Sunday, April 22, 2012

Sunday - Monday, April 22 - 23, 2012: Moving into Antepartum

When Christine arrived at OSF St. Francis Medical Center, she was given a room in the labor and delivery unit. On Sunday Christine's doctor wanted to move her to the antepartum unit of the hospital, just down the way from labor and delivery. Her doctor was comfortable enough at that point that she wasn't going to deliver at any moment, but that she would need to stay at the hospital on bed rest with IVs for fluids and magnesium sulfate and to take indocin. The magnesium helps to slow uterine contractions and the indocin, I think, helps to reduce swelling. The theory is that the unexplained hemorrhage in the fundus (top) region above the placenta in the uterus from a month ago slowly started to cause contractions which wouldn't have really been noticeable as contractions. Instead, they felt like really minor cramps. Those contractions then led to more irritation and bleeding which led to more contractions, which led to more bleeding... a vicious cycle which the drugs were meant to interrupt. We later learned that this distress helped Finnegan grow up a little stronger.

She didn't actually move Sunday because they were out of beds in antepartum, so she stayed in labor and delivery. Monday morning one of the neonatologists came to talk with us to help us understand what it would mean if the baby were born prematurely. We heard some scary numbers and scary things that could happen. Later in the morning we had an ultrasound that showed the baby was in breech and that her fluids in the placenta were down a bit. Also, she was 1 cm dilated and thinning, aka flirting with labor. When the doctor explained it to us, he had us worried. We thought he meant Christine would be staying in labor and delivery. Still, the good news was that everyone kept saying just how wonderful his heart beat patterns were! I'm a little fuzzy this much later, but I think they said that meant his brain was doing well.



Later someone came into the room and told Christine they were moving her to antepartum, without notice or an explanation. We were livid and Christine was scared. We explained to the nurse that no one had talked to us about the move and that just earlier in the day the doctor gave us the impression that wasn't the place for Christine. The nurse said it was the doctor who put in the order to have her moved, and that's she'd need to move. They were out of beds in labor and delivery. We resisted and so to help us understand, the nurse fetched the charge nurse and the patient care facilitator to come talk to us. To be honest, it felt more like a "talking to" than a "talking with". The charge nurse kept repeating that the doctor absolutely would not have put in the order if he wasn't comfortable with it. We said we still weren't comfortable with it because the doctor hadn't expressed this to us, but that we knew they had a job to do, so to go ahead and do it. 

On the way out the door they told Christine that, btw, she'd have a roommate and I wasn't allowed to stay the night. What a wonderful way to tell her that. Just the day before she was told (apparently slightly erroneously) that antepartum was all private rooms. As it turns out, some were and some weren't. When we got to the new room, Christine was in tears and they seemed baffled. I told them that hearing I wouldn't be able to stay with her was what was making her the most upset. Particularly so because she had just heard they were private the day before. I told them that they way they handled here move was not professional, comforting, well-communicated, or handled. Telling someone "we're moving you now" just after your doctor makes it seem like you weren't in the clear, and that on the way out the door that she'd have a roommate and I couldn't stay the night was NOT ok. The nurse who did the move and told her about the room appologized and said that she had wanted to make sure that she knew she'd have a roommate so it wasn't a surprise. I guess she thought springing it on her on the way wasn't a surprise, especially because of how her move wasn't communicated to us at all. The charge nurse said I'd be able to sleep down the hall on a couch near some well traveled elevators and that they'd come get me and I could come in if anything went wrong, but that I couldn't come in on my own just to check on her. Gee golly, thanks. Also, there is a waiting list for private rooms and Christine was on it.

Just after Christine got settled in I went to go make my appointment to have my surgery redone... Oh that's right, I haven't explained yet. Backtracking a little, I'd been having mounting pain in my buttocks region (I've lost all shame with discussing my butt, deal with it). It felt like a realllllly painful hemorrhoid and I was passing blood so I wanted to make sure it wasn't related to the surgery I just had to insert a fistula plug on the Tuesday a few days from that preceding week. I went to the PromptCare up the road and the doctor was questioning why the surgeon didn't give me this or that, and why he didn't do x. I explained he gave different instructions, and he's a professional so he knows what he's doing. She decided to clean the wound with a swab. The next time I used the restroom I found the plug had come out, stitch and all. I reached the surgeon through the on-call number and told him what happened and because I had a concern about one of the medications the prompt care doctor prescribed. He said we'll never know if she caused the plug to come out, but that she should have known better and had absolutely no business "helping" by cleaning the wound with a swab. He said he'd tell the girls at the office to schedule me for whenever I wanted over the next week. He also said he'd arrange to have it done by one of the surgeons here if I wanted so I wouldn't have to be at home so far from Christine because it would be difficult for me to get a ride home and then to drive back and forth from the hospital. If we just do it here, that makes everything much simpler.

...I digress. I left the room to go arrange my surgery and my mom was swinging by soon. By the time I got somewhere quiet it was too late to call the surgeon's office, so I thought for a while about whether or not I wanted to open a can of worms regarding Christine's room move. I came to the conclusion they had already opened it and I wanted someone to listen to me talk calmly and then act as our advocate and help get everything explained and to make sure it wouldn't happen to anyone else. Someone from patient care services came down and listened intently while I calmly bitched my heart out. I couldn't figure out why her doctor would change his mind without telling us. What really ticked me off was that I didn't know how long ago he made the call. Could we have experienced less stress and worrying all day and afternoon if he knew around lunch? I didn't know.She was really nice and sympathetic and told me she'd talk to the charge nurse or her old unit, charge nurse of the new unit, floor manager, and doctor. She'd also have someone from social services come by the next day to help us figure out how to schedule the surgery so that Christine would have a room where I could be comfortable after having surgery. When I got back upstairs Christine said her new charge nurse had come by and apologized for how everything happened and gave her some gift certificates for the cafeteria and gift shop.

Christine's resident came by to talk. She didn't have anything really new to say since she wasn't at the ultrasound, but reassured us like the charge nurse, that if the doctor ordered the move, he was comfortable with it. They would positively not have moved Christine out of labor and delivery if that's where she needed to be. The difference between labor and delivery and antepartum was units was that in labor and delivery they monitor the baby's heartbeat constantly and try to count the contractions (though almost none of Christine's registered. Some of them showed up because of the baby's heartbeat) and in antepartum they do so only every 8 hours for about 45 minutes. She said that she would still receive the same level of care. I asked her if she thought emotional support counts as a part of that care, and how could I offer that when I wasn't allowed in at night. She seemed to see the light. She told us she'd talk to the charge nurse about it, but room arrangements were up to the charge nurse who had to work with what she had and that she'd ask if they'd make an except to provide me with a cot in Christine's room (her room had two doors to the hall. I think they only reason they were semi-private was because they wanted to skimp on restrooms at construction time. Other than that it seemed like two, almost full-size, rooms). The doctor warned that she didn't have much say in the matter and didn't have any sort of authority over the charge nurse. She also said that Christine's doctor was not going to be at the hospital for the rest of the night, but would come by in the morning to talk about why he made the decision to move her.

I took the time, then, to find out just what the heck antepartum meant, cause no one had told us and for some reason I hadn't thought to ask. I had found earlier that it meant "just before birth", but that didn't make sense to me. Turns out antepartum is a unit of hospitals where pregnant women at high risk of preterm labor who are "flirting with labor" "hang out", get poked, prodded, monitored, and waited on, hopefully until they're full term. In my search I found a blog where a girl had walked through her 30 days or so of being in the antepartum unit.

Later still, Christine's doctor surprised us. He came into visit and said he was just as confused as we were, because on Sunday he told us he wanted to move her to antepartum but there weren't any beds. Today there were, so she moved. We told him that we recalled he wanted to move her, but that in the morning's ultrasound we (mis)understood that he was concerned about the baby coming early, concerned about the fluid level, bleeding, contractions and that she was dilated 1cm and thinning. I told him that since that time I had finally come to understand what antepartum meant. He reiterated what I learned, that all ladies in antepartem are flirting with labor and that's why they were there, just down the hall from labor and delivery. He offered advice about being in the antepartum wing:
  • The nurses like to pick out the people they think will be staying there for a long time and get them into the "princess room" at the end of the hall. It's a rounded room, not a bad size, but there's a lot of windows. With summer coming up, he suggested Christine turn it down because it would get really hot. He said she should take one of two rooms he's found that the ladies like the most. 
  • She should find things she could control, particularly about her routine and physical things within a three foot radius of her bed.
    • Christine should try to keep a schedule by showering at the same time, watching specific television shows, eating at the same times, etc.
    • She also should have some personal items brought in. She's welcome to wear her own clothes and use her own pillow from home. If mom makes something special for dinner once a week, have her bring it in!
Time to settle in for what we all hoped was a long three month stay.

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