From Crash Cart to Keyboard

An introduction

The first thing I saw when we ran into the room was a resident sliding across the floor on his knees to catch the baby.

It was 1992. I was a nursing student about a year out from graduation, on a labor and delivery rotation, and the unit was short-staffed in the way L&D units were always short-staffed back then — meaning everyone was already doing the work of two people when our new patient rolled in. She was thirty-six, spoke very little English, and her chart said gravida 19. Nineteen pregnancies. She was calm in the way only a woman who has done this eighteen times already can be calm.

My preceptor and I had just started her assessment. She hadn’t urinated in some time and was feeling a lot of pressure. I was about to ask if I could place a catheter when the intercom called us to admit another patient down the hall. We went. We were mid-admission when the overhead crackled again: our first patient says the baby is coming. Now.

We ran. The door was already open. The resident was already on the floor.

Someone put the baby in my arms.

The room collapsed around the mother — her blood pressure was falling, she was hemorrhaging, and every set of hands in the room was on her. I walked the baby to the warmer alone. I dried her. I stimulated her. I bulb-suctioned her. I did the things I had been taught to do without anyone telling me to do them, because there was no one to tell me.

That’s when my clinical instructor walked in.

She had never warmed up to me. I don’t know why. Some instructors don’t, and you stop trying to figure out the reason somewhere around the third month of being looked through. She took in the scene — the resident on the floor, the mother bleeding out, the Pitocin, the uterine massage, the student nurse at the warmer with a pink, breathing baby — and she didn’t say anything.

The mother was still hemorrhaging. They were pushing Pitocin and massaging her uterus and she was still bleeding. I said, out loud, that the patient had been complaining of a full bladder before delivery (I knew that a full bladder could prevent the uterus from contracting down). I asked if I should catheterize her.

One of the physicians looked at me and said, “Can you do it in thirty seconds?”

I did the fastest sterile catheterization of my life. The bladder emptied. Over 3,000 mL. The uterus clamped down. The bleeding slowed and then stopped. The mother stabilized almost immediately.

My instructor — the one who had never warmed to me — asked me to present the case at our next class.

I remember walking out of that room thinking one thing, and only one thing.

Wow. Maybe I could be good at this.

I graduated the next year at the top of my class and was recommended for a fellowship. I spent my first five years sampling every unit that would have me — progressive care, a short stint in NICU, SICU, CCU, ER, PACU, home health, hospice — often holding two jobs at once, trying to figure out where I belonged. I was, looking back, a critical care adrenaline junkie. I wanted the rooms where things happened fast. I wanted to be the person who knew what to do. I also got my CCRN certification during this time period.

In 1997 I went back to the NICU and never looked back.

I spent the bulk of my career there. Tampa General Hospital. Two years of travel nursing in the same specialty, because by then I knew the work well enough to walk into any unit in the country and be useful by the end of the first shift. Then Stanford Children’s, then Seattle Children’s, then back to Stanford, where I finished my bedside career — and where my back finished it for me. The last two or three years I worked as an informatics nurse, because the pain wouldn’t let me be at the bedside anymore, and I discovered that informatics is still nursing. Just nursing with a keyboard instead of a stethoscope.

Twenty-five years, start to finish.

I’m writing now because I have things to say that I couldn’t quite say while I was still working. Not anything scandalous — just the honest version. The kind of things nurses say to each other at three in the morning when the unit is quiet and the coffee is bad and someone finally tells the truth about a hard shift. I watched nursing change across three decades. I watched the babies get smaller and the technology get bigger and the charting get longer and the time at the bedside get shorter. I watched myself change too — from the student at the warmer to the senior nurse precepting students at the warmer to the informaticist building the system the new student would chart in.

This publication is for nurses. New ones, experienced ones, the ones thinking about leaving the bedside, the ones who already have, the ones who can’t anymore. It’s for the people who have had their own maybe I could be good at this moment and want to read someone who still remembers theirs.

I’ll write about NICU work — the long arc of it, the families, the babies you don’t forget. About what it means to spend a career in critical care and what it costs. About the transition out of bedside nursing, which almost nobody writes about honestly. About the thirty-year view: what’s changed in this profession, what hasn’t, and what the next generation should know.

Some of it will be hard. Some of it will be funny. Most of it will be the version I would have wanted to read when I was a new nurse standing at a warmer with a baby someone had just handed me.

If you’ve worked a code, lived a long career, or are trying to figure out what comes next — I’m glad you’re here.