Cesarean

On Friday night a 36-week pregnant woman with a history of anxiety was awaiting transport to the OR for a C-section due to nonreassuring fetal heart patterns. After some delays from missing consent forms and from one of the surgeons being in a lecture, she was finally cleared for transport to the room designated for her procedure. She was wheeled into an extremely brightly lit room where she was then rolled onto the OR table. Ten or twelve busy and bustling medical staff were running around shouting out mom’s and baby’s vitals, equipment requests and instructions for the patient…the patient who, as is routine, remained wide awake throughout the entire process.  Each new person entering the room increased the volume of the activity. The chaos was overwhelming, even for me the observing student nurse. “Is her epidural capped?”, “Can I get a baby nurse in here?!?”, “Where is Dr. So-and-so?”, “Hi, how are you? What are you doing this weekend?”, “Why isn’t this spot light working?”, “Can you spread your knees apart for this Foley, Hun?”  As they were placing a metal bar above her head to which they planned to tape her belly for better access her uterus… she just lost it.

The patient started yelling. “Sit me up. Put my head up. I need my head up now! Everyone stop this. I don’t want to do this no more!” Everyone in the room stopped their scurrying and simultaneously started barking reassurances to try to calm her down. Helpful, right?  “Just take deep breaths and you’ll be fine.”, “We can’t put your head up any higher.”, “You can’t go home now, we have to get your baby out.”, “Can someone get Dr. So-and-so in here right away?” 

The patient’s anxiety only escalated. “I don’t want a c-section no more. I want to go home. Unstrap me now. I can’t breathe! I’m going home.”

I started feeling like I couldn’t breathe. I felt her anxiety from across the room. I was shocked at the insensitivity and complete absence of empathy from the staff. I was honestly disgusted.

Then a nurse who the patient knew very well stepped in and took charge. She calmly told everyone else to shut up (with nicer words, but you get the idea) and started talking quietly and firmly to the patient. Her own 8-month pregnant belly gave her authority as she spoke. The rest of the room became still and silent.

“Ms. So-and-so, we have to think of the baby. He needs to come out of you today.”

“I’m so scared! I don’t want to do this no more”.  She began to cry.

“You are in good hands. This woman next to me who is taking care of you is exactly who I would want taking care of me if I were in your place.”

“And she’s not going to leave the whole time?”

“No, she is here through the entire surgery and you are going to be just fine.”

“Are you going to leave me?”

“No, I will not leave you. I will stay with you the whole time. You have my word”.

That nurse pulled over a stool, sat down by the patient’s head and took her hand in hers. She nodded to the rest of the staff to proceed with the preparations. The frozen workers melted back into their previous buzz of activity. My eyes were fixed on that nurse holding the patient’s hand. Everyone else went back to the bustle; she sat there caring for the patient. Through the noise I heard the patient ask again: “Do you promise you will not leave me?” “You have my word.”

She sat on that stool holding her hand the entire time until the cesarean was over.  Both mom and baby were fine and shortly thereafter transported back to recovery.  I, however, am still processing what I witnessed that remarkable evening. The staff preparing for the procedure were fast, efficient, like a well-oiled machine…but that is not how people should be treated, is it?

What I learned that night is this:
Nursing is a three fold cord woven of equally important fibers – knowledge, skill and compassion.