The Lonely Midwife

Sore feet with a smile

2009-11-10T20:46:00.004-05:00

My feet hurt. The office has been really, really busy. Seeing 3 to 4 new patients each day along with a completely booked schedule of existing patients.

My feet hurt. The shortest day has been 13 hours. I feel bad having the nurses call patients regarding their lab results (yet, this is the norm for the practice). I am trying to
keep up with them and even making some calls on the weekend.

My feet hurt. This wearing real clothes with real shoes is not so comfy. After many years of wearing my pajamas (those stylish blue hospital scrubs) to work, my feet are not used to such torture.

My feet hurt. Running down seven flights to L&D, because one elevator is broken and I don't have the time to wait for the other one because they called to say "the head's right there".

My feet hurt but I'm smiling!!!!

The definition of medical emergency

2009-10-25T12:48:00.003-04:00

12:30 am--

Message on pager

Had baby in August and now has a rash. Please call immediately.

Yup, she has a rash. Her PCP can take care of this at 9 am in the morning-- no need for both of us to be awake and knowing about her rash.
The definition of perception--rash="medical or obstetrical emergency"

Be very, very careful!

2009-10-21T20:16:00.005-04:00

Yes, the BIG BAD MIDWIFE is in town. She is here to steal your patients. The most important thing is that you don't let her talk to your patients.

We will be miserable that we don't have an extra person to answer the pager or share rounds with but we would not want to risk it. We will continue to rant to the nursing staff that we will lose 1/3 of our patients to the BIG BAD MIDWIFE.

We have heard that she actually sat on the edge of the bed and held a hand while a woman cried. It has been reported that she calls patients with their results when they are not what they expected. There have also been rumors that she cares about how things are going at home-are the kids well? everything good with your husband? are you sleeping okay? It's also been overheard that there are grumblings among the women she has seen that they think "she is nice".

Today, when I fed a pregnant woman that doesn't have enough money for food and had social services see her I was told by an Ob (not the doc I work with) that my job is to practice obstetrics and to practice gynecology and that it was not to "save" someone. He was mistaken my job is to practice midwifery and that is exactly what I did. Watch out--the BIG BAD MIDWIFE is here.

Interesting appointments

2009-10-09T12:00:00.003-04:00

Here are two of the better ones

Post-menopausal -- Follow-up for no period

Okay, isn't that menopause? I know I am new but---and that truly was the complaint. "I have been menopausal for a year and a half and I haven't got my period." We did some physiology education for that appointment. She was relieved.

Patient wants to find out who FOB is (that's "father of baby")

This young lady had two options and wanted me to tell her which one I thought she should pick. One was out of state and had been a bit of an ass lately but she liked him the best. The other one was around more but, eh-she wasn't so thrilled about him. "Can you help me choose?"

and I can't say anything about the secretary's because truly, that's what the appointment was. And, I did meet some wonderful women this week.

A really nice view

2009-10-08T20:48:00.003-04:00

So my first day was last Thursday and what happens Wednesday night--sick! Major sinus issue. Perfect! Anyways, made it through Thursday and Friday and then spent Saturday in bed. My first full week has been very busy and thrown right into it. The doc that I am working with was in the office on Thursday and then left the country to visit family for this whole week. She deserves it but it was tough being the new kid by yourself. The office staff, MA's and RN's have been fabulous though, so no complaints.

My first challenge last week was sitting on the right side of my desk. I know it sounds stupid but it just didn't feel right. This doc has a beautiful office suite-not your typical drab medical office. My office is decent size, great desk, big comfy leather chair with a view to die for. Nurses don't get that. When I came in the beginning of the week to move some stuff in and organize some paperwork I sat in the two chairs on the side of the desk where the patient's would sit. That leather chair felt like it should be for someone else--someone way more important. I did this for three days. I think both her and the office staff were probably thinking --what's up with the midwife?? So this week I sat in the chair. I finished some charts. I drank my coffee and gazed out at the awesome view. I am slowly coming to the realization that I can enjoy the benefits of my new job and still be the nurse I am.

2009-09-28T18:50:00.004-04:00

One of the biggest challenges for me is to let go and not feel like I need to save the world. Over the years I have cared for women who many have found difficult to take care of. I was usually nominated to take care of them or everyone else was "fired" and they were stuck with me. I have always been confident that I have given them the same care I would have given a family member.

But, it does begin to wear on me. I think of these women long after I have cared for them--are they in the same situation?, are their children safe?, did I do enough? did I miss some resource they should have been matched with?

I wonder about--

the mail-order bride who spoke no English, no family, no friends and pregnant.
the woman who had no prenatal care, gave an alias and we found out her other six babies had been taken away.
the young pregnant runaway who was being abused by her boyfriend.
the high-school girl who showed up fully, had her baby (no one knew), and left the baby at the hospital. She needed to get home before her parents found out
the parents of three children who gave their baby up for adoption because they could not afford another child.
the woman who had a psychotic break in labor.
the mother of two who was abusing prescription narcotics and didn't want her husband to know.
the new mother who knew that her husband was not the father of her baby.
the woman saying she is contracting to get out of jail.

I think about these women. I wish I could have made their lives better. I did my best but my best is no where near enough to solve these problems. I hate that.

Did I miss something?

2009-09-25T07:56:00.004-04:00

I always thought that when you needed a refill on a prescription (no refills left) you called the office of whoever prescribed the medication for you. Is this not true anymore? That's what I do. In fact, my PCP has a convenient answering machine set up so I just leave a message and don't have to bother anyone. But--

Recently I was at "big chain pharmacy" with neglected teen daughter waiting for a prescription. Middle-aged man and his mother are there picking up half the pharmacy. Middle-aged man proceeds to berate very young looking pharmacy tech about a missing prescription. Why isn't it there? He called the PHARMACY this morning for THEM to call HIS doctor to get refills. This took 20 minutes with a huge line behind him. I had a front row seat to this (next to a woman who I think coughed up her right lung into her HANDS). Am I missing the new way to get refills?

I have called to refill medication, discovered that there were no refills left and the pharmacy tech offered to call my doctor. I promptly declined. Isn't that my job? Why are pharmacy's even offering? Aren't they strapped enough for time and people? Customer service??--please we are creating a culture of people who can't take care of themselves. This guy was old enough to know better but now he clearly has come to expect this. I paid for my prescription and also threw in a pocket-sized spray hand sanitizer. Out in the parking lot I sprayed myself and neglected teen daughter down and shook my head in amazement.

YES!!

2009-09-24T13:33:00.004-04:00

You just passed your CNM exam, what are you going to do now?

Rediscover my life!!

Yes, I passed. I over-studied--there's a surprise. Anyways, my anxiety once I clicked the "all done" button was enough to precipitate a massive MI--but I survived. You then walk out and wait for the printer to spit out a piece of paper. The paper tells you whether you passed or not. Thank GOD the first word I read was "Congratulations".

I can go out to dinner tonight and not worry about studying. I can go to sleep without a book as a pillow. I can stop stressing about what I will do if I don't pass. My bedroom can be a bedroom, not a medical library. I can exercise without thinking that I should be reading that book, taking that practice exam. I can have that champagne and not worry that I will be too tired to study after a glass. I now only have my work and family. Well, I am sitting for my NP exam, too but I was hired as a CNM--so not so much stress for that exam.

Thanks for everyone's encouragement and YES, I PASSED!!!

This is it!!!

2009-09-23T08:42:00.003-04:00

Tomorrow is the day. I take my exam tomorrow morning. I have been wanting to "hurl", as my kids would say, for two days now. I have to pass. I have no choice. I have signed a contract with the practice, she ordered business cards. She called yesterday to ask about what alphabet soup I wanted behind my name for signage in the lobby of the two office buildings--yes, I think I can taste it in my throat now, ewww!. But, there's no pressure or anything. Oh, the write up in the hospital advertisement/newsletter they send to EVERY surrounding town that has already been printed, an article about how they are moving up in the world and now have a nurse midwife, that is waiting to be mailed--no pressure.

The funny thing is I kept saying along the way to everyone--can we not do any of this until I take the exam and know if I have even passed??!! No one ever listens to me. So, I guess I better pass.

Oh, here comes another wave of nausea---ugh!!

My birth is better than your birth

2009-09-18T07:56:00.006-04:00

Sometimes I wonder, are we our own worst enemy? I can think of several issues that, in my opinion, women as a whole, have sabotaged any true progress or wide-spread understanding. When looking at any issue that involves women's health, one can find articles, research, etc. on who is making the resolution or progress difficult. I may be narrow-minded in thinking this but I am one who truly believes that you can't blame everyone else for your problems. It's always a two-way street. How you respond to challenges is most often more indicative of achieving success in your endeavor. Here are a couple of hot-button issues I see that our in-fighting is not helping and in fact setting us back.

We have a group of pregnant women arguing for the right to give birth how they choose. Most women would say yes, of course. Now let's boil it down to--does the woman who wants a home birth have more rights than the woman who desires an elective cesarean section? Some would argue that the Cesarean poses risks, some will argue the home birth poses risks. Each group has a point but what they don't see is what they share in common and that is the idea of self-determination.

Oddly enough, as the numbers of female ob/gyn's increase we haven't made tremendous strides. Many males are not choosing ob/gyn residencies for many reasons but one being because they feel they will have a hard time finding a job and growing a practice. Female ob/gyn's are more marketable. For me this is sad, I have worked with some male ob/gyn's that are phenomenal. As the numbers of female ob/gyn's increase we haven't seen a decline in the cesarean rate and the politics of birthing have not improved. The informal boycott of male ob/gyn's hasn't helped our cause.

For me I see it as a lack of respect for women among women. We judge--

The woman who is choosing the elective cesarean.
The woman who chooses to birth at home.
The woman who has an epidural.
The woman who feeds her baby formula.

Now add this to those four situations

She has a history of sexual abuse and the thought of labor and vaginal delivery is traumatic to her.
At her last hospital birth she experienced a medical error.
She has been fully for two hours with no descent and an epidural was used to try and "labor down" for a chance at a vaginal delivery.
She has exquisitely sensitive skin and had skin breakdown. She was dreading every feeding of her baby until she gave him formula. Now she enjoys feeding time with her son.

Very rarely do we take the time to get the whole story. Sometimes it is not really any of our business. I think we would get further if we had mutual respect for others choices. If a woman is given the respect that she is making the best choice for herself at the current time, in her current experience that is all empowering. That empowerment is what we are truly seeking. The knowledge and confidence in ourselves and the freedom to choose what is right for us.

So next time we read or watch some sensationalistic piece of journalism, know that there is usually a story behind the story that we don't often know. Having confidence in a woman to make a decision that is right for herself, her baby and her family at that time, to me, is one of the biggest boosts we can give to women's health.

Real practice or book practice?

2009-09-17T13:20:00.005-04:00

I have been studying for my certification exam for quite some time now. I have taken several practice exams from review books. I have decided that in the area of taking exams my experience is a detriment. I look at a question and there are two answers--what really happens and what they want to happen. Sometimes it is easy because the what really happens answer isn't available as a choice, thus you are led to the one that should happen. Occasionally, some very smart individual has written a question that has both available for you to choose as the answer.

Now, if I went in to this with only the knowledge they placed into my head-the test would probably be easier. It definitely would not be easier in the office or the hospital. My experience has helped me there. It is very hard to erase 17 years of experience and knowledge. I second guess every answer. If I choose wrong, when I look at the "correct" answer--I think "are you serious??, In what world?" Often, as it should be, the answers are one and the same but there are those times, as anyone in healthcare will tell you, that they are not. It's a think called clinical judgment.

If I scored the exams, I am doing fine but my perfectionist side demands 100%, anything less is a bit disappointing to say the least. Frustrating---Book smart or clinical smart? I try for both but sometimes the clinical smart gets in the way of the book smart. Truly, I guess I really wouldn't want it any other way.

Jumping the bookshelves

2009-09-14T09:43:00.008-04:00

Varney, Creasy, Gabbe, Sperrof, Cunningham(William's), Oxorn, Guyton, Bates and Evanovich

Yes, I have jumped off of one of my bookshelves to another. Indulgent, especially since for me Evanovich is just plain old "book candy". Yes, I do read books that have literary worth but after living with and sleeping with some of the above-mentioned, I needed a separation. Janet Evanovich is the author of a series that follows Stephanie Plum, a bounty hunter in Trenton, NJ. I am reading book 14 but I just checked and 15 is out, too. It is the epitome of summer reading. I know it's September but I have missed three summers. I need to catch up. Plus, my brain is deep-fried and I needed something quick and easy. It's my guilty literature pleasure.

It's kind of like at night, on those rare occasions when I get to sit in front of the television. Lonely husband has on the History channel, NatGeo, Discovery, etc. Don't get me wrong, I love those channels. But, when your head is gone from thinking all day there is nothing like an hour of brainlessness (probably not a real word but it gets used here)--reruns of Cops or VH1's Countdown of Top 80's Hair Bands or some such nonsense. He looks at me like I have lost it. In fact, I think many days he may be right.

Back to the grind of studying. I am waiting not so patiently for my letter of eligibility to be sent to the board for me to sit for my exam. It should have been there by now. It should have been sent by now. But, someone made an executive decision to hold the letter until a few students who were unable to complete their course work on time finished. ARGGHHH! That is all I will say about that. It is "supposed" to be sent today. One will see. Off I go headed back to the tombs of textbooks. Every now and then I think I will peak out to see what trouble Stephanie Plum is stirring up.

Lessons: The good & the bad

2009-09-11T11:06:00.003-04:00

I learn from women of all ages every day. It is usually a little nugget of wisdom that is inadvertently shared. Often, we do not even know the impact we have on others. I learn the most from those people I am around who are positive. However, lessons can be learned from women who are the complete opposite. Yes, they are out there! I try my best to be positive with them, hoping that somehow they will learn something from me as I have learned from them what I should not be and hope my children will never become.

Now, don’t get me wrong, I am not Suzy Sunshine all the time, not even close. I am an optimistic realist. Yes, there can be such a thing. What I do believe in is manners, respect and a work ethic. I have run into people of all ages with no manners. Unfortunately, it seems to be more often the case than not. I try not to become frustrated but . . .

When you say you are going to do something, do it!!

When you do it, do it the right way and try your best.

Don’t expect that you are owed anything.

Say Thank You and mean it.

Any amount of initials after your name does not grant you special powers or license to be rude.

Instead of texting, could you hold open the door for the 80 year old man behind you with the cane? Yes, there is someone behind you.

Could you please notice that my children are sitting next to you and utilize the filter for your mouth which is called your brain?

No, I can’t write a note for you to not work. Yes, I know the donut shop is VERY stressful and that you won’t lose your health insurance because I already pay for it but I just can’t lie.

And then we have those women who do and say such things as . . .

What have you done for yourself today?

I am sorry that happened to you, what will make it better?

Listen

Cry with you

Love their husbands, their children, and themselves

Acknowledge what they have control over and what they do not

Love what they do and respect others for what they do

Know that they don’t know everything even with a bunch of initials behind their name

Accept help graciously and offer it similarly

We learn from both don’t we.

Practice what you preach

2009-09-11T08:54:00.005-04:00

For years, in various roles, I have counseled women on various things. My top five are—

Drink water-not juice, not soda, not water with artificially sweetened powder thrown it. Drink more than you possibly think you could if you are pregnant.

Exercise—not I walk the mall, I vacuum the house and chase after kids all day. I am talking about the kind of exercise where you really sweat and your heart rate goes up. And, once you get in the habit you will add weight-bearing on your own because you will feel good and want to!

“Diets” are evil! They don’t work. Yes, I know your sister lost 80 lbs on the hot dog diet but now she is 100lb heavier since she was unable to stay on the stupid hot dog diet. Eat fruits and vegetables, whole grains, lean meats. Eat a protein with your carb. Watch your sugar intake and be mindful of portions. If it is deep-fried—stay away.

Prevention—Big topic, I know, but the main points usually are—wear your seat belt. Wear sunscreen. Know your cholesterol. Know your blood pressure. Know your medications. Stop smoking. Manage your diabetes. Decrease or cease your alcohol intake. Stop using illegal drugs. Separate from the abusive partner/husband . . .

Be kind to yourself—And this is always the hardest one. We beat ourselves up for our failings. We see ourselves somehow responsible for every trouble of our husbands/partners, children, parents, siblings, friends, neighbors, co-workers, and anyone else we can rescue. We often own problems that are not in any way ours or those we have zero power to effect any change. This is stress management, time management, life management, and spiritual management.

So about 2 years ago, I was pretty good at about all of the above and felt absolutely great. Then along came the last year of school. A horrid commute was made that much easier with a latte. A vanilla frosted donut helped me feel better about leaving the hospital after 20+ hours and missing another bedtime. If it was a really bad day—McDonald’s fries were in order. I really should have needed to show an ID for the amount of caffeine I consumed. If not at the hospital or office, I sat with books. I went to sleep with books. The only variation my heart rate saw were the occasional runs of PVC’s from being overtired paired with too much coffee. I personally owned every ounce of teen angst that lived in my house.

DONE! I hopped back on the elliptical today. Healthy eating is back. Heading to restorative yoga tomorrow night. I practiced breathing when talking with neglected teen daughter. Although, thankful for the opportunity to return to school and the support from lonely husband and neglected children, I wasn’t able to be healthy. There are two mountains—the first is to start and the second is to keep going. Hopefully, I can camp for a while on the second mountain.

What does your mommy do?

2009-09-08T09:42:00.003-04:00

A beautiful Labor Day weekend vacation took my family to Salem, MA. Of course, we went to the Salem Witch Museum. Lonely husband took our youngest daughter out 3 minutes into the presentation--she was petrified. He unfortunately was not privy to my children's revelations about their mother's new job.

First, we heard the history of the Salem witch trials. Afterwards, we were shuffled along to a second area were we heard about the changing perceptions of witches over time. This started with an explanation of how the first “witches” were actually midwives. My son’s jaws just dropped. They looked at me and said—“you went to school and did all that work to become a witch?” Then the younger ones said to the older one—“Did you know she was a witch, now?” I thought to myself, I hope they don’t ask lonely dad and husband that question since I can only imagine he would have something very snarky to share! Thank God, the gift shop was next and thoughts of their “witch mom” dissolved into the “can I have” and the “I need’s”.

So, I can see it now on career day—“Can I bring in my mom, she’s a witch?”

My own Shawshank

2009-09-03T17:00:00.004-04:00

The Shawshank Redemption is a great movie. There was a character, Brooks Hatlen, who was paroled after 50 years in prison. This man has no idea what to do with his new found freedom. In fact, he finds it downright unsettling. So much so that he ends up hanging himself. He was happier in prison.

Okay, so no, I am not going to hang myself. After working obscene amounts of hours for years and then working full-time plus full-time school--oh, and the matter of the six children we have, one would think that I would be enjoying this week off. I am done with school. I am not traveling a total of 3 hours round trip to the hospital/practice that I was doing my internship with and I am no longer working as a L&D RN. All but one of the kids have started school and I am home. I am going nuts!!! I am trying to figure out what I am supposed to do with my new found freedom. Right now--I study. I highlight. I make index cards.

I feel like I went from driving in the left lane to the antique cars at an amusement park. Yes, there are things to enjoy about each--I just need to find it. I am sure that by next week I will settle in. Probably once I am comfortable with my freedom I will be thrown back onto the highway--a busy, busy office, call, finding my way as a new midwife and convincing the other OB's from different practices that really I am not there to gobble up their "piece of the pie".

Studying

2009-09-02T19:30:00.001-04:00

I read. I highlight. I make index cards. I do this every day.

Yes, on top of being a midwife it is safe to say I have OCD and a strong leaning towards perfectionism. But, I am comfortable with that. Over the years, nurses and doctors that share those same psychiatric diagnoses, are the ones I want caring for my family and myself. I obsess over taking the certification exam. Everyone tells me--"Of course you will pass". I am thankful for their confidence just wish I could own some of it. As I continue to read, highlight, and make index cards until I sit for the exam--the man I love in the next room will remain the "lonely husband".