the future

 

We moved to our current location in western South Dakota in May of 2012. Since that time I made 37 round trips (800miles each time) back to the east side of the state to complete my doctorate of nursing practice and family nurse practitioner degree. I drove in 100+ degree heat without an AC. I got the AC fixed. I drove, stopping every hour for a pee break and to prevent blood clots, while pregnant. I drove, white-knuckled, in really crappy snow/ice with a baby sleeping in the back seat. I drove through hours of crying, because what else was I supposed to do? I’ve spent many many nights sleeping in a bed that wasn’t my own, and for the last year, bringing a baby along for the ride every singe time but once. I’ve breastfed all over this state.

watching my baby grow from the drivers seat

watching my baby grow from the drivers seat

I owe my friend Karen SO MUCH (I’m still planning on paying you back!), because she’s shared her home with me to stay there when I needed to be at class and because she lovingly watched my colicky baby while I was in class. And, she brought me a life-saving care package when I was in the hospital, nearly septic, after Jackson was born.

love ya Karen!

love ya Karen!

I owe Angie, Nathel, Mindy, Karen, Darcie, Kassie, Jessie and so many others for participating in countless hours of cell phone conversation while I drove.  You’re welcome Verizon… however I will be reducing my minutes package very soon. You gals are my best friends, and you’ve seen me through so much.

he had lots of screen time with mom

he had lots of screen time with mom

I owe my family, Jesse’s family, and our extra family, because they have all taken turns helping with Jackson, whether for a day, a week, or over-night while I was suffering from a migraine. They’ve all given in some capacity to help me/us get to this point… money, time, help, food… we wouldn’t have survived without them.

I owe my husband, who has seen me through these most intense years of my life. He watched me, especially since moving, be at my lowest lows and my most enlightening highs. He’s loved me through ugly, cranky, sad, tired, and stressed. He’s taken his turn taking the baby so I could finish yet another assignment. He’s checked the oil, checked the tires, filled the gas tank and sent me down the interstate with his baby boy in tow, trusting me with his world. Trusting me to come home safely every time.

I don’t know how to repay any of them adequately… except to go out and be the best NP I can (and answering all of their random health questions). I want to make them all proud.

I laughed out loud a LOT at this ad in my NP magazine. Bahahaha!

I laughed out loud a LOT at this ad in my NP magazine. Bahahaha!

I will soon be signing a contract at the local clinic that is affiliated with the hospital where I currently work. I was terribly disappointed to decline my dream job that was offered to me last month back on the east side of the state, but unfortunately there were no transfer options for Jesse, and we made a choice to stay because it truly is best for our little family at this point. And, I am simply grateful to have such wonderful options to choose from, as not everyone is so lucky. I will start in the clinic October 1st in a family practice role… I am excited and nervous. I want to be great at my job, but I know that the next couple years will be a process of learning that is even more intense than school, because the patients are real and the decisions ride on my shoulders. It is an awesome responsibility.

lookin' all professional

lookin’ all professional

I haven’t fully realized the immense change that is about to be my life, our lives. I haven’t soaked in the fact that there is no “back to school” for me, EVER AGAIN, but instead the loans will come due. I haven’t absorbed the fact that I will no longer have RN hours, but instead will be able to count on Christmas and Easter being family time. These things will become real. We’ll settle into our new routine. Our life will continue to morph into whatever God has planned. So, with a happy heart, I look to the future!

supporting the momma alma mater

supporting the momma alma mater

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the simple. and the complicated.

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loving my son is simple. it’s easy and as natural as breathing, as involuntary as my heart beating.

but I’m not sure I’m enough.

I had to start clinicals this week. I had to leave my baby with his nanny, who loves him, but who is not me. I’m am ridiculously jealous of her. I keep telling myself to forge on, finish, and make the McMillan household a more financially stable place to live. I will not quit school. I will not give up. But I just wish… it wasn’t so complicated. I wish my 12 weeks of maternity leave from my job that actually pays me, could also be a leave from school, for which I pay. I wish I could spend every hour of every day with Jackson. My Wookie.  (I know, if I actually had to spend every hour of every day with him, I’d beg for a little break – wanting what we can’t have is tough).

I pray a lot. For strength. Courage. Compassion on myself.  I am so hard on me. I feel like a not-as-good mommy. I am tired, but I am trying.

Even though breastfeeding isn’t easy – it’s time consuming and it’s 100% dependent on me – I am considering myself more and more lucky that I can do it, and do it abundantly despite stress, sickness, and fairly extreme weight loss.  I will give him that gift. I cannot be with him every hour of every day, but I can nourish him when I am away. I am trying.

And, I am getting better at letting my husband help, he is getting better at helping. It’s a mommy thing, I think, to feel we know best, but I am trying.

One of my best friends sent me a link to a blog post about taking care of yourself as a new momma. Please, if you are a new momma, read it. I printed it off, folded it up, put it in my photo album in my pumping bag, and have it at my disposal whenever I need to remind myself that I am trying, and I am doing ok.

but on a much better, more beautiful note, these are Jackson’s newborn pictures… most handsome baby ever, of course. No trying necessary 🙂

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37 weeks. and a “birth plan”

Birth Plans. Even hearing the phrase makes me giggle. Smirk. Plans and babies. The fact that I’m still pregnant and Mr.Muffin hasn’t purposely chosen to go against my “plan,” my schedule, is a miracle.  I wrote a birth plan before I got pregnant. A long time ago, when we were still living in Mitchell, I was still an OB nurse, and we were still oblivious to PCOS. It is truly what I would like in my perfect birthing situation… it is also a total spoof on “real” birth plans. I have tweaked it since then, but it still holds the same core values.

When you work in labor and delivery you learn, quickly, that the “plan” is to have a breathing, pink, heart-beating baby.  The “no Pitocin, don’t augment me, I want the whole town in the room, no IV fluids, skin-to-skin, baby can’t ever leave my side” crap goes by the wayside quickly if your baby isn’t healthy. People are TOTALLY entitled to have preferences. You are entitled to not have your baby vaccinated (but please, don’t ask me my opinion), to refuse pain medication, to have the lights dimmed, or to have your great-great grandmother in the room. Whatever, as long as the nurses and physicians can keep you and your baby safe, most anything can be kosher.  (God help me, I’m speaking in the tense of a current L&D nurse, I miss that job so much!). What I learned was also, when things look scary or dangerous, the nurse will escort grandma to the waiting room.  The physician will do everything possible to make sure you don’t bleed out on the table. The pediatrician will whisk your baby away to make sure he starts breathing.  And… much to your birth plan’s surprise, you won’t care.  You’ll just want things to be okay.

So, in honor of being “full term” here is my birth plan:

birthplan1birthplan2

happy full-term week to us. anytime now, mr.muffin. anytime.

update

I went to bed last night feeling not-so-easy about the appointment yesterday. Today when I ran into the ultrasound tech, I asked him if we could squeeze me in today, despite the fact I was supposed to be working (my lame excuse for scatter-brained nursing that I was performing up to that point). He said he had an opening and my co-workers squashed my guilt about leaving them with a little extra work for an hour… I think they knew if I got a little reassurance, I would come back a more normal version of me. So I waddled down to the ultrasound room.He doesn’t have hydrops (the radiologist in me says so) THANK YOU JESUS.  Anatomically everything looked pretty good. I even got to see his little out-stretched hand for the first time (he had always had his dukes up in fists for ultrasounds). His heart is taking obvious pauses, about every 8-20 beats of so.  My nurse brain says, “it’s fine. quit worrying.”  my mommy brain is more concerned, but still super, duper relieved he doesn’t appear hydrops-y.

I have an appointment with the perinatologist next Thursday for a fetal echo… if I’m still pregnant at that point.  At least that will tell us if this is a physiological (caused by something normal) or pathological (caused by a problem) problem.  Until then, we wait. And pray. And be positive.  If it is something, or is the sign of something, we’ll deal with it.

hello everyone!

hello everyone!

epidurals

ah, the great divide. the epidural.

As I am quickly approaching my estimated date of confinement, my due date, I thought I would share some thoughts on pain management during childbirth.

An epidural is simply analgesia that is continuously injected into the epidural space, near your spinal cord, via a very small, flexible tube.  This medication, when placed correctly into the epidural space, numbs the area of injection and down, working mostly on a gravity basis, and can be stopped and pulled out at basically any time. This definition is mine, not a book’s, not a website’s, but how I know an epidural works.epidural

In my experience as a nurse, the “best” epidurals leave you with the pressure sensation (the medication CANNOT take that away people, no matter how many times you press that button), will numb the pain, and will still allow you some ability to move your lower half independently.  There are, of course, MANY variations to the outcome of a successful epidural – from great lower half movement, to complete “dead weight,” from still feeling pain, to absolutely no idea you even have legs because they are so numb. Sometimes the recipient of the epidural (or their significant others and family), doesn’t understand that an epidural is not a super-duper scientific thing – that the biggest factor is typically the patient’s anatomy and physiological response to the medication, NOT how the anesthesiologist put it in there.  While there is some room for adjustment or the option of replacement, typically, what you get is what you get – in my humble experience, of course. I am not an anesthesiologist. Or CRNA. Just a lowly nurse.

 

Anyway. What you are all dying to know. Am I planning on getting an epidural? Let’s explore that question.

I am not planning on not getting an epidural. Which means I am undecided. Which means, I will probably get an epidural. Here’s why:

  1. I am NOT afraid of getting an epidural. I am much more afraid of a cesarean.  Or hemorrhaging.  Or my baby coming early. An epidural, like any medical procedure, is generally safe. There are risks with everything, including an epidural. But childbirth is risky despite the epidural factor. Walking across the street is risky, too. That’s life. (Thank you Dr.VanRatface who drilled that into my head). Sometimes modern medicine is awesome. Epidurals are proof.
  2. I am not my grandmother.  My cousin, among many women, was quoted saying, “my grandma had babies without an epidural, and so can I.” And she was right, and she did it. YAY. Same baby, either way.  Here’s the thing… I’m pretty certain my grandfather has also had teeth pulled without anesthetic. Because he was a poor kid. And that’s just how they did it. Not because he was “tough” or really wanted to experience pain, or because rotten teeth are a “natural experience.” No, it was because it was pull it or become septic from a bad tooth.  Almost anything can be done without analgesia, but WHY in the world would you choose pain? Same baby, people, you get the same baby. They are not cuter or smarter based on your level of pain. Also, I’m pretty sure my grandmother delivered more than one baby in a state of twilight sleep. Which is analgesia, and much more dangerous that an epidural. Just sayin’
  3. This is my first baby. Let’s just say, this little boy will be plowing a new path. Those tissues are inexperienced to childbirth, they aren’t going to like it.  And a perineal repair, while it can be numbed by lidocaine, has appeared to me to be much less devastating if you have an epidural infusion running, numbing those tissues, and preventing the extra swelling that happens when you have to shoot those tissues up with lido… it’s not cute. I’ve seen women scramble towards the head of the bead, away from the doctor, with the lido injection after delivering a baby without pain medication.  That should tell you something about how much fun it is to get needles in your va-jay-jay after delivering a baby.
  4. Plus, the first labor is typically the longest. While I can endure pain in the short-term okay (I choose running for a hobby for goodness sake), I will wimp out after a few hours. I just will. I know and accept this about myself. Not to mention, for the sake of my husband, I don’t want to be a b*tch for a million hours. I want to look back and say, “yep, it hurt. yep, I got an epidural. yep, life was MUCH better after that.”
  5. IV pain meds are dangerous. Ok, maybe not dangerous, but much more touchy and much less effective. AND for those of you who choose to not get an epidural because “I don’t want my baby to get the medicine.” HAHA I say. Epidural medication does not go into the mother’s blood stream, so it sure as hell doesn’t go into the baby’s. Ask a doctor. They’ll tell you the same thing.  However, when you ask for IV pain meds, which are narcotics, they do go to you AND your baby. And stay in your body for a while. And make women (and the baby) feel sleepy or nauseous or dizzy. Not necessarily a perk in labor. Epidurals don’t do that. And you may need more than one dose of IV meds. And an epidural only targets the lower half of the body, you know, the part that hurts.  Perks!
  6. Just in case we need a C-section:  If we need to do a STAT, emergency cesarean, and I already have an epidural in place, there is a better chance they can “dose up” my epidural with stronger medicine and I won’t need general anesthesia. So I’ll get to be awake and hear the first cry. Of course, no guarantees, but it does help my chances of being awake in that extenuating circumstance. Let’s hope this reason doesn’t matter though.
  7. Breastfeeding might go better: because there is a good chance I can nap a little with an epidural before I need to push, so I’ll be (a little) less exhausted, and more focused on breastfeeding. It’s going to be clumsy and awkward not matter what, but epidurals don’t  make breastfeeding worse.
  8. I could do it, but I doubt I want to. Can I have a baby without an epidural? Yep! Do I want to? I doubt it.  Maybe I’ll surprise myself and handle things well. Maybe I’ll be dilated to 6 cms when I arrive at the hospital and know that I can gut out the last 4. And pushing. And a perineal repair (I’m obviously counting on one of those, whether by tearing or an epis).  BUT, because I am on the fence, I’ll probably ask for an epidural. Almost EVERY wishy-washy patient I cared for eventually asked for an epidural.  If you are planning on not getting one, and delivering in a place where they are available, DO NOT BE WISHY-WASHY. You have to be convinced 100% you don’t want it. And be concrete.  The nurses don’t like watching you hurt.  Your hubby does not like watching you hurt. And believe it or not, the doctors don’t typically care either way, but they DO seem to hate coming into a room of psychotic screaming to deliver a baby.  So, if you adamantly don’t want an epidural, GOOD FOR YOU, but prepare yourself. The moment you cave a little, everyone is going to willingly put you out of your misery and let you get an epidural.

This whole post is my opinion, based on my experiences.  Everyone is allowed to have  their own opinions, make their own choices. If you don’t want an epidural, for whatever (crazy) reason, it’s absolutely okay. And cool with me. I was always super-duper impressed and inspired by those women who delivered without an epidural on purpose (I would come out of those rooms and be all, “YEAH! I don’t need an epidural!!”). But realistically, I’ll probably get one.  And that’s okay, too.  I won’t be any less of a woman. My baby won’t change from the little guy he is meant to be.  Life is made of choices, risks, and all sorts of stuff we can’t control.  That’s how it is. My whole life path will doubtfully be changed based on getting an epidural or not for this delivery.  So, I’m not going to worry about it (very much).

the flu

O.M.G. you guys. I took care of a 6 year old little girl Sunday morning in the ER who had the stomach flu. I wore gloves and disinfected every surface like a Nazi. Sunday night I went to sleep at 9pm. At 10pm I woke up with terrible nausea. I haven’t been nauseous this whole pregnancy. My nausea must have been annoying the baby, because he started moving and moving and moving. Which made the nausea worse. Pretty soon I was up and puking. And then the diarrhea started. Worst night in a long time. Called in sick to work by 11pm. Didn’t get more than 15-45 minutes of sleep at a time all night. And I kept getting contractions when I’d jump up to run to the bathroom.
By morning I called my OB and my PCP in town. Went in for IV fluids and meds to stop the nausea. My PCP was worried about PTL… but I said I just needed fluids. And promised if the pain and cramps didn’t go away after the fluids and a nap, I’d go to the OB floor for monitoring. Went home, slept almost solidly until this morning. With the exception of eating a little chicken noodle soup. And texting my boss to tell him I wouldn’t be at work tomorrow. Because that makes sense, right? To not go to work if one can’t even eat toast? Especially to a boss who’s a nurse. Who also got a note from my PCP confirming my illness and excusing me from work.
(I try to not use this blog as a rant-hole. warning: rant in process). HE sends me a message back asking if I will make it to the “mandatory” in-service the next day (today) at 2 pm. I said, no, not unless I feel a million times better. I fell back asleep then. And woke up this morning to a text that said, and I quote, “So you are requesting to be absent from your shift and a mandatory meeting?” WTH? I couldn’t even reply without being snotty. So I didn’t reply at all. BUT SERIOUSLY? Like I requested to get sick? I still am not eating well. My pee still looks almost orange. I still don’t have the energy to get off the couch. And MAYBE if I wasn’t pregnant I would try to go to the meeting… BUT I’m in charge of 2 lives here, and the responsible thing is to get healthy before going 100% again. Not to mention, this is a pretty catchy little virus, does he really want everyone I work with exposed??
Needless to say, I’m really mad about it. And hopefully getting it off my chest on the blog will stop me from telling him this to his face. My husband suggested I ask him if he want to share a glass of water with me. If he wants the flu? Anyway… the moral of the story is I am NOT going to the stupid mandatory meeting. I followed the correct channels. I have an excused absence due to illness. And I’m doing what’s best for me and my baby.
Hope everyone else feels better than I do this week!

baby belly… public domain

this week was pretty standard, school and work.

but something, well, fun started happening at work this week. The old people starting asking me about being pregnant.

I think I’ve looked obviously pregnant for at least the last 7 weeks. but scrubs are forgiving and hide things (both good and bad) pretty well. so, at work the only ones who would make comments about my growth were co-workers who knew what I “normally” look like. However, in the last week I’ve have a 90-year-old women who had no idea about many things going on around her look me straight in the eye and ask, “Are you PG?” haha. yes, mama. and then an old man waited until I had both hands busy opening his pills, reached up and rubbed my belly! at first I was a little shocked, but seriously, it was so dang cute. these little things haven’t stopped since.  my elderly patients LOVE talking about me being pregnant. they want to know gender and due date and names. They have no filter. They’ve let me know how to be a parent and how to love a child.

In the everyday normal world this would probably get annoying. But with my patients, it makes them happy, so it makes me happy. they want to remember being young, they want to connect with that, and I guess this baby-belly reminds them. in fact, a woman I cared for this week will be almost 100 years old this September… she really, really wants me to deliver on her due date and let her know all about it. Just another thing I love about nursing.

so, this week, in honor of the sweet elderly population, I didn’t change out of my scrubs to take the picture.

26wks

OH, guess what else????? if you’d followed my previous blog about trying to get pregnant, you might remember a story of how much I struggled to tell one of my friends when I got pregnant because she was struggling with sub-fertility, too??? She’s due in December!! YAY! It’ll make going to class a lot easier again, since we will be back on some common ground, but gossiping about breastfeeding instead of semen analyses. It sucked when it felt like I had something she didn’t, and every time I saw her, I felt like I was hurting her feelings by just being there. It is such a stinky thing to be pregnant when someone else wants to be, but isn’t.

I have one more close friend who is still striving to get there. Breaks my heart, because part of me knows. I know we didn’t have to try as long as some. I know I get to feel the rolling around of our little boy everyday, and it heals some of the pain of those months when I thought I’d never be here… BUT, anytime you have to use science to get pregnant (I was on multiple medications) it loses its intimacy and spontaneity. It becomes everyone else’s business. And it sucks. SO, I’ll keep praying, and I ask you to do the same as she and her hubby continue to pursue parenthood.

-a.

green pokadot tankini

there’s no rest for the wicked. or the grad student.

today my husband, my student-loan-paying-full-time-working-not-in-school-anymore husband, left for the east side of the state to spend memorial day weekend fishing and bbq’ing.

I, on the other hand, have to work the next 4 days, so I stayed home.  And today, I could come up with (and should not come up with) no more excuses to ignore working on my final paper and project for school. but it’s so nice out… so I compromised. I compiled my paperwork and highlighter, found a beach towel, and put on this sweet green poka-dot tankini number…

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{which I got at a second-hand store and is in mint (green) condition BTW 🙂 }

and I did research.

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whalla. sun and studying. bazinga.

and if any of you are super interested in using text messaging reminders to increase completion of HPV vaccination series among adolescents, please feel free to be my research assistant.

have a great weekend (and try not to do anything silly that lands you in the ER…)

-mcmanda

“nurses week”

we each attach our identity to some thing. we’re all something. “i’m a runner.” ….  “i’m a Christian.”  ….  “i’m a nerd.” …. “i’m a wife.”

When I was 18, well, I was 18. I really didn’t have an identity. I was a college student. I loved to run, read, and write. (funny, how 10 years later, i’m still a college student, but with less reading, writing, and running time). my dad really wanted me to go to pharmacy school.   really, really, really.  So I went to a private out-of-state college and double majored in chem and biology. (barf, right?) I had a very cliché’ freshman year of college, but luckily didn’t cremate my GPA and managed to stay on the track team. After that, I transferred to a state school close to home back in South Dakota and majored in pre-pharm. For about 2 weeks.

Right before my sophomore year of college I had interviewed for a job as a nurse’s assistant at my hometown nursing home. I can’t even begin to tell you what kind of nightmare job that had always been in my head… I was terrified of old people. And when I was in high school, my mom implanted doubts about my ability to care for other human beings due to my selfish, adolescent attitude.   (in all fairness, I was quite the little bitch for a while there). Back to the story. I applied for the CNA job, got it, and believe it or not, LOVED it. I loved going home at night, being exhausted, but feeling like I had made a real difference (you don’t really make an important impact serving ice cream at Dairy Queen…) I’d helped someone. I put others’ needs before my own. And it paid me back 20-fold. So I changed my major to nursing. (I was SO nervous to tell my dad, but he accepted it pretty well). And I suddenly got a new identity.

I became a nurse. It was actually pretty magical. Lots of other crappy stuff happened in my life during that time. But nursing became me. I became nursing. I was so proud to graduate. So proud to pass my boards. Nursing is part of me. And I kinda think I’m pretty darn good at it. I’m a slow runner now. I barely have time to read anything un-nursing. And, my writing is limited to this blog, Facebook updates, graduate papers, and my charting at work. Nursing seeps into every part of me.

seriously, best job ever...

seriously, best job ever…

Being an OB nurse was extra-extraordinarily special. When I worked at the nursing home, I was there multiple times as people’s souls departed this earth. It was an honor to be there at the end of those lives. But the miracle of birth? Nothing beats it. Nothing.

I’ve heard so many very first tiny cries. Seen young ladies become mommies and young men become daddies. Watched toddlers become big brothers and sisters. I’ve actually delivered babies when the doctor couldn’t quite make it in time. Best rush ever! And yes, I’ve seen some bad things, too. Those days sucked. But, as a general rule in nursing, the good out-weighs the bad. Every day there is good. Every day God shows us why the human race is. It makes you grateful. Humble. Small. Selfless.

In a few months, I’ll gain a new identity. I have a feeling I’ll feel even more grateful, humble, small, and selfless. I’ll be a mommy. Which, in my mind is a nurse on steroids. I’m sure I truly can’t fathom it yet.  I’m not sure my heart will be able to handle all of it, but I’ll learn.

I’m nervous about trying to separate nursing and motherhood in my mind. But they are the same in so many ways. Responsibility for a life.  Doing the right things, the best things I know how to do. I’ll learn every day. I’ll cry sometimes. And think I suck and I fail some times. I’ll be peed on, pooped on, puked on, bled on. I’ll have to explain things I don’t quite understand. I’ll need help, need my hubby to take over, need a vacation. But, in the end, I’ll be sucked right back. I love being a nurse. I’ll love being a mom. Maybe that’s why they put mother’s day and nurses week together… because they are kinda inseparable.

So, hug your mom. Hug your nurse. They both want the best for you.

-amanda