes care to leave work at work. He's an M.D. from 8am-6pm Monday-Friday and that's it. So I made an exception because he's a catch I just couldn't throw back.
I know a lot of docs and nurses that embody their profession in all that they do, carrying that identity throughout their life. That's fine, I'm guilty of it and not rendering criticism, but I admire terribly his ability to turn the M.D. off, and turn on the hippie, artistic, creative car mechanic/circus artist. Anyone who meets him outside work and then learns his day job says something to the effect of "I never would have guessed..." that the greasy t-shirt, longish hair, humble smile and quiet-and-shy exterior contained a highly trained, highly respected professional.
And then the questioning ensues.
Every M.D., R.N., R.T., C.N.A., or anyone else with any remotely medically-related letters after their name has been cornered at one point or twenty by a friend, family member, or recent acquaintance and presented with Too Much Information, in the hopes that said healthcare worker will shed some light in their darkness. I really don't mind it, personally, but Perfect Husband spends his days listening to madness and maladies galore. He cares for the poor and uninsured; those who place many things above preventive care in their hierarchy of needs, and so are usually highly complex when they finally reach him. It's really difficult work, much harder than mine, and I'd say I don't know how he does it, but I do: he goes out of his way to retain some ounce of passion for his work by fully removing himself from it at any opportunity. He tries not to be an M.D. from 6:01pm to 7:59am so that from 8-6 he won't feel quite so much like quitting his job to be a surf bum in the Bahamas.
So when a slightly inebriated woman we met 10 minutes ago hears he's a doc and starts giving him a painfully detailed family history, he all but vomits on the spot. He's such a kind, gentle soul, though, that he smiles and tries to keep from squirming while she rails on about her sister's breast cancer and how she died and was brought back to life three times in the ER... He politely listens, rather than saying "Hey, how about the weather, huh? And by that I mean: Look, Cuckoloma Extraordinaire, I'm off the clock, ok? Do you see a stethoscope or a white coat in sight? No. Yes I am a doctor, but everyone else I give medical advice to has to pay for it, and so should you. I'd be happy to see you in the office."
I'm sure he wasn't thinking that, sweet man. He just turned to me sometime later and whispered "I'm getting asked Questions. Can we go home soon?"
Perfect Husband, I am sorry you were uncomfortable, but you're just so darned cute and personable...

Benzo Salvation.

I spent the better part of 6 hours last night with a friend who took too much. She had been told: "Here, take this, it's old and probably not so good anymore, so you'll have to take a couple..."

Half an hour later, she was curled up in her car, headed for the worst trip of her life.

Pupils the size of dinner plates, tachypneic, anxious, having visual and auditory disturbances, and begging to go home, my poor friend took little comfort from her boyfriend who was "...not feeling anything."

I heard she was sick, and stepped in with my labor & delivery skills to help calm her. My experiential toolkit is stocked with coping strategies and support techniques for anxious, pain-full laboring women - this situation wasn't all that dissimilar.

She started complaining about muscle cramps, and as observed her contorted lips and hands, the possiblity of malignant hyperthermia or some serotonergic syndrome popped into my head. She didn't feel particularly hot, and wasn't overly tachycardic, but was only 45 minutes into this ride, and who knew how long, or how deep this rabbit hole went. I talked her through some slower breathing, helping ground herself, focusing on not adding to the anxiety. It helped for a little while.

Two other medical professionals assessed her, one experienced in primary care, one in operating room protocol. I suggested a benzodiazepine that I had at home. That we should offer her an oral sedative, take her home and watch her closely until one drug or the other wore off. One agreed with me, the other thought she looked cyanotic, needed 100% O2 and an ER bed.

Here lies my dilemma.

Do I continue to support her, decrease stimuli, attend to her basic needs, assess her ABC's frequently, and keep feeling for rising temperature, or any other signs she might be decompensating? Do I take this responsibility for her healthcare, knowingly blur the lines between friend and nurse and give her an oral sedative? What about injectable? Can I rely on my experience and my 5 senses to tell me when something is wrong and she needs more help than I can give her?

Or do I withhold my skills as a nurse, protect myself, and deliver her to the ER, where she will be in a bright, loud, scary place; get an IV and a slot in the locked Psych room for the next 8 hours while she wrestles with a universe of demons. Would she be even further traumatized by that experience? What defines a safe place? A place where your vital signs can be monitored, or a place where your friend can help you fight your way back to reality.

Could I recognize the signs of MH, stroke, or cardiac arrest fast enough to save her from permanent damage?

Did my own experience with the very same drug color my assessment of the danger she might be in? (Neither of the other two professionals had had any experience with this particular recreational pharmaceutical)

In the absence of clear threats to her health, would an ER trip be a threat to her mental health in the long run?

When I worked in the ER, we did not sedate people on bad trips - the rationale being some possibility of adverse interaction between the recreational drug and the sedative, causing more harm than good. People on bad trips are very unhappy, but as long as they do not present a threat to themselves and the people around them, let 'em be uncomfortable.

I couldn't do that to my friend. I knew that if I stayed by her side, I could minimize her fear and anxiety. I could assess her constantly and recognize danger that was beyond my capability to manage. I could safely give her a medication to help calm her and trust that it would overtake the beast inside her and give her some peace. Lastly (least importantly, but still deserving of consideration) I could save this artist/student from the ER bills that could quickly mount into the thousands of dollars.

And so I did.

My partner in crime and healthcare professional extraordinaire helped me to give her sips of water, hold her hands from thrashing, keep a blanket under her head when she fell to the floor screaming. She became an animal, totally disconnected from reality, floridly psychotic.

But she was breathing. She was not hot, alarmingly tachycardic, or developing any focal deficits. The muscle spasms went away, and after a second dose of said benzodiazepine, she finally fell asleep.

She is well this morning. Still suffering the bruises of her thrashing, and echoes of visions still dance in her head, but my friend has returned; the beast within her gone.

Was I right? Was I wrong? What more could I have done? How do you draw the line between your job and your life? In your own conscience, which is the ethical decision - sterile Professional overkill where her health is more guaranteed, or the love of friends who watch over her with professional eyes? The outcome was good, but would it be next time? What if it had been different?

What if I had been wrong?

"Why did you become a nurse?"

Everyone wants to know. From the nursing school admissions committee to family members, to dates to coworkers, everyone wants to know the reason behind your selfless and honorable choice to go into the virtuous profession of caring for others.
For, what could be more admirable than soothing the hurt, helping the injured, caressing the upset, the damaged, the deranged. And what drew you to make such a difficult choice?
My pat answer for years has said something about how my aunts are nurses and I grew up with their stories and blah blah about loving to take care of people and how rewarding it is, not to mention a good job... I've listened to other nurses talk about the shining example of Nightingale-esque nurse-tasticness that took care of their dying grandmother or mother who drove them to carry on that light in the grieving darkness, and caring for others in the same way. Nurses whose mothers and grandmothers were nurses, people who thought the human body was fascinating, who loved to watch surgeries, and the ubiquitous and oh-so-cliche "I wanted to help people."
And while that's all good and makes everyone sigh "How graceful, how noble," the truth of a nurse's caring nature may lie in a darker part of her character.
Don't get me wrong, I am sure that some people have very admirable reasons for their career choice, but I was recently enlightened about the dark secret that some nurses carry on their hearts; the real reason some of us spend our lives caring for others.

A good friend recently confessed to me her struggle with addiction. She had just started treatment, and unfortunately had her nursing license suspended. As part of her healing process, my wonderful friend has taken it upon herself to educate others about the sordid history of substance abuse in healthcare professionals such as ourselves. Despite our lily-white public image, nurses are just as likely as the general public to abuse, but much more likely to have a problem with prescription drugs (narcotics, benzodiazepines, etc...). Think about it: not only do we have easy access to such drugs, we know just what to tell someone to get them prescribed to us legally. Nursing is a high-stress job - with increasing amounts of overtime, short staffing, sicker patients, and high injury rates, it's no wonder we seek some kind of escape - healthy or not.
So, she talked with me for a while about what got her sliding down this icy, lonely slope. She said nurses care for people, right? So, where does all that nurturing come from? How do you teach a child to selflessly give to others? You force her.
Nurses often go into nursing because that's what they've always done. We often come from families with a history of physical, emotional, or sexual abuse, substance abuse, or co-dependency, forced at an early age to take care of our parents who could not take care of us. We felt the pressure of dysfunction in our home, strove to achieve lofty goals at school (as kids with something to hide often will) and have spent our lives repenting for our parents' sins. Nurses have a very high incidence of alcoholism in their families of origin. We know that addiction is a disease, arguably with a genetic component - people with substance abuse problems are highly likely to have parents with substance abuse problems. No matter how much we'd like to think we should know better, that we can recognize the signs of a problem, that we are immune to the consequences of drug abuse, the apple does not fall far from the tree.

"So why did you go into nursing?" The real answers might go something like this:
Because my mom was an abusive alcoholic, and I was the go-between for her and my distant dad.
Because I was abused by my uncle until I was thirteen, and have spent my life absorbing energy from others to cover the hole he left in my soul.
Because my dad had a heroin problem and no-one else was there for my little sisters.
Because I have spent my life trying to take care of other people instead of taking care of myself, and I don't know how to do anything else.
Because at a young age, I learned that being tough, working too much, and large doses of denial and other highly addictive drugs could make me feel invulnerable to the attacks on my self-esteem, character, coping ability, and sense of self.
Watch me change shame into guilt.
Watch me save someone else, because I cannot save myself.
Watch me cover up my weaknesses with attitude, aloofness, and sly denial.
Watch me find other ways to cope that all have to do with feeling less, instead of dealing more.
Watch me become addicted to my job, to helping others, to the sickness and the pain of others, and when that's not enough anymore, to painkillers and sleeping pills.

I am a nurse, and that means somewhere inside me is an addict. My conversation with this friend opened my eyes to my own personal risk for substance abuse. While I don't have a violent family, there are people with addictions in my family, and that puts me at very high risk for using. I am so glad I know now, and can keep an eye out for dangerous situations. I became a nurse to help others to stay healthy. But first and foremost, I have to find good ways to keep myself healthy.

Quote for the Day

"Safe care, then appropriate care, then quality care."

L&D Rant.

The medical model of childbirth care (pregnancy as a disease state) in the US is backward and brutal. If you're pregnant or looking to get that way or the partner of someone who is pregnant or looking to get that way, the best thing you can do for your child is educate yourself. Ask questions. Find out what the American Association of Women's Health, Obstetric, and Neonatal Nurses and American College of Obstetrics and Gynecology say about Labor & Delivery care. Insist on intermittent fetal monitoring. Decline IV fluids (but accept IV access). Stay out of bed.
Remember that your caregivers' recommendations about your care are influenced less by quality, researched evidence and more by who got sued for what last week... And that this is not necessarily what is best for you and your baby. Remember also that you are ultimately responsible for your care - your doctors and nurses cannot do anything to or for you without your consent: you have the right to refuse! The goal of an in-hospital birth is a healthy baby and healthy mom. The problem with this model of care is that we see way more problems than are actually there, and intervene at every given opportunity. This is your birth experience! Own it! Do the research, read the books, get opinions! All that said, however, some women have medical problems, poor support, poor access to care, or other problems that make the hospital the very best place for them to get the very best care. Hospitals are very good at taking excellent care of high-risk women.
But if your pregnancy is low-risk, for goodness' sake, give birth at home! Or at least labor there as long as you can!
And please, please don't make a Birth Plan. The moment you hand me that birth plan, I turn around and print out the paperwork I'll need to do your C-section. Murphy's Law: if you are a nurse, a doctor, or bring in a birth plan, something WILL go wrong with your labor.
Discuss the things you do and do not want as part of your birth experience with your physician, and with your nurse, and negotiate a compromise based on evidence and AWHONN and ACOG guidelines. Bring me the studies, not "I want my perineum massaged with this crystal..."

Oh, I sound like a rabidly anti-establishment hippy.

Holoprosencephaly

I had a twelve-fingered baby tonight.
And an alien-headed one.
Not bad for a Thursday.

There's awful hush in those rooms.
The ones where everyone knows what's going to happen,
But no-one has the words to say.
There's some fear that if you say it, then it will definitely come true. Or someone will come unglued.
Really, what do you say?
"So... Your baby's gonna die, huh? That must suck."
"So... Are you having a boy or a girl? What's her name? What theme did you pick out for the baby's room? Did you get a lot of pink... Oh yeah. Your baby isn't going to need clothes."
"So... How 'bout those Mariners?"

There's no talk of birth or death. It all happens in airy euphemisms like a funeral home. It's "when the baby comes" and "it" and "when the baby passes" (gas?)
"demise"
"the falling leaf card"
"your loss"

Not "when your baby is born" or "when your baby dies". There's a sort of finality to it, when you say it that way, I guess. A terminability that we aren't used to in labor and delivery. Birth, born, all these have connotations of warmth and joy of new life, and when everyone already knows that that little life will be fleeting, it really spoils the fun.

We reassured the mother. Like some women, part of her was horrified by the thought of holding her strange son, not knowing whether he would cry, or move, or breathe. Perhaps the images she had conjured up of his blank, staring eyes was enough to make her turn him away. The pain of knowing he was dying was made even sharper by feeling his warm, living flesh.
We reassured her, that if she didn't want to hold him, couldn't bear to watch him die, that we would carry him; that he wouldn't be lonely.
He wouldn't die alone.

We stood outside and patted eachother on the back. "I hate it when they breathe."
"I hate it when they cry."
"Yeah, that gasping is the worst."
We try hard to pretend there's a speck in our eyes, as two very pregnant women waddle expectantly around the corner.
Labor and Delivery is supposed to be a happy place. Crying nurses make healthy women nervous.

We have such a unique job of every day welcoming a new soul into the world; watching a new family fold around a sweet little life with a big future. When we are faced with a dying baby, it's a hard gear to shift. I had welcomed a newborn, red and screaming, into the light only an hour before. And now to hush my voice and try to think of ways to be helpful, but not trip over my labor & delivery patter.
"So... How did you get his name?"
"So... Are your other little ones excited?"
"So... How does it feel to be saying goodbye to your only child, when you only just said 'Hello'?"

No-one has the words, everything you say seems like a mockery of the situation.
I am sorry. I am so sorry.

My new twelve-fingered friend down the hall howls at his mother's breast. He clutches and unclutches the extra tiny finger hanging from each of his pink pinkies, and yawns toward his smiling parent. With all the things that can go wrong in our development from oocyte to "ooh! She's cute!", the miracle is that we get it right so often.