The Case of the Missing RN

It's no secret that I have a fascination for nurses of the alternate gender.  When I was in nurses' training, we only had ONE in our class, and he didn't finish (this was a loooooooong time ago). 

When I went to work at my first job at a medium size hospital (approx 260 beds) - we did not have even ONE nurse of the alternate gender apart from psychiatry.   Psych had 3 total - one in the position of "head nurse" and 2 on the floor.  Loved the two that I worked with on the floor.  Wasn't sure about the manager - he always seemed a little odd to me.

Then I started working in L&D.....and there were even less of the alternate gender within the ranks of the Nurses.

 I did work with ONE in Canada....and I thought he was very good - he was actually a midwife trained in another country - but was working in the capacity of RN. 

I enjoyed working with him and the moms had no issues with him, as they shouldn't,  since no one ever had any problems with the fact that Male OB's cared for the patients.  There shouldn't be any difference. 

Unfortunately, however,  he left fairly soon after starting because he felt that he was being discriminated against - not by the patients - but the other RNs.  I couldn't understand that, since his practice was without fault.

I worked with another very special and wonderful RN in a smaller facility.  He was a Jack-of-all-trades - mostly worked ICU/ER but would float anywhere - even worked L&D.  He was an excellent L&D RN.  His patients loved him.  His co-workers loved him.

 He got along with everyone. He drew raves from all patients.

On nights, on our breaks we would visit - and some of the stories he told were nothing short of amazing. He told me about the time an ambulance meandered in sans lights and sirens with an MVA who the paramedics deemed to be "dead".  They had extracted the patient from a horrific crash.

 This RN climbed into the back to check it out.....and found.....a pulse! They quickly hauled that patient out of there and subsequently saved her life.  It took months - but she recovered fully without deficit,  and later came in to thank him for saving her life.

He would occasionally go on travel nurse stints to the USA - for several months - then return.  About the time I was ready to leave, he tried to sell his laptop to me, which I found a little curious because he used it extensively to connect with his family while away.

He had  a wonderful family - three teenage girls - and a wife.  It seemed that they had a good life.  I never heard of any sort of problems or concerns.  He was always a happy person - smiling all the time.  He was a thoughtful, kind person - always helpful.  He was a loving father - this is a letter he wrote to his daughter on her graduation from high school.  He certainly was a very proud father.

He and his wife volunteered with Gideons.   He asked me if I received a Gideon's Bible when I graduated from Nursing, and when I responded in the negative - he gave me one.  

It is a little white New Testament with "Nurse" printed under their lamp on the bottom Right hand corner. Inside is a Canadian flag and the Florence Nightingale Pledge.

Shortly after I moved away, something shocking happened.

 No one knows "why" - but this RN, after having an argument with his wife, left the house and wandered away - never to be seen again.

He didn't ever seem depressed, never mind suicidal. 

Pleas from his daughters "Daddy, come home, we don't care about anything else, just please come home - we love you"  in the newspapers and online were left unanswered.

Some people thought that perhaps he went back to the USA to start a new life, but his American License didn't show any activity. Nothing was found.  He left all ID and his wallet behind. 

It is now coming on Nine Years, and not one trace of him has been found - not even a body.

You can read some of the heart wrenching posts by his daughters, sister, wife and friends here on Facebook.
One of his daughters posted a letter he had written to her upon her high school graduation.

So far, he has missed the death of his father,  weddings of all three daughters and the birth of his first grandchild.

If anyone has seen him, please contact the police.  His family misses him.

The "Midwife Doc"

When I moved back to Canada from the USA - it was a bit of an adjustment to what you can and can't get off the shelves at the drugstore.

I remember in the early 80s, telling the MD I saw in Hawaii on vacation, that I would just go to the drugstore to buy the benadryl for my swollen eye  - and he looked at me like I just told him I was a drug abuser. 

"You can't get that off the shelf - you need a prescription for it" he told me. 

That was news to me - in Canada, at that time, you could just get it off the shelf, just as you could the ibuprofen.

Same with codeine. You can still buy acetaminophen with 8 mg of codeine over the counter without an Rx.  Mersyndol is one of my favorites.....it has an antihistamine in it as well as the codeine. Expensive at $23 a bottle of 100's but a very good medication for migraines.

So,skipping back to the move home to Canada:

 I was in the local pharmacy, and after waiting the 2 or 3 persons ahead of me in the lineup to speak to the pharmacist - I asked the ill-fated question:

"Where on the shelves do you put the Monistat?" - not realizing that it wasn't available except by Rx in Canada at that time. 

I had spent a good half hour looking down every aisle for that life-saving medication.

Loud enough so the entire drugstore could hear, he announced:  

"Dear - you need a doctor to prescribe you Monistat - it's NOT an OTC..."

I was humiliated.  I started to back away, embarrassed to the point of wanting to run.

 Then - He stepped forward.

"Hi" He said. " Would you like me to write you a prescription?" 

I looked over at the kindly face and recognized him instantly as one of the docs that occasionally came to do deliveries and must have recognized me from the Labor Delivery unit.  He had been in the lineup behind me, and -  along with the rest of the crowd - overheard the conversation with the Pharmacist.

"Uh. Oh sure! Thanks so much! " I was relieved and mortified at the same time.

Later, back on the Labor Delivery unit at work,  I asked him if he was taking on new patients. 

"Certainly - for a colleague " he replied.

And so our relationship began.

He was the best MD.  You couldn't ask for a kinder and thoughtful MD.  He was soft-spoken and meticulous in his practice.  AND - his deliveries were always so quiet and relaxed. 

We called him "the Midwife Doc" because the deliveries he attended were so lovely.

I can still picture him sitting on the lowered foot of the bed as he was getting ready for the delivery of a baby on our L&D unit.  The lights in the room were off - except for the soft glow of a portable lamp next to his elbow.  

There was a warm quiet  in the room.  He spoke softly and encouragingly to the woman as she pushed in her own style -  lying on her side on the unbroken bed, husband next to mom, holding her leg during the little pushes.   Midwife Doc patiently waited, supporting the perineum as the baby's head slowly pushed it's way through - crowning ever so slowly. 

Each 5 minute interval Doppler tone had a reassuring - *dop*dop*dop* - as we encouraged the mom. 

No loud noises. 

No counting. 

Just mom and quiet words........

He never panicked. He didn't see the need for an episiotomy.   He looked up me and then over at mom and said casually, "Well, nurse, how is everyone doing?"  Twinkle in his eye.

I looked at the mom - face glowing with sweat, but a serene smile on her face.

"Perfect.  Just perfect" I replied.

In the next few minutes,  the baby easily slid out.....






A month later - it only took one little mistake to change everything.

On the way home from attending a delivery, Midwife Doc was talking on his cell phone as he drove along one of the little town's streets.

He didn't see his red light at the intersection. 

His sturdy car was T-boned, and he was thrown half a block away, through the side window and out of his car - unconscious.

As talk in the town would have it - his GCS scoring on arrival in ER was the lowest it could be.  There wasn't a person in the entire hospital that didn't feel sick about the accident.   

He had little kids - and in fact, I still had the thank-you note from when I had attended at the delivery of his baby that same year.

People that had never prayed before, prayed fervently for this kind doctor. 

Miraculously he did recover, but unfortunately, never to the point where he could go back to his practice. 

I saw him in passing in the community several times.   There was a blank look in his eyes.  Not even a little sparkle.  No recognition of me, or anyone else.  Still the same kind face - but no longer the man I knew.

You could tell he was trying to remember, but he just couldn't quite get there.

His entire life - as he and his family knew it - was destroyed. 

He no longer had a means of employment. 

He was alive, yes.  He still recognised his children and wife....but he no longer had the same joy and was no longer able to follow conversations or remember ..... and definitely all knowledge of his medical training had disappeared.

This tragedy happened at the time when cell phones were just emerging,  and no thought or concern was given to talking on a cell while driving.  It was just the beginning of many such accidents to come in the community and the country.
  

Although there are some people who are in opposition to it and say the statistics don't prove cause and effect - my hope is for every state and every province to make talking/texting while driving illegal.  

All I know is - if that someone I knew hadn't been distracted by a cell phone - there would have been one darn good MD still practicing.

What are we teaching our children?

Labor Delivery in a Rural Hospital

I did a stint at a small country hospital that had only 5 beds for post partum moms and one labor room.   The usual count of babies per month was around 24 to 26 - give or take.   It was a sweet little hospital, all on one floor, and as the the Night Shift RN - I was the only L&D RN on from 10 pm to 7 am.  

 

My patient load would often be a couple of post partum moms (maximum of 5) and perhaps one mom in labor....and if it was quiet, I would get an "easy" patient that wasn't critical or in need of a lot of attention to fill up the extra room....because when things got hopping in L&D - there was going to be very little attention shown to anyone else.

Occasionally there would be another mom in labor and there was an extra room just in case, that was set up for deliveries if need be....in a pinch.  It had everything needed for a delivery - but due to the population numbers....it was rare that you would have two deliveries at once, although it has happened.

The small town I worked in had a good number of moms that were what the nurses in the hospital I worked in in California called "Berkeley types"(....and hey, if you are from Berkeley - no disrespect meant, that is just the way they referred to the sandals/long hair/au naturel types down there).  They seemed to deliver their babies with no problem and little effort.  It was amazing.

There were several GPs that did anesthesiology that would come in to put epidurals in.  Now, some RNs  might not be familiar with GPs having the training to do epidurals and give anesthesia might give pause at that bit of info, but the truth is, this is a commonplace thing in rural Canada where the access to anesthesiologists is limited.   It has been shown that it is quite safe to have an epidural put in place by one of these GPs and in fact studies have shown there is no difference in complications and no life threatening incidents occurred when compared to a university affiliated hospital. (these GPs do not do complicated cases - only ASA class 1 or 2)

We did not have obstetricians at this small town hospital.  I looked at that as a positive thing.  Coming from a hospital in California that only had OBS specialty docs and Midwives, I was suspicious at first.   But, I was soon to find that the GPs in Canada are quite competent and usually -  if they knew you were an experienced nurse - they would treat the nurse as a peer rather than someone beneath them.

The GPs I worked with were very capable and did lovely deliveries with less intervention than in the larger hospitals I had worked in - and in fact - were comparable to the midwives I worked with in California.  Mind you, most of the moms were low risk types.  Anyone complicated would go to the next town over.

It was interesting to work at night. Alone. There was a float RN available at home that you would call in if you needed help - if a second laboring mom walked in, or if delivery was imminent.   Of course, not really knowing when a mom was going to deliver had it's challenges.   After the multitude of deliveries I had done up until that point which was in the thousands....one has a little bit better idea as to the timing.  It is just something you *know* after a while....based on a combination of the behavior of the mom in labor, mom's delivery history and intuition..... and somewhat on the dilatation, believe it or not. 

It was nice to have the woman in charge of her labor as opposed to the MD or the nurse.  She was allowed to mobilize at her leisure and only have intermittent monitoring with a Doppler.   I saw very few care plans because there was really no need for any.  Everyone just knew that whatever the woman wanted, or requested, we did our best to fulfill.  There were never any objections to anything that I knew of.    The birthing beds were rarely, if ever, broken down.  I never saw a scalp electrode or a pair of forceps the entire time.   Sometimes babies would go home without the "newborn bath".

I find it interesting that when you google "laboring moms"
they are all pictured in a supine position......

I can remember one winter night one of the GPs phoning up to let me know that she was going on a cross-country ski Christmas excursion put on by the town.   She told me she "might" be out of range with her cell at certain times, so if one of her patients went into labor and she doesn't answer right away - don't worry, she would pick up the message at some point.  As luck would have it, one of her patients did come in and, sure enough, I wasn't able to get a hold of her for a good 2 hours.  I almost had to deliver the baby myself, which wouldn't have been a panic at all, really.

When a laboring mom came in, the practice was to wait until approximately 1 hour before she delivered (!) then have one of the other nurses from another ward would call the "2nd pair of hands" to assist with the birth and I  would pick up the phone in the delivery room to notify the GP to come in. 

Most of the time they would get there in time.   Like I said, you develop a 6th sense after a while, and at that point I was at 4 to 5 thousand births and counting.    If they or the backup nurse didn't get there on time, the RNs from the Med/Surg side of the hospital would come and "help out".  Mostly all they did was stand at the door with eyes wide open - they all hated L&D.  Most of them wanted nothing to do with the deliveries - and when they asked if all was OK....and they would give me an expression of relief at my "no thanks" - and run off.

By the time I had worked at the country hospital, I had been fully conditioned to the way most hospitals delivered babies in BC.   It was easy to orientate to the new place -   the same "Partogram" or delivery record is used for monitoring labor and immediate post partum throughout the province.  It didn't matter what hospital you worked at  - the charting was all the same.   Basically, it was just getting used to the MD's routines and where stuff was kept.   Being alone on nights had it's advantages in that I could develop my own routines without interference.

The nursery was another ball of wax entirely.    There was a room beside the nursing station that the moms could wheel their baby into if they wished.  There was no nurse - just a baby monitor that would have the other listening end at the nurses station.  My problem with that system is that sometimes there would be no nurses at the station if it was busy on the Med/Surg side.

 I always encouraged moms to keep their babies with them at all times, and if I did have a baby between feeds if a mom was desperately in need of a rest and wouldn't take "no" for an answer,  I would take the baby with me on my break - I couldn't ever bring myself to leave a babe unattended in the "nursery". 


All in all, a great experience.  I would work there or at any other small hospital again in a minute.   Anyone contemplating working in a very small hospital such as this....I would advise that you be very secure in your OB skills.

The one other piece of advice? Listen to the mom.

She knows her body better than you do.  If she tells you something - listen!  I don't understand those stories I hear that some moms have told me: "the nurse didn't believe me when I told her I felt like I was going to deliver....."

The one thing I can predict about L&D ?

                             - it's unpredictable.



(all photos googled and borrowed from "wikihow" and employment sites)