Tag Archives: Nursing

“Sometimes You Have to Just Walk Away…”

There is a particular statement that I have heard on Labor & Delivery units — not just on one, but on every single unit where I’ve attended women’s births. I have heard it from nurses, I have heard it from OBs and anesthesiologists, I’ve even heard it from midwives.

What happens before the statement is made is that a woman is laboring. She is in pain, and she is doing something to express that pain: perhaps she is calling to her family members for help; perhaps she is unable to keep still in the bed, causing the fetal heart monitor to fall off. Perhaps she is saying over and over that she can’t get comfortable, or begging to be allowed up out of bed to walk, although she will not be allowed to because of her epidural. She may be asking why she is still in pain despite the fact that she had an epidural. She may be loudly vocalizing her contractions — she may be screaming as they occur. Perhaps she has been doing some combination of these things for hours.

The nurse has wandered in and out of the room and said that the woman can’t possibly be in that much pain at only 4 centimeters dilated. The anesthesiologist has been called in and swears that the epidural is in correctly and that the woman is just feeling pressure, not pain. The midwife, shame on her, has stood three feet from the woman’s bed and said that she can ask the anesthesiologist to replace the epidural catheter, if that’s what the woman would like.

Everyone clears out into the hallway, leaving the woman alone in her room. And then someone turns and says to me, the student, as if offering some great wisdom: “Sometimes you have to just walk away and then she’ll calm down.”

I am recording this here because this statement should never become normal or acceptable to me, no matter how nonchalantly it is said, no matter how reasonably intentioned the person who says it. Bear in mind that I don’t mean a situation where a woman asks for privacy to labor (privacy being something that she will never get in a hospital), but rather one in which the clinician judges that the woman would be better off by herself.

The assumption behind this statement is, first and foremost, that the woman will essentially be alone in her labor. There is no expectation that she should be continuously supported throughout labor (as has been shown over and over again in research to lead to the best outcomes), no expectation that one should do anything other than spend a few minutes at a time dealing with her.

This statement also represents the feeling that a woman asking for help in labor is, after a certain point, just a complaining, attention-seeking, pain in the ass. Her pain, discomfort, or distress isn’t real — especially if you already gave her medication. She’s just being melodramatic, and what she really needs is for you to ignore her a little bit so that she can spend some time alone in her room. Like a child. You acknowledge that the woman is having anxiety and frustration — and your reaction is to walk out.

I have recently had the realization that the people who make this statement are also fundamentally ignorant — despite being professionally involved with women giving birth, they have almost no idea how to comfort them, calm them, and make them feel cared for. It’s not exactly their fault; most clinicians have lots of patients and are taught to use very few tools to relieve suffering apart from epidural anesthesia. Nevertheless, it is galling to see that this is apparently good enough for them, and that they consider it natural not just for women to be in pain in labor, but to suffer deeply as well. (The difference between these things is a topic for another time, but sufficed to say that they do not have to go hand in hand.)

Finally, this statement begs an obvious question: If you’ve left the room entirely, returning only hours later or when she shouts loudly that she is going to push the baby out right now so you’d better get in here, how on earth would you know if you helped her to calm down?! You left her alone, you fool — you have no idea whether she is curled up in a knot of suffering, or whether she’s actually glad to be rid of your ham-fisted, anxiety-provoking presence.

I know that there are some future midwives reading this post, so my reminder to all of us is this: the next time you hear someone offer you this particular “wisdom”,  remember that a gentle hand, a low voice, and a calm, steady presence can be the difference between a happy, healthy birth and a violent, traumatic one. Go back into the room and stay with her.

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Ripping Off the Band-Aid

When I moved to China in 2009 with the intent of writing about my experiences there, I believe I began simply by beginning. When too much has happened in your life, you begin to feel as though you can never catch up in recounting it all — meaning that perhaps you never try. So now, as then, I’ll just begin again, and hope that the stories of the past year that I have wanted to share will simply surface.

If this is the first of my posts you’ve read, let me save you a little trouble: when I moved back to America in 2012, I tried writing about nursing school as it was beginning — but what ended up coming out was a lot of narishkayt about how much homework I had. It’s true that in the past 16 months I’ve sat through lecture upon lecture, studied for hours and days on end, and passed my nursing boards a few months ago — but so did everyone else in my class.

I’m now in my second semester of midwifery school, and since this past week I had my own patients for the first time (as in, alone in a room with a pregnant woman doing her 20-week prenatal visit), I have been thinking about the many firsts of the past year: the first patient I cared for as a nursing student (a 54-year old man with liver failure), the first patient whose body I bathed (an 81-year old woman with a small bowel obstruction), the first patient I had who made me feel so insignificant and incompetent that I cried in the medication room (a 16-year old girl — of course — with bone cancer and a serious attitude).

The first patient I had who died in my care. She was 3 years older than I am. I was alone in the room with her, my hands on her chest.

The first patient I had whose life I knew I had changed, and who in turn changed me. She was a Chasidic woman, and though I have now seen perhaps 75 women give birth (not many, in the life of a midwife), this woman immediately held some special power over me. I stayed with her for 12 hours as she labored with her 6th baby, predicted to be not much larger than the 7 lbs of each of her previous children. She labored all day, struggling with her daughter still inside her, doing the slow dance of the birthing woman that speaks of a deep and private pain. Towards the end of her labor she lost almost all of her English, speaking only Yiddish, a language in which I could not then communicate — but she dropped her head on my shoulder and wailed to me that she could not, that this work was not possible. And somehow, with the low words that were all she wanted, I helped her to believe that indeed she could. She gave birth to her 11-pound daughter not long after, and the love I felt for that moment, for her strength, is still with me. One of the great moments of my life.

I began learning to speak Yiddish in earnest a month later, and found a deep ethnic identity that I did not know I had lost — another first. Perhaps more about that later on.

*****

Autumn has arrived in earnest in the past few days, and it’s approaching midnight — both of which I will blame for the mawkish turn of this post. I used to write poetry, and this moment in my life is a time that is probably deserving of such attention, but I’m finding it enough to read the poetry of others. I recently found Rachel Eliza Griffiths’ slim volume,”Miracle Arrhythmia,” on the shelves of a second-hand bookstore in Brooklyn. Recently I’ve been thinking of ordinary things that anchor a life — of food, of sleep, of mending tears in a shirt. This is what I read tonight:

Portrait of a Sunday Woman

Once I saw your mother as a wife.
Sunday morning she stood at the stove,
pressing her wrist simply against her hip.

She wore a robe, red as temper.
Her shorn hair glowed like a burn. Fire
haloed the filter of her cigarette.

One bare breast welcomed the sun; steam
curved from the tin kettle. She wiped
her eyes, over and over.

Turning her head, silent as a bird, your mother
lifted a wedge of lemon and sucked
the dull dream from rind.

By then I had been kissed by a man and knew
something of the crumple around the corners of
the mouth on those godless mornings.

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The End of Week One!

In case you’re wondering how this first week of class went, allow me a brief, illustrative anecdote: I was intending to update here on Tuesday night, after the second day of class. Instead, I fell asleep in the laundromat over my notes on vital signs.

What I’d really like to tell you is that this week wasn’t as tough as I thought it would be, that I had just psyched myself out in advance and been worried for nothing – but that isn’t the truth. The truth is that I came home after 7 hours of class on Monday and reported to RP that the day had been terrifying, and that I came home on Tuesday after 11 hours of class half-convinced that this whole grad school plan was really, REALLY not going to work out.

Thank goodness I didn’t post on Tuesday night, hm?

I’ve since calmed down. Or rather, I’ve since spent hours and hours studying, and then calmed down. There are a few things that I’ve had to recognize:

  1. I am not being modest when I say this: not everyone in my program is finding this as difficult as I am. I think mostly what this summer is exposing is what each of us has just been doing; I have classmates who just graduated from other institutions with degrees in biology. I have classmates who have spent the past 5 years as nursing assistants in hospitals. They know a lot more about the topics we’re studying this summer – physiology, say, or physical assessment – than I do. They’re looking pretty relaxed right about now.
  2. Having said that, lots of my classmates are finding this just as difficult as I am. I’ve stopped a few people in the lecture hall during breaks just to confirm that I am not alone in already being sleep-deprived — check. People are already starting to show up to lectures in their pajamas, so I didn’t feel so bad when I looked at myself in the mirror today and noticed that, after only 5 days of lots of stress and less sleep than normal, I look terrible.
  3. The structure of the program means that students are bound to feel overwhelmed at the beginning; not only are we taking seven courses this summer, but we move from topics that are highly abstract to highly concrete as if it were no big deal. Yesterday I spent 8 hours memorizing facts about the nervous system. The day before, I learned how to change a bed pan.
  4. I’m not going to be doing much socializing for a while. Or possibly ever again.
  5. I’m going to be just fine as long as I don’t much other than study.

I was hoping to move through this summer with no problems, and with time to see friends, read novels, and hang out in Prospect Park. Between nursing fundamentals, physical assessment, advanced physiology, and pharmacology, it’s pretty clear that none of those things is going to be happening for the next couple months. And while it’s a little embarrassing to admit, I had been hoping that this process was going to be fun. I can now see that I’m going to have to take a slightly more adversarial position on the whole business, at least for this summer.

Nursing school: I am going to OWN YOU. Watch out!

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