Clinical firsts

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.

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