Yawn

It is 10pm and I just got back from work 10 minutes ago. I was there since 6:45 am. I got one 15 minute break.

We are switching to computer charting, and this was my first "live" shift. Wowsers :-o My head hurts.

My hubby was in bed when I left and when I got home. So were my kids. I basically live to give my kiddos cuddles before bedtime (it is one of my favorite times with them), and to cuddle up with my husband before I go to bed. So it was sad that he was already sleeping. I knew the boys would be in bed. Hopefully they will forgive me for not seeing them at all today.

They want me to work again tomorrow. They are really short, so I feel guilty. If I didn't have kids, I would have said yes in a heartbeat, but tomorrow I am going to cuddle with my boys, and see my hubby a little as well! :)

Juggling Work and Mommyhood

21 weeks pregnant in my work scrubs

So this is a blog of a wife AND nurse AND twin mom, and I have been writing about mainly the twin mom part. A reader called me out about that lately, and she is right. So I am going to make an effort to round out the blog a little and write about the other aspects of my life.

I still work one day a week in the NICU. I don't have a set day, I just try to schedule myself when the unit is shorter on nurses. I enjoy my job. The hours are long though. I wake up at 5am the days that I work (on my days off I get up at 7 and the boys get up about 7:30.) I leave around 6:15 with the house completely quiet and asleep. Both grandmas come over to babysit the boys while both me and Alan are gone. They get here at 7:30. Then one grandma will leave when the boys take their nap (around 1pm) and the other stays until Alan gets home at about 5:30. I get home about 8pm. This actually works really well, and I don't feel too guilty about leaving, and I know they are well taken care of.

When the boys were smaller, it was a lot more complicated, and I honestly think maternity leave should be 6-9 months minimum. I knew the boys just needed their momma (they did nurse 12 out of 24 hours!!) I would nurse them before I left, or as they started sleeping through the night, I would pump their morning feed and leave it in the fridge before I left.) When the boys started sleeping longer stretches at night, It was very very hard for me to get up when they were sleeping. Sleep is so precious during that time! When the boys were not sleeping through the night, the grandmas came at 5:30am so both me and Alan could get ready, because sometimes they thought morning was that early. We are very blessed that the grandparents live so close and are willing to help out. Then I would pump 3 times at work (gradually I got down to twice, then once.. and then none at around 13 months). During the early months, I wondered how ANYONE works more than one day a week with kids. In some ways it may be easier, because it truly is like "time off" from your mommy job, but there would have been no way I could have kept my supply up enough to keep exclusively breastfeeding. Kudos to those moms that do that. Also there is no chance to squeeze in a nap at work during those early months either.

I still haven't decided if being a mom of twins has made me a better or worse NICU nurse. I have way more opinions now than I did before, and not all of them jive completely with all of our policies. Also I personally thought twins were very difficult, and I really don't want to scare our brand new twin moms. But I am not as judgmental as I used to be. And I can really empathize more with some of the things the moms are going through. Also if I am having a shaky relationship with a NICU mom, I sometimes mention I am a mom of young twins who spent some time (just about 8 hours) in the NICU, and that usually gets them to trust me a little more. It is kind of cheating, but not really because it does help me understand them better.

My favorite part of my job is being able to support the parents. Also I love positioning the little tiny babies in the isolettes, the ones that are too little for clothes or swaddling (about 28-32 weeks) because they need to be on "servo control", so they have tons of positioning aids to position them like they are in the womb. I love making them all nice and comfy in their isolettes :) I also love cuddling the "chronic" babies that were born in the 20's gestation but are now 32+ weeks and still needing support... They are old enough to really look in your eyes while you hold them and really melt your heart. For all these reasons, and also seeing my fellow nurse/nicu friends, I really like my job.

But I still miss my sweet boys when I am at work. I never see them before I leave for work, and sometimes they are asleep when I get home. (That is really sad). So I try to have Alan keep them up until I get home. They are SO SWEET when I get home from work. They are always so happy to see me, and usually run up to me and give me huge hugs. It makes me happy.

Me and Matthew

Me and Adam cuddling (he is my Momma's boy :))

Sorry for my baby fat belly in these pics... I also need to write a post on post -baby body image ;)

Me and Adam

And here is Adam and his Granny Bee who helps watch him while I am at work.

Working, working, working

There are some days I really enjoy my job. Like today! I am really blessed to have my dream job of a NICU Nurse. AND I'm blessed to work only one day a week, and spend the other 6 with my precious babies. I feel having children of my own really helps me support other mothers better, especially other twin moms. I also really enjoy the interaction with the other NICU nurses (ie: adults ;)

On the downside, my frozen milk supply is completely gone :( There is no milk in my freezer for the first time since the babies were itty bitty. There is only the milk I pumped today. I am okay with supplementing with formula for the two or three shifts we have before the babies turn one. I have finally realized I am NOT super mom, and that is ok :)

We will probably breastfeed for several more months though, because we all love it. Today when I got home from work, Alan had just finished putting the boys to bed. Adam must have heard my voice though, because he started crying. I went in and nursed him, and he seemed to just melt into me. He quickly passed out, and I just stared at his sweet exhausted face for a while before putting him in his crib. :) (They go to sleep on their own really well too... I am working on a post about our experiences with sleep training.)

The NICU is a dangerous place to work though... if you are trying to wait to have children, or trying to space out your kids. I have started getting baby fever again ALREADY because of taking care of those little tykes. Especially those that are close to going home, but are still growing & learning to eat. They just sleep, eat & cuddle. So well behaved and ADORABLE. I was seriously about to come home & give my husband the, "I'm ready for another baby" talk.

Of course our babies were not so well behaved for him today (they had to pick today!), so I postponed that talk :)

Working while Preggo

Before I got pregnant, my plan was to work full time until I delivered. (That would be 3 twelve hour shifts a week). That's on your feet!! I am so glad I didn't do this. Earlier this year I requested to be put on the list for part time... (for after I delivered) and I was offered the position right away. So I have been part time (2 twelve hour shifts/week) since around February of this year. Which has been awesome for being pregnant! I have been able to pick up some extra shifts & do some required education stuff without overdoing it.

However.

Now I am 30 weeks pregnant with twins. I am humongous. I have probably 7-8 pounds of baby in there already. (Not to mention the two separate swimming pools I am providing them.) My feet hurt when I stand too long. I have pelvic pressure when I stand too fast or too long. And my contractions increase when I stand too long. Not to mention I get tired soo easily now it is pathetic!!

Last Wednesday at work, I actually requested an easier assignment than they had assigned. I
got the easier assignment, during which I was able to sit quite a bit. However, that day was also the deadline for some audits that I do for the unit, and the last day to do this required central line education seminar. So even though all my body wanted to do was go home and sleep from about 4pm on, I was on my feet taking care of my babies, completing the audits, and then I had to stand on my feet at the education thing (after my shift was over). I got home around 8:15pm.

It seemed like that last bit of standing on my feet was really not good for me. I started to almost feel crampy (which I knew was not good), and I was having a lot of contractions. It was actually uncomfortable contractions (usually they are painless). I knew I just needed to go home & lay down.. so that's what I did. It really took me about 3 hours of laying down before I felt better. (Of course if I hadn't started to feel better, I would've called the hospital). Alan took care of me and brought me food during this time. :) I could get used to being pampered :) That experience was very scary for me though. I thought my water was going to break, because of all the pressure I was feeling, and it really made me think I should start me leave from work. Alan really thinks I should start my leave too.

Taking leave from work when you are only 30 weeks pregnant though is not easy. Especially if you want to come back to your job. You can only take 12 weeks off with your job guaranteed. And I'm not sure if I can even start taking off without a doctor's note. Soo.. I may just wait until I see my doctor again & see if she will give me a note. That's only two more shifts at work. I can do that right? I was scheduled to work today, but I requested to be cancelled. Thankfully they cancelled me, because I ended up sleeping in until almost 12:00. (Would've had to get up at 5:00am for work). That's seven extra hours of rest that I was obviously needing! In fact, I probably would have slept longer, but Alan called me at about 11:40 and asked about lunch. I told him I would make something simple since I needed to get up anyway, and I needed to eat. :P

So I am kind of back and forth right now. I enjoy my job & I like my coworkers, I just don't think I can physically work much longer. I really hope my doctor agrees with me and gives me some kind of note. Oh, I also wish there were different laws for multiples pregnancies. Like extra time off. Because if I take extra time off to take it easy before they are born, that's less time I have with my two babies after they are born. (Even though I'm only planning on going back 1 day a week). Sigh... America needs to get on these laws. Because even though I want to go back 1 day a week after I have the babies (the grandparents would take care of them, and I would get some time away)... I would really like at least 3 months at home with them before I do that. Which I probably won't get if I start my leave early. So complicated :-/

Ramblings

I am looking out the window here at the hospital (yes, I'm blogging at work... I'll get to that), at 6:15pm and it's already dark outside. That threw me off guard! Boo to going back to Standard time. And this morning, sunrise was still 30 minutes off as I was driving to work. I do not like missing all of my daylight hours. :( I love the long days of summer :)

I have time to blog here at work because I am only taking care of ONE baby today. He is in isolation because he has (or had) a "superbug" that we don't want the other babies to catch. So, lucky him, he has his very own nurse. He is a cutie, and I've been able to spend a lot of time holding him (unfortunately I don't think he gets held very often)... but one sleepy baby is not enough to keep me busy for 12 hours! (I'm sure I would be busy for that long if I had a baby of my own at home.. but there are other things to do there.. and this baby sleeps all the time, lol). So this has been a looong day, but also a nice break from all the craziness that can happen around here :)

On a side note, my husband has been earning lots of brownie points lately. I also worked yesterday (I don't usually work Sundays), and I got home to all of the laundry done AND hung up (he always does the laundry, but sometimes we hang it up together), and he had ordered a pizza for us (not the healthiest meal, but I didn't want to cook, lol). Then this morning, he got up at 6am (as I was leaving) to take out all the trash, and he deep cleaned our cat's litter box (big job). I married a good one <3

Chronic Babies

Almost sounds like a juxtaposition... "Chronic Babies." Babies shouldn't be old enough to have a chronic condition already!

But that's what we call our babies in the NICU that were born 3-4 months early (about 24-26 weeks gestation) and continue to have medical problems that prevent them from going home as they approach their due date. The most common problem they deal with is their premature lungs. Premature babies are born without all of the branches of their lungs fully developed, and the lungs do not grow as well once they are out of the womb, leaving the baby without enough surface area to transfer oxygen to their body. They are also born without Surfactant, a molecule that keeps the lungs open when they breathe out, so their body doesn't have to reopen our lungs every time they inhale (This is so much work that their bodies would just shut down.) The only way these extremely premature babies survive is by giving their mom's steroids before the baby is born (which helps the baby make surfactant) and by giving the baby surfactant directly into their lungs when they are born.

Of course no medical breakthrough is as good as the babies developing fully in mom's belly. These babies usually need extra oxygen (via nasal canula of bubble CPAP) for months, and often even after they go home.

And that is why I am so exhausted this week! I have been taking care of babies with Chronic Lung Disease this week, and they are a handful!

They are not happy about having something on their face giving them oxygen, so they will knock it off, and their oxygen saturation will decrease to 50% (usually when I am busy taking care of another baby), so I will have to quickly save the baby (who doesn't want to be saved based on the fight she puts up) and go back to what I was doing.

These babies as a general rule don't like to be touched at all, because throughout their little lives, they have associated touch with painful medical procedures. :( This makes even taking a temperature or changing a diaper a struggle, because the baby will fight (and they are strong) and cry (loudly). After I finish my cares on one of these babies.. I wrap them up nicely and give them a pacifier and calm them as much as I can before moving on.

In the Pod I was working in this week, 3 out of the 6 bed spaces had these chronic babies. So all day we heard the beeping of the monitors when the oxygen saturation dipped... on 3 different babies. I went to sleep last night hearing those beeps in my head. Beeeep beeeep beeeep. Lol.

At the end of the day though, I enjoy taking care of these babies. You really get to know the babies. I love it when (after nothing at all will calm them down) I pick them up and they cuddle into me, and instantly settle down. That melts my heart every time.

Update

I am exhausted today, but I feel like blogging. It has been a few months since my last update, but it feels like more because of all of the changes we've been through! Here are some of the highlights that have happened over the last few months (in rough order).

• Someone broke into our apartment. They stole some money, checkbooks, passports and jewelry.
• I had a stressful, emotional week at work that involved some tears on my part.
• We started looking for a house before our apartment lease expired.
• We chose and closed on a home.
• Before we moved out, a fire destroyed a building in our apartment complex (our apartment was thankfully unharmed)
• We moved into the new house.
• Deep cleaned the apartment and turned in the keys.
• Set up the new house! (Still finishing up decorating, and one of the guest bedrooms is still full of boxes... it's a work in progress!)

And finally, yesterday we had a Mother's Day Lunch for my mom and Alan's mom. We had my family over and Alan's parents.  We ate, talked, and played pool/ping-pong. It was great having everyone over, enjoying themselves. After yestday, then staying up late watching Survivor (guilty pleasure), and then getting up early and working 12+ hours today, I am exhausted. Tomorrow, it's work again, and then one day off to pack for our one year anniversary trip to Buffalo, NY/ Canada! 

So a busy few months in the life of the Orr's! 

Sad Day

Today at work, one of the babies I was taking care of died :( 

She had begun to get really sick, so after several interventions we transported her to a higher-acuity hospital. She was coding when she got there, and died shortly thereafter.

It is emotionally draining to go through this. I am really glad I have at least 2 days off to cool down. I just feel bad for the family :(

Off Orientation

So after about 4 1/2 months working in the NICU (during which I have been working under a Preceptor for guidance/asking questions/help) I am officially on my own, as of last week. I am both excited and nervous about it!! So far, the babies I have taken care of on my own have been feeder/grower babies, which are the more stable babies who have resolved most of their medical issues and are learning how to eat before they go home. I am hoping they give me some more critical babies too, to challenge me. Below is a picture that my mother in law sent me in an email. It's a good example of a more critical baby that we would take care of. It really is amazing working with these infants and their families, and I feel like I will be learning the rest of my career about the best ways to take care of them.  

Neonatal Nursing

I love working in the NICU, it's been my dream since before starting Nursing School. The premature/sick babies are so dependent on the doctors/nurses/respiratory therapists/developmental therapists to take care of them, and they are so precious!! And working with the families of these babies can be very rewarding (and challenging). One of the websites that made me start thinking about this career was http://www.allnurses.com/... which is where I found this great post about being a NICU Nurse:

You know you're a NICU nurse when...

1. You've eaten hamburger patties bigger than most of your patients.

2. You define colors by the color of stool you've seen - ex. baby poop green/yellow.

3. You don't understand why talking about sticking a needle in a baby's head is making other people at the dinner table ill.

4. At one time or another you've had breast milk, poop, or urine on your work clothes.

5. You have affectionately called a patient Cletus the fetus, wimpy white boy, troll, or FLK (funnylooking kid) in report.

6. You can change your patient's bed linens with one hand while holding your patient in the other.

7. You can make an IV arm board out of some 4x4 gauze and tape.

8. You've almost caught your hair on fire on your patient's radiant warmer bed.

9. You've used a sock or a piece of tape for a restraint.

10. You check out the scalp veins, cap refill, and fontanels on a friend's new baby.

11. You use a cotton ball to obtain urine samples.

12. You use Saran Wrap to keep your food fresh and your patients warm.

13. You think all crying babies need Benadryl, Versed, or intubation.

14. You think the pulse oximeter, CPAP, and those crappy no sticking leads were created by the devil.

15. You have ever shown a doctor a green residual while they were eating.

16. You have obtained a 10cc residual when the patient only gets 1cc.

17. You have put an intensive care patient in a swing.

18. You don't get excited if your patient has a heartrate of 180.

19. You do chest compressions with two fingers.

20. Most of your meds come in TB or 1cc syringes.

21. You prepare your patient's bath water in a Dixiecup.

22. You draw blood from your patient's heel.

23. You use a rubber band for a tourniquet.

24. You've seen two complexes on the EKG screen and not been excited - you merely pat your patient on the butt and it's all good.

25. Newborn babies look like preschoolers to you.

26. You tell people what you do and they think you sit around and rock babies all day.

27. When you tell people what you REALLY do they start to cry and/or vomit.

28. You have assisted with surgery on your patient in their bed and on the unit.

29. You have considered using duct tape to hold a pacifier in a screaming baby's mouth.

30. You have met your patient's father, mother's boyfriend, and mother's husband all in one day.

31. You have made a mental note that no matter how stupid people are, they still know how to get their groove on.

32. And lastly, you know you're a NICU nurse if you've read 1-31 and have laughed your fanny off!

(Photos from http://www.kodak.com/US/images/en/corp/1000words/lauren_640x480.jpg & http://www.jillstanek.com/pree.jpg)

My Day "Off"

Since I am an RN working as a staff nurse, I work 3, 12 hour shifts a week. I get weekends off, which I spend with my husband, with friends, and at church. That leaves me 2 days off during the week, which is really really nice!

I had yesterday off. Today I had mostly off, except I had to take a test with the rest of the NICU/Newborn interns. I didn't really know what to expect from the test, but our educator seemed pretty laid back about it, so I didn't spend too much time studying.

This morning I planned to study until the test at 1:00, but for some reason when I plan to study, cleaning the apartment seems much more appealing than usual. Does that happen to anyone else?? So after some studying, I started cleaning. I got more done today than I would have if I didn't have to go into work. The test lasted about an hour, and it wasn't too bad.But I was most proud of my work on the apartment! Take a look: (I have been working on being a good wife and cleaning more often)

Also, the kittens are getting along a lot better today :) Hobbes is still attacking, but not nearly as often. And Lucy actually chased Hobbes a little bit, haha.