I'm posting the abstract of the study that I'm about to try and accomplish. It's in rather boring and scientific terminology - but enjoy if you're interested.
Post partum hemorrhage (PPH) is the leading cause of maternal mortality in Zambia and around the world. Active management of third stage labor (AMTSL) can reduce PPH by 60%. The Zambian government supports this practice and has invested in nursing and midwifery training programs. Prior research and anecdotal reports from the field, however, suggest that AMTSL may be practiced in less than 30% of births attended by SBA. The proposed triangulated study uses quantitative and qualitative methodologies to answer these questions: (1) Are skilled birth attendants (SBAs) in Zambia practicing AMTSL? (2) What is the lived practice experience of a skilled birth attendant with the third stage of labor? Data will be collected in two Zambian sites, the Central Ndola Hospital (Copperbelt Province) and the Chilenge Health Center in Lusaka. The quantitative component involves observation of 52 births (26 births at each site) conducted by SBAs and completion of a standardized tool to record utilization of the components of AMTSL. The qualitative component involves interviewing eight SBAs (four from each site) about their knowledge, attitudes, practices, and perceived barriers encountered when managing the third stage of labor. This study aims to describe current adherence to AMTSL guidelines, and will generate hypothesis regarding barriers to routine use of AMTSL. Knowledge of current practices and information regarding the experiences of SBAs will be useful in the development of future programs to promote AMTSL and other safe motherhood interventions. This study will add to the growing body of literature on the pragmatic implementation of routine use of AMTSL.
Wednesday, May 28, 2008
Saturday, May 17, 2008
my new haven
A pile of discarded childrens clothes on the bridge. They've been there for weeks. There is a story behind that pile that has not yet been told. Did something happen to the person carrying theme home from the laundry matt? Did they never make it? Did they get to lazy to make it to the salvation army? How did they get there?
No dumping at the dump. Figures.
Green water beneath the boardwalk. Today they we re selling lobsters from the water below. $7.99 for any lobster. Any size. Delicious.
The walking path of the bridge.I have been meaning to photograph some of the sights I see each day on my bike to school from my house in Fair Haven. Now that finals are done, I finally brought my camera as I walked to school.
The juxtaposition of wealth and poverty in New Haven is it's most interesting feature - in my humble opinion. It's also what makes living here hard. There is no way to forget the stark fact that in this world - there are 'haves' and 'have-nots'. The recent earth quake and cyclone remind us that we 'haves' can soon have not as well. Those labels are not with us for a life time - and can shift and change with the economy, our emotions, and what life serves up on a plate.
New Haven serves up some interesting city scapes at least - here is a fraction of what I pass each morning near the bridge into New Haven.
On my ride this morning I wanted to bottle up the pungent smells that accompany the photos above - rotting fish, a dusty texture from recent construction, and a sweet toxic odor from the scrap metal yard.
Wednesday, May 07, 2008
Strawberry Cervix
Trich - see the ovid shaped protozoa in the center of the slide? That's the bugger trich.... what we see under the microscope.I saw one last Friday at clinical. It was so obviously infected, and it's owner, a teenage girl, had been suffering with it for weeks. It was one of my first experiences in this new skill set that I'm developing where I just KNEW something major was up with her. I followed my instinct, and the advice and assurance of my preceptor, and treated her for a whole gamut of STIs even without the return of test results.
Results came back yesterday. Trich and chlamydia indeed. She took her medication, and is feeling much better... it's nice to know that sometimes, I have a small semblance of confidence and actually know what I'm looking at.
Then, to remind me that I'm really still quite clueless, my professor asked me yesterday during a skill-set check off: "Is English your second language?" My mushy brain forgot the word laryngiscope and instead said "The tube that we intubate with." Yikes - at least I could have said "With which we intubate!" I passed, thank goodness.
I am ready for finals to be finally done and move on to the next big adventure in Zambia, where things more exciting than a strawberry cervix will certainly occur.
Saturday, April 19, 2008
uterine rejection
Midwifery is not always a happy field. Perhaps what we dread most is birthing an unexpected still born baby. Or a late term fetal demise - one in which labor needs to be induced to birth the now-still child.
Yesterday, while not so dramatic, reminded me of the sad components of both life - and reproduction.
Our first patient was a 30 year old woman, there for her first prenatal visit. She was 13 weeks and 1 day pregnant - and was coming to us for her labs, her physical work up, and a long discussion about the signs and symptoms of pregnancy. Before I geared up for my shpiel, I asked her the standard questions. "Do you have any vaginal bleeding, any loss or leak of fluid? Can you feel the baby move?" Now, 13 weeks is too early for fetal movement, but not, in her case, too early for bleeding.
When I did her exam, I felt she was 1 cm dilated, and I saw blood in the hole (os) of her cervix. I knew in my heart that she was having a misscarrage. She had been trying to get pregnant for 5 years (since the birth of her now 6 year old boy). She was a recent immigrant from Mexico - and had no insurance what-so-ever. She had already had one miscarriage at 12 weeks (3 months) and now, I was going to have to tell her she was having another. Her husband was in the room, excited to hear the heart beat for the first time. But, of course, we found none.
She cried and cried when we told her. She kept asking "why?" Was it something she did? or ate? or a problem with her? We had no answers. Expensive genetic tests and infirtility work ups are the only possible way to find these answers. But for an undocumented worker with no insurance and minimum wage - well, the explination that "we don't know." Will have to suffice.
Our next patient was HIV positive. She was staying in a half way house, and admitted to me early on that she was coming for an annual exam just cause a doctors appointment was the only way to get out of the house. She told me - when offered condoms - that she didn't want to have sex ever again. "I have the virus, and I have my toy. No condoms, thank's any way."
Our next patient was a 16 year old girl - who had a baby about 2 months ago. Two weeks ago, I had put in an IUD. THis week? It was falling out. Her uterus expelled it. This girl made me sad - her BMI was 38 (ie: She weighed 274 lbs on a 5'5 frame), her teeth were chipped and grey, and in the 3 times that I'd seen her since the birth of the baby, never once had I met the little tyke.
The day continued, in a more normal patter of pre-natal checks and acute complaints. But the start of the day sobered me up a bit. Sometimes the uterus rejects. And our system is not ready, willing, or able, to be there.
Yesterday, while not so dramatic, reminded me of the sad components of both life - and reproduction.
Our first patient was a 30 year old woman, there for her first prenatal visit. She was 13 weeks and 1 day pregnant - and was coming to us for her labs, her physical work up, and a long discussion about the signs and symptoms of pregnancy. Before I geared up for my shpiel, I asked her the standard questions. "Do you have any vaginal bleeding, any loss or leak of fluid? Can you feel the baby move?" Now, 13 weeks is too early for fetal movement, but not, in her case, too early for bleeding.
When I did her exam, I felt she was 1 cm dilated, and I saw blood in the hole (os) of her cervix. I knew in my heart that she was having a misscarrage. She had been trying to get pregnant for 5 years (since the birth of her now 6 year old boy). She was a recent immigrant from Mexico - and had no insurance what-so-ever. She had already had one miscarriage at 12 weeks (3 months) and now, I was going to have to tell her she was having another. Her husband was in the room, excited to hear the heart beat for the first time. But, of course, we found none.
She cried and cried when we told her. She kept asking "why?" Was it something she did? or ate? or a problem with her? We had no answers. Expensive genetic tests and infirtility work ups are the only possible way to find these answers. But for an undocumented worker with no insurance and minimum wage - well, the explination that "we don't know." Will have to suffice.
Our next patient was HIV positive. She was staying in a half way house, and admitted to me early on that she was coming for an annual exam just cause a doctors appointment was the only way to get out of the house. She told me - when offered condoms - that she didn't want to have sex ever again. "I have the virus, and I have my toy. No condoms, thank's any way."
Our next patient was a 16 year old girl - who had a baby about 2 months ago. Two weeks ago, I had put in an IUD. THis week? It was falling out. Her uterus expelled it. This girl made me sad - her BMI was 38 (ie: She weighed 274 lbs on a 5'5 frame), her teeth were chipped and grey, and in the 3 times that I'd seen her since the birth of the baby, never once had I met the little tyke.
The day continued, in a more normal patter of pre-natal checks and acute complaints. But the start of the day sobered me up a bit. Sometimes the uterus rejects. And our system is not ready, willing, or able, to be there.
Wednesday, February 27, 2008
Bienbenido bebe
The hazy blue of this poor quality cell phone photo represents the day. This message was scribbled on the white board by the 21 year old husband of the 17 year old girl who was in labor when they first came in. She, then, was dressed, walking slowly, but barley breathing heavily.
Over the course of the next 4 hrs, she transformed from a young Mexican, looking girlish in jeans and a sweater, with gorgeous long black shiny hair in a braid swinging behind her, to a powerful woman - pushing out a baby with a grunt and a moan with no pitocin, no pain meds, clutching the arms of her husband on one side and her cousin on the other, and me at her perineum, grinning behind my plastic mask. In the interim, she learned to be intimate with strangers, to try rolling on the birthing ball, and to listen to and trust her body.
The baby, Shanelle (pronounced like the perfume), came out spinning, with her fist raised up and held high, yelling her way into this big beautiful world. I did nothing more graceful than just hold on and slip the slippery wet cord around her slippery wet head and - oops - that hand. We laid her on her mama's belly and reveled in her wales.
Who knows what her life will grow into, if she will have her first baby at 15 like her strong mama, or if she will be the first in her family to speak English, go to college, and keep her fist raised high in the fight for immigrant rights, for human rights, and for being fully human.
Life is precious indeed.
Friday, February 15, 2008
babe in toy land!
I caught my first kid today..... she was slip sliding right out of her 21 year old mom. It was stressful - I did not cry, but instead sweat up the inside of my gown and fogged up my shield mask so I could barely see. It's the little things.
She came in at 7am for an induction (induction: beginning labor with medication, not time...). The bag of pitocin was hung at 8am. By 10:58 she had a broken bag of water, and by 11:19am a screaming baby and a sweating nurse midwifery student staring at her perineum with wide eyes.
We sewed her back up a bit, the other student did breastfeeding counseling while I filled out paper after paper after paper. It was a great event. At 5pm the midwife and I went upstairs to visit her. She was sitting in bed, surrounded by family and friends, breastfeeding like a champ.
It warms a fledgling midwife's heart. I feel inducted into this tribe. I have caught my first baby. It was not magical, but very very real. Very stretchy. Very stressful. Very wet and messy and beautiful.
She came in at 7am for an induction (induction: beginning labor with medication, not time...). The bag of pitocin was hung at 8am. By 10:58 she had a broken bag of water, and by 11:19am a screaming baby and a sweating nurse midwifery student staring at her perineum with wide eyes.
We sewed her back up a bit, the other student did breastfeeding counseling while I filled out paper after paper after paper. It was a great event. At 5pm the midwife and I went upstairs to visit her. She was sitting in bed, surrounded by family and friends, breastfeeding like a champ.
It warms a fledgling midwife's heart. I feel inducted into this tribe. I have caught my first baby. It was not magical, but very very real. Very stretchy. Very stressful. Very wet and messy and beautiful.
Wednesday, February 13, 2008
No babes in toy land
Although I awoke each hour almost on the hour last night to check my phone for a dreaded missed call, there was none. No call. No labors. No births. No snowy adventures. Perhaps next time.
Tuesday, February 12, 2008
Ring ring
I have my first overnight call shift right now. And it's snowing. And my car was stolen this week. So I'm experiencing a moment of self pity.
This is our third week of clinical - and thus far, I haven't used my fingers as measuring tapes once. Nor have I seen a little head crowning. Nor have I helped guide a screaming, milky newborn into this snowy world.
So, as I sit at my desk to study, with fingers un-decidedly crossed, I await my first birth. I am trepidatous about the snow, my car-less situation, and how this whole thing will unfold. The thing about normal, natural birth is that it doesn't go by my clock. Silly birth.
I'll keep you all posted.
This is our third week of clinical - and thus far, I haven't used my fingers as measuring tapes once. Nor have I seen a little head crowning. Nor have I helped guide a screaming, milky newborn into this snowy world.
So, as I sit at my desk to study, with fingers un-decidedly crossed, I await my first birth. I am trepidatous about the snow, my car-less situation, and how this whole thing will unfold. The thing about normal, natural birth is that it doesn't go by my clock. Silly birth.
I'll keep you all posted.
Monday, February 04, 2008
Before it was Varanasi
It was Banares. This photo was taken circa 1982. Can you spot me?My mom found this photo recently and shared it. She suggested we put it to music.... "One of these things is not like the other, one of these things is not quite the same."
Cheers to adventures, bicycles, and chupples.
Thursday, January 24, 2008
not just hands
A midwife's hands do so much more than hold and support. Indeed, it is not cheesy when people talk about their power. Much of what they do is to feel the invisible - and 'see' what is under the skin, just out of reach, and up and back behind what we can image. A good (and practiced) midwife can tell the estimated weight of a fetus in utero, it's position, if it's head is flexed or extended, if it is facing a bit to the left or right inside the mother's uterus, if the head is down or up or (lord forbid) sideways.
Hands become measuring tools as well - how much is she dilated? how big is her pelvis? how far down has the baby dropped? there is no scientific measurement - just very educated guesses - placing one or two fingers in the cervix and thinking - if two tips of my fingers are 3cm - she must be just under three cm dilated. Yes, sobering how un-exact it is - but excited how precise it can become. We have all measured every length and width of our hands, fingers, and fingertips. I have really never paid so much attention to any part of my body. The length from my pointer finger to the base of the thumb is 13cm.
To practice estimating dilation - we have been instructed to measure every round thing with our fingers - then check the diameter with a tape to get a sense of truth. For example, the middle and pointer fingers of my left hand stretched to their maximum is about 10cm from edge to edge. And so, voila - if I can fully stretch them - she's ready to have that baby.
So, there goes distancing my self from just about anything - a water glass, a water bottle (mine is about 3cm in diameter at the opening, a door knob, a shampoo bottle.
It's all a cervix. And my hands are my tape measure.
Hmmm.... I think I deserve a manicure.
Hands become measuring tools as well - how much is she dilated? how big is her pelvis? how far down has the baby dropped? there is no scientific measurement - just very educated guesses - placing one or two fingers in the cervix and thinking - if two tips of my fingers are 3cm - she must be just under three cm dilated. Yes, sobering how un-exact it is - but excited how precise it can become. We have all measured every length and width of our hands, fingers, and fingertips. I have really never paid so much attention to any part of my body. The length from my pointer finger to the base of the thumb is 13cm.
To practice estimating dilation - we have been instructed to measure every round thing with our fingers - then check the diameter with a tape to get a sense of truth. For example, the middle and pointer fingers of my left hand stretched to their maximum is about 10cm from edge to edge. And so, voila - if I can fully stretch them - she's ready to have that baby.
So, there goes distancing my self from just about anything - a water glass, a water bottle (mine is about 3cm in diameter at the opening, a door knob, a shampoo bottle.
It's all a cervix. And my hands are my tape measure.
Hmmm.... I think I deserve a manicure.
Wednesday, January 23, 2008
boot camp
I fondly call the last two weeks "midwifery boot camp." Each day from 9-5 (or beyond), our class of 16 has sat through lectures, demonstrations, skits, pretend-you're friend-is-birthing-a-plastic-baby-in-the-squat-position sessions, chicken-thigh suturing lesions, and other creative means to determinate the how-tos of being a midwife. Today we ended with a two hour tour of the labor and birth unit where we will be taking call starting next Tuesday.
Honestly, how fun, and what a whirl wind. Two weeks ago I really didn't know much about being a midwife, and wasn't really sure that this whole labor and birth thing is what I really wanted to do - and now I am undeniably excited about the years to come - and could probably even bumble and fumble my way through explanations about latent, active, second and third stage labor, and a myriad of genetic tests that we offer during prenatal care, and why.
There is certainly a HUGE amount still to cover, and lots of practice to obtain, but what a way to start the new year.
Perhaps one day I'll sneak my camera into the lab while my friend Amber is butt up in the air, grasping a plastic head while the rest of the class coaches her and rubs her back, and one of us take the seat as the catcher...and she huffs and puffs and pushes out that plastic head and soft little body right through her legs to the applause of 15 other midwifery students.
Honestly, how fun, and what a whirl wind. Two weeks ago I really didn't know much about being a midwife, and wasn't really sure that this whole labor and birth thing is what I really wanted to do - and now I am undeniably excited about the years to come - and could probably even bumble and fumble my way through explanations about latent, active, second and third stage labor, and a myriad of genetic tests that we offer during prenatal care, and why.
There is certainly a HUGE amount still to cover, and lots of practice to obtain, but what a way to start the new year.
Perhaps one day I'll sneak my camera into the lab while my friend Amber is butt up in the air, grasping a plastic head while the rest of the class coaches her and rubs her back, and one of us take the seat as the catcher...and she huffs and puffs and pushes out that plastic head and soft little body right through her legs to the applause of 15 other midwifery students.
Sunday, January 13, 2008
the goings and comings
While in Kentucky, visiting Jo, I quit my job. What a relieving, freeing, scary, odd, sentimental feeling. I did it in the respectful way, with lots of notice and an explaination.
I worked my last shift on Saturday - complete with a 28 year old drug addicted man who fell while jumping down some stairs and broke his ankle in 2 places - and nothing could 'touch' his pain - a 25 year old law student who was scared and brave, admitted with a small bowel obstruction, young, blond, shivering in the bed, wishing she was anywhere but here - a 51 year old guy who looked 72 with no teeth, grey hair and recovering from a hip replacement with a crit that, even with 3 units of blood - wouldn't creep above 28 - and a handful of others, in and out, in pain and out of it- admitted and discharged.
It was such a strange feeling to walk out at 7:30, running to meet caleb for a delicious dinner and movie. Everything seemed so normal - but also so disorienting, knowing that I would never work there again. I finished a chapter after I had started the next book, reminding me of the multiple stories that weave throughout a life, and how new doors open and close continuously, and nothing is ever done really, but just is added into the ever expanding record - our own sort of chart.
So too do I go and come. I just drove back from Cambridge to New Haven after a wonderful three weeks away. A new chapter is starting tomorrow. Second semester. Monday starts at 9 and goes 'till 7:30. A brutal amount of sitting and listening, in my opinion. And while last semester was in a midwifery program, tomorrow is the start of learning to be a midwife. We will be focusing on IP (intrapartum - labor and delivery) and AP (antepartum - pre-natal care) throught out the next 4 months. Clinical will start in a few weeks, and I will finally catch babies, assist with breastfeeding, hold hands, wipe sweat, and memorize, memorize, memorize. This is a chapter, that while seemingly is beginning tomorrow, actually began years ago - perhaps even 28.
A funny moment from today, below. A flat. As if I needed another excuse not to leave Cambridge.
I worked my last shift on Saturday - complete with a 28 year old drug addicted man who fell while jumping down some stairs and broke his ankle in 2 places - and nothing could 'touch' his pain - a 25 year old law student who was scared and brave, admitted with a small bowel obstruction, young, blond, shivering in the bed, wishing she was anywhere but here - a 51 year old guy who looked 72 with no teeth, grey hair and recovering from a hip replacement with a crit that, even with 3 units of blood - wouldn't creep above 28 - and a handful of others, in and out, in pain and out of it- admitted and discharged.
It was such a strange feeling to walk out at 7:30, running to meet caleb for a delicious dinner and movie. Everything seemed so normal - but also so disorienting, knowing that I would never work there again. I finished a chapter after I had started the next book, reminding me of the multiple stories that weave throughout a life, and how new doors open and close continuously, and nothing is ever done really, but just is added into the ever expanding record - our own sort of chart.
So too do I go and come. I just drove back from Cambridge to New Haven after a wonderful three weeks away. A new chapter is starting tomorrow. Second semester. Monday starts at 9 and goes 'till 7:30. A brutal amount of sitting and listening, in my opinion. And while last semester was in a midwifery program, tomorrow is the start of learning to be a midwife. We will be focusing on IP (intrapartum - labor and delivery) and AP (antepartum - pre-natal care) throught out the next 4 months. Clinical will start in a few weeks, and I will finally catch babies, assist with breastfeeding, hold hands, wipe sweat, and memorize, memorize, memorize. This is a chapter, that while seemingly is beginning tomorrow, actually began years ago - perhaps even 28.
A funny moment from today, below. A flat. As if I needed another excuse not to leave Cambridge.
Monday, January 07, 2008
Not in order of importance
Ok - an update since my last post (no promises regarding order and significance)
1. I am currently eating ice cream for lunch in Charlotte Airport on my way to Lexington to visit a dear friend
2. 3 out of 16 women in my midwifery class got engaged over break. odd. amazing
3. Obama won the Iowa caucus and is well on his way in New Hampshire tomorrow - a fact that is hard not to get excited about... regardless of how undecided I was before
4. I had a very relaxing and computer free vacation - a lovely Christmas at home with Caleb and my family complete with a plastic talking Jesus - a quick trip to Virginia to see my whole entire quasi-Mennonite crew and some historical houses and (out) houses - a visit to Frank Loyd Wright's Falling Water - and a snow filled fabulous few days for new years in New Hampshire.
5. I haven't worked a day at the hospital while on vacation - but did send a huge check to my union, as I'm still technically a member of my bargaining unit. Argh. Union dues. Good in theory. Making me broke in practice at the moment. I think I may have forgotten how to be a nurse.
6. Luckily for me, I'm working on other things - and am knee deep in information on maternal mortality and post partum hemorrhage for a research proposal I'm writing for the summer (fingers crossed).
7. My ice cream (it had fresh blueberries and raspberries - the best thing I could find in this airport - snobby me) is all gone now.
here are some pics to share from my vacation.
Don's John, Virginia, 2007
Frisbee on the frozen lake, New Hampshire, 2007
UNO! New Hampshire, 2007
Bob's famous Christmas Stolen, Hastings, 2007
My cousin Hillman and his mock apple, VA, 2007
1. I am currently eating ice cream for lunch in Charlotte Airport on my way to Lexington to visit a dear friend
2. 3 out of 16 women in my midwifery class got engaged over break. odd. amazing
3. Obama won the Iowa caucus and is well on his way in New Hampshire tomorrow - a fact that is hard not to get excited about... regardless of how undecided I was before
4. I had a very relaxing and computer free vacation - a lovely Christmas at home with Caleb and my family complete with a plastic talking Jesus - a quick trip to Virginia to see my whole entire quasi-Mennonite crew and some historical houses and (out) houses - a visit to Frank Loyd Wright's Falling Water - and a snow filled fabulous few days for new years in New Hampshire.
5. I haven't worked a day at the hospital while on vacation - but did send a huge check to my union, as I'm still technically a member of my bargaining unit. Argh. Union dues. Good in theory. Making me broke in practice at the moment. I think I may have forgotten how to be a nurse.
6. Luckily for me, I'm working on other things - and am knee deep in information on maternal mortality and post partum hemorrhage for a research proposal I'm writing for the summer (fingers crossed).
7. My ice cream (it had fresh blueberries and raspberries - the best thing I could find in this airport - snobby me) is all gone now.
here are some pics to share from my vacation.
Don's John, Virginia, 2007
Frisbee on the frozen lake, New Hampshire, 2007
UNO! New Hampshire, 2007
Bob's famous Christmas Stolen, Hastings, 2007
My cousin Hillman and his mock apple, VA, 2007
Tuesday, December 18, 2007
And finally, finals
In a strange way, I'm glad finals are upon us. I feel as if I have been studying for weeks - ok, semesters. It's good just to push it and knock down these tests. Ok, the one yesterday was gently pushed over, or perhaps it pushed me. However, 1 down, 1 today - and then 2 more.
Thursday evening will be sweet, sweet joy.
More soon, when it is all wrapped up.
Thursday evening will be sweet, sweet joy.
More soon, when it is all wrapped up.
Tuesday, December 11, 2007
me, a quarter, and a spinning brain
Today was my last day of Gyn clinical and I am making a big pot of soup, preparing to hibernate until December 20th when exams are over.
The semester simultaneously feels like it is winding down - and gearing up. We have 4 exams next week - one each day - and the preparation feels both overwheming and underwheming. Underwhelming in the sense that I am not excited about it - and overwhelming in the typical, I'm about to take four big tests, kind of way. My brain is spinning, and not so articulate, but I will try to eek out a bit before hitting the books.
I put in my first IUD today. To those of you not in midwifery school(which means everyone who reads this as I have not gone public yet) and are not doctors (who put central lines in on the regular, and other fun things) putting in an IUD is a pretty big deal. Perhaps it won't be on the 4th or 5th - but the first time is a make-the-palms-sweaty kind of moment. It entails tenaculums (think: big huge pinchers. ouch), betadine, some pulling, some ouchieness, some measuring of the uterus, and some chutzpa. (wow, that didn't get a red underline, I can't believe I spelled chutzpa correctly on the first try). My victim, er-um, patient, was an adorable 19 year old girl who just delivered her first baby 6 weeks ago. She prepped correctly with a bunch of ibuprofen, and seemed to do well. If she had been yelling, I would have been yelling, and then it might not have been so smooth...
That was my first patient of the day - and the rest, as if a gift, were all happy cases as well. No "I slept with 6 men and have some nasty critters and huge heap of medical problems" kind of patients. I saw a grinning 18 year old with a doting boyfriend at one of their last prenatal exams, I saw a 62 year old woman with no real complaints except constipation (yeah! I know what to say about that), and some other benign cases that all blend into one...
So the first semester, 1/4, of my clinical experience is now finished. I do not feel like 1/4 midwife yet - or, well, perhaps I do.
Yes, 1/4 done is exactly where I am - and when exams are over, being 1/3 done with coursework will feel just fantastic.
The semester simultaneously feels like it is winding down - and gearing up. We have 4 exams next week - one each day - and the preparation feels both overwheming and underwheming. Underwhelming in the sense that I am not excited about it - and overwhelming in the typical, I'm about to take four big tests, kind of way. My brain is spinning, and not so articulate, but I will try to eek out a bit before hitting the books.
I put in my first IUD today. To those of you not in midwifery school(which means everyone who reads this as I have not gone public yet) and are not doctors (who put central lines in on the regular, and other fun things) putting in an IUD is a pretty big deal. Perhaps it won't be on the 4th or 5th - but the first time is a make-the-palms-sweaty kind of moment. It entails tenaculums (think: big huge pinchers. ouch), betadine, some pulling, some ouchieness, some measuring of the uterus, and some chutzpa. (wow, that didn't get a red underline, I can't believe I spelled chutzpa correctly on the first try). My victim, er-um, patient, was an adorable 19 year old girl who just delivered her first baby 6 weeks ago. She prepped correctly with a bunch of ibuprofen, and seemed to do well. If she had been yelling, I would have been yelling, and then it might not have been so smooth...
That was my first patient of the day - and the rest, as if a gift, were all happy cases as well. No "I slept with 6 men and have some nasty critters and huge heap of medical problems" kind of patients. I saw a grinning 18 year old with a doting boyfriend at one of their last prenatal exams, I saw a 62 year old woman with no real complaints except constipation (yeah! I know what to say about that), and some other benign cases that all blend into one...
So the first semester, 1/4, of my clinical experience is now finished. I do not feel like 1/4 midwife yet - or, well, perhaps I do.
Yes, 1/4 done is exactly where I am - and when exams are over, being 1/3 done with coursework will feel just fantastic.
Tuesday, December 04, 2007
eating is healing
Sometimes healing involves eating, hiking, cooking, and more eating... which is just what we did for 4 days in New Paltz over thanksgiving. I have been let in on a fun and long lasting tradition of Caleb's family and have been taking full advantage.... (the whole 2007 crew above)
The making of Lumpias (it doesn't decrease the deliciousness to see this pot of oil)
Turkey Trotters pre race.
Liz by her electric stove - The joy of kitchen duty
Saturday, December 01, 2007
balance
There is a sad difference, while training to be a nurse-midwife, or any health care provider, I suppose, between what is practiced and what is preached - or taught - in the classroom.
In our primary care class, we are taught to always look at the whole person - a theory to which I subscribe fully - if a woman comes in for a specific complaint: an itch, an earache, a pregnancy test, some pain - we should deal with the complaint... and then pay attention to her picture as a whole. Is she obese? Is she depressed? or does she have a history of mental illness? which co-morbidities does she have? can we manage them today as well? How are her relationships? Is she at risk for abuse? We have learned tricks and tools and resources for dealing with all of those things - wonderful, great, I'm ready to go...
But then, in my clinical site, I have barely enough time to diagnose and manage the one complaint- let alone target anything else about her history. When I launched into weight management discussions with a 342lb woman who came in to use for an STD check because the was 'trying' three men currently... I was told to hurry - we had 3 folks waiting. But how can I feel comfortable sending her out with an antibiotic prescription (indeed, she did have some critters) and not addressing this 28 year old woman's diabetes, high blood pressure, and obesity. The STD check, while important, seemed almost to be the least of her problems. My preceptor, when I pushed it, told her to make another appointment with the medical clinic and another one to go get labs drawn. With a full time job, and 2 kids with no father figure, I don't hedge my bets that she will keep them. She was in our clinic, here, now, with an acute complaint, and I just wanted to start her process...
I gave her my 30 second schtick, a pack of condoms and a rx for flagyl 2g POx 1 - and sent her on her way. Lamenting the gross difference between practice and ideal, and the way in which to pressures of low income health care surely does necessitate less than optimal care.
In our primary care class, we are taught to always look at the whole person - a theory to which I subscribe fully - if a woman comes in for a specific complaint: an itch, an earache, a pregnancy test, some pain - we should deal with the complaint... and then pay attention to her picture as a whole. Is she obese? Is she depressed? or does she have a history of mental illness? which co-morbidities does she have? can we manage them today as well? How are her relationships? Is she at risk for abuse? We have learned tricks and tools and resources for dealing with all of those things - wonderful, great, I'm ready to go...
But then, in my clinical site, I have barely enough time to diagnose and manage the one complaint- let alone target anything else about her history. When I launched into weight management discussions with a 342lb woman who came in to use for an STD check because the was 'trying' three men currently... I was told to hurry - we had 3 folks waiting. But how can I feel comfortable sending her out with an antibiotic prescription (indeed, she did have some critters) and not addressing this 28 year old woman's diabetes, high blood pressure, and obesity. The STD check, while important, seemed almost to be the least of her problems. My preceptor, when I pushed it, told her to make another appointment with the medical clinic and another one to go get labs drawn. With a full time job, and 2 kids with no father figure, I don't hedge my bets that she will keep them. She was in our clinic, here, now, with an acute complaint, and I just wanted to start her process...
I gave her my 30 second schtick, a pack of condoms and a rx for flagyl 2g POx 1 - and sent her on her way. Lamenting the gross difference between practice and ideal, and the way in which to pressures of low income health care surely does necessitate less than optimal care.
Sunday, November 18, 2007
X rated
It's going to be hard to write this year without using culturally racy words... and I say culturally, because in the didactic portion of nurse-midwifery school (and the clinical) they are our every day language. We put the Vagina monologues to shame on the regular.
So, with that preface, I will recount a touching and and amusing story that happened on Thursday at my clinical site (a public Gyn clinic in a hard-knock city in Connecticut where the average age of first pregnancy can't be much over 17....)
A twenty year old hispanic girl came in to get an IUD placed. She brought her adorable 6 week old baby girl clad in pink and swimming in the biggest ensemble of carriage, blankets, stuffed animals, diaper bags that I had seen that day. She also brought her partner, who sheepishly wiped the long dark hair out of his eyes as we asked him to take a seat next to the exam table where his nervous girlfriend lay. He spoke very little English, and his girlfriend, by now wearing a hospital gown and draped in a sheet, translated each word we said.
As my preceptor gave the instructions, they both nodded in agreement "Take 2 ibuprophen when you get home, feel the strings to see if they have moved, you may have some cramping and spotting for a month... and nothing in the vagina for 2 weeks." The long haired partner sat up a little straighter - obviously understanding.
"And that includes penis." The midwife mater-of-factly said.
Her partner smiled an embarrassed smile, laughed, and looked between us and his girlfriend - his eyes saying "Are you suggesting we have sex? How could you think such a thing?" She giggled, he giggled, and the procedure began.
While grimacing during the IUD placement, her partner started laughing again. "No penis!" He blurted out. She couldn't help herself in her nerves and pain and laughed too.
As I drove away from the clinic at the end of the day, I saw the two of them walking, pushing their baby entourage, and holding hands.
It is nice to feel good about the dynamic of the young couples once in a while. And I was sure they would follow the instructions and advice they had gotten that day.
So, with that preface, I will recount a touching and and amusing story that happened on Thursday at my clinical site (a public Gyn clinic in a hard-knock city in Connecticut where the average age of first pregnancy can't be much over 17....)
A twenty year old hispanic girl came in to get an IUD placed. She brought her adorable 6 week old baby girl clad in pink and swimming in the biggest ensemble of carriage, blankets, stuffed animals, diaper bags that I had seen that day. She also brought her partner, who sheepishly wiped the long dark hair out of his eyes as we asked him to take a seat next to the exam table where his nervous girlfriend lay. He spoke very little English, and his girlfriend, by now wearing a hospital gown and draped in a sheet, translated each word we said.
As my preceptor gave the instructions, they both nodded in agreement "Take 2 ibuprophen when you get home, feel the strings to see if they have moved, you may have some cramping and spotting for a month... and nothing in the vagina for 2 weeks." The long haired partner sat up a little straighter - obviously understanding.
"And that includes penis." The midwife mater-of-factly said.
Her partner smiled an embarrassed smile, laughed, and looked between us and his girlfriend - his eyes saying "Are you suggesting we have sex? How could you think such a thing?" She giggled, he giggled, and the procedure began.
While grimacing during the IUD placement, her partner started laughing again. "No penis!" He blurted out. She couldn't help herself in her nerves and pain and laughed too.
As I drove away from the clinic at the end of the day, I saw the two of them walking, pushing their baby entourage, and holding hands.
It is nice to feel good about the dynamic of the young couples once in a while. And I was sure they would follow the instructions and advice they had gotten that day.
Thursday, November 15, 2007
Was there life before pap-smears?
Ok, ok. A blog is no good if you don't write on it.... no one will read it, check it, and friends will give up on you and your determination to share the joys and pains of life on a regular basis.
I appologize, life moved out from under me and updating this blog fell through the missing spaces of free time.
I am back in school - studying to be a nurse-midwife - and it is, cliched as it may be - all that I dreamed it would be. And this dream has certainly been a long time coming... I have been talking about this since 2003 - so with two years of pre-reqs, a year of nursing school, a year of nursing, and more debt than I care to admit, I am here.
In the past 3 months I have become adept at pap-smears, staring at body fluids under the microscope, talking to young girls about the evils of douching and the joys of birth control, and more than anything, sitting at my desk reading, reading, memorizing... It is certainly not everyone's cup of tea. But it is mine - and with a little sleep under my belt and a newly vacuumed floor - I feel positive about the direction this is heading.
In the mean time, here are some pictures of Caleb and my vacation to Italy and Croatia this summer - which seems like longer ago than 4 months. Was there life before pap-smears?
Yes....
I appologize, life moved out from under me and updating this blog fell through the missing spaces of free time.
I am back in school - studying to be a nurse-midwife - and it is, cliched as it may be - all that I dreamed it would be. And this dream has certainly been a long time coming... I have been talking about this since 2003 - so with two years of pre-reqs, a year of nursing school, a year of nursing, and more debt than I care to admit, I am here.
In the past 3 months I have become adept at pap-smears, staring at body fluids under the microscope, talking to young girls about the evils of douching and the joys of birth control, and more than anything, sitting at my desk reading, reading, memorizing... It is certainly not everyone's cup of tea. But it is mine - and with a little sleep under my belt and a newly vacuumed floor - I feel positive about the direction this is heading.
In the mean time, here are some pictures of Caleb and my vacation to Italy and Croatia this summer - which seems like longer ago than 4 months. Was there life before pap-smears?
Yes....
Tuesday, April 24, 2007
Montreal
Caleb and I had a fantastic road-tripping vacation this past week from New Haven, to Burlington, and onto Montreal. It was so easy to leave the working world behind and join the land of the living and relaxing and not going to work all the time. Here are some pictures.
Emeleia - Zoe's baby. Loving her spoon while the rest of us enjoy Pepe's Pizza and some beers.
Helen and Nick. Two great New Havenites.
Sahir and Justin - narcissistic and wonderful as ever.
Caleb - yes, the sad truth of road trips. But look how beautifully blue the sky became.
Grafitti. Montreal integrates it so well into the urban landscape. It was everywhere. We decided to celebrate....
And kiss.....
And eat....
And frolic...
How fun.
Emeleia - Zoe's baby. Loving her spoon while the rest of us enjoy Pepe's Pizza and some beers.
Helen and Nick. Two great New Havenites.
Sahir and Justin - narcissistic and wonderful as ever.
Caleb - yes, the sad truth of road trips. But look how beautifully blue the sky became.
Grafitti. Montreal integrates it so well into the urban landscape. It was everywhere. We decided to celebrate....
And kiss.....
And eat....
How fun.
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