Back to the grind…

September 24, 2009

Well, that’s a little misleading, I’ve been back to the school year grind for a few weeks now. But, I did have my first clinical day of the year (clinicals: rotations at the hospital). I am a wonderful 1.5 hour commute from Brooklyn to the Bronx (discouraged? Never! It’s a WONDERFUL opportunity for me to get in some undistracted study time. But gosh, who knew the 4 train would be so crowded at 6:00 in the morning? And where exactly is everyone going?…”ok,I’ll get a seat at union sq….fine fine, I’ll sit down at grand central…ok, ok, 86th street, people HAVE to get off there…um, 125th?…well, I’m glad other people got an opportunity to rest their legs. No, really, I am!”.

Good news: my OB (obstetrics… babies… you know babies right?) clinical instructor is awesome. A high light is that she’s not only familiar with holistic care but she’s an advocate of it. So I get to hear her say things like “you don’t need gloves to touch a baby” and “well, they practice this, but, it’s more just because of tradition then for a good reason”. How refreshing to have a teacher who doesn’t just robitically reguritate all the key concepts of the text book!

More good news: They’re so hard core into infection control at the hospital that not only is no one chastising me for having tattoos on my wrist showing, they absolutely FORBID me to cover them up (no one, not even the observant, can wear anything past their elbows). Well…now that I think about it… that’s the policy. Practice wise there were plenty of people wearing sweaters…

More policy vs. practice conflicts:

1) In school we learned no one takes rectal temperatures on bebes anymore (rectal temps are sooo passe) People do it mostly axillary (arm pit) or temporally (across the forehead). Guess where the lucky little neonate (new born) who came to the nursery fresh from a c-section got stuck? You are correct: right up the tuchus! Maybe the nurse just wanted to check to make sure the anus was patent (open). Not even a warning for lil babe or a moment to catch his breath…honestly though, he didn’t seem too mind much…

2) Our instructor strongly encourages us to not wear gloves if we’re not coming into contact with bodily secretions.  As I didn’t have much to do in the nursery this week I asked a first day, first year resident if I could watch him do his assessment. In full glove attire he checked the baby from head to toe, took off baby’s diaper, checked around, re-fastened diaper (I self-righteously noted that he tucked the umbilical cord into the diaper, instead of ensuring it was over the diaper by folding the edge of the diaper down, AND he fastened the diaper too loosely to stay on effectively. God, can’t doctors do anything right?) After checking the diaper and genitals he took a moment to look over the baby, trying to remember if he had left anything out of the assessment. Oh, he forgot to check the sucking reflex. So he took his pointer finger and shoved it in the baby’s mouth. Oooh…that doesn’t seem very hygenic…then of course that debate begins in my head: to say something, to not say something, to seem cocky and arrogant or to not say anything but let the doctor continue to go around sticking his fingers in babie’s butts and then in their mouths? Granted, there is that LARGE part of me that DOES want to tell a doctor that they’re wrong, and so I can’t tell if my motivations are pure or impure. But that does seem like a MAJOR infection control issue…speak up, speak up! “Um…do you think you should change the gloves before you stick your finger in it’s mouth?” I say AS innocently as I possibly can.  Shame, poor resident, I can tell he’s REALLY nervous. “Uh…no, no. It’s fine, plus the baby is still sterile anyway.” Hmm..really? The baby is sterile? I don’t know, I did take nursing 101 all the way last year ago….but I vaguely remember something like… when a sterile object touches a non sterile object it becomes non sterile…has a baby touched anything non sterile upon entry into the universe?….I’m being petty aren’t I? I know, I never can tell!

But I do jest, people, of course there is no natural adversarial relationship between nurses and doctors. I mean, there is often an adversarial relationship, but it’s not natural and it doesn’t have to be that way (it’s the system, man!).

7 Responses to “Back to the grind…”

  1. Erin Says:

    So nice to know I can show off my tattoos at Lincoln!

  2. Dina Says:

    Well maybe the resident was right in away. After all mothers these days keep there kids away from everything, hence the rise in allergies and illnesses. So he could of been doing the baby a favor in the long run by giving his dirty finger, exposing him to who knows what.

  3. Plus…unless the doc was wearing STERILE gloves to do his exam, and not just NORMAL gloves, he wasn’t sterile anyway!!!

  4. maha Says:

    Sterile baby! That’s brilliant – and a common sense fail!

  5. Sean Says:

    NIIIIIIIce.. Baby being sterile.
    I think you scared the resident.

  6. man-nurse Says:

    Baby’s aren’t exactly sterile – they’re supposed to be exposed to / colonized by bacteria from the birth canal, but they’re also unfortunately colonized by flora from the hospital environment, so hopefully this fecal-oral route won’t transmit anything bad. :P

  7. man-nurse Says:

    Somehow my face sticking its tongue out turned into a happy face!

    Anyhow, I was also gonna say I was lucky to have holistic and/or sensible OB instructors in my rotation, which was nice because after four home births with my wife I didn’t feel like hearing about traditional non-evidence-based obstetrics. We watched parts of “The Business of Being Born” and were lectured on how supine positioning causes obstetric emergencies. Of course, we also heard stuff like it’s nice not to have an epis, but it’s up to the doc, but oh well.

    Of course, policy vs practice showed up, since we were being taught very proactive, healthy, evidence-based or common-sense practice in school, but then we pretty much only saw women permanently immobilized by EFMs, being given Pitocin too early, in poor positions, leading up to unnecessary tearing or c-sections.

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