A year at U of R

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Thursday, September 07, 2006

Foley catheters

Today, I feel like I summited Everest. In fact, all I did was insert my first foley catheter. It doesn't sound like a big deal, and it actually was very easy once I did it. But it was like the plunge a skydiver makes from an airplane at 14,000 feet. You have to get out the door before you can float.

I was in labor and delivery today. The clinical rotation in women's health is divided up, so I'll spend a few days in labor and delivery, a few days in triage and a few days in postpartem care. I started with the labor and delivery at 6:45 this morning. The nurses work one-on-one with the laboring moms in delivery, so I was shadowing the same nurse and the same mother-to-be the whole day.

The mother was very dilated when the day started, and in a lot of pain. To add to the pain, she was scared. I had never considered that anxiety could be such a factor in labor. It seems obvious to me now that the combination of pain, exhaustion, and fear of the process could make an expectant mom break down and cry. It is a lot to go through. I tried to praise her, and tell her how brave she was. Meanwhile, I was quaking myself, feeling totally out of my league with no knowledge of this whole new branch of medicine.

Labor and delivery is so different than the acute care I became used to. The nurses spend inordinate amounts of time recording notes on the tracking of the fetal heart rate every time the mother changes position. They also monitor the mother's blood pressure and vitals constantly. All of the vocabulary was new to me; "IUPC, Terbutaline, variable deacceleration" to name a few. But like anyone thrown into a a country where they speak a foreign language, you sink or swim. I just tried to pick up as much as I could.

I watched the mom get an epidural, and grilled the anesthesiologist for a while with questions about the procedure. He laughed, and joked that he felt like I was giving him his board exams. I learned to assess the level of the epidural by touching a wet alcohol pad to the mom's trunk, and asking at what point she felt it. If the level was too high on her trunk, the bed had to be raised to make sure the anesthesia didn't rise any higher.

An lucky for me, the epidural also meant that the mother could no longer sense a full bladder. She needed a foley catheter inserted to drain the bladder for her. When the nurse asked if I wanted to do it, I was inches from chickening out. I had just returned from a two week break. I learned how to do a catheterization how many weeks ago? Five weeks? Ten? Was I prepared? No way! But something in the back of my head said, "Jump!"

I ran to the other end of the unit searching for my instructor, to get permission to do the insertion.

"Go ahead," she said. She may as well have just said "cleared for takeoff" to a flying elephant.

"I'm a little nervous," I told her. Understatement of the century.

"Go through the steps," the instructor said. I told her exactly what I was going to do, and verbalizing it helped.

I dashed back into the delivery room, praising fate that because of the epidural, my first urinary catheterization patient wouldn't feel anything. But there was still her whole family in the room, watching me perform. Thankfully, the nurse was fantastic, and she walked me through it. I was so focused on the procedure that I didn't notice the family at all. I opened up a kit, and set up a sterile field. Once my gloves were on, and I'd swabbed the whole area, I inserted the catheter. Just like they told us in lab, urine started to come out through it. One more first out of the way. I wiped up the betadyne stains and hung the urine bag on the bed frame, thinking "Now I can float for a while."