Mid-week last week, a 16-almost-17 year old primip had gone for an ultrasound to evaluate size greater than expected for dates at 21 weeks, and was found to be carrying conjoined twins. Because the twins shared a heart, termination was recommended. After a not-very-informed discussion (this based not on being there, but on what the doctor told me about the plan), the family agreed that the pregnancy be terminated as soon as possible, which translated into misoprostol induction on Monday.
The misoprostol caught up to her finally this morning, and T and I were present when her babies delivered vaginally without issue, completely unresponsive and unmoving although with a heart beat. The babies made no attempt to survive. Their mother was relieved it was over. The family is taking the babies home to bury.
Not too much later in the day, we began the admissions process for a woman in labor at term with her third baby, and were unable to find heart tones. She reported last feeling movement early this morning. The ultrasonographer was on lunch and unreachable, so every person on the ward tried again, and again, for almost an hour, unsuccessfully. The mom reacted very little to this. By the time the ultrasound happened, the expected conclusion was fetal demise. The ultrasound confirmed a non-beating heart. The mom was still not reacting much to this news at all when we left, even laughing with the hospital billing person. This baby will be almost a pound larger than her other two, and as she was already in labor (although just 2cm), she will likely deliver her dead baby some time tonight.
Perhaps the only good part of our day was greeting the postpartum women whose babies we had caught yesterday and the day before.
I was amazed yet again at how much the women on the ward seem to enjoy having each other around. When the labor ward was full the other day, two of the immediate-postpartum moms wanted us to remove the separating curtains so that they could chat, which I found amusing. In the overheated, overcrowded "extension" room, where moms and babies stay if they need a bit longer for whatever reason - usually low birth weight - I've walked past to see groupings of moms talking, playing cards, nursing babies in a circle. I won't say it is ideal, just that the sharing of space doesn't feel as bad as I imagined it would.
We've seen a fair amount of the hospital and are concluding that the maternity ward is the highest volume spot but is in a state of furthest disrepair. It is also the hottest spot in the hospital, and this is not our imagining. It is shameful. The doctor that is the most motivated to make changes seems oddly focussed on crazy little things like the boards that are used for bandages maybe carrying staph bacteria (not a problem that has been encountered...) instead of things that are actually making people sick, like the inappropriate reuse of suctioning equipment. We are not here to fix anything, we are here to participate and to provide good care the way we know how. But it is hard to see things proceed in such a mal-coordinated fashion.
T and I both left early; T because she felt unwell, myself because it was just an hour until the end of shift and I was very hot and very done, and there were more people there than things to do already. I had taken to sanitizing all the surfaces in the delivery rooms (um, is this ever done? oh the disgusting things I found), but once all the handles, knobs, and cabinetry were done, I was about finished with scrubbing things with gauze.
We are back, in air conditioning (oh lovely air conditioning), being overheated and exhausted in our room.
Monday, March 23, 2009
Bored-and-not
Yesterday (Monday), T went in to the hospital a couple hours before I did, while I stayed behind and did some business-plan writing and blog-catching-upping. She admitted three women, and when I arrived, one had delivered, she was coaching the second - a primip who had been pushing for an hour already - to push in a variety of positions, and another woman was writhing in looks-like-ready-to-push condition across the way with nobody in attendance. I went out, found her chart, and did an exam; she was complete, and relieved to be "allowed" to push. She pushed for about 15 minutes, and then we had a 5 minute shoulder dystocia that I was completely alone for, with T across the hall just having caught the other baby, which began to cry as I began to move through maneuvers. What ran through my mind? A passage from Gabbe - "you must not pull desperately on the head." I find that somewhat random and not entirely helpful, but the maneuvers are so entrenched in my mind at this point that they were pretty automatic. Hip flexion, Rubins, posterior shoulder, sweeping for an arm...Woods Screw maneuver - pushing both shoulders simultaneously, in this case counter-clockwise, to find the spot where they would come through - worked, and out came a floppy baby with a blessedly acceptable heart rate. T came across the hall just as the baby was beginning to respond to my stimulation, to let me know she was available - I told her the baby was coming around, thanks, I'd call if I needed another pair of hands, since she was all of 15 feet away. Baby cried vigorously at 2 minutes after suctioning and further stim - at which point I lunged back at the bed to catch a placenta - and by 5 minutes was happily snuggling with her mom, who had uncharacteristically requested her baby be handed to her.
This episode was then followed by 6 hours of utter boredom. Two primips arrived, one at 3cm who was still at 3cm when I left, and another at 4cm who was at 5cm when I left, both of them laboring quietly and with the help of relatives. I sat and read, watched the midwife and nurse play computer games, chatted, and was in many similar ways completely sleepy and bored out of my mind.
10 minutes before the shift completed, we got an interesting phone call...they were sending someone down in labor. The catch here is that this woman hadn't known she was pregnant.
Apparently, after having her fourth child, she had begun depo provera and had been getting regular shots for 10 years, including during this pregnancy, uninterrupted. She continued to have monthly "cycling" with light spotting, which happened even during this pregnancy. At some point a few weeks previous, she had become suspicious of pregnancy because she had felt strong movement, but then her monthly bleeding occurred on time, and she concluded that something else must be wrong. She came in to the hospital in labor, still not totally sure what was going on and entirely unprepared to give birth or have a baby. We felt her belly and concluded that she was somewhere around 38 weeks, we couldn't know really but it seemed reasonable that she was at term.
She apologized to me throughout. For what, I'm not sure; maybe for not having prior care, maybe for not having her things with her, maybe for having another baby at all, maybe she was apologizing to herself and her baby by apologizing to me.
Her baby came quickly. Fifth baby, after all. Vigorous boy in a sludge of mec, looking 40-ish weeks old. Mom had through the swift (half an hour from admission and being told that yes, she was pregnant to having a baby) labor apparently managed to come to terms with the fact that she was having a baby. "Wun smol boy!" she repeated after us. After she'd delivered her placenta, she sat up in her bed, nursing and staring at her baby. "Gonna have a STORY to tell when I get home," she said.
I wandered home through the ever-so-dangerous (insert eye-rolling here) alley, through the usual chorus of "good night"s from the people living there, a bit past midnight, and sleep was not far behind.
This episode was then followed by 6 hours of utter boredom. Two primips arrived, one at 3cm who was still at 3cm when I left, and another at 4cm who was at 5cm when I left, both of them laboring quietly and with the help of relatives. I sat and read, watched the midwife and nurse play computer games, chatted, and was in many similar ways completely sleepy and bored out of my mind.
10 minutes before the shift completed, we got an interesting phone call...they were sending someone down in labor. The catch here is that this woman hadn't known she was pregnant.
Apparently, after having her fourth child, she had begun depo provera and had been getting regular shots for 10 years, including during this pregnancy, uninterrupted. She continued to have monthly "cycling" with light spotting, which happened even during this pregnancy. At some point a few weeks previous, she had become suspicious of pregnancy because she had felt strong movement, but then her monthly bleeding occurred on time, and she concluded that something else must be wrong. She came in to the hospital in labor, still not totally sure what was going on and entirely unprepared to give birth or have a baby. We felt her belly and concluded that she was somewhere around 38 weeks, we couldn't know really but it seemed reasonable that she was at term.
She apologized to me throughout. For what, I'm not sure; maybe for not having prior care, maybe for not having her things with her, maybe for having another baby at all, maybe she was apologizing to herself and her baby by apologizing to me.
Her baby came quickly. Fifth baby, after all. Vigorous boy in a sludge of mec, looking 40-ish weeks old. Mom had through the swift (half an hour from admission and being told that yes, she was pregnant to having a baby) labor apparently managed to come to terms with the fact that she was having a baby. "Wun smol boy!" she repeated after us. After she'd delivered her placenta, she sat up in her bed, nursing and staring at her baby. "Gonna have a STORY to tell when I get home," she said.
I wandered home through the ever-so-dangerous (insert eye-rolling here) alley, through the usual chorus of "good night"s from the people living there, a bit past midnight, and sleep was not far behind.
Sunday, March 22, 2009
Busy, Busy, Busy
Yesterday (Sunday), T left for an overnight to see the volcano at Tanna, and I left for what was supposed to be a swing-shift at the hospital from 10-6 but wound up being a bit longer.
I arrived to find the ward pretty quiet, a situation which changed dramatically over the next hour as we admitted 4 women, all of them primips and all but one of them hovering around 5cm. They labored into the afternoon; shift change happened at 3, leaving myself, one midwife, and one nurse on staff. At 4 a multip showed up at 5cm. Two of the primips were creeping their way slowly (for here) towards the finish line, and it looked like we were in for a bit of a rush. Another primip showed up fully dilated. Fortuitously, an advanced nursing student showed up at this time as well, and although he required the midwife's continual supervision (something she doesn't think I need...hahahahaha), he was another set of hands. We split up one per bed, with three women in the four-bed labor ward (which they typically like to have only two women in at a time).
The multip's contractions had spaced out to almost 10 minutes, and although she was eager to push, her cervix was a firm 8cm which didn't yield well during a push, so I discouraged it. Someone opened the door and pleaded tearfully for me to come check her relative who was "so much soa now, please you check?" Which I ran out and did between multip-mama's contractions, to find her at 6-7cm, which was only slight progress from her last check 3 hours previous.
The fully-dilated-on-arrival primip delivered first, which I observed while the student nurse and MW Tamanu did a four-handed catch.
The multip delivered next, as I held back a decent sized anterior lip of cervix; this birth I managed completely with the student nurse swooping in to give a shot of pitocin on my request, and MW Tamanu showing up to suction the baby for some random unexplained reason (breathing fine) about two minutes after the birth (ok not so random, since there was moderate mec, but this was a pretty nonsensical time to suction) - both of whom disappeared rapidly because they were still cleaning up from the first birth, while I was occupied with the mom's somewhat-larger-than-average blood loss and they were entirely uninterested in the matter. Her placenta came out fine, her blood loss ceased, her baby looked fine hanging out in the warmer, and another primip began to push.
MW Tamanu proposed that she monitor multip-mom and baby while I managed the next primip's birth. I had feared for this primip's perineum since I had checked her on admission, because of the difficulty admitting my fingers for the VE despite her good attempts to release tension and her apparent calmness about the exam. She had perhaps the best pushing control I have ever seen, and she breathed and slowly pushed her baby past an intact perineum with absolutely no issues whatsoever. Her placenta arrived just 3 minutes later. The entirety of her blood loss, I could have cupped in one hand.
All this she did less than 25 minutes after the first mom had delivered.
We got the babies their shots, registered the births, got the moms and babies sorted out and into their beds, and I left the MW and the student nurse to handle the remaining women, one of whom had been admitted with SROM and no labor and continued to have a non-labor, and the other who I had recently checked at 7cm looking no closer to delivering. I walked back to the room through the usual chorus of "goodnight"s from the village-in-a-city occupying the block adjacent to the hospital, and fell into bed at 10:30.
I arrived to find the ward pretty quiet, a situation which changed dramatically over the next hour as we admitted 4 women, all of them primips and all but one of them hovering around 5cm. They labored into the afternoon; shift change happened at 3, leaving myself, one midwife, and one nurse on staff. At 4 a multip showed up at 5cm. Two of the primips were creeping their way slowly (for here) towards the finish line, and it looked like we were in for a bit of a rush. Another primip showed up fully dilated. Fortuitously, an advanced nursing student showed up at this time as well, and although he required the midwife's continual supervision (something she doesn't think I need...hahahahaha), he was another set of hands. We split up one per bed, with three women in the four-bed labor ward (which they typically like to have only two women in at a time).
The multip's contractions had spaced out to almost 10 minutes, and although she was eager to push, her cervix was a firm 8cm which didn't yield well during a push, so I discouraged it. Someone opened the door and pleaded tearfully for me to come check her relative who was "so much soa now, please you check?" Which I ran out and did between multip-mama's contractions, to find her at 6-7cm, which was only slight progress from her last check 3 hours previous.
The fully-dilated-on-arrival primip delivered first, which I observed while the student nurse and MW Tamanu did a four-handed catch.
The multip delivered next, as I held back a decent sized anterior lip of cervix; this birth I managed completely with the student nurse swooping in to give a shot of pitocin on my request, and MW Tamanu showing up to suction the baby for some random unexplained reason (breathing fine) about two minutes after the birth (ok not so random, since there was moderate mec, but this was a pretty nonsensical time to suction) - both of whom disappeared rapidly because they were still cleaning up from the first birth, while I was occupied with the mom's somewhat-larger-than-average blood loss and they were entirely uninterested in the matter. Her placenta came out fine, her blood loss ceased, her baby looked fine hanging out in the warmer, and another primip began to push.
MW Tamanu proposed that she monitor multip-mom and baby while I managed the next primip's birth. I had feared for this primip's perineum since I had checked her on admission, because of the difficulty admitting my fingers for the VE despite her good attempts to release tension and her apparent calmness about the exam. She had perhaps the best pushing control I have ever seen, and she breathed and slowly pushed her baby past an intact perineum with absolutely no issues whatsoever. Her placenta arrived just 3 minutes later. The entirety of her blood loss, I could have cupped in one hand.
All this she did less than 25 minutes after the first mom had delivered.
We got the babies their shots, registered the births, got the moms and babies sorted out and into their beds, and I left the MW and the student nurse to handle the remaining women, one of whom had been admitted with SROM and no labor and continued to have a non-labor, and the other who I had recently checked at 7cm looking no closer to delivering. I walked back to the room through the usual chorus of "goodnight"s from the village-in-a-city occupying the block adjacent to the hospital, and fell into bed at 10:30.
Sunburnt on Saturday
On Saturday, off to the beach at Hideaway. The day looked dreary and we settled ourselves out in the open, where the light was enough to read by and just slightly warmer than the wet/shade. The sun began to shine brightly, I did some snorkelling (although the water was somewhat murky, the fish were abundant and the corals very much alive - Hideaway is definitely the place for easy snorkelling), and then headed into dappled shade under a tree.
Somehow, my forehead, one thigh, and a particular portion of my back became dramatically sunburnt whilst the rest of me remained pretty much fine. And yes, I did apply sunscreen to the entirety of the exposed all-too-white surface of my skin.
The effect of the sunburn on the flushed appearance I managed to work up last night on shift was incredible. Anyway, we left the beach at around 1:30 and were at the hospital at around 3pm, which is when the afternoon shift starts.
*following portion concerns stillbirth and is not for the faint of heart, please stop reading here if easily disturbed and skip past the indented portion of the post, or to the next post entirely if you'll be tempted*
Meanwhile, the laboring woman appeared to have been deserted by whatever much-older man had brought her to the hospital, and was having difficulty dealing with her labor. I walked with her for a while, rubbing her lower back during contractions (it seems that this is most often what labor support consists of here) and essentially just being present. She decided to lie down in the admissions room as another mom came in with some sort of early labor going on, and started sounding transition-y, which for a multip is cause for some sort of action. Off to the labor room we went, but when I checked her she was 7 and not yet ready to push.
She seemed most comforted at that time, unfortunately enough, to drape her arm over my shoulder and flex her hand right against the spot on my back that was sunburnt. Attempts to rearrange the situation failed. I feared for my ability to break loose and catch her baby when the time came; fortunately, she got more used to T and began to switch up her routine a little bit.
About an hour later she was actually ready to push, and out came her 3.5k (7 and a halfish pounds, large for here) baby, with linebacker shoulders and looking huge for this small mama, over an intact perineum with a push for the shoulders, a push for the chest, and a push for the hips. Baby came out floppy and blue, and her APGARs were 2/5/7, which is misleading in that because her heart rate was over 100 the entire time, and she was attempting to breathe by 2 minutes, the situation was not particularly panicked. MW Tamanu had been in and out of the room in this time, while she was giving report to the midwives during shift change. Baby improved, mama delivered the placenta without major incident, we got baby set up and nursing, and we left to stagger to our room just after midnight.
Somehow, my forehead, one thigh, and a particular portion of my back became dramatically sunburnt whilst the rest of me remained pretty much fine. And yes, I did apply sunscreen to the entirety of the exposed all-too-white surface of my skin.
The effect of the sunburn on the flushed appearance I managed to work up last night on shift was incredible. Anyway, we left the beach at around 1:30 and were at the hospital at around 3pm, which is when the afternoon shift starts.
*following portion concerns stillbirth and is not for the faint of heart, please stop reading here if easily disturbed and skip past the indented portion of the post, or to the next post entirely if you'll be tempted*
A woman whose baby had died in utero (this had already been established the previous day) appeared at the hospital in what looked like early labor, and then left again, only to reappear a couple of hours later in roaring labor. T volunteered to catch after a bit of encouragement from midwife Tamanu. The woman, an 18 year old primip, disassociated heavily while she pushed. Her macerated baby girl came out weighing 1k, with the cord wrapped very tightly around its neck three times. T had to exit the room while Dr Robin and MW Tamanu examined the baby; in the meantime, I attended to third stage, which Dr Robin encouraged me to hurry along with cord traction but I was reluctant to do because I wasn't sure about the heartiness of the cord. All was well there. The baby was carefully wrapped and arranged and brought to the family outside; there was much crying, and at one point T and I walked by to see the dad with his whole body draped over the bassinet, just sobbing.
Meanwhile, another woman was laboring up and down the hallway, and although she paused to stroke the back of the grandmother for a moment, appeared not to be upset by the mourning family, nor them by her.
After the hour was up, we moved the mom out onto the floor. Mercifully, the patient load was light, and she got a room with four beds (normally fully occupied) to herself, but her family was nowhere to be found. She continued to essentially stare off into space and interact with us minimally. Almost an hour later, her family reappeared. I'm not sure I've ever been so glad to see such a crowd of people show up postpartum. She sat up, reached out, and sobbed into her mother's shoulder...and sobbed, and sobbed, and clung to her aunties and to her boyfriend, and each time we passed for hours there she was, clinging to a relative and crying.
Meanwhile, the laboring woman appeared to have been deserted by whatever much-older man had brought her to the hospital, and was having difficulty dealing with her labor. I walked with her for a while, rubbing her lower back during contractions (it seems that this is most often what labor support consists of here) and essentially just being present. She decided to lie down in the admissions room as another mom came in with some sort of early labor going on, and started sounding transition-y, which for a multip is cause for some sort of action. Off to the labor room we went, but when I checked her she was 7 and not yet ready to push.
She seemed most comforted at that time, unfortunately enough, to drape her arm over my shoulder and flex her hand right against the spot on my back that was sunburnt. Attempts to rearrange the situation failed. I feared for my ability to break loose and catch her baby when the time came; fortunately, she got more used to T and began to switch up her routine a little bit.
About an hour later she was actually ready to push, and out came her 3.5k (7 and a halfish pounds, large for here) baby, with linebacker shoulders and looking huge for this small mama, over an intact perineum with a push for the shoulders, a push for the chest, and a push for the hips. Baby came out floppy and blue, and her APGARs were 2/5/7, which is misleading in that because her heart rate was over 100 the entire time, and she was attempting to breathe by 2 minutes, the situation was not particularly panicked. MW Tamanu had been in and out of the room in this time, while she was giving report to the midwives during shift change. Baby improved, mama delivered the placenta without major incident, we got baby set up and nursing, and we left to stagger to our room just after midnight.
A Day Off
On Friday, we spent our morning huddled over our computers yet again, at work on our Senior Papers. Mine is very close to being finished, thank goodness.
Around noon, we wandered downtown, mailed off some postcards to the kids, ate lunch where many of the local people do, at the large produce market:
We wandered through a large school assembly that was taking place near the shore; some kids on stage, others playing in the grass or jumping off the concrete wall into the bay (it looked like they were having insane amounts of fun). The playground set there includes the typical swings and slides and such, and then a slide off the edge of the wall and into the water. Not that the kids looked confined to the slides; play was happening everywhere. Preteens and teens walked around, wearing a set of street clothes under their school uniforms (T and I both wondered, how on earth could they handle that much clothing in the heat and humidity? I guess people can get used to just about anything).
Through a tourist-trap open-air market, where we got some goodies for the kids; as we were looking, the air got thicker and heavier, and women began pulling their merchandise under cover, so we hastened to a nearby cafe, where we waited out the rainstorm with lattes (each of which cost the same as both of our lunches at the market, yay tourist-centric pricing...) under an adequate awning that kept out the rain but was powerless against the humidity.
A slow...easy...way-too-hot-still walk back to our room, where I jumped into the pool as soon as I possibly could and then talked to my family on Skype, which was a lovely experience - the kids were very much into showing off their new musical learning on the piano and ukulele and drum, which was very not the torture it could have been, mainly because they've managed a fair amount of rhythm and it lasted only about 10 minutes and absence makes the heart grow fonder.
I said goodbye somewhat reluctantly, but happily, after our short conversation, and we threw on clothes and headed off for the "Melanesian Feast," which turned out to be a really great experience. Vanuatu is a very diverse country, with many cultures evolving in relative isolation (the reason Bislama is so prevalent here is that a large number of the native languages aren't similar enough to allow good communication), so we saw just one culture's dancing, singing, and food. Perhaps my favorite thing was the kids that were completely allowed to steal the show, and the adults that indulgently encouraged the little ones to sing, dance, and drum along.
We avoided getting rained on, major incidents with insects, cultural inappropriateness from the 4 elderly gentlemen on holiday from Holland (whose major sin so far appears to be stating "basket blong titi" loudly during the bus rides, but oh boy do those men have some embarrassment potential), and got back in time to sleep at a reasonable hour.
Around noon, we wandered downtown, mailed off some postcards to the kids, ate lunch where many of the local people do, at the large produce market:
We wandered through a large school assembly that was taking place near the shore; some kids on stage, others playing in the grass or jumping off the concrete wall into the bay (it looked like they were having insane amounts of fun). The playground set there includes the typical swings and slides and such, and then a slide off the edge of the wall and into the water. Not that the kids looked confined to the slides; play was happening everywhere. Preteens and teens walked around, wearing a set of street clothes under their school uniforms (T and I both wondered, how on earth could they handle that much clothing in the heat and humidity? I guess people can get used to just about anything).
Through a tourist-trap open-air market, where we got some goodies for the kids; as we were looking, the air got thicker and heavier, and women began pulling their merchandise under cover, so we hastened to a nearby cafe, where we waited out the rainstorm with lattes (each of which cost the same as both of our lunches at the market, yay tourist-centric pricing...) under an adequate awning that kept out the rain but was powerless against the humidity.
A slow...easy...way-too-hot-still walk back to our room, where I jumped into the pool as soon as I possibly could and then talked to my family on Skype, which was a lovely experience - the kids were very much into showing off their new musical learning on the piano and ukulele and drum, which was very not the torture it could have been, mainly because they've managed a fair amount of rhythm and it lasted only about 10 minutes and absence makes the heart grow fonder.
I said goodbye somewhat reluctantly, but happily, after our short conversation, and we threw on clothes and headed off for the "Melanesian Feast," which turned out to be a really great experience. Vanuatu is a very diverse country, with many cultures evolving in relative isolation (the reason Bislama is so prevalent here is that a large number of the native languages aren't similar enough to allow good communication), so we saw just one culture's dancing, singing, and food. Perhaps my favorite thing was the kids that were completely allowed to steal the show, and the adults that indulgently encouraged the little ones to sing, dance, and drum along.
We avoided getting rained on, major incidents with insects, cultural inappropriateness from the 4 elderly gentlemen on holiday from Holland (whose major sin so far appears to be stating "basket blong titi" loudly during the bus rides, but oh boy do those men have some embarrassment potential), and got back in time to sleep at a reasonable hour.
Around the Isle and Back Again
On Thursday, T and I did an almost-all-day around the island tour (9am to 5pm). It was absolutely wonderful. Our tour guide was *this post interrupted to let you know I've just squashed a spider the size of my fucking HAND, "no poisonous spiders in Vanuatu" is the best thing I've read in a while, seriously* entertaining and knowledgeable. We got to see several beaches, our tour guide pointed out many villages, farming areas, etc. All of which, due to the dreary rainy non-photogenic nature of the day, I didn't get much photographic evidence of. Nevertheless, the tour was more useful than I had anticipated.
Efate, the island we're on, contains several paved roads in the main area (Port Vila and immediate surroundings); after that, the road is unpaved. The government is working on a sealed road to circle the island, but is nowhere near completion yet. Our driver did a masterful job of remembering that his passengers were pretty much used to flat, even, not-water-covered roads.
We got out at a beach mid-morning where we swam in crazy variable-temperature water, stared at a few fish, and drank/ate coconuts. We stopped to look and play at a banyan tree:
At lunch, we had local food at a "restaurant" that was owned by a man from an island you could see from the beach, and ate some great local food:
T made a friend (I even held a hermit crab...not kidding). There is some insane number of hermit crabs on this island, just look at a piece of beach and it will start moving:
And we saw the "American swimming pool," so named because the Americans made it in other endeavors not intended for recreation:
To top the day off, we visited Mele Falls and Cascades, which has to be the most photogenic river/stream ever:
A little past that point, we had to cross the river multiple times to get to the top, and that combined with the waterfall spray from the larger falls was too dangerous for the camera. It was awesome, though.
We decided to go that evening to the hospital, and spent about 5 hours there attending to women in various stages of labor, none of whom delivered by the time we left just before midnight.
I still didn't work on my business plan. Tomorrow is another day (as is the next day...and the day after that...)
Efate, the island we're on, contains several paved roads in the main area (Port Vila and immediate surroundings); after that, the road is unpaved. The government is working on a sealed road to circle the island, but is nowhere near completion yet. Our driver did a masterful job of remembering that his passengers were pretty much used to flat, even, not-water-covered roads.
We got out at a beach mid-morning where we swam in crazy variable-temperature water, stared at a few fish, and drank/ate coconuts. We stopped to look and play at a banyan tree:
At lunch, we had local food at a "restaurant" that was owned by a man from an island you could see from the beach, and ate some great local food:
T made a friend (I even held a hermit crab...not kidding). There is some insane number of hermit crabs on this island, just look at a piece of beach and it will start moving:
And we saw the "American swimming pool," so named because the Americans made it in other endeavors not intended for recreation:
To top the day off, we visited Mele Falls and Cascades, which has to be the most photogenic river/stream ever:
A little past that point, we had to cross the river multiple times to get to the top, and that combined with the waterfall spray from the larger falls was too dangerous for the camera. It was awesome, though.
We decided to go that evening to the hospital, and spent about 5 hours there attending to women in various stages of labor, none of whom delivered by the time we left just before midnight.
I still didn't work on my business plan. Tomorrow is another day (as is the next day...and the day after that...)
Tuesday, March 17, 2009
Maybe it's the Barometric Pressure?
I came in late today, a little after 8am rather than at shift-change at 7am, only to find out I'd missed three births in that hour. I got there just in time for a birth, and had finished postpartum (got baby's shots done and latched on, everybody stable) and moved on to measuring babies by the time T arrived at the hospital. It was VERY HOT at the hopital today. Even the midwives and staff, who normally are fairly impervious, were sheltering in the delivery rooms or fanning themselves.
A twin mom arrived around 11am, was asked (it looked like the 5th or so time according to her chart) if she really wanted a c-section - they were actually game for a vaginal delivery, breech first twin and all, not that the doctor tried to sell her on the idea at all. Despite the fact that she was a multip in labor, they scheduled her c-section for 2pm.
In the meantime, T and I did a birth together; T caught, I assisted, and one of the midwives observed.
As we were finishing that up, we saw the twin mom getting wheeled off a tad bit early for her section. We ran off down the hall in pursuit, changed into scrub-dresses and crocs (the operating-room uniform, oddly enough) and arrived well before the doctors did. The first baby came out breech and pretty much fine, the second the doctor had to do an awful lot of fishing-around for. Both received PPV long after they stopped needing it (what on earth that was about, I don't know). Two decent-sized (2.7k and 3.2k) babies, a boy and a girl, looking slightly undercooked; this mom's first baby had been 4.4k. Multiply those numbers by 2.2 to get pounds, I'm too lazy...
There were three more moms in labor when we left, none of them particularly close to delivery. One of them had brought along a husband/boyfriend/something that was actually involved in labor support and excited to see all the new babies, something men around here aren't very active in at all. Sadly, I am pretty sure he got shut out of the delivery room, although he didn't look upset...just excited about all the babies he was seeing come through the ward.
T got some pictures of the twin c-section, look at her blog (link to the right) to see if she posts any!
We left the hospital in relatively good shape, and made it back to the "resort" before a major rain hit. Maybe that's why so many women were in labor today.
I am missing my family tonight, after BittyPrincess had some tears while we talked on Skype. I'm taking some solace in the fact that she probably wouldn't have started up if she hadn't been shushed because she kept interrupting everybody else to shout random things at me.
The business plan - this is a school assignment - needs some work tonight, as does the senior paper. Tomorrow, a day off, and a touristy around-the-island excursion for T and me.
A twin mom arrived around 11am, was asked (it looked like the 5th or so time according to her chart) if she really wanted a c-section - they were actually game for a vaginal delivery, breech first twin and all, not that the doctor tried to sell her on the idea at all. Despite the fact that she was a multip in labor, they scheduled her c-section for 2pm.
In the meantime, T and I did a birth together; T caught, I assisted, and one of the midwives observed.
As we were finishing that up, we saw the twin mom getting wheeled off a tad bit early for her section. We ran off down the hall in pursuit, changed into scrub-dresses and crocs (the operating-room uniform, oddly enough) and arrived well before the doctors did. The first baby came out breech and pretty much fine, the second the doctor had to do an awful lot of fishing-around for. Both received PPV long after they stopped needing it (what on earth that was about, I don't know). Two decent-sized (2.7k and 3.2k) babies, a boy and a girl, looking slightly undercooked; this mom's first baby had been 4.4k. Multiply those numbers by 2.2 to get pounds, I'm too lazy...
There were three more moms in labor when we left, none of them particularly close to delivery. One of them had brought along a husband/boyfriend/something that was actually involved in labor support and excited to see all the new babies, something men around here aren't very active in at all. Sadly, I am pretty sure he got shut out of the delivery room, although he didn't look upset...just excited about all the babies he was seeing come through the ward.
T got some pictures of the twin c-section, look at her blog (link to the right) to see if she posts any!
We left the hospital in relatively good shape, and made it back to the "resort" before a major rain hit. Maybe that's why so many women were in labor today.
I am missing my family tonight, after BittyPrincess had some tears while we talked on Skype. I'm taking some solace in the fact that she probably wouldn't have started up if she hadn't been shushed because she kept interrupting everybody else to shout random things at me.
The business plan - this is a school assignment - needs some work tonight, as does the senior paper. Tomorrow, a day off, and a touristy around-the-island excursion for T and me.
Settling In
Another day in the hospital today. It seems like the staff there, and the women too, are getting used to us (maybe as the staff increasingly acts like we just belong there).
On our personal development/learning agenda, I think today turned out to be intake day. Several women - all but one of them primips - presented over the course of the day in varying states of labor-or-not. One woman at 41w5d had misoprostol placed. One woman at 19w presenting with lower abdominal pain remained pretty much unexplained, the assumption being infection. We admitted two women, sent two home with half-hearted dehydration not-labor. Another midwife finally admitted a primip in good hard labor, 8cm. When we told the midwives at the shift change that we were staying until she had her baby, one of them told us to break her water and have a baby. So I did. Crazy molded-headed baby boy (wun smol boy) born through moderate mec, totally happy and healthy. Mom wanted to touch her baby's head as it came out and the midwife that was supervising said no (drat!). This woman would also have been game for a wet slippery baby handed straight to her, but that's not the way it's done. Urgh.
After that, we headed off to the market, and walked home, overheated, in the dark, heavy-laden with fresh greens and groceries. We're back in the air conditioning now, drinking Tusker (local beer) and watching not-so-great Australian TV. I think the key words in that last sentence were "in the air conditioning now," though. Happily off to bed soon, to do it again.
Ah, and I'll end this post with a photo of the mom/baby from yesterday:
On our personal development/learning agenda, I think today turned out to be intake day. Several women - all but one of them primips - presented over the course of the day in varying states of labor-or-not. One woman at 41w5d had misoprostol placed. One woman at 19w presenting with lower abdominal pain remained pretty much unexplained, the assumption being infection. We admitted two women, sent two home with half-hearted dehydration not-labor. Another midwife finally admitted a primip in good hard labor, 8cm. When we told the midwives at the shift change that we were staying until she had her baby, one of them told us to break her water and have a baby. So I did. Crazy molded-headed baby boy (wun smol boy) born through moderate mec, totally happy and healthy. Mom wanted to touch her baby's head as it came out and the midwife that was supervising said no (drat!). This woman would also have been game for a wet slippery baby handed straight to her, but that's not the way it's done. Urgh.
After that, we headed off to the market, and walked home, overheated, in the dark, heavy-laden with fresh greens and groceries. We're back in the air conditioning now, drinking Tusker (local beer) and watching not-so-great Australian TV. I think the key words in that last sentence were "in the air conditioning now," though. Happily off to bed soon, to do it again.
Ah, and I'll end this post with a photo of the mom/baby from yesterday:
Monday, March 16, 2009
First Catch in Vanuatu!
This morning when we arrived at the hospital, a woman was laboring in the hall. Not quite two hours later, we were in the labor ward with one of the midwives, intending to observe. "You really wanna observe this one? You can do it?" After a brief exchange, I stepped forward and just a few minutes later, there was a baby in my hands. The birth happened just in time for the newborn room to be occupied by a veritable mob of other mamas and babies waiting to be discharged or back for weight rechecks, and this mom was (unusually) game for cuddling and nursing her unwashed baby, so we settled in for a just-slightly more American-midwifery postpartum.
Less than two hours later, with that mama/baby pair still across the hall (although washed up and about ready to move into the main ward), T caught her first Vanuatu baby.
Maybe tomorrow I'll see if the woman whose baby I caught was up for photos. For now, me logging my first Vanuatu birth in the big-book-of-births:
We settled postpartum women, rewashed labor rooms and redid beds, and left about 15 minutes before the shift officially ended. Tonight, beer and pizza by the pool, and early to bed.
Less than two hours later, with that mama/baby pair still across the hall (although washed up and about ready to move into the main ward), T caught her first Vanuatu baby.
Maybe tomorrow I'll see if the woman whose baby I caught was up for photos. For now, me logging my first Vanuatu birth in the big-book-of-births:
We settled postpartum women, rewashed labor rooms and redid beds, and left about 15 minutes before the shift officially ended. Tonight, beer and pizza by the pool, and early to bed.
Sunday, March 15, 2009
Ah, the Weekend
We spent Saturday - yes, all of it - working on our senior papers. Why I didn't finish mine in the dreariness of Seattle before coming to Vanuatu, I don't know. It was mildly gratifying that it rained/drizzled/poured on and off all day, as we worked in our "cabana" thing, or near the pool. Satisfyingly, my paper is about done. Unsatisfyingly, we didn't do anything else that day.
On Sunday, we went to Erakor Island and did some snorkeling and beach-sitting. I finished one of the books I brought with me. We ate lunch, swam again, and got back in time to do a half-shift starting at 3pm. We *just* missed a baby before we got there, did some postpartum, and then T nearly caught a baby by accident (one minute the midwife was there and the woman was not pushing, the next minute the midwife was gone and the head was visible!) By next week that scenario won't be such an issue, but this was the first birth there and we were planning to observe and assist. *A* midwife, although not the one who was supposed to be at this birth, arrived in time and we were spared that fiasco.
Off to bed, and back to the hospital in the morning.
On Sunday, we went to Erakor Island and did some snorkeling and beach-sitting. I finished one of the books I brought with me. We ate lunch, swam again, and got back in time to do a half-shift starting at 3pm. We *just* missed a baby before we got there, did some postpartum, and then T nearly caught a baby by accident (one minute the midwife was there and the woman was not pushing, the next minute the midwife was gone and the head was visible!) By next week that scenario won't be such an issue, but this was the first birth there and we were planning to observe and assist. *A* midwife, although not the one who was supposed to be at this birth, arrived in time and we were spared that fiasco.
Off to bed, and back to the hospital in the morning.
Thursday, March 12, 2009
Slow Day
Arrived at the hospital this morning to find that the woman from yesterday had delivered her baby overnight, a big but initially floppy baby ("mama say she take the kastom medicine befo she come") that looked healthy by the time we saw him.
No babies born while we were there today. More baby measuring, gauze folding, doctor-and-midwife following. The midwives shared some breadfruit with us, all pudding-y and wrapped in leaves. Encouraged us to "kakae moa." The student nurses we've befriended were having their last day, which was disappointing to us; one in particular had been trying to teach us Bislama, and they had been happy to share their work with us.
We left somewhat early. I contacted my family, finally, by Skype, and have settled in with my senior paper.
No babies born while we were there today. More baby measuring, gauze folding, doctor-and-midwife following. The midwives shared some breadfruit with us, all pudding-y and wrapped in leaves. Encouraged us to "kakae moa." The student nurses we've befriended were having their last day, which was disappointing to us; one in particular had been trying to teach us Bislama, and they had been happy to share their work with us.
We left somewhat early. I contacted my family, finally, by Skype, and have settled in with my senior paper.
Missed Triplets! Argh!
(internet is punky, updates may be scattered...)
So after that last post we hiked up to the hospital, said hello, handed over some instant coffee, and left. We went snorkelling and sat reading over senior paper materials while a rainstorm passed.
In the meantime, triplets were born at the hospital. Both the doctor and the midwife thought of us but had no way to reach us. Triplets and then a set of twins.
We could kick ourselves. Probably will.
Both T and I are hoping that our trip is not defined by this...oh yeah, Niki and T went to Vanuatu and they missed triplets because they decided to sit off their jet-lag at the beach!
Yesterday, a full 8 hours at the hospital with nothing more exiting than a woman who was 1cm walking around like she was in full-on labor when we got there, and only making it to 3cm by the time we left. We washed a couple of babies, discharged some women, restocked things, learned to use the EFM, made boards full of little ripped-up bandages, and called it a day. We sweat heavily the whole time. So fucking hot.
So after that last post we hiked up to the hospital, said hello, handed over some instant coffee, and left. We went snorkelling and sat reading over senior paper materials while a rainstorm passed.
In the meantime, triplets were born at the hospital. Both the doctor and the midwife thought of us but had no way to reach us. Triplets and then a set of twins.
We could kick ourselves. Probably will.
Both T and I are hoping that our trip is not defined by this...oh yeah, Niki and T went to Vanuatu and they missed triplets because they decided to sit off their jet-lag at the beach!
Yesterday, a full 8 hours at the hospital with nothing more exiting than a woman who was 1cm walking around like she was in full-on labor when we got there, and only making it to 3cm by the time we left. We washed a couple of babies, discharged some women, restocked things, learned to use the EFM, made boards full of little ripped-up bandages, and called it a day. We sweat heavily the whole time. So fucking hot.
Tuesday, March 10, 2009
In the meantime...
After my last blog post, it started to rain. And then it RAINED. Like I haven't seen in years, like a big push-up-the-stormdrains Hawaii storm. Kids were running down the driveway and steeper roads sending little boats made of bits of trash into the new-made rivers. We sat in our little cabana-thingy and waited, sleepily, for the rain to abate. Which didn't happen. Intent on beating the time change, we refused to fall asleep, and instead went to the pool and swam as the downpouring rain began to overflow to the deck.
A bit over an hour later (time really can crawl when you're trying not to fall asleep, can't it?) we made the decision to walk into town, rain or no rain.
This may have been a mistake. Ankle-deep fast moving water all over the roadways carrying god-knows-what. We got a few encouraging words from the locals: "you beat that storm!" in addition to the usual "hello." As we passed a school, a bus (van) sent up a mighty splash, soaking the last bits that our umbrellas were protecting. This amused the children greatly, but the way they laughed and waved felt friendly rather than mocking.
Despite all that, we had a good outing. We went into Port Vila:
We walked through the main town, made our way to the waterfront, and made a portion of our return trip along the water. There, the rain let up enough to take pictures:
Although not quite enough to explore the open market we saw there. We re-entered the town strip at the very-amazing market; so much stuff available! The exchange rate is around 120 Vatus per US dollar; the humangous(!) avocados in the picture are less than a dollar. The greens looked beautiful. Many local people were at the market eating or lounging (or doing both of those things while attending tables).
We came back to the "resort" in time to sit with the other guests at the weekly barbecue, drink a beer and have some lovely grilled fish and edible steak. We made our way back to our room (all 50 feet away), exhausted, to finally sleep.
I didn't sleep well, but I did sleep.
The coffee maker we requested apparently went to the (happy recipients at) next cabin over, so we're drinking coffee brewed in a pot until the grounds settled and then poured off the top, courtesy of T. Brilliant, I say. Who cares if it's chewy, it's caffeinated! I made some omelettes. We opened an avocado and discovered that it needed a while yet to mature.
On to the hospital today to make ourselves known.
(I don't know why some of the pictures are showing up smaller than others, sorry).
A bit over an hour later (time really can crawl when you're trying not to fall asleep, can't it?) we made the decision to walk into town, rain or no rain.
This may have been a mistake. Ankle-deep fast moving water all over the roadways carrying god-knows-what. We got a few encouraging words from the locals: "you beat that storm!" in addition to the usual "hello." As we passed a school, a bus (van) sent up a mighty splash, soaking the last bits that our umbrellas were protecting. This amused the children greatly, but the way they laughed and waved felt friendly rather than mocking.
Despite all that, we had a good outing. We went into Port Vila:
We walked through the main town, made our way to the waterfront, and made a portion of our return trip along the water. There, the rain let up enough to take pictures:
Although not quite enough to explore the open market we saw there. We re-entered the town strip at the very-amazing market; so much stuff available! The exchange rate is around 120 Vatus per US dollar; the humangous(!) avocados in the picture are less than a dollar. The greens looked beautiful. Many local people were at the market eating or lounging (or doing both of those things while attending tables).
We came back to the "resort" in time to sit with the other guests at the weekly barbecue, drink a beer and have some lovely grilled fish and edible steak. We made our way back to our room (all 50 feet away), exhausted, to finally sleep.
I didn't sleep well, but I did sleep.
The coffee maker we requested apparently went to the (happy recipients at) next cabin over, so we're drinking coffee brewed in a pot until the grounds settled and then poured off the top, courtesy of T. Brilliant, I say. Who cares if it's chewy, it's caffeinated! I made some omelettes. We opened an avocado and discovered that it needed a while yet to mature.
On to the hospital today to make ourselves known.
(I don't know why some of the pictures are showing up smaller than others, sorry).
Monday, March 09, 2009
In Vanuatu
Here I sit with my classmate/travel partner/friend (hereafter to be referred to as T) in a lovely little cottagey-"resort" room thing, after nearly 24 hours of travel time. From Seattle to LA, and there, we had less than two hours of time for us to get our bags, get rechecked and through security and onto an international flight...I don't think I've run that much since I was actually in track and doing it on purpose. And I enjoyed it way less than I used to. Luckily, we then transitioned into a hella-long (I am not even sure how long that flight was, 11 hours maybe?) flight to Fiji, which was mercifully empty; so much so that we each took a row and slept the flight away (well, most of it anyway). On to Vanuatu.
I have sweat more in the last 24 hours than I have in the entire last year. Pathetic, really. Comfortable now.
We have been to the market already. Plotting a trip to the pool later this afternoon. We will present ourselves at the hospital in the morrow, and see how that goes.
I have sweat more in the last 24 hours than I have in the entire last year. Pathetic, really. Comfortable now.
We have been to the market already. Plotting a trip to the pool later this afternoon. We will present ourselves at the hospital in the morrow, and see how that goes.
Saturday, February 14, 2009
In which Niki cleans her bathroom floors...finally
I have discovered that the surest route to a clean bathroom floor is a good old-fashioned toilet overflow incident.
Ah, the squeaky-cleanness.
Once the kids' bathroom floor was scourged, I of course had to do my own. Procrastination is a lovely thing so far as my housework is concerned.
I am a mush of conflicting emotions today. Irritated because the kids aren't getting along very well and keep bickering, satisfied because I have clean bathroom floors, frustrated because of a missed connection this morning, happy to be off call. It is odd that I can't shake an uncommonly high nervousness today. I think what I really need to do is stop procrastinating, worry over when I am going to pull out the LOs and start studying in earnest is not helping me in the slightest. Procrastinating, though, is so much more fun.
Ah, the squeaky-cleanness.
Once the kids' bathroom floor was scourged, I of course had to do my own. Procrastination is a lovely thing so far as my housework is concerned.
I am a mush of conflicting emotions today. Irritated because the kids aren't getting along very well and keep bickering, satisfied because I have clean bathroom floors, frustrated because of a missed connection this morning, happy to be off call. It is odd that I can't shake an uncommonly high nervousness today. I think what I really need to do is stop procrastinating, worry over when I am going to pull out the LOs and start studying in earnest is not helping me in the slightest. Procrastinating, though, is so much more fun.
Sunday, February 08, 2009
Of course
Of course, primip births over the weekend that my MIL, my weekend "if-I-get-called" babysitter, is out of town.
Had my first experience with a placenta that just *would not* (not after an hour, or after a crapload of drugs, or after manual removal) come out. Finally extracted a gnarly-looking most-of-a-placenta that obviously had a cotyledon missing. And off to the hospital. Luckily the 9lb babe, postterm by examination, was happy and healthy.
And I officially hate prelabor rupture of membranes when the woman is GBS positive. UGGGHHHHH. Can I officially *detest* it when she lives over an hour away, so it isn't like I can just zoom in for a dose of antibiotics and a pep talk?
I'm not feeling quite so lost at this new place now. I suppose you could say I've settled in a lot more in the past week, having done a lot more and talked a lot more with my preceptors, but I remain uncomfortable there for a variety of small reasons that aren't particularly important, but add up. I'm also not sure whether it is about a mismatch on some level or about my complete readiness to be done with this whole schooling thing. I'm not saying that I don't need more experience; I'm just saying I'm tired and ready to be done living this way.
Had my first experience with a placenta that just *would not* (not after an hour, or after a crapload of drugs, or after manual removal) come out. Finally extracted a gnarly-looking most-of-a-placenta that obviously had a cotyledon missing. And off to the hospital. Luckily the 9lb babe, postterm by examination, was happy and healthy.
And I officially hate prelabor rupture of membranes when the woman is GBS positive. UGGGHHHHH. Can I officially *detest* it when she lives over an hour away, so it isn't like I can just zoom in for a dose of antibiotics and a pep talk?
I'm not feeling quite so lost at this new place now. I suppose you could say I've settled in a lot more in the past week, having done a lot more and talked a lot more with my preceptors, but I remain uncomfortable there for a variety of small reasons that aren't particularly important, but add up. I'm also not sure whether it is about a mismatch on some level or about my complete readiness to be done with this whole schooling thing. I'm not saying that I don't need more experience; I'm just saying I'm tired and ready to be done living this way.
Sunday, January 25, 2009
Head Above Water
Three births last week. Our "not busy, taking it easy" month. There are more women in dates, only one of them actually overdue, but I have felt curiously at ease about this weekend not involving any of them.
I am feeling like a real idiot at times in this new practice. A lot of that is about not knowing how they think some things should be handled and some of that is about getting thrown a few situations I've never seen before, but that are so common that my preceptors have assumed I'd know what I was doing.
Went to an NNR renewal course on Thursday, and school on Friday, but then got home early enough to go out with ~L~, something that pretty much never happens and was really great for my mental health. I did assorted house things and grocery shopping things and played tennis with the kids yesterday (Saturday), and today I am stubbornly refusing to leave the house until the Christmas stuff is properly stowed away in neat plastic bins. Currently writing while eating hummus and very salty chips. Listening to Bob Marley and packing away Christmas decorations. Entertaining.
I lost a chunk of my senior paper when my computer died (like, it won't even power on) last week. That hurts so bad that I'm not even wallowing about it, I'm just trying not to poke at that bruise until it is mostly healed.
Pondering whether I might manage to go to Vanuatu after all.
Busy beyond busy. School assignments are falling by the wayside in the desperate scramble to get enough time with my family to make this whole thing tolerable. Somehow managing to find time for most of the things I need to do, but no energy left to think about the future, something that I really do need to get around to.
I am feeling like a real idiot at times in this new practice. A lot of that is about not knowing how they think some things should be handled and some of that is about getting thrown a few situations I've never seen before, but that are so common that my preceptors have assumed I'd know what I was doing.
Went to an NNR renewal course on Thursday, and school on Friday, but then got home early enough to go out with ~L~, something that pretty much never happens and was really great for my mental health. I did assorted house things and grocery shopping things and played tennis with the kids yesterday (Saturday), and today I am stubbornly refusing to leave the house until the Christmas stuff is properly stowed away in neat plastic bins. Currently writing while eating hummus and very salty chips. Listening to Bob Marley and packing away Christmas decorations. Entertaining.
I lost a chunk of my senior paper when my computer died (like, it won't even power on) last week. That hurts so bad that I'm not even wallowing about it, I'm just trying not to poke at that bruise until it is mostly healed.
Pondering whether I might manage to go to Vanuatu after all.
Busy beyond busy. School assignments are falling by the wayside in the desperate scramble to get enough time with my family to make this whole thing tolerable. Somehow managing to find time for most of the things I need to do, but no energy left to think about the future, something that I really do need to get around to.
Sunday, January 11, 2009
Yum
I am making a massive batch of black bean soup and it smells gooooood.
Yesterday I canned apples and they smelled good, too.
I finished a bunch of school work, which didn't smell good, but was gratifying.
And I unpacked a few more boxes, which also didn't smell good, but was also gratifying.
My Christmas tree is up, and I think that's pretty pathetic. I still have school work I'm avoiding, also pathetic.
Girliness is back from Hawaii with a mystery rash (probably viral as her lymph nodes are swollen), a bit of a tan, and many happy memories.
Yesterday I canned apples and they smelled good, too.
I finished a bunch of school work, which didn't smell good, but was gratifying.
And I unpacked a few more boxes, which also didn't smell good, but was also gratifying.
My Christmas tree is up, and I think that's pretty pathetic. I still have school work I'm avoiding, also pathetic.
Girliness is back from Hawaii with a mystery rash (probably viral as her lymph nodes are swollen), a bit of a tan, and many happy memories.
Tuesday, January 06, 2009
I Don't Waaaaannnnnaaaaaaaa
After 12 hours of clinic a day, with a one hour drive time each way, I do NOT want to do schoolwork.
I just don't.
Bite me.
MWHWHAHAHAHAHAHAHAHAHAHA.
*silver lining* I like the new clinic building. A lot. *silver lining*
The weather sucks right now.
I have a massive headache and PMSy crampy hormoney issues, and came home after 8 tonight STARVING to find absolutely no prepared food in the house. ARGH.
/random headachey thoughts from Niki
I just don't.
Bite me.
MWHWHAHAHAHAHAHAHAHAHAHA.
*silver lining* I like the new clinic building. A lot. *silver lining*
The weather sucks right now.
I have a massive headache and PMSy crampy hormoney issues, and came home after 8 tonight STARVING to find absolutely no prepared food in the house. ARGH.
/random headachey thoughts from Niki
Saturday, January 03, 2009
Found my Camera! Christmas pics!
Well, we were snowed in - and others snowed in at their respective places - so BittyPrincess turned 4 with just our family and a little homemade heart-shaped cake. She was ever so thrilled, so I guess the fact that we had to cancel the BittyPrincess Birthday Solstice Superparty didn't hit her so very hard. I think our friends - snowed in for a week or more - were harder hit than the birthday girl was. I can't believe how big she's getting, how fast.
Girliness made her a snowman, and Boyness grilled her some salmon burgers:
Our Christmas went off without a hitch. It was nearly perfect. Despite the fact that we didn't bring out nearly all of our decorations (in particular, we only lighted the patio and we definitely had enough lights to have done up our front yard), the effect was lovely and very happy-making for us.
Christmas morning happiness:
A few days later, Girliness was picked up by my dad and they flew together back to Hawaii, where she is having a solo visit for a week. She's my independent one and I'm certain that she's fine. Building memories, having fun, probably missing her mom and dad only a little bit, enjoying lots of attention from her grandparents and aunt and uncles.
On Monday, I dive back into four days a week of clinic, 9-7. I learned this holiday season that it takes me approximately two weeks of normal life to recover completely from a big burnout. I am ready to go again. Not eager...but ready. I am wanting to be done working on other peoples' terms already. I know I'm not quite ready for that yet - so off I go. The practice moved recently and I hope the new location is better. *Sigh* I can do that. 1 month down, 8 to go.
Girliness made her a snowman, and Boyness grilled her some salmon burgers:
Our Christmas went off without a hitch. It was nearly perfect. Despite the fact that we didn't bring out nearly all of our decorations (in particular, we only lighted the patio and we definitely had enough lights to have done up our front yard), the effect was lovely and very happy-making for us.
Christmas morning happiness:
A few days later, Girliness was picked up by my dad and they flew together back to Hawaii, where she is having a solo visit for a week. She's my independent one and I'm certain that she's fine. Building memories, having fun, probably missing her mom and dad only a little bit, enjoying lots of attention from her grandparents and aunt and uncles.
On Monday, I dive back into four days a week of clinic, 9-7. I learned this holiday season that it takes me approximately two weeks of normal life to recover completely from a big burnout. I am ready to go again. Not eager...but ready. I am wanting to be done working on other peoples' terms already. I know I'm not quite ready for that yet - so off I go. The practice moved recently and I hope the new location is better. *Sigh* I can do that. 1 month down, 8 to go.
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