The Whole Sad Business

Friday was my mother's birthday, but I had an on-campus clinical to do, so we made plans for Saturday instead. I texted her a happy birthday, though, and Saturday we went to a matinee of Thor and then we had lunch together. I know she's trying to declutter her apartment, so Dave and I gave her some scented candles which burn away, leaving nothing to have to get rid of.

Over lunch, we chatted about what we're going to do for Thanksgiving, which is apparently this Thursday. The year is fast coming to a close, which, I can't even think about. I have two more weeks of classes, four more exams...but I'm done by December 6th. Maybe? I'm not sure.

But like I said, Friday was the last day of on-campus clinicals. We had more simulation exercises with the damned mannequins. Luckily there was no CPR involved, because had there been, I might have just walked out.

The first simulation was a man whose blood sugar was too high so he needed insulin. Then it went too low, so he needed IV dextrose. The second was an asthmatic child who needed a nebulizer treatment and an IM shot of methylprednisolone.

I did not work with my usual beautiful, wide-eyed, terrified partner. Instead, I was paired with a loud, brash young woman who has been part of my clinical group for the last ten weeks. We worked well together. In the down time between simulations, she complained to me about my other partner, saying, "We're more than halfway through the program. It's time for her to step up! She needs to get some confidence!"

Right? I agree. 

My new partner and I finished our simulations quickly with only relatively minor criticisms from the instructor. (I didn't prime an IV flush. We didn't raise the head of the bed first thing.) Later, talking to other students, I realized that our experience had not been the norm. Many students had been unable to complete the exercises for one reason or another. My old partner and her new partner didn't make it all the way through either simulation because they were busy perfecting their Keystone Cops routine apparently. (When things are going really, really badly, they instructors just step in and put a halt to the fiasco.) I was kind of glad not to have been paired with her this time, considering.

Despite being very young, my new partner was a doula for several years and has helped more than a hundred babies come into the world. While a group of us chatted in the down time between the simulations and other types of activities, she made a remark about having had to hold dead babies, which she found unpleasant. She told us that she once had to cradle a dead baby for 45 minutes. I asked why she had to hold a dead baby for so long and she said that the parents asked her to. She explained that after a "fetal demise" (the euphemistic term used when a baby dies during or shortly after birth), the parents could keep the dead baby and take pictures and hold it or ask others to hold it. She mimed holding the baby and said that the parents had remarked that the baby had beautiful hair and, as she lifted the baby's knitted cap to look at the hair, the baby's scalp had come away, too. (She had hastily replaced it and the knitted cap, too.)

I asked how long parents were allowed to keep their dead babies and she said, "As long as they want to," and I said, "Soooo...that means there must be some kind of dead baby refrigerator where they keep them between visits?" And she said, "Yep. It's a refrigerator that is labeled FETAL DEMISE and they keep the babies in there."

Which...I mean, I get it. I do. But also: A very horrified why?

I like babies fine, though I don't consider myself to be sentimentally maternal. I have no desire to work with mothers and babies, even though the people who do say it's a great because most of the time the situation is a happy one, unlike in other parts of the hospital, where things are so often in a controlled crash and burn mode. So I suppose that's nice, babies being born, right?

Anyway, like I said, we were just chatting between simulations and other activities.

I'm not sure that I've ever explained the set up of the simulation exercises. The rooms we're in are set up like hospital rooms and there's a medication room and supplies and telephones and so on. The place is supposed to run like an urgent care or a hospital, depending on the scenario. While we're working on the mannequins, the instructors and techs watch from behind one-way glass. (We're also recorded doing the exercises and we can go watch the recordings if we want to, which I don't want to, so I don't.) We are partnered up and the simulations run one after the other. What I mean is, if two are planned, we start the first and when we are finished, the next pair starts while we move on to the second. That means that there are two groups working at the same time. (We rarely cross paths though, depending on the simulations.) The same instructor introduces each simulation to us, watches us from behind the glass, and, at the end, critiques/debriefs us.

After we finished the simulations, we headed upstairs to do some other activities. I don't know who decides which instructor does what, but there is one instructor who speaks only very rudimentary English and she is always the one tasked with giving us rather complicated directions for everything. The jokes with her write themselves--though I've worked with so many non-native English speakers over the years that I can generally untangle what she's trying to convey. She recognizes this and for the last couple of simulations days, has given me the directions first and then assigned me to tell everyone else what they are.

Anyway, later as I was upstairs waiting with another group of students to complete yet another activity (we had about four hours of downtime between about half an hour of activities), I was joking around about my loony toons off-campus clinical instructor. In our patient write ups, we have to discuss the pathophysiology of the patient's illness along with some of the potential complications and what actions we would take in the event of those complications. Instructor Loony Toons had critiqued one of my write ups of a patient with cirrhosis of the liver. I had written up sepsis as a complication and she said I needed to write up "death" as my complication. I joked, "I was, like, so, what actions would I take in the event of that complication? I mean, should I, like, put the head of the bed up and administer oxygen?"

Everyone laughed.

"Up his IV fluids? Epinephrine shot? "Vaya con Dios"? What?"

Because there's kind of no coming back from that particular "complication," is there? No way to really turn that ship around, right? Or is there? I mean, if I could do something about death, I wouldn't even be in school right now, would I? I would probably be going around the world emptying out all the FETAL DEMISE refrigerators.