Tuesday, April 22, 2014

When It's Someone You Love

I thought I knew what it's like to be with someone in labor. And I did, in a sense. With my patients. My patients are lovely and amusing and sometimes frustrating but brave and powerful and utterly remarkable. But I am their midwife, and they are my patients, and those are our roles.  

Two weeks ago, my oldest friend had a baby. She is brave and powerful and amazing, just like my patients are, but I am not her midwife and so I was a wreck. I was a wreck because I love her so much and I loved her baby even before she was born and I didn't know how different it was to be with someone, really with someone in that space, someone that you love. 

I drove the six hours to be with her because I couldn't imagine missing it. I met her boyfriend for the first time when I got there, and gladly accepted hugs from her mother, who I've called "Mom" for as long as I can remember.

I made her walk the halls with me for four hours and we caught up on life as it is now, and reminisced about our high school antics until she couldn't talk during her contractions and we were running out of ice chips. I tried very hard not to hover over her when the midwife would check her cervix, and I tried to be helpful to her nurses who were, every one of them, so kind. I listened carefully to everything every doctor and midwife said and then explained it all again to her family, drawing little diagrams in the air when the baby turned out to be OP, and explaining what the fetal monitor meant with all its squiggly lines.

I held her hand and dozed in between her contractions, because her epidural only took the edge off and she woke up with every one. Twice, through a haze of Nubain and Benadryl, she woke up and looked at me and told me, "I'm so glad you're here. I couldn't do this without you," and I smiled and told her there was nowhere I'd rather be. She closed her eyes again and I felt like breaking open as a tear leaked down my nose because I wanted to take all her pain and hold it inside me and bury it deep but I couldn't.

I changed the pad under her every time she felt wet, and I made her open her eyes and look at me when she couldn't stop saying, I can't, I can't, I can't, and I told her that yes she could, she already was, and to squeeze my hand as hard as it hurt and to push through the pain even though it felt impossible.

And in the end, after the consent had been signed and her epidural was bolused, I pulled the curtain around us and sat on her bed and told her that it wasn't her fault, that the baby wasn't moving down because of how her head was positioned and that she did such a good job, the best job ever, and that everything was going to be okay. I told her how brave she was, and how strong she had been, and how after 48 hours of labor, the doctors were right, it was time for a Cesarean.

They wheeled her away and I fell apart. I felt like I'd failed her, like I'd let down my oldest and dearest friend by not being able to doula her out of an OP, asynclitic and unflexed baby's head. I am blessed to have midwifery friends who very gently and matter-of-factly pointed out how ridiculous that was.

So I waited till she was out of surgery, and helped her get the baby latched on, and stayed just a tiny bit longer and then drove all the way back to Connecticut in the wee hours of the night, already missing her sweet face and the baby's soft downy hair. 

I couldn't be her midwife, but that was okay. Because I am so lucky to be her friend.


Thursday, March 27, 2014

The First

The first birth was awful.

I wanted it to be amazing. I wanted it to make me feel like a real midwife, like I could be good at this thing that I am both in love with and utterly terrified of. Instead, this woman I was with, she was only a couple of years younger than me and she did not trust me. In hindsight, this does not faze me. I get it. I'm 26, I was doing a less than spectacular job at faking any semblance of aptitude or confidence, and she was just done. Done with her contractions, done with the baby's father talking on his phone while she was racked with pain, done with her mother-in-law asking loudly when the hospital was going to do paternity testing because she was sure, she was positive that this baby was not her son's, and of course, done with the student midwife even being in the same room as her. So I did my best and offered to my preceptor to sit this one out and merely observe, in a genuine attempt to respect this woman's wishes, and was met with deaf ears.

"This is a teaching hospital. She needs to get over it."

Um, okay. Wow.

So in the end, no one was happy. My preceptor was annoyed that I dropped my hands away from the baby's head when the mother screamed, "No!! Don't touch me!" I was done trying to walk a fine line between respecting a person's body integrity and right to refuse whatever the hell they want to refuse - including having a student catch your baby - and trying to please whichever random "teacher" I'm spending a given 12 hours with. I was shaken by being so despised, in that moment, by someone who didn't know me at all, and - I'll admit - I was hurt and upset and took the whole thing far too personally. I grazed the baby's ears as they emerged and then, a few minutes later, managed to very messily deliver the placenta with shaking hands, waiting to be screamed at again by someone (anyone, really).

Ten minutes later, we were sitting in the chart room and my preceptor says matter-of-factly, "Okay, great. So that was your first catch. Here's the birth certificate, can you fill this out? Front and back."

I nodded, smiled, and excused myself to the bathroom where I sat on the floor, shivering uncontrollably, and took deep cleansing breaths until I'd breathed out all the adrenaline and guilt and fear and disappointment and anger and confusion until I was an empty shell of somebody calm and detached and wholly unlike me. That night, in the dark of my bedroom, I finally gave in to the sharp stab of hurt at being unwanted, of being terrible at something I so badly want to be excellent at, but mostly, at feeling such overwhelming sadness and guilt that I had been a part of something awful. Of a woman having a birth that was not her own, and not what she wanted. I hated everything about my implicitness in that.

If I've learned anything so far in school, it's that resiliency is far more important than aptitude. I still hate that school is a place where I am not the midwife I will be one day. Where I jump at the chance to perform amniotomies and place intrauterine pressure catheters because if I don't do those things now, I'll never learn how. Where I'm at the mercy and whims of every single preceptor, all of whom want different things, and none of whom are wrong. Where I spend 12 exhausting hours doing labor support for a primip only to be told to walk away at 7 PM so that the ER resident can catch her baby at 7:15. But - and this is a big but - the moments of wet squalling babies whooshing out on a wave of fluid, the pulsing cords, the reaching hands, and the tears that cross every language barrier in the room, those moments remind me why I'm here.

And they're what have finally brought me back to writing, after far too long.

Wednesday, February 12, 2014

Birthday Shenanigans

The night before my 26th birthday last week, there was a snowstorm and I gave myself a snow day from clinical.  It was heavenly.  Made more heavenly by coffee and breakfast.


 And this was Tucker's birthday gift to me.  Isn't it special?  The artist and his masterpiece.

And this is the birthday vlog, version 3.0.  Mostly for my own posterity's sake, so that when I'm 95 and decrepit, I can remember what I thought about when I was a wee 26.  But also for your viewing entertainment, if you have nothing better to do.


Movie on 2-12-14 at 8.29 PM from Caitlin on Vimeo.

Thursday, January 30, 2014

Repeated Exposure

It's very subtle, how it begins.  It's like a twitch, in the back of my brain.  A flare of activity in a place that's long laid dormant but somehow, once triggered, feels instantly and sharply familiar.  There is frustration and impatience at first - I do not have time to feel like this now, thanks very much.  I hastily push it aside and move on.  Then, because it is so familiar and because it has never been nearly long enough to forget how it feels, there is slow acceptance.  I am a little older now, and a little wiser, and a little better at recognizing it when it comes - the rising tide of anxiety has found its way back to me.

I check myself, all the time.  I try to step back and assess whether this is actually stressful or difficult, or if I'm oversensitive and magnifying it to be so.  A psych lecturer the other day was discussing the roots of anxiety (free self-diagnosis is always an entertaining part of provider education).  In her world, everyone who is anxious is a war veteran, a victim of child abuse or rape, a closet drug addict and alcoholic - or all of the above.  Stupidly, perhaps, I asked her about those people who are anxious and depressed and none of those things.  She assured me that some people are just "extremely oversensitive individuals" and just don't know "how to handle stress."  Ah.  Got it.  Thanks a bunch.

It's January.  I know this.  It is dark, and the very most typical time of the year to feel this way.  It's cold, bitterly cold, every single day.  I haven't seen the boy since break and I miss him with an ache that is barely touched by Skype conversations and text messages.  I know all these things, and yet when I stand paralyzed in the middle of my kitchen, half-dressed and already panicking about the day ahead, it doesn't help to know those things.  It doesn't help when I feel my chest tightening around the knowledge that I have a quiz, four lectures, about a thousand pages of reading I'm behind on, twenty-four hours of clinical a week, and an empty gas tank facing me when I walk out the door.

I cry at the slightest thing.  I can feel my nerves that are exposed, like raw wires sparking in the sub-zero New England air.  The slightest thing - an insensitive comment from a friend, the way my preceptor spends two minutes with each OB patient - will set me off and I'll be leaking tears in a matter of moments.

The raw familiarity of these feelings is always the worst.  I think, forever, there is a part of me that hopes to be free from a history of mental illness.  That wishes if I could run far enough or fast enough away from it all that it will never catch me.


In my more rational moments, I know that familiarity, and education, and privilege also make me that much more able to access help, if I could only find the time to do it.

Wednesday, January 1, 2014

New Year's 2014

1.  What did you do in 2013 that you'd never done before?

Became a nurse!  And pelvic exams.  Lots and lots of pelvics.

2. Did you keep your new year’s resolutions, and will you make more for next year?  

I had to look back and here's the rundown:
1.  Keep running -- sort of, I did for several months, and then took several months off, and now I'm trying to start up again.
2.  Keep doing well in school -- yes, in so much as I'm passing and happy and learning as much as I can.
3.  Pass the NCLEX/become an RN -- yes!  Currently applying for summer camp nurse jobs with my fancy new license.
4.  "…move from loathing to loving your own skin." -- a never-ending process, but this is the first year I can remember where I spent more time appreciating my body and its capabilities than I spent wishing it were different and hurting myself to change it.  So that's pretty huge.
For this coming year, I strive to:
1.  Be consistent with fitness.
2.  Nurture the relationships and friendships I am blessed with - stop being lazy about Skype, phone calls, and emails to the people I care about.
3.  Less screen time.  Books are awesome, even my textbooks.

3. Did anyone close to you give birth?

No, but someone very dear to me is due in April.

4. Did anyone close to you die?

No, and I'm very grateful for that.

5. What countries did you visit?

Nada.

6. What would you like to have in 2014 that you lacked in 2013?

A better balance between school and life - a lot of times this past year, I felt like I was either burning the candle on both ends, or slacking so utterly that it made my stomach clench.  I'm not sure either was true, but if I am consistently more balanced, then if helps me not feel like a swinging pendulum all the time.

7. What dates from 2013 will remain etched upon your memory, and why?

August 20th - took (and passed) the NCLEX
November 9th - my boy moved away

8. What was your biggest achievement of the year?

Becoming a nurse.  Being halfway done with grad school.  Sticking through the shitty times and finding that on the other side of those times, is the best/safest/most loving relationship I could have ever imagined.

9. What was your biggest failure?

I tried very hard to find an RN job after I got my license and didn't.  That still stings.  I also left many a patient visit this fall feeling like I had failed them, that I couldn't do nearly enough.

10. Did you suffer illness or injury?

Definitely sore after the half-marathon in April, my first ever UTI in July, and some fun GI stuff this fall that is now greatly improved.

11. What was the best thing you bought?

The solid beginning of a professional wardrobe. 

12. Whose behavior merited celebration?

The boy's (again), my parents' (always), and - perhaps most importantly - H. and I worked really freaking hard on our friendship and it shows.  And that makes me happy.

13. Whose behavior made you appalled and depressed?

I had some, um, interesting patients this fall.  I whipped out my very-serious-very-calm-but-very-intimidating clinician voice to good effect a few times.

14. Where did most of your money go?

Yale.  Always and forever.

15. What did you get really, really, really excited about?

Finishing my GEPN year, becoming a nurse, feeling like a real midwife, planning a future with the one I love.

16. What song will always remind you of 2013?

"Half Acre" by Hem.

17. Compared to this time last year, are you: a) happier or sadder?

Happier.  Onward and upward.

b) thinner or fatter?

Maybe a little thinner?  I don't really know.

c) richer or poorer?

Poorer.  Those emails from FedLoan Servicing are like punches to the gut.

18. What do you wish you’d done more of?

Listening.  Sitting still.  Reading.  Running very fast.

19. What do you wish you’d done less of?

Overthinking.  Being defensive.  Feeling angry.  Facebook.

20. How did you spend Christmas?

With Richard's family in Ohio.  It was really hard being away from my family.

21. Did you fall in love in 2013?

Every single day, over and over again.

22. What was your favorite TV program?

I liked watching New Girl with the boy, and H. and I liked watching NY Med on Hulu during dinner.

23. Do you hate anyone now that you didn’t hate this time last year?

I don't hate anyone.  I hope that nobody hates me.

24. What was the best book you read?

I'm really enjoying The Golem and the Jinni by Helene Wecker.

25. What was your greatest musical discovery?

Hem, but mostly I listened to podcasts during my drives.  I fell in love with This American Life, Radiolab, The TED Radio Hour, and The Moth.

26. What did you want and get?

A relationship that lasts through the tough times, another year to grow and develop, and some truly amazing friendships that I didn't have before.

27. What did you want and not get?

A baby.

28. What was your favorite film of this year?

The boy and I watched "We're the Millers" the other day and it was, by far, the funniest thing I have seen in a very long time.

29. What did you do on your birthday, and how old were you?

I turned 25, and felt suddenly very, very old.  I had a test that day, and two more that week, but in between a very stressful school workload, Richard and I went out for dinner and saw a monster truck show.

30. What one thing would have made your year immeasurably more satisfying?

Again, easing this loan stress would be nice.

31. How would you describe your personal fashion concept in 2013?

Adulthood!  I wear dresses and slacks and flats and blouses to clinical now, and jeans and scarves and sweaters to school.  And plenty of old scrubs and stolen boyfriend t-shirts the rest of the time.

32. What kept you sane?

Richard.  My parents.  Hallie.  My garden.   Cooking.  Sleep.

33. Which celebrity/public figure did you fancy the most?

Pope Francis, without question.  He is a leader and a revolutionary, and I admire him.

34. What political issue stirred you the most?

Healthcare, again.  I am extremely disappointed in how the ACA is going so far.  I lost count of the number of patients I saw this year who attempted, and failed, to get healthcare for themselves and their families and were left with no good options.

35. Who did you miss?

I missed Richard so, so much when he moved (it's nice being here with him on break, but that is ending soon).  I miss my parents, always, and especially this Christmas.

36. Who was the best new person you met?

I have two amazing school friends that I only knew peripherally last year.

37. Tell us a valuable life lesson you learned in 2013.

You don't have to have all of the answers.  You just have to be willing to listen to the stories.

38. Quote a song lyric that sums up your year.

All my life is arm in arm with you
When you've got trouble I've got trouble, too.

Long post!  Congrats if you got through it all!

Here's to a happy, healthy 2014 for us all!

New Year's 2013
New Year's 2012

Monday, December 30, 2013

A Year in Pictures

Sitting here, reflecting on 2013, the first thing I thought of was…nothing.  What happened this year?  I mean, seriously?  I tried to think back through the months, waiting for the re-rememberance of some awful tragedy or gut-wrenching sadness and for the first year in a very long time, couldn't remember a single thing.  Sometimes boring is good.  Sometimes boring gives us the space for all the tiny, infinitesimal ways that we grow into the calmer, brighter, and more whole version of who we can actually be.

January and February
I ran my first 5k - sub-30 minutes and I was quite proud.
Superstorm Nemo dropped three feet of snow and CT failed utterly on the clean-up, but we had a ball sledding and trying to stay warm.
March
The first hints of spring.
April
Post half-marathon.
May
Memorial Day weekend hiking trip - it snowed!
June
Planted and grew my first adult garden.  It was a ton of work, but the fresh vegetables and shelf full of canned tomatoes were definitely worth it.
July
Cherry picking
Happy dog
August
Wildlife…in suburbia.
A wonderful visit home at my parents' house on the lake.
September
I made a lot of pie this year.
October, November, December
The new view.
I hate moving.
Thanksgiving homework help.

The love of my life.
2012 Wrap Up

Thursday, December 12, 2013

Taking Part

Decorating for holidays is one of those things that - like cooking my own food and taking cough medicine voluntarily - always makes me feel like I'm play-acting at being an adult.


And then I remind myself that being an adult, like being a midwife, is a whole lot of acting like something you don't quite feel is legitimate until some day you wake up and realize you don't remember ever being anything else.


Tomorrow is my last day at my clinical site.  I will miss everyone there, but especially my patients.  My mind reels when I think about all the women that I will care for in this lifetime and how even the dozens from the last few months will fade into the background of my memories so soon.  The human heart cannot hold them all.  At least, not with faces and names intact.


As I battle through finals and not feeling well and the penetrating cold that has dropped over New Haven, bringing snow and ice and slate gray days, I am reminded to be grateful for warm slippers, Skype calls with Richard, and cats that while they may have a personal vendetta against the Christmas tree, are still very effective foot warmers.  The end of the year always brings with it a bit of panic (for me, at least), as I grasp to hold on to what seems to be flying by, struggling to keep pace with time's inevitable march.  My school friends and I sit in the warm car in my school's icy parking lot before going inside for a truly punishing exam.  We take deep breaths and tell each other, "The time will pass anyway.  All we have to do is go in there, and be a part of it."

Cheers, to being a part of it.

Sunday, December 1, 2013

The Cold Has Come

I avoid walking down my street now, in the direction that I paced a well-worn path into over the past year and change.  When I walk past his old place and reflexively look up to see if the lights are on, my breath catches in my throat.  The windows are dark.  No one lives there now.

I lay here in my bed that has barely been slept in for a year and even with a cat at my feet, it feels too big and too cold.  I stay up too late, avoiding the nightly challenge of falling asleep without his solid warmth at my back.  I wait until the last possible second, until I've already guaranteed I'll be exhausted for school in the morning before I turn out the light and curl around my still cramping belly, my uterus apparently deciding to take several months to acclimate to my new IUD.

I don't want to wish away my time here at school.  I don't want to, and yet I find myself doing just that. I see him on some weekends, and for a blissful three packed days of Thanksgiving, and it's wonderful and reassuring and always, always too short.

I want to be there, in his bed, with the sunrise pouring through the windows over the buildings of a city that is starting to, maybe, feel like home.

I tell myself, here is good, too,  and, here is where you need to be, and several times, there are worse things in life than a long-distance relationship.

My toes curl as another cramp rips through me, and all I want is his hand there, holding me in.

I miss him.


Edit: Yeah, not pregnant.

Tuesday, November 26, 2013

Whole30 Update

I wrote this a few weeks ago:

"I'm on Day 10.  It's interesting.  I think I went into this whole thing with simultaneous beliefs of, "This will fix EVERYTHING," and "It is impossible for diet changes like these to fix ANYTHING."  I am so far wrong on both counts.  My favorite things so far, in no particular order:

1.  My food is delicious.  It's tasty, and I feel good eating it because I know how wholesome it is.
2.  I am not hungry in between meals.  This is huge for me.  I used to get so cranky and hungry in between meals during my epically long school days that I would often develop migraines and/or resort to eating crackers or trail mix or whatever I could find in the vending machine.  Now, I make it to my next meal, with maybe a small snack (packed and planned) if it's a really crazy day.
3.  I get hungry before meals, but not "hangry."  I am not the first person to discover this while eating Whole30/paleo, and I'm sure I won't be the last.  It's a very liberating feeling, to not ever feel like If I don't find a food item to put in my mouth this very instant I will either melt into tears or just DIE OF STARVATION."

So!  All of those things were true and awesome and I felt a lot better for the two-ish weeks that I made it without messing up on the Whole30.  Then the fact that my other half moved to a different city and we spent two frantic weeks finding an apartment in said city, packing up all his stuff, and moving him to said city - yeah, I got a little distracted and found it impossible to pack and eat paleo/Whole30 food all the time.  While I was doing it, though, I noticed improvements in my skin, my GI system, and I lost about 6 pounds.  But over the last few months I've been feeling more and more run down, and that didn't improve, even as everything else did.  I chalked it up to me not lasting the whole 30 days.  Until it got worse.  And worse.  And then I went to donate blood and got turned away for the second time in six months because my hemoglobin was too low.

A doctor's appointment and several vials of blood later, there appears to be something wrong - which is both a relief to not think I'm making up how crappy I feel, but also anxiety-provoking in that I'd really like to know what it is, please, so I can do something about it.  Some of my key vitamin levels were quite low, as was my hemoglobin, hematocrit, and most especially iron (after some serious meat-chowing, no less).  For the next couple of weeks, I'm under doctor's orders to eat as much gluten as I can stand, because she wants to see if I have celiac disease, and that's only accurate if you've been eating gluten for at least three weeks.  Even after I stopped attempting the Whole30, I was still eating substantially less gluten than I had before, and the difference now is marked.  My face is breaking out, my chronic skin stuff has flared up and is the worst it's ever been, I'm nauseas and bloated pretty much 24/7, and I seem to have misplaced my waist.

As much as I love baking and all things flour, I can't wait to be given the all-clear to go back to no gluten (even if I don't have celiac).  And then maybe I'll give this Whole30 thing another shot.

Thursday, November 14, 2013

What I Know Now

My patients, they do not leave me.  We exist now as a group, I feel them stringing along behind me when I walk to class or to my car, they hover over my head when I lay down and try to sleep.  Their voices echo in small phrases, glimpses swim in front of my tightly shut eyes while I rub the now permanent line that is etched between my eyebrows.  I struggle to recall faces, instead my mind is filled with a collage of body parts that I try to piece together - clenched hands on the exam table, the paper crinkling under their white knuckles, pale inner thighs that shrink away from my touch, chapped lips that answer my questions in whispers, eyes that won't meet mine.

Sometimes my patients are like the horses I grew up drawn to.  They size me up as I walk into the tiny exam room, the whites of their eyes following my every move.  I sit and lean back against the wall - I have no agenda, I want them to know.  I have tamed the single-minded eagerness to explain, to educate, to inform, to counsel that often fills us as we learn.  I know so little, it seems, I have been trusted with so much, I want to impart every speck of what I can offer, because even that is not enough.  Instead, I sit down and say hello.  I smile.  I ask how they are, and what brings them to me.  I set my pen down and listen.  I nod, and they seem unsure if they should continue to speak when I don't interrupt them immediately with questions.  I've stopped trying to have all the answers, but sometimes the questions still make my heart pound with anxiety.  I ask them anyway, my voice soft, the walls are thin, do you feel safe at home, where are these bruises from, how many partners in the last year, can you tell me how often you're shooting up, are you planning on becoming pregnant at this time, have you ever had symptoms like these before, how long have you had this pain?  I say, I'm so sorry that happened, that sounds really difficult, you don't need to apologize, ever, can you let your legs fall out just a bit more, you're in charge here, okay?, will you tell me if this hurts, let's use the other arm for this blood draw, let me know when you're ready.

I think back to a before time, when it felt important to do it all perfectly, to remember the order for collecting a Pap and how many centimeters into the cervix to insert the cytobrush in order to extract a sufficient sample, to perform a breast exam so flawlessly that no inch of tissue went unexamined by my probing fingers.  I think back to when I would recite my pelvic exam "lines" in my head on the drive to clinical, terrified of forgetting our textbook's directions for the best way to elicit cervical motion tenderness and what that would mean.  The words fall out of my mouth now, scoot all the way down, this is my hand on your leg, these are my fingers, this is the speculum, lots of pressure now, cervix looks good, little crampy now while I take a sample for the lab, you might have some spotting today, no need to worry, speculum coming out now, we're almost done, these are my fingers again, I'm going to press on your belly, any pain while I do this?, I'm making you have to pee, I know, okay, you are all set, you can scoot on back and up.

I know now that a sufficient sample and a smoothly performed exam do not erase the bruises on her inner thighs.  I know that my ability to rattle off the medication regimen for gonorrhea, chlamydia, pelvic inflammatory disease, and herpes does nothing for the woman whose trust has been shattered by a disease she did not give herself.  I hand her tissues and say, again, I'm so sorry.  I hope, maybe, that this tiny exam room with the fake wood paneling and the ancient posters on the walls can be something more than a bizarrely furnished box.  This tiny space we share where I ask them about their day, their dogs, their children, where I admire their socks and listen to what they say and even harder for what they do not say.  It is in this place I think, maybe, that in spite of all my weird and deeply probing questions, in spite of my hands inside them and my far from perfect technique, even in spite of all that I fumble and trip over and the answers I do not have, it is my hope that they feel safe.  That she sees that when the door shuts, I am with her and that is all that there is.  That I am long past the point of ever batting an eye no matter what she may ask or tell me, and that I will do my best to answer her questions but will tell her frankly if I cannot.  And maybe for five or ten insignificant minutes, maybe that is enough.

I've stopped trying to be right.  I only try to be kind.