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.

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.

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.

Body Talk

I have become a person who exercises.  This would have been unthinkable to me a couple of years ago, when I was far past my days of varsity crew and smack in the middle of my days of eating so little that climbing stairs was a dizzying workout.  And then came the long hard slog of running semi-regularly for more than a year before it finally clicked with me that running, hiking, yoga, lifting, and - most recently - Crossfit, are not things I do to lose weight but rather are things I do because my body rocks and is strong and because they keep me sane and they keep me honest and they keep me eating.  And all of those things are so much more important than how badly I used to want to be a size 2 again.  Like, bad enough that it kept me awake at night.

So all that working out did make me lose about 15 pounds.  It feels good.  I had gained so much weight (about 40 pounds) so quickly when I started eating again back in the spring of 2012 that I couldn't fit into any of my clothes and felt enormous and awkward and like I would never in a million years be comfortable in my body, or, more distressingly, figure out how to eat normally and not like a caged animal.  And the first year of nursing school did not help all that much.  And then finally, this summer, it was like all the being patient and gritting my teeth and refusing to starve myself and refusing to stop running all started to pay off and it felt easier to work out and easier to eat normally and actually possible to make good food choices consistently and to push my plate away when I was full.  You know, skills most adults have mastered long before now.

That said, as it started to get easier to eat better (consistently, and normal amounts, and a pretty decent balance of vegetables, proteins, etc.) I started to pay more attention to what I was eating and how it made me feel.  It struck me that while it was easy to feel like I was eating better - not bingeing, purging, or starving - I still was eating more sugar, processed foods, and "treats" than I maybe thought I was.  I've also developed some skin issues that have stubbornly stuck around for more than a year now, despite frequent doctor visits and medication regimens.  And I get bloated, crampy, and gassy at least once or twice a week.  Lightning bolts probably shot out of my head when it occurred to me that that wasn't entirely normal, and that it was also almost certainly preventable.

So today marks the first day of my own Whole 30 experiment (I know I'm late to the party, don't worry).  I'm really curious to see if cutting out all of the junky stuff from my diet clears up my skin, helps me sleep better at night, and gives me more energy.  Full disclosure: I've been toying with the idea of doing this since July, and never quite got up the nerve.  Last night, lying in bed, R. told me his stomach felt gross from eating pizza that day.  I asked him if he wanted to try this elimination diet thingie with me, for kicks.  He whined a bit when I told him no sugar and then said sure and asked me when we started.  I said maybe November 1st, so we'd have time to prepare and plus, it just sounded like a nice day to start.  He laughed and said that was ridiculous, we're starting tomorrow.  Gulp.  So we did.  And then we went to Crossfit this morning and I almost died and threw up and vowed that for the next few months, the midwifery goal can take a back burner to my singular and all-consuming goal at this time - to not be the last person done with the workout, just once.

(Kidding, guys, I'm still in school and loving it.  More posts to follow soon about the fact that - holy sh*t - I'm seeing patients on my own now, and I get to call myself a "student midwife" rather than a "student nurse" and I whip out pelvic and breast exams like they're no big deal when even two months ago I was all OMG VAGINAS AND WHAT THE HELL AM I DOING.)

So!  Follow along on my clean eating adventure and I'll probably come here to complain more than once about not eating all of the things that make me feel yucky but just taste so darn good.

Long Days

I hear the whispers outside the room in which I'm sleeping.  They float through my subconscious even as my body pleads, No, no, no it's not time to wake up yet, please no.
"Mommy, can I wake Cakey up yet?"
"What time is it?"
"Almost 6."
"Okay, but be gentle."

Tap tap tap.  I feel her feather hand on my shoulder and crack my eyes open to see her smiling face.  "Hi, Sage," I whisper sleepily.  She grins and flings herself in for a hug while I try to pull myself upright.  She is so grown up in daylight hours, eloquent and mature, and achingly in between childhood and adolescence, but at 6 AM on Thursday mornings, she is my sweet warm buddy again, crawling into my lap and telling me in excited whispers about her school's hiking and overnight trip she's going on today and do I want oatmeal for breakfast and how was my clinical yesterday and should we wake up June so she can see me too?

Half an hour later, June is still not awake.  I sneak into her room, where she is splayed across her mattress, naked except for her wedgied pink underpants, blankets tangled about her feet.  I stroke her back softly, whisper, "Juney-Bee, wake up..."  She turns toward me blearily, her hair in her face.
"Mommy?" she asks.
"No, sweetie, it's Cakey."
"Cakey??!  Is it really you?"  Her sleepy eyes wide open now, she pushes her bangs away, sees it's really me and scrambles her hot little monkey body into my lap and wraps all four impossibly long limbs around my torso and squeezes till my eyes tear up.  She lays her head into my chest and sighs.  "I'm so happy you're here, Cakey.  I love you."
"I love you too, sweetness.  I'm so glad you're mine."

We eat oatmeal at the table and the chatter washes over me while I pour milk and slice apples and we talk about what to wear for school picture day and hiking trips and their mother, a former boss, and now a friend, smiles at me over their heads while I mouth, Thank you for all of this, and she only laughs and shakes her head and wraps me in another hug.

It's a long drive to Massachusetts every Wednesday afternoon for a clinical shift in a tiny community sexual health center whose two exam rooms are each big enough to touch all four walls while you stand in the middle.  I cram myself by the door while my midwife preceptor wedges herself behind the exam table and moves mountains for her patients and teaches them about birth control.  I leave with my face hurting from smiling and my stomach rumbling its emptiness.  I drive to the home of the only nanny family I still keep in touch with, where I bask in the light of being loved and needed and welcomed and family, even while I miss my own family so much it hurts.  I drive the two hours home, shower in a flurry, drive to work and prop my eyelids open for the rest of the day, momentarily panicking when I remember I have a midterm on Monday, a test on Tuesday, an assignment due Wednesday, and a mountain of work before clinical next week.

But today I got to wake up to my two favorite girls and for now that is more than enough.

Cake Fail

I follow a blog called The Bitten Word that does what I could only dream of doing - actually cooking the recipes from their monthly supply of food magazines.  Now, granted, the only food magazine I subscribe to is Cook's Illustrated, which comes every two months and definitely lends itself to well-intentioned stockpiling on the bookshelf with promises to myself of, "I will definitely make that someday."  Anyway, the folks at The Bitten Word issue a yearly challenge to help them cook every recipe out of the September issue of Bon Appetit.  I signed up this year, and was issued the task of making this: buttermilk cake with sour milk jam and gin-poached cherries (whew).

All my ingredients.

It was less than impressive.

It incorporated several elements of baking that I find vexing - like the need to go to Whole Foods for a strange and expensive ingredient (juniper berries?), the finished product requiring complex assembly, the use of three (3) separate complete elements, and a wholeheartedly unrealistic amount of time spent doing active work (not, say, cooling something on the counter or baking something in the oven).  So, not only was it a great deal of work, but it tasted gross.  This saddened me.  But!  (There's always a but.)  I had fun making something that I never would have made otherwise, and the cake part itself tasted delicious.

First, I planned.  I got most of the stuff I needed on a grocery run - in the process acquiring more dairy than our fridge has held in months: buttermilk, whole milk, and creme fraiche.  Then, I traded picking up a friend at her mechanic for a cup of leftover gin she had since I didn't want to buy a whole bottle.  (Meanwhile thinking to myself, isn't a cup of gin, like, a LOT of gin??).  Finally, I resigned myself to going to Whole Foods after class one day to buy a four-dollar jar of dried whole juniper berries.  I will be personally indebted to anyone who finds another recipe with which I can use any more of the (barely touched) bottle of juniper berries, by the way.

The cake part, like I said, was delicious and simple enough.  Just a yellow cake batter, using buttermilk, which gave it a lovely soft crumb and a delicately sweet flavor.  Scrumptious.

Then, I spent 45 minutes cooking down milk and sugar into a syrup of such sickening sweetness that even mixing it into 8 ounces of creme fraiche didn't make it not taste like a cavity.

Finally, I followed the recipe exactly and attempted to make a gin, sugar, juniper berry, and dried tart cherry syrup thing to also put with the cake.  Total fail.  There was nothing syrupy about it, and the cherries were macerated within minutes.  I took one taste after cooking it for at least twice the amount of time called for (in an attempt to reduce the vast volume of liquid) and it was like taking a shot of gin in a spoon.  I'm not in college anymore, so this made me gag.

The finished product.

I took one bite of it all together, threw the sour milk "jam" and the alcoholic cherries in the trash, said a silent apology to the friend whose gin I'd wasted, and ate a piece of the cake with my hands.  Whomp whomp.  I'm very curious to see what others who made this recipe thought of it!  And I was at least happy to note that my instincts when looking at this recipe (looks complicated, and, is that seriously going to taste good...?) were spot on.

Anyone else had some recent cooking adventures they'd like to share?

Summer's End

Summer has abruptly and unceremoniously come to an end.  On my run the other day, I realized with a start that my bright sneakers were shuffling through dry leaves and there was a hint of woodsmoke in the air.  Unequivocally, fall.  It's still 85 degrees during the days here sometimes, but the chill of the evenings and early mornings are insisting, nope, fall.  I love it.  I also hate fall, but as we've discussed, I'm a fan of strong things in opposition.

This guy built a web across our entire front porch.

Basking in his grandparents' love and attention.

Tomato chutney, freshly canned.

I miss this.

School has started again and it's a heady mix of Oh my good god, how can I possibly keep up with this insane workload? and Babies! Bellies! Fetal heart tones! Leopold's maneuvers! Holy jeebers, I can't believe we're actually learning all of this!

It feels both surreal and like the most natural thing in the world, all at the same time.

Happy Radish, RN

This radish is licensed to nurse.

One year down, two to go.  Bring on the babies!



Thank you for all of the support, encouragement, laughs, and wisdom that you all have shared with me during this past year.  This blog has always been my outlet, but that took on added meaning over the past twelve months, and I am, again, grateful for everyone who reads and roots for me in my tiny corner of the internet.
xo
Cait

Things I find

I've been seriously neglecting this blog, of late.  I take my boards tomorrow though, so hopefully I'll have more to say once that's over with.  In the meantime, some favorites from the past few weeks:

Sunset over Brooklyn

I found this fascinating, largely because I applied for Teach for America during my senior year at Smith, and made it through several rounds of interviews before being cut.  I felt a little dejected and snubbed, but found something else to do.  Looking back, I am so, so glad that I didn't get accepted - here's why (and here, too).

Birth is expensive.  During my pediatric rotation, I spoke with a family who had just received their hospital bill for the birth of their second child.  They had insurance, and they were shocked at the price tag on her epidural, in particular (I think it was around $10,000).  They asked me why it wasn't covered and I told them probably because it's an elective procedure.  The mom looked at me like I was crazy and said, "Well, what was I going to do, have the kid in my living room?"  I smiled angelically and suggested she consider that with her next child before giving her the name of the Connecticut home birth midwives' group (who charge around $4,500 flat fee for all your prenatal, birth, and postnatal care).

I liked this piece about - as a woman - being your own story, not just the supporting character in somebody else's.

Grandmothers cooking - and some beautiful photographs of food and women and kitchens.

Lots of people I know are obsessed with Netflix's new show, Orange is the New Black.  Several of these friends then ask if I'm watching it, knowing that I went to Smith (the alma mater of the series' protagonist, Piper Kerman, who wrote the autobiography on which the show is based).  I am not, and here's a pretty good explanation of why.  [Full disclosure: I tried to read the book a few years ago, and the author rubbed me the wrong way.  Probably because my best friend in college volunteered in a prison, did a Fulbright looking at prison systems around the world, and is now getting her PhD in sociology at Berkeley focusing on this same topic.  Suffice to say, I was better educated in the idea of prison reform and our country's messed up system than would have allowed me to tolerate Kerman's self-congratulatory and blatantly racist memoir.]

Expecting a lot of new mothers is something the US is particularly good at.  What if we looked at how everyone else in the world did things?

Timing Is Everything

I love the word ambivalent.  I loved it long before I even really knew what it meant, which did nothing to curb my use of it.  Thank goodness for the movie, Girl, Interrupted or I probably never would have learned that I, like Susanna Kaysen, had been using it to mean the equivalent of "I don't care," when in fact, "ambivalence suggests strong feelings...in opposition."  Armed with my new knowledge, I used ambivalent when several other words would have sufficed: to describe the fact that I was indecisive, perhaps, or simply a tad bit lazy and prone to procrastination when it came to important decisions.  But no, I was torn, you see, I was ambivalent.  Eventually I learned some new words and thank goodness, or else my psyche might have bowed under the weight of so much hand-wringing.

In May, just a few months ago, I found myself in a situation that brought whole new depths of meaning to the word.  I thought I was pregnant.

Back in September or October, after several weeks of dating and a few weeks of knocking boots with this new boyfriend of mine, I got my act together and went on the pill.  I had taken the pill for years as a teenager to help curb my viciously painful periods and had never had the issues with it that I know so many women do (thank goodness).  I went off of it in college because I was dating women, and it took a few months of being on it again this time around for it to sink in with me that now I was taking it because every single time we had sex, I could potentially get pregnant.  This might seem incredibly obvious, but for me, this was kind of mind-blowing.  All of my previous sexual encounters with men had been so short-lived that whatever potential for worry there might have been was gone within a month.  So, despite being not only well-educated but pursuing a degree in women's health care, it took some effort on my part to get my shit together.  I set alarms on my phone, I carried my pills in my school bag, I did whatever I could think to retrain my brain into acknowledging that yes, this could happen to me.  And things were fine.  I was lucky - I don't have any bad reaction to the pill and thanks to Yale's health care coverage, my pills were free.  Does it sound too good to be true?

And then, one day in late May, as I started my run on the treadmill, a fleeting thought blipped through my mind, Why are my breasts a little sore?  Did I mistakenly grab the less supportive sports bra out of my drawer this morning?  My mind drifted to other things until later that night, when we were lying in bed together, he asked me, "Um, hon?  Why are your boobs bigger?"

My heart dropped to the floor and words failed me.  The darkness of the room pressed against my eyes and I managed a faint, "I- I don't know.  Are they really?  No, they're not."
"...I think if anyone would know, it's me."

One beat, two beats, three beats of silence while I thought I might burst into tears.

"I love you," he told me firmly, gathering me in a hug.  "But I am not ready for kids right now."
"I- I know," I stammered, realizing with a cold and heavy certainty that this was truer than true.  "Neither am I."  And as I said those words, my heart wrenched and I knew it was true, but I didn't want it to be true.

And thus began the longest week of my life, while I waited to get my period, knowing that the reassurance of a negative pregnancy test could be entirely false since I wasn't even late yet.  I cursed everything I knew about pregnancy, because it meant nothing I felt that week, nothing, went undetected and uninterpreted as a symptom.  My breasts were sore, I was moody, I was vaguely nauseas, I was freaking textbook pregnant, until a week went by and there on the toilet paper was the reassuring sweep of red.

That week gave me a new perspective on the word ambivalent, as I considered what would happen if I was pregnant.  You see, there was a part of me that simply thrilled to the idea that I might have a baby now.  A part of me that lay awake at night with my hand on my lower abdomen and thought about how he and I could make it work.  But it was fleeting, because the much bigger and more mature part of me thought about the kind of things like, what a terrible way to tie someone to me forever - by knotting us together with an unintended pregnancy.  And I thought about how, sure, maybe it's old-fashioned and prosaic of me but yes, I really do want the wedding and the marriage first and then the conscious decision to be made together, of yes, let's procreate.

In the dark of one of those sleepless nights, I landed on it: I want kids, and I want them with him, but not like this.  

Which is why when I get back to school at the end of the summer, I'm going to get an IUD.  The pill is just not a long-term solution for me.  It's too much stress every month, between the remembering and the worry.  I am wary of an IUD, I'm not going to lie.  But I have several friends who have them who I've spoken to at length, and I'm willing to give it a shot.  If I hate it, then I'll reassess.  But even though it makes me a little sad to be so decisive about saying, No, not now to having kids, I know it's the right thing to do.  I take deep breaths and tell myself, No, not now, but someday.  Someday, soon enough.