Notes from the Clinic

As a student, one of my favorite places was not the L&D unit but the outpatient clinic, where we saw an endless line of women with every imaginable issue come in and out of the four cramped exam rooms. Some had infections, some needed prescriptions, some were pregnant when they didn’t want to be, some couldn’t get pregnant and didn’t know why. Sometimes they came alone, and other times they brought their children, their partners, their mothers, their friends. I carried around a little notebook in my pocket on those long clinic days, scrawling clinical short-hand so that I would remember the diagnostic cutoffs for gestational diabetes, say, or the ultrasound results indicating the need for an endometrial biopsy. I spent a lot of time being nervous about what I would encounter during a day at the clinic, as indicated by the following snippet that I found today in the back of my little notebook.

*****

What will I find behind the door?

The slightest grin, a quiet anticipation of the first sounds of the muffled, aqueous heartbeat so longed for?
Or a suppressed desperation, the dread of a tiny, internal gnawing, the hope that there is some explanation for this feeling other than a child that she does not want?
Or the tired, resigned sigh of a seasoned mother who knows how many more gray hairs another baby will bring, of the honesty she does not offer — dear God, let this be the last!

I scrawl my notes in preparation, I scan them one last time, I breathe deeply and close my eyes before entering.
I make myself like a blank page to be filled with the woman’s pleas and inquiries, her interpretations, her offers of thanksgiving.

Behind door #2 I hear a metallic crash, the unruly work of a toddler’s blunt fingers against a tray of medical instruments, followed by the swift, sharp: Jorge! Basta!
Behind door #3, a soft weeping, as she understands that the child will be born, but not live.
Behind door #4, the pointed cry of the cervix being gripped, of an IUD placed, of the pain she didn’t know was coming.

And I head to door #1 to deliver the measured, non-news we all want to hear:
Everything is alright, today. Today, there’s nothing for us to worry about.

I stand outside the fern-green door: she anticipates me from one side, and I anticipate her from the other.

The Long Wait, or, Other People’s Babies

During my midwifery training I worked 24 hour shifts on the Labor & Delivery unit of a community hospital. Several independent practices run by midwives or obstetricians admitted women to the unit; the practice with which I worked almost exclusively saw women who were recent immigrants to the United States, and who were insured by Medicaid (public insurance) due to their low household incomes. Women from the other practices tended to be higher-income and covered by private insurance. As a general rule, I was not allowed to assist with births unless they were for women whom we had cared for at our prenatal clinic, which is as it should be.

  *****

A woman has been hastily escorted onto Labor & Delivery; the familiar hissing noise of the unit’s automatic double doors opening brings me scurrying hopefully into the hallway. The curse of the student is the desire always to be considered worthy of assistance (pick me, pick me!), the anxiety ever present that you will miss out on that critical experience that will make you feel, finally, competent.

But I am shooed away from the room. The woman is “not mine,” I’m told: “one of the Privates.” I stuff my hands into my lab coat pockets and skulk back to the midwives’ office, where I sit flipping through stiffened back issues of medical journals.

The days without births are the longest days. It’s the nature of the time — not electrified with the rush of an impending new being, not suffused with the peace that finally comes when everything has gone well: a contented baby clasped against the chest of a beaming new mother; a feeling like that one, perfect note for which Miles Davis claimed always to be searching. No, the days without births are staccato; my mind only half-able to engage, always in a state of tension like a muscle ready to spring into extension. Without a release of that energy my mood turns sour by nightfall.

The hours wear on with all but one room standing empty and pristine; fresh bed linens and sealed, sterilized instruments await the flurry of activity associated with a new arrival. For now, this one woman has the L&D floor to herself.

To stave off restlessness I sit outside her room and listen to the noises of her labor through the drawn curtain: the rise and fall of her moans, her labor as a stringed instrument. The low tones of her doula, the uncomfortable interjections of her husband. I watch the patterns created by the dual monitoring of her contractions and the baby’s heart on a screen at the nurses’ station, trying to find a correlation with the human sounds emanating from below the curtain; I cannot.

My calves go numb from squatting against the wall and I rise to move the minutes along. I complete my rounds on the postpartum unit early, listlessly. The women with their new babies seem uninterested in another face, another interruption, further instruction.

Returning to the labor floor, I pass the visitor’s lounge; the three silent, grey-haired occupants can only be expectant grandparents. I make the mistake of lingering too long outside the door. My white lab coat has caught their attention and they turn with a start, in unison, to hear the good news of a new baby’s arrival. No news! I say, unsatisfactorily. No news is still news, says the grandpa. We’ll just wait here, the two grandmas say. We don’t want to be a disturbance.

The light through the windows changes from yellow to grey and I watch clouds creep over the broad sky above the Hudson River. I hear sudden shrieking coming from the hallway and rush out, anticipating an imminent birth; instead I find the nurses huddled around a screen in the empty triage room cheering for Spain versus the Netherlands. The birthing woman herself remains hushed, and I wander up and down the hallway silently reciting clinical algorithms to occupy my mind: Repeat pap smear in 12 months…Colposcopy if HPV 16/18 positive…10-day progesterone challenge followed by a withdrawal bleed…TSH will be high and free T4 will be low…

Finally, the corridor is filled with the sudden vocal peaks and exhortations to blow, to pant, that mean that a labor is ending, that a baby’s head will soon be born. I tiptoe to the curtained doorway of the woman’s room — That’s it! I hear, The head is born! Now just rest before the last push. I know that I have less than a minute. I quickly slap the oversized metal button that opens the L&D doors, and see the three grandparents-to-be poised in the hallway. I gesture sharply to them to hurry, mouthing silently, Come right now! They skitter through the doors onto the labor floor, and we form a semi-circle outside the woman’s room. One more push, we hear, and then the wave of joyous cries of the woman, her husband, the nurses, the midwife.

The grandparents look to each other — has it happened?

The husband’s relieved voice reaches us from under the curtain: It’s a girl. The grandmas weep, the grandpa cups his face in his hands, and then: the short, sharp cry of their first grandchild. One of the grandmas jumps up with delight, and tears line the cheeks of all three.

I retrieve tissues from the nurses’ station, pass them around and then simply hand over the box. It will be a while now, I whisper. They nod vigorously and silently and, clutching each other, return to the worn black couches of the visitors’ lounge.

Making Sense of What You See

A critical midwifery skill is to prevent (to the greatest extent possible) and repair the damage that can occur to a woman’s body when a baby is born. Sometimes, even if a laceration (“tear”) occurs in the genitalia or perineum, the best thing to do is to let the body heal on its own. At other times, suturing (stitching) of the damaged skin or muscle is required. While the hand skills of administering local anesthesia and suturing are not very difficult, learning to identify the relevant structures of the body in their damaged state and learning how to use one’s judgment as to where and what to repair is difficult and intimidating for any student. Here I recount a complex laceration repair that I observed early in my midwifery training. The woman’s personal details have been changed to protect her privacy.

*****

I have been on the unit for two minutes, and have forgotten to eat breakfast. I have missed a birth by a hair — I arrived early, but not early enough — and have had time to change and take a breath before entering Alba’s room. Her baby has been taken away (“Smelly baby,” the nurse whispers to me); its fever and odor indicate chorioamnionitis, an infection of the membranes surrounding the baby in the uterus. Alba is propped up with her legs open as the midwife finishing 24 hours on the L&D unit investigates her vaginal laceration.

It is not the worst laceration I have ever seen, but it is the most unfathomable. Is it a “2nd degree”? A “3rd degree”? How many muscle groups will need to be brought back together? The midwife has begun suturing but Alba bleeds and bleeds — she has already lost 600cc of blood, and has received misoprostol to stop the hemorrhage. I enter with the midwife coming on for the day, her bright pink lipstick meant to inspire energetic confidence. After being awake for nearly 30 hours, the midwife repairing Alba’s laceration is showing signs of exhaustion; the repair is seeming unmanageable to her. She has missed the deepest point of the laceration, and is now wondering aloud if what she has done needs to be removed so that we can start over. The new midwife relieves her, and tells her not to worry. She positions herself at Alba’s perineum and adjusts her glasses.

Sitting by the midwife’s side, what I see is: lacerated tissue on the right, lacerated tissue on the left. Blood: rivulets, seeping, the occasional tiny spurt. Swelling. Interlocking stitches and a suture hanging from the vagina onto a clean towel. I am allowed to insert one sterile hand into the deepest part of laceration to feel the tunnel it forms under the existing suture; I am thankful for the epidural placed during labor that allows me to do this without Alba feeling pain. I am allowed to offer my opinion on how to repair it — a few deep, interrupted stitches, followed by further interlocking stitches — and I am permitted to wonder aloud how to perform such a deep repair when stitches have already been placed. (Repair on the horizontal plane, I’m told, not the vertical.)

Alba continues to bleed. I feel lightheadedness creeping over me and think about the granola bar in my bag, wishing I had stuffed it into my mouth before coming into the room.

The midwife stitches, I blot and retract labia. She instructs me: Suture like to like, and I attempt to identify any two pieces of tissue that actually look alike to me. I watch her deftly place interrupted stitches deep into the wound, and she points out the borders of the intact anal capsule; a deep 2nd degree laceration, then.

And as she slowly repairs, the bleeding stops and the muscle and skin come together — seemingly by magic, although I know very well that it is no such thing. After two midwives, nine packets of suture, 30 gauze sponges and an hour and a half, Alba’s body looks almost as if no damage had been done at all. I tell her how brave she has been, and how we will make sure that she heals properly with no infection. I am sweating.

The midwife turns to me and narrates my thoughts in a low voice: When I was a student, I was sure I would never be able to do this.

 

Telling Hard Birth Stories

Today is a quiet one on my narrow New York City street; the still, cold air, thick with snow, seems to be keeping everyone indoors. From my window I can see a lone soul scratching at the sidewalk outside his doorway with a shovel; the dull sound of ice giving way from the concrete echos distantly. Such days put me in mind of birth, of the calm needed to allow a woman to proceed unmolested, of the womb-like protection that should surround the mother. A day like today, on which I feel so grateful to be sheltered by four walls and roof, makes me want to shelter others, to bring everyone in from the storm.

For the past few months I have been wanting to use this space to tell stories from the end of my training as a midwife, but I’ve hesitated because they are often difficult stories. They are not the joyful, life-affirming tales of an eager, almost-midwife. Instead they reflect my state of mind at that time: sleep-deprived; constantly worried that I wasn’t skilled enough; convinced that I going to harm a woman or her baby.

As I was finishing my training, I was preoccupied with the transition to the very serious role of becoming a clinical decision-maker, and my concern over what would happen to the women and families that I cared for became all-consuming. All of which is, of course, a recipe for the burnout I then experienced and from which it took several months post-graduation to recover.

I’ve been wanting to tell the story of the last birth I attended as a student, mostly because it was so glorious, such a ringing high note on which to end my training. Instead of the sudden complications and near-disasters I had been witnessing, that last birth went so beautifully that there was almost nothing for me to do but admire the woman in her elemental elegance. No one laid an unnecessary hand on her, and she gave birth to her baby “in the caul” — that is, still encased in the bag of waters — like a goddess giving birth to the moon. For those of you who aren’t squeamish about human birth, here is a video of what that can look like:

 

Not long ago I realized that I had also been wanting to tell that happy story first in order to cushion the blow of all of the hard stories to come. I hadn’t wanted to scare off the students or aspiring midwives that read this blog, to have them think that this tremendous work is all anxiety and sleeplessness and heartache. But I do want to record how I actually experienced that time of transition, so I will begin with a snapshot of what happened to me at the end of last summer, when I slept very little, and with a promise that these stories won’t last forever.

*****

I am starting to forget things.

I always remember to check total weight gain, blood pressures, immunization status, but it’s all the other things — my parents’ anniversary, what time I’m supposed to be at the dentist’s office, which day last week I met with a friend…I’ve lost my makeup case three times this week. I definitely remember going out for dinner last night, and I definitely remember coming home and eating blackberries on the couch — and then I woke up in a haze at 8am. I have a vague recollection of announcing, at 11pm, that I was “just going to take a little nap.”

I read through a woman’s prenatal chart and see my name at the end of two of her notes; there is proof that I’ve seen her before, though I have no memory of it. I see a woman in the clinic elevator and put on the cocktail party face meant to meant to communicate all things to all people: that I’m a friendly stranger, that I’m happy to meet you, or that I’m so pleased to be seeing you again. I wait for her reaction to tell me which one is the case.

Five hours is starting to sound like plenty of sleep to me, and I’m beginning to wonder if I’m the only one unable to function after a few days of so little rest. On days off when I can sleep for eight or nine hours I wake up feeling like all is well with the world, and then wonder what on earth I would do if I had small children and couldn’t sleep for eight or nine hours on these days off. The next night I get five and half hours again and feel as if I haven’t slept in a year.

Normal people, the non-future-midwives, can’t understand why I start getting nervous and looking at my watch at 9:00pm the night before a shift. And I can’t understand how the seasoned midwife who has been on for the past 24 hours greets me looking so fresh, makeup recently reapplied and hair repositioned just so.

On the nights when I lie awake for a few minutes before sleep, after reciting the Shema, I think of Keats: “Save me from curious Conscience, that still lords/ Its strength for darkness, burrowing like a mole;/ Turn the key deftly in the oiled wards,/ And seal the hushed Casket of my Soul.”

 

 

Forged

When I was considering applying to nurse-midwifery school, I read a lot of nursing students’ blogs. Invariably, these students reached a certain point at which they caved; they had previously had lots of nice ideas about how they were going to lead balanced lives, in which school was simply one of their pursuits, but eventually they gave up that pretense. FINE, they would say, addressing nursing school as an evil taskmaster. You win! Here is every ounce of my energy and every hour of my time! Let me know when you’d like a pound of my flesh!

Since I’m an arrogant jerk, I thought that they were kidding. Or that they didn’t know how to manage their time well. Or maybe that they were just sort of slow. You will notice, however, that I stopped blogging after week 3 of the summer term – that’s about when I too gave in and acknowledged that basically all I was going to to do this summer was commute, sit in class, go to the hospital, and study – every day, approximately 16 hours a day.

I’m now on vacation, which means that I made it through the first term and am gearing up to begin the second in less than two weeks. Before it all gets going again, I want to try to write something here that might be helpful for anyone else considering this education.

The kind of accelerated BSN/MSN program that I’m in involves a totally unreasonable, uncivilized amount of work: all-day lectures, constant examinations, basic care of real patients beginning in week 2. It’s also a kind of academic work that, for someone with a liberal arts undergraduate degree, resembles nothing so much as weight training. Whereas most of my previous education involved polishing my skills of writing, critical analysis, and argumentation, 80% of my work this summer has been the straight memorization and application of large quantities of information: I spend my weekends bench-pressing pharmacology. It has been a muscular, at times numbing, process.

The rapidity with which this process not only educates you but prepares you to take on a new identity as a clinician is breathtaking, and quietly thrilling. They call this first summer Boot Camp because it is the academic and clinical equivalent of shaving your head, waking you up at 5am with reveille, and running you through combat drills until you’re not totally positive that you remember your full name.

Your vocabulary is remade, and you annoyingly delight in telling friends and family members the medical terms for common conditions and physiological processes. (“Did you know that your stomach growls are called borborygmi?” “I see that your baby has a club foot – did you know the name for that is actually congenital talipes equinovarus?!!”) You can see how completely insufferable you are becoming but you can’t do anything about it because you’re so stuffed with new information that you JUST HAVE TO TELL SOMEONE.

You come to find it normal to get up at dawn, spend a full day at the hospital, come home and study for six or seven hours. You ask unsuspecting friends to remove their shirts so that you can listen to their lungs. You conduct full physical assessments of your parents, figuring that if they’ve agreed to support you through grad school they might as well see that you’re learning something. You practice identifying physical anomalies by scrutinizing fellow passengers on the subway. (Nail clubbing! Bouchard’s nodes! Acanthosis nigricans!)

When your lab instructor sets out a table of needles, bottles of saline, and sterile swabs and offers you the chance to inject your classmates, you feel not horror but elation and recognize this as the highlight of your week.

After a couple months in the hospital you realize that you can no longer smell the eerie, sterile, chemical aroma of the unit that you initially found so disturbing. You find that you are increasingly comfortable touching the bodies of sickly strangers. You are humbled, but no longer surprised, when patients stand in front of you naked as the day they were born, asking for your help to clean themselves.

This is how these programs begin to turn a bunch of East Asian Studies majors, financial analysts, and Peace Corps volunteers into advanced practice nurses and midwives: they kick your ass until you’re pretty sure this is what your life has always been like.

I know I’m going to regret saying this, but I can’t wait to start again in September (when I am considering blogging about something other than the sheer volume of work that I have). Having finished the first term of this education, and with the perspective that comes from being on vacation, I feel completely remade – and exhilarated.

Open Your Mouth And Say “Aaah”

Somehow, it’s the end of week three – and I’m still sort of standing!

I really thought I was doing well; I’ve been on top of my work, doing well on tests, even managing to get a decent amount of sleep. And then today, after my 6am wake up for my weekly four hour pharmacology lecture, I realized that I am actually feeling an overwhelming sense of exhaustion and the desire to sit in a cool, dark room for the entire weekend. (Not that that’s an option, what with all the studying I need to do.)

Has it really only been three weeks of class? Hasn’t it been more like three months?

I keep reminding myself that this summer is a sprint: intense and over before you know it. Truly, there are aspects of this program that I’m loving – why don’t I go ahead and write them down to keep myself from turning this post into an unsavory whinge-fest:

  1. For the most part, the standard of the teaching is very high. I have enormous respect for my professors and instructors, and am constantly concocting little reasons to schedule an office hours meeting with them, despite the fact that I don’t have any questions of an academic nature. Just so that I can hang out with them and ask them about their lives and careers.
  2. My classmates are excellent – sharp, engaged, compassionate, and with a dizzying variety of backgrounds and accomplishments. I’m glad to know them and proud to be counted among them.
  3. I’m loving learning how to conduct a full physical exam. During this summer we’re each paired with a classmate on whom we practice inspecting, palpating, percussing, and auscultating from head to toe; I swear it’s like being given the keys to a secret garden of weirdness. Did you know that your optic disc looks like the sun setting inside your eye? Or that your ear’s tympanic membrane looks like mother of pearl? Or that there’s actually a reason that they ask you to open your mouth and say “aaaah” at the doctor’s office, apart from making you look like an idiot? (It’s to visualize your pharynx and tonsils, as well as to ensure that your soft palate rises symmetrically while your uvula stays midline – indications that your cranial nerve X isn’t damaged.)

Interestingly, I’m feeling a little more tepid about the thing that other members of my class seem most excited about: the one day each week that we spend in a hospital unit learning how to be actual nurses. There’s nothing like suddenly being assigned to care for an ill stranger in a hospital to make you realize that you are ignorant in the most fundamental of ways: how should you speak to the patient? How should you touch them? How do you walk the fine line of providing care appropriate to the professional role of a nurse, without veering into non-professional areas like socializing with them or being their “fetcher?” (Hint: pouring water from a pitcher on the bedside for a shaky patient whose medications give them dry mouth is a-OK – fetching them (or their cousin) a Coke from the vending machine – NO A SPRITE! NO A GINGER ALE! – just because they want one, is not.)

This isn’t my first time interacting with people and providing them with intimate care in a hospital setting – but the last time I did anything like this, it was as a doula in China. And those women weren’t sick – they were just pregnant. True, they were sometimes in pain, but the pain of “back labor,” and how to manage it, isn’t the same as someone who has back pain following surgery for a herniated disc. Those women didn’t have open sores as a result of being bedbound in their homes; they didn’t have central lines that needed cleaning or tracheostomy tubes that needed suctioning. They were never so neurologically impaired that you couldn’t tell if their sudden grimacing was because you were hurting them or because some mental demon was flashing before their eyes.

Or perhaps it was something about the hospitals I visited in China made that those experiences so different from this one. The hospital to which I am currently assigned is such a nice institution: it’s recently built, it mostly serves the surrounding community (as opposed to being a magnet for transfers from other communities or hospitals), it isn’t a level I trauma center. It is well staffed, and mostly calm. They even have “quiet hours” during the day on the unit where I work in which the lights are dimmed and people speak in hushed tones to allow the patients to get rest during the day.

As much as this is all to promote a healing environment for those being treated there, it also creates an otherworldly atmosphere that I find unsettling. When I enter the hospital I feel as if I’m leaving the world of the living and entering a place of sterility and suspension – a place somewhere between this world and the next. No matter how nice you try to make it, a hospital is a place that serves as a land of limbo for the sick and dying; it makes my heart hurt to be in one.

I didn’t have this feeling in China, and perhaps, perversely, it has to do with the fact that the hospitals I was in were nowhere near as “nice” as the one I work in now – they were chaotic and dirty. Families wandered all over the place, carrying in food, clothes, and supplies for their loved ones (who are otherwise not provided with these things by the hospital itself). At the hospital that I visited in The Valley, a stray animal or two could often be seen roaming the halls.

While this made them much worse places from a clinical standpoint (my God, the rates of infection), they felt like places in which life was happening on a continuum with the outside world. I felt, oddly, more comfortable in them.

My role is different now, of course. The expectations that my wonderful preceptor has for me and my classmates are high, which puts me in a state of mild terror every time I have to do something new – although I am pleased to say that I was able to rally my Spanish skills somehow to interact with the first patient for whom I was responsible, who did not speak any English at all.

I’m uneasy just at the moment. I hear that it passes.

Meltdown Tuesdays!

This morning when I got up, I was feeling pretty good. I had been studying for days, felt like I basically understood what I had been taught so far, and was ready to take on Tuesday, my longest day of the week at school.

Oh plus, I had my first test of the year yesterday and I aced it. (NURSING SCHOOL I OWN YOU.) Et cetera.

I was even feeling pretty good around 4pm today, 7 hours into my 11-hour day of in-depth discussions about varieties of hideous, crusty, skin lesions and a lecture about hospital bureaucracy in New York State.

(This is where you start wishing you had my life, right?)

Things started to deteriorate about 30 minutes into my advanced physiology lecture, when I realized that I wasn’t entirely clear what the professor was talking about, and broke down entirely at the 2-hour mark (that’s 9 hours into the day, for those keeping track at home), when I realized that I just. didn’t. get it. I could see the professor standing at the front of the hall, and I could hear that there were words coming out of her mouth about the cellular-level workings of the endocrine system, and that’s about it.

I started to panic that I wasn’t ever going to understand this material, or any of the hideous crusty skin lesion material, and that I am going to fail, AND that the real point is that I am possibly a complete dolt.

Good thing that was about when we got a break and I was able to go hide in the bathroom for 5 minutes and collect myself.

I somehow made it through the final two hours of the lecture, had a moment of sanity with a new friend who admitted that she had no idea what a beta-1 adrenergic receptor was either, and collapsed into a mostly empty subway car headed back to Brooklyn. Suddenly, I had a stroke of genius – a moment that clearly proves that I am not a huge dolt – because I knew what would fix the tizzy of utter dejection and despair that I had worked myself into!

THE BOSS. The Boss would fix this.

I will leave you to imagine the break dance I did down the middle of the A train (as well as to ponder how you are going to find a headscarf as fetching as Steve Van Zandt’s).

I felt the panic dissipate, like a fever breaking. (Which is known as the defervescent third stage of pyrexia, just by the way.) I remembered one of my realizations from last week, which was that, as long as I study for hours and hours, I’m going to do just fine. I put my focus on tomorrow, when I’ll get to do such fascinating things as practice physical assessments on my unsuspecting labmates by poking around their ears and inspecting their skin for any suspicious looking moles – and then thought even further ahead to Thursday, when I will spend my first day in a hospital unit. Taking care of actual humans. Who don’t really care whether or not I had a meltdown during my physiology lecture.

And I emerged from the subway, back home in Brooklyn, to a gentle rain falling.

So when next Tuesday comes around and I’m curled up in a little ball on the floor wondering how I’m going to go on – remind me that Tuesdays are the worst, alright?

And that The Boss knows best.

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!

New Phase, New Blog: This Woman’s Work

Tomorrow begins a new chapter of my life: the first day of class in my nurse-midwifery program. For three years I housed my thoughts on trusty ole BirdAbroad, but this is a transition large enough to warrant a blog makeover. Welcome to This Woman’s Work, where I’ll be blogging about life as a student nurse-midwife, women’s health, healthcare in America, New York City, Jewish life in Brooklyn – and whatever else is on my mind.

I decided to become a nurse-midwife over two years ago, when RP and I still lived in China, and getting to this point has involved endless little steps: postbac prerequisites, training as a birth doula, harassing every midwife from New York to Beijing for their advice and guidance, applications, interviews, and decision-making. Having settled on a combined BS/MS program in New York City, RP and I have moved back here and settled into an apartment on a leafy street in Brooklyn; the thousand tiny tasks a new home demands have distracted me for a solid month from the fact that tomorrow is actually going to happen. It’s time to hang up my frame pack (at least temporarily), go back to school, and finally make this dream real.

What’s with the new blog title, you ask? There’s the Kate Bush reference, of course. For the uninitiated:

But the larger significance of this title is related to how my thought process has evolved about “women’s work.” As a feminist, I have been loathe to be too involved in this category of work – that is, the customary activities and skills not necessarily chosen by individual women, but foisted upon us as a group through tradition and sometimes with force. Care-taking, for example. Home-making. Mothering. Handiwork.

It’s not that I take issue with these activities themselves, but rather that I have a fear of leading a life unexamined, of embracing tradition without challenging it first. (God forbid anyone should think that I baked that bread because it’s my duty as a woman to have such skills, or that I wore a skirt because I think it’s my main job in life to look pretty!…etc.) The truth is that my fear of “women’s work” actually kept me from admitting that the issues I wanted to make my life’s work, the topics that most interested me intellectually, were “women’s issues”: reproductive and sexual health, pregnancy, birth, abortion. I wasted a lot of time trying to divert my mental energies into areas deemed more muscular, more formidable, more estimable.

So please don’t give me a quizzical look and ask whether or not I’ve considered medical school – I’ll get into that later. Please don’t ask if I’m becoming a midwife because I really want to get pregnant and have lots of babies. Please don’t lower your voice and say, “You’re not going to have to, ya know, clean up shit, are you?” (For the record: yes. That’s part of my training as a nurse.)

For the moment, just know that I am embracing what I really want to do in the world – which, I’ll admit, is “women’s work”: the arduous, astonishing, and worthy work of a nurse-midwife.

This is not to say that I’m over all of my hang-ups. When my stethoscope arrived in the mail and was pink, I have to say that my first thought was, “Oh come on! I’m already going to be a nurse, and now my stethoscope is PINK?!” And when I first tried on my regulation white nursing shoes, regulation white socks, and “honey beige” compression stockings, I was not so much thinking, “What a noble profession I’m joining,” as, “I’m pretty sure that nursing school is where radical feminism goes to die.”

At least what goes over this is blue scrubs instead of a little white dress.

My point is that I’ve got plenty of internal mishegas to deal with, which I’m sure will only become more pronounced as I move forward in my education. And tomorrow is Day 1.

After so much wind-up, I’m a bit of a nervous wreck – so let’s just rip the bandaid off and get started.