Category Archives: Hospital

The “Ew, gross” Continuum

Apparently, I still have a relatively low threshold for being grossed out. Especially when so-called “gross out factor” is innocently paired with “the element of surprise.” When I walk into the trauma room I know, more or less, what to expect. A rush of adrenaline, perhaps a shocking sight, something to brace myself for. If I scour deep into my heart of hearts I am still stunned to find myself in the profession of nursing. I never saw myself in medicine, and it is not without a degree of disbelief that I find myself in one of the busiest ERs in the most populous city in the country. I am happy to be here, but I still feel like I have to prove that it’s not a wild dream to someone (maybe myself.) So, when I walk into the trauma room, along with my gloves, I also don a mask. It is a figurative shield of pseudo-bravery, utter calmness and serenity. Inside, my heart might be pounding and I may be thinking shitshitshit, but no one wants to see that on the outside.

However, I can’t pull on that protective mask if I don’t have a moment of fair warning.

I tried out my first 12-hour night shift the other day. I was paired with a wonderful preceptor, one who has many years of experience under her belt, and has oriented a plethora of new grad and recent-hires. She was very kind, no-funny-business, and utterly confident in my abilities. I did my best to live up to her expectations. I ignored my typical self-doubt and plowed ahead. The night sped by, hours melting away as I focused on remembering my patients, honing my skills, and keeping the facts straight. I assessed, I gave meds, I started IVs, I charted. Our partner on the team took “lunch,” so we took her patients. All along, my preceptor helped me organize my tasks, but took a background role to my work. Soon I realized that I was functioning more autonomously than I ever had before. Granted, I wasn’t flying completely solo, but I hadn’t crashed and burned either. I glanced at our chart rack and realized that I was caring for 12 patients. Twelve! I knew a little bit about each one, and what they needed from me. I felt pretty darn good.

Of course, my very next patient threw me a total curve-ball. A slimy, puss-laden softball. My preceptor told me to go assess a new patient that we had just picked up. There was a scant note from triage about a foot infection, and that he had left AMA (against medical advice) from another local hospital that very same day. She told me to get a history and help the patient remove his clothing and socks. I went in. I blanched at the smell. I stoically held my breath and put on my gloves. Our patient had already urinated in the bed and soiled his clothing. He was incontinent, but not because he was old, just because he didn’t care. I struggled to help pull his double-layer of sweat pants off; he didn’t help me. Suddenly, the fabric came free and I stumbled back a step, sweats in hand, along with one sock. What I saw made me gasp. No time to pull on the straight face. I’ll spare you the gory details, but the gist of it was a VERY fresh, and VERY infected total metatarsal amputation. I soon found out that the infection was osteomyelitis and the prior hospital had tried its full arsenal of antibiotics to treat it, with no success. Gingerly, I pulled off the second sock. My gift was a big toe amputation, in a stage of healing that looked much better off than the other foot, but certainly not pretty. The patient was not friendly, refused care, and stunk. I am embarrassed to say that I avoided his room whenever possible that night. He wasn’t a fun patient to treat, but he is one I will most certainly remember. It reminded me that I am still quite new, I am not an old hat in this business, and I can still feel shocked and grossed out. In fact, maybe I always will. It’s a spectrum, and my gross-out quotient has already improved dramatically. Maybe one day an infected TMA won’t even make me blink. Maybe, but somehow I doubt it.


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Dr. Seuss in room 4 needs emergent care, STAT

biggest smile of the day

No…I didn’t take a picture of a patient. But, I did take a picture of what, or whom rather, a patient left behind. Upon our 7am arrival, there was a patient sleeping off her intoxication. Not a rare occurrence in the ED, despite what one may assume is the purpose of the ER (emergencies). My preceptor sent me in to this room to see if I could elicit any information from the patient. Since most of my encounters with drunk people in the ED have been less than pleasant (think: belligerence, lechery, obstinate and loud) I was expecting more of the same, and braced myself. But when I walked in, I saw a middle-aged lady, with hands folded primly above the covers. 1st clue that things would go differently. I asked her about how she arrived here, and if she knew where she was. I was right in assuming that she was oriented times 3. And then she took me for a trip down storybook lane, telling me all about how she had no idea why EMS picked her up, she only drank 3 beers, she was in her own home, alone, not disrupting anyone. To top it all off, someone had stolen her pants and shoes. She was bottomless. Scratching my head in some confusion, I left the room, promising to seek out some clothing for her. I reported back to my preceptor about what I thought was our mistake. My preceptor laughed at me and then very gently pointed out the 28 prior encounters in our EMR that this very same lady had been in for intoxication. I had been hoodwinked. Sober patients are night&day different from their drunk counterparts. After finding this patient a set of bottoms and sending her on her merry way, I noticed the stuffed animal left behind. I guess she didn’t need it anymore. Another nurse set the Dr. Seuss character up in bed, as you see above and closed the curtain. When the 11am shift came on, this same nurse told one of her coworkers, “There’s an emergent case in room 4. Can you go assess, stat?” The nurse agreed and quickly went over to room 4…to find our little friend, all tucked in, with a flat-line for O2 saturation…

Ah, the joys of the ER.


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The Emergency Room or a Comedy Club?

Is that man being rolled in on a stretcher by EMS really singing opera? (Also noteworthy: he had a surprisingly good alto soprano.) If you happen to look in his triage record, which I did while puzzling over his diagnosis, you would read that it states simply and accurately, “Loud and singing.” Really?

Is this lady really refusing to remove her diarrhea-saturated panties and jeans because she has money in the pockets?  Upon closer examination, the pockets are actually safety-pinned closed at least 10 times on each side. Maam, do you honestly think I am going to steal your diarrhea-saturated money? Really?

Is that man-struck-down-by-car in the trauma room really arguing with approximately 10 residents and nurses and 3 attendings about the need to lie still while he is being examined because, as he (rightly, as it turns out) states, “I am a physician and I know exactly where I am injured!” He then proceeds to sit up on the bed, ignoring all protest, and removes the C-collar himself. Really?

While I wasn’t present for this, the story is far too good to go unshared. Young drunk lady comes into the ER asking every nurse/resident/doctor that she encounters, “Wanna see my kitty?” Despite stern admonishing, by a nurse that she needs to lie still and keep her gown on, she repeatedly keeps pulling it up while squealing, “Wooooo!” Finally an exasperated nurse says, “Put away your cookies! No one wants to see them.” Too true. But still, really?

Is the nursing student soon-to-be-nurse really still puzzling over the diagnosis of our lovely opera singer? Ah, drunk, yes, that took about 20 seconds too long. Really.


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Two Traumas, Lots of Drama

11:09PM, 1 hour after getting home from a 14-hour shift

Well, I am already behind on my pledge to document this ER experience. Little did I know just how draining 12-15 hour shifts can be. Especially as a nursing student fresh off the press, I almost feel like I am being thrown to the wolves every morning at 7am when I walk onto the floor. Luckily, (most of the time) I have a very protective preceptor who keeps me close under her wing, but it’s still a lot to take in for a newbie.

Today the trauma room saw its fair share of blood, gore and more. And I saw far more than my typical allotment. First a man came in who had fallen from a 30-story building. That didn’t last long. While in my freshness I was very much distracted by the nearly-severed foot jutting out from a protruding tibia and fibula and a matching skull flap, the internal injuries were the real outcome-predictor. Seasoned nurses told me that shearing forces can cause the entire aorta to rupture. I only spent a few moments in the trauma bay on that case, but it was more than enough time to be imprinted in my memory. The second case was more hopeful. A middle-aged man came in to the ER already in cardiac arrest with CPR in progress. Lost in the hubbub of the moment was a warning from a veteran RN for us NOT to cut off the man’s down jacket. But once the presiding resident made the call, all hands were on board cutting off and removing clothing at lightning speed. Soon there were downy feathers snowing down and nestling in every crevice. In an already chaotic scene, the sight of the feathers made it even more absurd. I served as the scribe, which was an excellent way to follow the rapid-fire succession of events. From no pulse and asystole, this man was successfully revived and stabilized with a v-tach rhythm before he was quickly shipped off to the cath lab. This was a much better outcome to be a part of. Minus the bird feathers and blood that tarred the floor at the end of the code…

One sad event that really stuck with me and I need to unload before going to sleep. We discharged a young woman who came in for seizures. Since we weren’t on her team prior to discharge, we asked for a brief history. She said that she fell down a flight of stairs during the seizure. My preceptor asked if she hit her head on the way down and the patient nodded, like it was obvious. She asked how she got help and who found her, and this poor young lady said, “What do you mean, who found me?” I took care of myself.”

My preceptor tried to clarify, and asked, “Oh, ok, but who called the ambulance?”

She responded simply, “I got myself up, and called it myself.”

For some reason that really sounded sad to me, and more so when my preceptor asked how she was getting home. She had no one to come pick her up and she didn’t feel safe going to the subway because of all the stairs, and her discomfort around trains. Even though she lived less that 2 miles from the hospital, she barely knew the bus lines. Taking her out to discharge, I glanced through the glass exit doors to see a dusky sky, quickly turning black. My sadness for her was almost overwhelming. No one should both come to the ER and leave completely alone, yet too often this is what happens.

Let’s leave this entry on a funnier note. My first patient of the day was a loud old blind man with an Albert Einstein-esque hairdo, who compensates for his lack of sight by screaming all the time. Anytime a shadow of a person walked by his room, he would yell, “NURSE, NURSE! CAN I GO HOME YET?” When asked to lower his voice by my sweet and mouse-like preceptor, he would yell, “I CAN’T HEAR YOU! WHY DO YOU TALK SO QUIET?” She would reply, obviously bothered by his loud volume, “Why do you talk so loud?”


“Sir!” Finally reaching to the top of her internal volume modulator, my preceptor gathers all her strength and yells back, “We can’t send you home until we have your lab results. Sir, we are getting them as soon as we can!”

“OH OK! FINE, WELL WHY DIDN’T YOU SAY SO?” Exasperated, my preceptor escapes the room. Thinking it’s over, I go onto the next patient, but it’s not two minutes later that I hear him again, “NURSE, NURSE, I AM READY TO GO HOME. CAN I GO HOME NOW?”

I don’t know why this was so funny, but somehow it was, and we were all laughing. In an ER, where things are so emergent and tense for so many people, sometimes you just need to take things a little more lightly and help others see the small humor in daily things as well. I find that I say cheesier jokes in the ER, and brace myself, expecting a courtesy grimace at most, but I actually get more laughs there than I do at any better jokes that I ever crack outside of the ER. Happiness is a hot commodity in the ER and it’s in demand. I like this work because no matter what, I always find reasons to smile.


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Entering the Emergency Room

In the wake a devastating tsunami, the nuclear reactor disaster and all the events that have succeeded the earthquake in Japan, it seems somehow appropriate that I begin my integration period tomorrow in the Emergency Room of a bustling metropolitan hospital. When I told the director of my program that I was very interested in Emergency Preparedness as a subspeciality, I had no idea that she would take my interest so seriously and give me an eight-week ER clinical placement. I feel so lucky, and also SO nervous. I am going to try to document this experience, as I work eight weeks under the tutelage and supervision of a RN. I will be taking her normal hours which means 12-hours shifts for a total of 36 hours per week, for 8 weeks.

In my anxiety-flavored preoccupation over what tomorrow will hold, I called my grandfather, for some sage words of advice. In typical fashion, he proffered a few more that I initially asked for, but absolutely helped to assuage my fears. When I told him I was afraid, he reminded me that it was normal to feel scared in a setting where everyone is having personal crises. Nerves run high, but he told me that among emergency personnel, calmness and composure are paramount. He reminded me that people work together in the ED like a well-oiled machine, and that I will never feel stranded. I hope this last part is true. He also told me something that I know: I will feel uncomfortable. I will not feel proficient. I will make mistakes. But then, I will ask questions and I will learn from these mistakes. If I don’t ask a question when I have one, that is the biggest mistake I can make. This is my time for learning, and I will learn.

He also told me that he knows I will be calm in the face of a crisis. I don’t know how he can be sure of this, since I am certainly not sure of myself, but then he told me about the night when my grandma took his own hypertension medication accidentally, and how terrified he felt. In response, he called his cardiologist at home (ah, the benefits of having doctor colleagues) who told him that he could manage the situation on his own, rather than bring her into the ED so late at night. So, my grandpa pushed his fear back and kept it at bay throughout the night while he stayed awake and cared for the love of his life. He told me that he fed her so much coffee, that by the morning he had induced hypertension in my grandma. Not exactly the most settling story for a granddaughter to hear, but very sweet all the same especially since the outcome was good.

My goal for these few weeks is to chronicle my experience, writing down the wisdom of veteran nurses for my future practice as well as the more fun and interesting cases that I run into. Now I just have to wait a few more hours to see what tomorrow has in store…


Posted by on March 21, 2011 in Hospital, Memoir, Nursing School


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The Ilk of an Interview

There are so many kinds of interviews. From the factual nature of a journalist’s interview to the nurturing version of a therapist’s, I never considered all the different kinds that exist until now. The quality of interview that a nurse performs is unique in its own right but is also reminiscent of the compassionate contact that a friend might provide. In the didactic portion of nursing school, they teach you an alphabet of acronyms to remember, so that you don’t forget a single sign or symptom to ask for. But OPQRST, MAKING IT P, and OLDCARTS only get you so far. For me, the letters get jumbled in a heap in my brain and I can hardly extract one without tripping over another. It can be difficult to recall that the interview you are conducting is hardly more than a conversation. And most of the information you need will be provided if you just ask the right questions. Most of the questions we are told to ask are basic common sense.

Still, when my new nursing instructor for Med Surg charged us with the responsibility of taking a comprehensive patient history, the task was daunting. I went into my patient’s room timid and bashful, hoping that I somehow, impossibly, exuded confidence. My patient initially seemed reluctant to speak with me, a mere student, after he had shared his story probably a gazillion times before with people much more “important” than me. After a few minutes of probing gently, I was ready to throw in the conversational scalpel and call it a day. I had the basics: his chief complaint was chest pain that radiated down his left arm. He lost consciousness while doing pull ups and didn’t remember the specifics of his initial symptoms, but knew what it felt like when he regained consciousness. His past medical history consisted of a TIA when he was 30 years old, and an amputated leg from 1988. He is currently not much older than 30. Too early for a stroke and possible AMI? It seemed that way to me. Especially considering that he works out religiously, dare I say compulsively, six days a week. Genetics couldn’t be the sole cause of his problems. He is in good shape and it seems impossible that lifestyle factors play a big role. In asking about his nutrition (his cholesterol leaves room for improvement) he reported that he never cooks with salt, prefers to cook for himself than eat out, and consumes vegetables indiscriminately (except spinach, he amended with a shudder). We laughed together, and had a brief moment of friendly banter — about spinach, of all things! Without realizing it, our conversation began to flow. Soon I was able to insert more sensitive questions about drug and alcohol use without an inward cringe that he would close up tight like a clam. He responded well, albeit in the negative for drug use. Still no progress on why he was experiencing cardiac symptoms. Finally, I addressed the elephant in the room, his prosthetic leg.

By this point, our conversation was running smoothly like a well-greased bicycle. I was confident but still faltered over the question, not knowing what answer it would elicit. It was my patient that led the conversation now. He told me the story, with barely a word from my end as I listened and absorbed. As a young, prepubescent teen, he had been playing a game called “quarters” with a few friends on the sidewalk. Oblivious to their surroundings, they didn’t even look up as the events occurred around them in mere seconds that would change the lives of these young boys drastically. A drunk driver ran a red light and was T-boned by a car that had the right of way. The drunk driver’s car flipped up in the air and landed on the sidewalk, where the boys were playing. They were all hit. A few died instantly, a couple walked away virtually unscathed (physically, at least) and my patient was pinned between two cars. He spent two years in a hospital, recovering. One leg was mutilated beyond repair. The other one was in bad shape as well, but miraculously they salvaged it. His skull was “crushed,” although I didn’t get the specifics of what this meant. But suddenly, it all became clear. His early onset TIAs and unstable angina must be due, at least in part, to the trauma and stress he underwent as a young teen. All of this history-taking was essential for complete understanding of his current diagnosis and hospital admission. When I went to his chart, in hopes of filling in the gaps, I realized that I had more information in my head than was written anywhere on paper. Certainly I couldn’t interpret the troponin and creatinine kinase levels as well as one of his medical providers, but I had his background and health history, an essential part of his focused physical assessment. I felt like this was quite the accomplishment for my first day on the floor. I sincerely hope this bodes well for my five-week-speed-read immersion in the catchall speciality that is fondly known as “Med Surg.”

Now, if only I could take 30 minutes for history-taking with every patient, even after graduating from nursing school…Hey, a girl can dream.

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Posted by on January 7, 2011 in Hospital, Nursing School


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Birthing Baby Burritos

I am in nursing bliss: the happiest place on earth! (Or at least as far as the hospital environment is concerned.) I started my OB rotation yesterday with no real expectations or high standards to meet. I have baby-sat plenty of little munchkins, but none so wee as a newborn. And I have surprisingly little experience with pregnant and laboring mamas-to-be. I walked into this rotation bleary-eyed and lacking my ritual “it’s-too-gosh-darn-early-to-be-awake” pre-hospital caffeine infusion, or even breakfast. I didn’t have these things because I was running late on this particular day, but I expected it to be okay since most first days are mellow and mainly orientation-centered.

Nope, not for me on this day.

I arrived at our prearranged meeting site in the hospital and our preceptor immediately announced that myself and another student would be marching straight up to Labor & Delivery for observation of c-sections and vaginal deliveries! Wednesday was my day for vaginal birth, and Thursday was supposed to be cesarean. Shocked, I completely forgot to even say that I needed to eat something first, and once I realized my error, I just crossed my fingers and swore to myself that I wouldn’t pass out no matter what crazy things I saw. So, up we went, me still trying to surreptitiously rub the sleep from my eyes. The first nurse I was placed with asked me point-blank if I could go get my nursing textbooks or homework and sit in a corner somewhere far away from the laboring mother because she said the mom was anxious about having me there. I must have looked crestfallen, because when I awkwardly mumbled something about this being my only chance to witness a real-live delivery and really wanting to be there, she heaved a sigh and said,

“Oh, well, fine. Let’s see if there’s another nurse that has a mom that’s further along in her labor. You know, my lady’s only 5 cm dilated so far, it could be hours.”

Thank goodness, I thought. That nurse must have woken up on the wrong side of the bed, or quite possibly off the bed entirely, and I was just thrilled to be pawned off on another nurse who, thankfully, turned out to be the complete opposite of Ms. Negative Nelly. This new patient was a mere 18 years old, but there’s something about a huge baby bump that makes one look automatically older. I had to keep reminding myself of how incredibly young she is. As I walked in, she was just receiving an epidural. She was 4-5 cm dilated, but her contractions were already 2 minutes apart.

From the get-go I was enthralled. My nurse showed me the fetal heart and contractions monitors, and she taught me all about monitoring the baby’s heart rate during the contractions, and comparing it to the feed that was being spit out of the machine, to make sure there weren’t an excessive number of variable deceleration, indicating cord compression, and that the baby wasn’t in danger of becoming hypoxic. The fact that this mother-to-be was already having close contractions at 5 cm meant that she certainly didn’t need any other stimulant like Pitocin, and in fact, they really didn’t want the contractions to get much closer together at all. After we gave time for the pain meds to kick in (and boy did they work – she went from writhing and twisting in bed, to a wan smile saying that she couldn’t feel anything below the umbilicus anymore) we took a short break. My nurse told me that she was going to go get some breakfast because it would surely take awhile for the woman to fully dilate. I counted my lucky twinkling stars that I wouldn’t get all hypoglycemic and pass out on her…(how mortifying, even though I am still just waiting for that day to come). 20 minutes and an apricot-studded scone later, I came back up to Labor & Delivery. Immediately I saw that our young mother was quite the overachiever! When I arrived, she was already 10cm dilated, fully effaced, and ready to push. All in a matter of the 20 short minutes that it took me to scarf a scone! I hurried in behind my nurse and we jumped into action. Or rather, I should say she jumped into action. I mainly watched, and pitched in where I could.

It was only a few short minutes until we had the bed revamped into a birthing bed, the resident who would deliver the baby was fully gowned and ready to go, and we had helped usher her family out of the room – saying that only 2 people could be present form her family during the birth due to space constrictions. (I will amend the story at this point to say that by the end of the birth process, I am fairly certain that I counted at least 6 people from the family present and accounted for, surrounding the bed, but who’s really counting anyways?) Anyways, at this point, I was awkwardly peering over my nurse’s shoulders as she and the birthing mother’s own mother helped support her legs outwards while she pushed through her first contractions. The doctor felt for the baby’s head, and found it well-positioned and ready for steady pushing. To maximize each contraction, my nurse told the laboring mother to take a deep breath in and push hard for a count to ten, and then let the breath out and do it again. She did it three times in quick succession for each contraction, and then took a brief respite while waiting for the next wave of contraction to arrive. I was completely mesmerized.

My first glimpse of another life emerging from the mother was a shock of a black hair. My jaw almost dropped and I wanted to pinch myself, it all felt so dreamy. But there was barely time to think. My nurse leaned over to me and verified that I wasn’t about to pass out, to which I quickly shook my head, “No, no, no,” beaming. She smiled back and said, “OK, well would you like to help hold her legs open and count the contractions for her?” Thrilled, I answered in the affirmative and took her spot at the helm, which happened to also be the best viewing spot in this small birthing theater. I didn’t miss the popcorn a bit. My first count was hesitant, but I quickly learned my role and loved it. I encouraged her to take in a deep breath and push. I counted to ten, each number, internally encouraging her to push a little more, to give it her all. After each contraction, I warmly told her how well she was doing, and encouraged her to rest for the brief interlude. During this short period, which still seemed to stretch on for ages, I don’t remember looking at anyone else in the room besides the mother. It could have just been the two of us. I was so alive in this moment, helping a laboring mother was thrilling and intimate and so impossibly surreal, I couldn’t think about anyone or anything else. Watching the baby’s head slowly emerge was thrilling and compelling, while also shocking. Not only the obvious factor that something so big can emerge from somewhere seemingly so small, but because another life was about to appear in the world. And when he did, that first breath was one of the most miraculous things I have ever witnessed. The tiny blue and white body seemed to almost instantaneously swap for a healthy pink tone as the tiny infant drew in his first breath and let out his first lusty cry to the world. So many factors must come together for this breath and subsequent cry to occur and I couldn’t take my eyes of this tiny miracle. Leaning in close, I watched as the doctor clamped down on the umbilical cord, now rendered obsolete, and let the eager medical student do the honors of cutting it. In his eagerness however, and my obtuse baby blissed-out unawareness, as he cut the cord, her sent a smattering of ruby red blood droplets showering down all around, including on my scrubs and forehead. Whoops.

Said medical student also threw out the placenta by accident a few minutes later, in an apparent effort to be helpful and start the clean up process. Double whoops. The nurse and I had to go digging in the biohazard bin for it. Gross.

After the last vestige of physical connection between mom and babe was severed, the nurse and I rushed the baby to the warmer to vigorously rub his tiny body, removing excess vernix and stimulating his nascent blood circulation. I didn’t know about skin-to-skin time with mom and baby at that point; now I wonder whether it’s better to hand the baby right to mommy – disregarding any extraneous fluids, serum or vernix for the moment. Hopefully, I will see many more births in the future and many different methods for doing things. In this case however, without discussing whether this was the best way to do it, we spent about 5 minutes with the baby, taking footprints, extracting cord blood samples from the placenta, and administering the baby’s first medications: prophylactic eye cream and a Vitamin K shot to his miniature thigh muscles. Then I got to watch my first example of baby burrito-ing. The nurse twisted the baby up so fast and expertly in a little bundle that I would have missed it if I blinked. Peeping out of the burrito bundle was a teeny tiny squishy face with a spiky black head of hair. We then passed the little bundle of joy off to mom for their first precious moments together.

I can hardly put words to the beauty and sheer surrealism of this event. These first moments of life really bring it full circle for me. It’s mind-blowing to think that this full-fledged tiny human being emerged into the world from the meeting of just a few specialized cells, designed to do the world’s most magical thing when they met in an event called conception, only 9 months ago. It was miraculous to watch life arrive. It all happens in such a natural way, yet it looks so insanely foreign to a newcomer. I felt so privileged to be present for this birth, so amazed to witness firsthand the miracle of life.  The human body is amazing, and in countless ways I truly cannot believe what a rewarding profession I have entered; I am so excited to be here.


Posted by on November 12, 2010 in Babies, Healing Spoonful, Hospital


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