Belly Tales

Just a quick post to say that the Week of Swampedness is upon me. I am now officially *swamped*. Finals are in two weeks. I have a TON of work to get done, including my presentation on Hyperthyroidism (tomorrow), my second research chapter (due next monday) and my first final exam in Physical Health Assessment of Women (what we fondly refer to as PHAW…also due next Monday). In my copious free time, I’ll be working on my take-home final exam for Primary Care, which will be distributed tomorrow. Soooo, I’ll be blogging a bit sporadically, but will do my best to keep somewhat on top of things. I have another lovely birth story to post for you, but I’ll have to do that tomorrow. I wish I had more exciting things to write about right now, honestly, but this is it: the reality of being a student means that, mostly, all you do is study. Funny how that goes.

In the meantime, feel free to amuse yourself by reading about Ayotte v. Planned Parenthood, which is due to come before the Supreme Court next week, and may be the first skirmish of the looming War on Choice. For something a bit lighter (but only a bit), check out CodeBlog, which I only just discovered today. Otherwise, go buy pretty holiday cards from the Syracuse Cultural Worker, visit any of the gazillion links I have painstakingly assembled on this site for your viewing enjoyment, or work on your spitwad technique. I’ll catch up with all of you soon…

RU-486 (Mifeprex), the pill used to induce chemical abortions in early 1st trimester pregnancies, has come under fire recently because of the deaths of 4 women in California who died of a rare bacteria infection (Clostridium Sordelli) shortly after taking RU-486. The NY times has the full article.

Wow. Very disturbing. And now it’s just a matter of waiting for the inevitable: how will the Pro-Lifers use this to their advantage? And just how dangerous is this drug?

Well, as predicted, my second clinical experience was SO much better than my first. For one thing, I was on time; actually, EARLY. I was working w/ a different preceptor this time, and she had asked us to meet at her office 8:45 to go over what we’d be doing, and discuss any issues we had. This made a big difference for me. Instead of feeling like we were just being thrown in, I felt like we had a plan. It also helped to go over the physical exam again and discuss which parts of it we were absolutely supposed to do, since all of it wasn’t necessary.

Armed with a Plan, I was able to actually take my patient’s histories while they were still dressed and we were sitting across from each other like equals. And when we finally did get to the physical exam part, I was much less nervous, and able to go through the exam pretty smoothly. Head, face, mouth, a quick eye exam, the lymph nodes of the head and neck, thyroid exam, lungs, heart, breast, abdomen, and then pelvic. I was much more thorough this time, and thankfully not shaking. I even got to talk to my patients about breast self-exams, and teach both of them how to do them. Believe it or not, they’d never had a health practitioner do a breast exam on them before. Sadly, I think a lot of it is cultural: these are poor, under-served, urban women, most of them african american or latina, most of them without health insurance…thorough annual physical exams are not something I think they’ve had a lot of. They were both so receptive to what I was showing them and telling them. In a way, being a student is a really good thing, because your case load is not so overwhelming that you’ve got to rush through all of your patients. I was able to spend about an hour with each patient, which is such a luxury. They both seemed so grateful for all the attention, and I was very pleased to be able to give it to them, and teach them about their bodies. That’s always one of the best parts of what I do.

The pelvics also went more smoothly. I still had a hard time finding the cervices of my patients, but was able to find them in the end; I think that’s just a practice thing (these are, after all, only the 5th and 6th cervices I’ve ever examined!) I was using small speculums this time, as opposed to mediums, and I think it really made a difference (although, on one of my patients, the speculum wasn’t quite long enough, and the posterior vaginal wall kept getting in the way). How do you know for sure which size to use? How do you judge it? Is there a way to tell, just by looking at the size of the woman? Or do nullips always get small speculums, and multips use mediums, and if she’s unusually large, then use a large? Anyone have any handy measuring system they’d care to pass on? Same thing with sizing a uterus. My preceptor kept asking me how large I thought it was, during the bimanual exam, and I would feel, and feel, and feel, and finally say something like: a large lemon, or an orange, or a small grapefruit. I’m still not sure exactly what an 8 week uterus feels like, versus a 12 week uterus, or a 14 week uterus. It’s so hard to tell! I guess nothing is going to fix that except practice, practice, practice. One can only hope that after I’ve examined 100…200…uteruses, I’ll start to get a better sense of it.

This time around I was also armed with tissues, and made sure my patients were given the tissues to clean themselves up with before the exam started, which, I think, made both of us feel better. I’m also pleased to report that I didn’t make either of my patient’s bleed this time, when I was collecting their specimens.

My preceptor’s comments were overall positive. Her one critique was that I’m very slow, and need to work harder at getting more efficient at my exams. Which is true. And again, I think that will just take practice, as well. I can’t wait for well-woman gynecology and antepartum next semester. Really, really looking forward to that!

Anyway, off to shower and hit the books, and then go to work tonight. Happy pre-Turkey Day, everyone!

There’s not much on my plate this week, schoolwise, so it’s easy to let your gaurd down, especially with Thanksgiving this week, and that lovely holiday feeling in the air, but Note To Self: it’s only the deep breath before the plunge! Starting next week, and moving into December, things are going to get Very Busy ™. Next week (the 29th), my presentation on hyperthyroidism is due for primary care; we’ll also be receiving our final take-home exams on class on that day, due the following week (12/6). Then the week after, I have the second chapter of my Research proposal due on Dec. 5th (i.e., a veritable TON of writing to get done); I also have an exam in Physical Health Assessment of Women that day. So, basically, next week will be crazed, writing my research proposal chapter, and studying for all of these upcoming exams. After that, though, the semester is nearly finished, with only one more exam to go on 12/13, but it will be a doozy: our Pelvic Assessment of Women exam, which will include all the muscles of the perineum, all the bones of the pelvis, pelvimetry, speculum exams, specimen collection and the external and internal anatomy of the female. Good lord!! I’m getting a bit stressed just thinking about it. I better make the most of this coming week.

Now here is a diaper product it seems like I can really throw my weight behind: Flushable diapers! What a neat idea: putting the solid waste where it belongs, in a toilet, rather than a landfill. Another environmentally friendly alternative to disposables, and perhaps these diapers are even a bit better than cloth (and certainly use less water, for those of us who like to conserve). It’s hard to know for sure, but it does seem like this company has done its homework: they’ve accounted for their environmental impact, they’ve tested their product on 6 different US toilet brands, they’ve followed these diapers through the waste management system as well as conventional composting, they’ve made sure that the companies they work with operate under fair labor laws, and truly seem to care about kids, diapers, parents and the planet. Neat! And really refreshing to see. I’ve always assumed that when I have a kid eventually, s/he is going to have a cloth-diapered tush, but now, who knows….maybe s/he’ll wear flushables. Check it out!

Another fabulous, and very in-depth birth story, this one courtesy of Emily Marynczak, by way of Mirial Axel-Lute. Actually, we get to hear all about her first birth, too, so it’s sort of like a two-for-one special. Thank you so much for sharing your birth story, Emily! For what it’s worth, you don’t sound like a radical to me! (Read on …)

Having spoken to a few of my classmates today regarding their own clinical experiences, I am at least somewhat relieved to hear that mine was not unique. We spent a good long while comparing our experiences on the subway home today, and complaining about the crappy speculums at the clinic, and the lack of cytobrooms (they only had cytobrushes and spatulas to collect specimens with, and we were taught that you use a broom for a thin prep pap), and tissues, and a goose-neck lamp in one of the rooms, and reminding each other that next time will be much better. And it will be. For now, it’s just nice to know that we’re all in this together, and that I may not actually have the worst speculum technique in the world (or, at least, their technique is just as bad). I feel so much better.

Today’s random factoid: did you know that cardiovascular disease is the biggest killer of women in this country, period? Did you know that 1 out of 2 (let me repeat that for you: ONE out of TWO) women will die of cardiovascular disease?? Also, because women don’t often present with classic heart attack signs (such as chest pain and pain radiating to the left shoulder), women actually die from heart attacks much more frequently than men do. True, men might get them more often, but many of their heart attacks are caught in time because everyone knows what the “classic” heart attack symptoms are, and knows what to do for them. Women, on the other hand, will present with indigestion instead of crushing heart pain, and pain that radiates to their jaw rather than their arm, so they end up going to their dentist and getting diagnosed w/ Tempo-mandibular joint pain, when really they’re having a heart attack! It doesn’t help that most of the studies are done on men, so the “classic” signs for a woman are rather underemphasized at the moment, if they’re even recognized in the first place. Where are the subway ads telling women what to do if they feel radiating jaw pain? Yeah, I thought so.

Anyway, feminist food for thought. I’m off to go cook some food of another sort.

I had a feeling my very first clinical experience was going to be a pretty special, and boy was it! Thanks to the glory and wonder of the MTA, I arrived ten minutes late, having left at least 15 minutes early for my usual 45 minute commute to school. The plan was for the students to meet the professor who would be doing clinicals with us at her office at 9:30 on the dot, and then walk over to the clinic, which was located somewhere in the nearby, sprawling hospital complex—but I had no idea where! In a panic, I ran all the way from the subway to the education building, hoping to catch the professor and the other student before they left for the clinic, but when I got up to the midwifery department, no one was there. I searched high and low for a note, but couldn’t find one. Nor could I find the office of the professor who was precepting us. Almost all of the offices of the midwifery professors are in a row in the same hallway, but I had never bothered to double check that every professor’s office was in that hallway—I had just assumed that they were all there. Little did I know that the professor who was precepting us today actually had her office in a different hallway, so I had no idea where to meet her in the first place (although, had I known where her office was, I would have indeed found a note, which would have saved me an eternity of heartache). I knocked on the doors of the other professor’s offices, but none of them were around. The midwifery secretary wasn’t there, either. I was completely on my own. Even more panicked, I raced down the stairs to the lobby of the building, where I started wracking my brains. I had the contact information of several of my other classmates, but none of the professors. I called a few of my classmates, but none of them answered their phones. I asked the security gaurd if she had any idea where the clinic was (she didn’t). I was now nearly half an hour late for my clinicals. Finally, out of desperation, I went to the library and went online, trying to look up the professor’s contact numbers online (they weren’t there). I was just about to go to the hospital complex and start asking around when, out of the corner of my eye, I saw my professor walking past the window of the library!

Turns out, the other student hadn’t shown up either. The professor had waited half an hour for both of us to turn up, and was finally about to walk over to the clinic to see if we were there, instead. I was so relieved to have found her! I was a nervous, apologetic, sweating mess. What a great way to start my clinical experience—ugh!

When we finally made it to the clinic (over half an hour late), things settled down somewhat, but I was still quite frazzled, and all of a sudden extremely nervous (well, even MORE nervous, because I was nervous to begin with). Our task as students was to take the patient’s health history, then perform a heart, lung, abdominal and pelvic exam on them, including a pap smear and bimanual exam. Like any good clinical experience, we weren’t given much of an intro, or even a tour of the clinic or how their system worked (although, perhaps that would have been possible, had we actually been on time); instead, we were just tossed into the fire. Our professor, bless her, went between our two rooms and helped us out where needed, and I felt like weeping with gratitude every time she stuck her head in my room.

It seemed like everything I had learned about how to perform a physical exam had completely flown out of my head, and I must admit, it’s been quite awhile since I felt so clueless. I’ve been a nurse for long enough now that the nervousness and cluelessness of those early nursing days are nothing but a distant memory, and I’ve gotten used to feeling comfortable and confident in my environment and role as a nurse. Well, guess what? I’m not a nurse any more! And I have NO CLUE how to be a midwife yet. I was wearing an impressive, long white coat, and I’m sure I must have looked very official, but I felt like the world’s biggest imposter and baffoon (which is, I recall from nursing school, exactly how you feel, most of the time, during clinicals). It’s not a pleasant feeling. It’s been awhile. Welcome back, butterflies. There is an enormous ocean of difference between doing a practice speculum exam on your partner in class, and doing one on an unsuspecting woman in a clinic who has come to you for her health care.

The water out of the tap was freezing cold, so I wasn’t able to warm the blades of the speculum. I wasn’t able to get my speculums to lock. I wasn’t able to find the cervix on either of my patients on the first go, and had to withdraw and insert again, and again, and even again on one of them, in order to find their cervices. I managed to make both of my patients’ friable cervices bleed while taking their samples. There were no tissues to give to them so that they could wipe themselves up afterwards, so they ended up having to use their drape (it was either that, or paper towels, and the drapes seemed softer). The clinic had a one-size-fits-all approach to speculums, so I was using a medium speculum on a tiny, 20 year old nulliparous woman who winced every single time I tried to insert the blades. Additionally, the speculums (rather a crap model, honestly) had only three settings: wide, wider, and widest. I felt certain that I was absolutely torturing my patients, and providing them with the worst speculum exam of their lives. So much for my idea of tender, gentle midwifery care!

When I asked one of my patients about why her chart said that she had had a pap smear less than a month ago, her eyes welled up with tears, and she told me that she had been thinking of keeping her baby, and that she had gone for prenatal care, but had ultimately decided she couldn’t do it. I had no idea how to comfort her. I told her that we all do the best we can, and that no one was judging her. She smiled through her tears at me like I was a complete and total idiot, and I had no tissues to offer her.

And yes, I know it gets better. I know you start at the bottom, clueless and incompetant, and slowly improve and refine and get better and learn more…but gah! I hate feeling like this again! It took me so long to finally feel comfortable as a nurse. Now I’m back to square one. My professor seemed to think I’d done fine, but dammmmn. I’m sure my fear and nervousness was written all over my face. If I were a patient in that clinic, with such a nervous student midwife approaching me, I probably would have jumped right off that table and run for my life. I feel fairly certain that I must, in fact, have the worst speculum technique in the world.

I guess the good news is, it can only go up from here.

Amazing how much of midwifery school has absolutely NOTHING to do with pregnant women, or babies, or birth, AT ALL. I’m up to my neck in a presentation on hyperthyroidism at the moment. Haven’t even discussed anything pelvis or speculum related for the past two weeks. Le sigh. At least our clinicals start tomorrow, at a county abortion clinic. Weee-ha, bring it on.

Life works in mysterious ways. Last week I was pining after birth stories, and this week, through an unexpected turn of events, I’ve got three amazing stories to share! Miriam Axel-Lute, the reporter from Metroland who wrote last week’s feature on homebirth in the capital region, has talked to some of her sources to see if they’re willing to share their birth stories with us here, and they are! These are transcripts of the woman’s own words, and they are just incredible. My goodness, I love birth stories! I remember reading Ina May Gaskin’s Spiritual Midwifery nearly all in one go, because it was nothing but birth stories, and I was absolutely eating them up. I’ll dole these stories out one at a time to stretch the beauty. First up is Caroline Sharkey, who birthed her baby at home with homebirth midwives in the capital region, all of whom are sadly working illegally, and none of whom can be mentioned by name. Even so, their caring, and the grace and joy of the birth shines through, even during a necessary transport to the hospital afterwards because of a retained placenta. Caroline, thank you so much for sharing your birth story with us!
(Read on …)