There's a calm under the waves,

Did you know that the World Help Organization had designated 2020 as the International Year of the Nurse and Midwife? That was something that happened before COVID-19. But instead of celebrating us, this year has been beyond anything I could ever imagine.

I haven't posted since April, it's been too stressful. For awhile, our policies regarding COVID-19 were changing almost daily. Though over the past few months, things have stabilized a bit. And living in California, so many things are still closed or restricted.

At the hospital, my floor (NICU, Mother Baby, and L&D) plus Pediatrics are the only places allowing visitors in the hospital, though in special cases (end of life), visitors might be allowed. All patients admitted to the hospital are getting swabbed for COVID-19. However, at first the testing was taking awhile, then we had reagents (I think?) that allowed the lab in the hospital to process the test in 24 hours, then 4 hours, then 1 hour. However, now we only have a few 1 hour tests left, and those are usually used for stat (emergency) surgeries. Now results usually take 4-8 hours.

Lately, we have 1-2 COVID positive moms on L&D/Mother Baby every day. Though a few times we haven't had any, and our max was 10 positive moms! Our usually patient ratio is 4 couplets (mother-baby pairs) to one nurse. With COVID positive moms, we get a maximum of 2 couplets, and both would be positive, we don't mix positive and non-positive patients. Luckily, most of our positive moms have been asymptomatic. And we are swabbing the babies of positive moms and 24 hours of age, and then some of our hospitalist Pediatricians also want them swabbed at 48 hours of age, if they are still there. We aren't separating COVID positive moms from their babies unless the mom have to go to ICU (from a bad postpartum hemorrhage or from COVID symptoms) or baby has to go to NICU for some reason (cardiac issues, preterm, respiratory distress, etc).

Patients have to wear masks when staff (nurses, doctors, etc) are in the room, and if they are visiting baby in NICU. Us nurses have to wear masks and goggles in patient rooms. In COVID positive rooms, we wear a procedure/surgical mask over a N-95 mask, goggles or face shield, shoe covers, gown, and gloves. Most of us have also gotten our own scrub caps or hair covers. Plus we wear hospital-provided scrubs that we change into and out of at the hospital, and leave them in a hamper in the locker room.

Last month we started to see a lot of moms who had a history of testing positive for COVID, but had been cleared by Public Health and we are to treat them as if they are negative.


We have had moms come in sicker. A lot of patients are having telehealth appointments with their OB, or have stopped receiving prenatal care, so things have been missed. Plus it does seem like our COVID positive moms are more likely to have clotting issues. One mom straight up didn't seek any prenatal care and had 2 eclamptic seizures, which is just so uncommon to see here.

Since I shift lead a lot, I have barely been on the floor. I was on the floor July 4th and had COVID patients, and I was on the floor Thursday, and since it had been 2 months, it was my turn again to take COVID patients. Plus I had an orientee. And then one of our moms tried to hemorrhage at the end of the shift. I was fucking stressed.

One of my coworkers had to quarantine because her husband got COVID from his work. He was sympaotic only a few days after exposure and quarantined himself early, and luckily neither her nor their 6 children got it. Another coworker had to quarantine because her boyfriend got it at his work, though she actually got very sick as well. Public Health cleared finally cleared her to come back, even though she was still swabbing positive, so I am sure it's fine *eye-roll* but finally she swabbed negative a few weeks ago.

I feel bad for other floors. Most COVID patients are going to Med/Surg, Tele, or ICU, depending on how sick they are. And our plan has always been, if we have a mom sick enough, we will send her to the ICU. Pediatrics has even had a few kids with COVID. One night I was working, the ICU had 2 patients die from COVID within a few hours of each other.

At work, we are all burned out/on edge. I can't even imagine how the staff on those other floors feel. I am sure they actually have PTSD from this.

For 2 months, I didn't even go see my parents. In May, I had minor surgery. I had a hysteroscopy, D&C, uterine biopsy, and I had a Mirena IUD placed. The day before surgery, I was swabbed for COVID, and I had antibodies drawn. Both negative. My mom drove me to and from surgery, and stayed over the first night. I figured since I was negative, I wouldn't pass anything on to her. Now, I see them every once in awhile, now that work is providing us with proper PPE. Let me tell you, the cramping from surgery/the IUD has been brutal. And here I am, 4 months later, STILL bleeding. But at least I wont get endometrial cancer, yay I guess.

Most of my friends are nurses, and carry the same amount of risk/possible exposure, so we hang out outside of work. Restaurants in California are closed except for take-out, so we hang out at someone's house. One of Alyse's cats had 3 kittens and they are so cute and fuzzy. Unfortunately, I have been using Door Dash/Grub Hub and cooking less. I just overall have less motivation to cook/clean/go shopping. I do laundry every week though, I have to so I can have clean scrubs.

And now we are in fire season again in California. To the parents who started a fire with a gender reveal party, fuck you. I can't wait until we start getting rain, hopefully next month. Air quality has been shit. A few weeks ago, we had a weird thunder and lightening storm, and the lightening caused dozens of fires all over the state. Cal Fire told Californians to be ready to evacuate. To where? The whole state was on fire. Where I live, it would take me almost 9 hours to get to Oregon, 6 hours to get to Nevada, 6.5 hours to get to Arizona, and 5 hours to get to Mexico. Where am I going to go? The ocean? Though there are multiple beaches within 30 minutes of where I live.

Last week, I worked Tuesday, Wednesday, and Thursday. Friday I went to the grocery store, came back home coughing, sniffling, and I was really itchy, so I am sure it was allergies and not COVID-19. But any time I cough, I wonder, you know?

This week I worked Sunday, Monday, and Tuesday. We had 2 potential COVID-19 patients, both in isolation. I heard one of the local labs is going to start doing their own COVID-19 test? Or processing them closer to home? Not sure. Anyway, supposedly it will go from 5-7 days for results to come back to 24-48 hours, which is much better.

We have been having nightly conference calls at work, each department is supposed to get on, as well as our CNO (Chief Nursing Officer). Plus a few nights, an infectious disease doctor was also on the call. Right now, our protocol for COVID-19 is changing nearly daily. Currently, we have enough PPE. Tuesday night on the conference call they told us we are allowed to wear masks at all times if it makes us feel more comfortable, and we wont get in trouble for it, though they don't want us wearing homemade masks. I heard today that now it is mandatory to wear a mask in all patient care areas.

My county has 99 positive COVID-19 patients, the county to the north, which my city borders, has 88. My hospital is the biggest local hospital and we have 12 positive patients, on ventilators, and 21 potentials, most of whom are on Tele, with the exception on the 2 on my floor. Thursday, the first death in the county was at my hospital.

My floor (Labor & Delivery, Mother Baby, and NICU) and Pediatrics are the only units allowing a care partner/visitor now, and only one. On our floor, it is whoever is banded to match mom and baby, so usually the father of the baby or the mom's mom.

As if that wasn't scary enough, since nearly all my shifts I am shift lead/charge nurse, we had a bad maternal hemorrhage on our side Tuesday night.

The mom's original blood loss from delivery was 275ml I think? She had a clot out that weighed 160ml, but her fundus (top of the uterus) was firm, vitals normal. Then she had another clot come out that was 250ml. For a vaginal delivery, 500-999ml is a stage 1 hemorrhage. I told the nurse that had her to call the doctor while we did more vitals and restarted her fluids. Plus I told the L&D supervisor.

The doctor came and did a bimanual exam to check for clots and 660ml worth of clots came out, so at this point she was now a stage 2 hemorrhage. The doctor decided the patient had to go back to L&D (since they have a lower patient ratio). Then her blood pressure dropped to 81/66 and she got this look, like she was extremely unwell and terrified and like shit was about to hit the fan. They rushed her across the hall, and I kept the baby since the boyfriend/husband was at home with their other children. She ended up being a stage 3 hemorrhage and they put in a Bakri balloon, which is a special balloon placed in the uterus and filled with sterile water. The weight of the water is supposed to stop the uterine arteries from bleeding. An hour or so after she went over, she was stable enough for the baby to go back in the room, thankfully.

I cant believe it's taken me so long to finally sit down and post the pictures from my trip, but I can't get the pictures to load on here or livejournal.

I can't believe that in about 2 weeks, I will be leaving LAX for Australia! I am excited and nervous. Mainly nervous for leaving my cat alone. Well, he won't be alone alone. I hired a cat-sitter through Rover who will come every day for about a half hour. And my mom will come over every few days and will stay over Halloween night, since that will be s scary night for him, and she might stay over a few other nights. 

And what if we get lost? Or lose something? The only other time I've been out of the country was to Mexico, years ago. 

And I also don't know how I am going to pack 3 weeks worth of stuff into a carry-on and a backpack. But I am determined to do it. 

 Oops can't believe I didn't post a follow up after my last post. I DO NOT HAVE CANCER or anything like that. 

I have adenomas on my liver, which are benign tumors. In women my age, they are usually caused by birth control, and are common in the liver and breasts, though I only have them in my liver. I have multiple small adenomas and one large (8cm) adenoma. 

My primary care doctor told me I can't even take combined hormone birth control again, just the progesterone only kind, which that kind doesn't help with PCOS much. And she said that we can induce a period ONCE A YEAR with progesterone, which is not nearly often enough to be safe. But whatever. She put me on spironolactone, which I was on before, to help with acne, and I can tell it really is helping. She also referred me to a GI doctor. 

I saw the GI doctor March 6th. He was pretty cool. He said I can't even take any hormonal birth control ever again, and to not get pregnant. I totally forgot to ask him about inducing periods though. He also said that they get concerned with adenomas over 5cm, because they can burst. 

Initially, he referred me to another GI specialist that comes down here from Stanford once a month, and that guy would make the decision to either keep an eye on the large adenoma, or decide to do surgery to remove it, which would have to be up at Stanford, because it's a high risk surgery I guess. 

Well, the insurance instead approved me to see a different specialist at USC, which means I have to make a 3 hour drive down to LA to see him on May 7th. 

The first GI doctor ordered all these labs, so last week, I had 9!!!!! vials of blood drawn. Good news is I don't have Hep B or C, bad news is my RBC, HCT, and ferritin are all high, which is indicative of liver disease, and my AST and ALT have gone up even more, prompting my primary care doctor to call me in for an appointment on April 2nd.

So I have my appointment with her in April, the specialist in May, and supposedly another MRI in May as well, and then back to seeing the regular GI doctor in July I think?

Once I had the MRI results, I told my parents, since I finally had answers, plus my friends Simone, Alyse, Halie, Jenn, and Staci. My mom legit cried. And then my parents gave me a 20 minute lecture on how I am fat and now I need to just eat veggies, chicken, and rice. Lord help me. 

 Last year my doctor put me on a medication to lower my cholesterol. I have labs done every few months to make sure everything is good, cholesterol labs and a liver panel as this type of medication can be hard on the liver I guess. 

My last set of labs was in July and my most recent set last month, in January. My liver enzymes hag done up, one had even doubled. My doctor clearly gave zero fucks and said she wouldn't be worried until they had tripled or quadrupled. Okay, well, we are well on the way there? I reminded her my mom has non-alcoholic fatty liver, so she gave a quarter of a fuck maybe and gave me an order for a liver ultrasound. 

I had the ultrasound done and the next day, my doctor called me and left me a message AT CLOSING TIME saying she would call me back the next day. So I was definitely nervous. 

Apparently I have a 7.8cm cyst with vascularity on my liver. She said 7.8c, is large. What makes me nervous is that cysts aren't vascular. I think she was trying to not scare me and said that instead of tumor, but I am a little scared. The radiologist that read the ultrasound wanted me to get an MRI so I have an MRI on Tuesday at the hospital. I hope I don't run into any coworkers while I am there, though I work on the 3rd floor and Radiology is in the bowels of the first floor, so I should be okay. 

I haven't told my parents yet because I don't want them to freak out, it would freak me out more. 

And by the way, yes I have a fatty liver. That was the news I got after she told me about the cyst. 

 My friend and former coworker Halie goes on all these trips with a tour company, so even if you go by yourself, you are in a group, and I think the tour guide is usually a local. She's gone to London, Ireland, Scotland, Italy, and is going to Iceland in March. We have been talking about going on a trip together and we took advantage of a cyber Monday deal and booked a trip to Australia, New Zealand, and Fiji. It's about 18 days I think? Not including travel days from the US to Australia and Fiji to US. 

I am excited but nervous. I told my mom about the trip. but not my dad yet, because even though I am 31, he won't take it well. My mom said no way can my cat stay at their house. So I am not sure what to do but I know I can't board him somewhere for that long. I think I will have Alyse, Simone, and my mom rotate checking on him? Plus I am nervous about my dad freaking out. 

All I heard for days before driving up to Sacramento to see Jenn was "you're going to die." And also, "don't get off the freeway in Stockton, you'll really get killed there." Thanks Dad. And I wonder sometimes why I am so paranoid. And he also thinks everyone hates Americans, so. Yeah. 

But like I said, I am excited too. We are going the end of October/beginning of November, so I think it will be springtime? And I have always wanted to go to Australia and New Zealand. 

I need to get a new passport, a travel visa for Australia, travel insurance, and plane tickets, but we are waiting a bit on those last few things since the trip will only go if there are 15 people. Halie and I were number 8 and 9 to sign up, and 11 months ahead of the trip, so I am sure soon they will have 15 people. 

It's expensive enough to be my gift to myself for this Christmas, next Christmas, and my birthday.  

 A lot has been going on at work. Our old boss Kathy didn't give 2 fucks about night shift, so even though at the time she left, night shift had lost 7 or 8 nurses, she never hired anyone for us, saying that we were well staffed. And now we have all these people out on maternity leave and medical leave, and more will go out on leave soon. Almost every night I am off, I get a call and/or text asking me to work extra. One week I worked an extra 8 hours on a night off and then another night, came in 2 hours early for a shift. It's exhausting. Supposedly new people have been hired, but most are new grads, so they still have 12+ weeks of orientation to go through.

One reason I haven't posted much lately is that last month, we had a maternal death while I was working. We haven't lost a mom on my floor in 8 or 9 years, so it was very shocking. Yes, we have babies die, but it's something that is known ahead of time usually, due to defects or being very early.

The woman was an antepartum (someone who is pregnant and being monitored closely), 35 weeks pregnant with twins, there to be monitored for hypertension (high blood pressures). She was set to go home that day.

It happened around 12:15am or so. One or both babies came off the monitor, so the nurse, Arlene, went to go in the patient's room and adjust  the tocometers. The mom was on the floor, unresponsive; no heart beat, not breathing. A code was called, everyone rushed up to our floor from the rest of the hospital. Apparently, an ER doctor took over the code, and was so set on bringing the mom back (I believe that she was immediately dead). The L&D supervisor, Alaina, was trying to get him to stop so they could do a c-section in the room and get the babies out. He didn't listen. Finally, they took her to our OR and coded her throughout the section. From the time the mom was found, to the time the babies were out was 20 minutes. Twenty minutes without oxygen, so then both babies were being coded. They coded mom fro 3 hours. At one point she went into DIC, meaning the clotting factors in her blood were used up. Finally, they let her go. The family got there about the time the county coroner did, so the coroner waited an hour for the family to say goodbye.

The room this woman had been in was across the hallway from our nurses' station, so we saw the whole thing up until they took her to the OR. It was very traumatic for all of us there. And the whole family was out in the hallway crying.

The doctors thought maybe she had had an amniotic fluid embolism, but wouldn't know for sure until the autopsy came back.

Later that day, the twins were sent out to another hospital to go on cooling measures for neuro protection. I believe they went to Children's Hospital LA and then later to Cottage. They are still alive, but may have deficits from lack of oxygen.

Turns out the mom had a large clot in her pelvis, and something knocked it loose. It was good that it happened in the hospital, instead of happening at hope. Her man is in jail, so her children probably would have found her and the twins dead in the morning. She had a 16 year old set of twins and a 9 year old.

 So Thursday afternoon through this morning, my county was under a red flag warning, which means a warning that forest fires are likely with the weather conditions, basically, low humidity, high temperatures, and wind. 

Of course multiple fires started. Thursday afternoon, the Alamo Fire started, north east of me, just off Highway 166. It's moved south and is now directly east of me, 10 miles east of the 101, and I live about a block west of the 101. This morning it was 6000 acres and now it's 20000 acres and only 10% contained. Air tankers have been flying over my house for 2 days now. I imagine firefighter will do everything they can to prevent the fire from getting close to the 101 but I am low key panicking and I am tempted to pack some things and drive myself and my cat to my parents' house. 

The Tower Fire started yesterday from a burning care on the 101, on Cuesta Grade. Only 70 or so acres burned, and it's now 100% contained. 

Today the Whittier Fire started near Lake Cachuma, also caused by a burning car, I heard. On the 6pm news, that fire was 5400 acres and 0% contained. 

I was watching the US vs Panama game on TV when an evacuation alert flashed on the TV. For the whole fucking county, which freaked me out. What a big oops; the online evacuation alert was for the areas around Lake Cachuma. 

I feel bad for my friend Simone. There was a fire by Cachuma last year, and her dad lives near the lake and refused to evacuate. Luckily, he was fine. Now he doesn't have a phone so she doesn't know if he evacuated or not or if he is okay.

Air quality is shit so I have been inside all day with all the windows closed. 

Hopefully, the fire near me is more contained by the time I go to work on Tuesday, because I don't know how comfortable I will be leaving my cat home alone. 

 This is week 2 of class 1 of my BSN- and I am still not in the flow of things and over it and procrastinating. I am totally not into having a group project for an online class either. Ugh