Dreaming in the Dark

Yesterday was Everything You Ever Wanted to Know About Hormonal Contraception Day, EVAR. Yes, truly. Everything. We staggered out of class at the end of the day with pressure ulcers (read, bedsores) on our ischial tuberosities (read, butt bones), and heads that felt rather like over-full waterballoons ready to burst, or maybe gigantic blisters ready to pop, or huge, overstuffed armchairs that are slowly leaking fluffy white stuffing out of a tiny tear in the upholstery. And yeah, don’t get me wrong: hormonal contraception is way cool, but maybe not 6 straight hours of it in a row.

Today was a bit more varied. We began the day with antepartum vaginal exams and ended the day with our microscopy check-outs, with a 2 hour lecture on abnormal pap smears thrown into the middle for good measure. Management of abnormal pap smears: wow, there’s a lot to know about that (note to self: CONSULT!!). Microscopy: will be a lot more fun when we actually get to examine real yeast and BV and trich, instead of perfectly healthy vaginal secretions which just aren’t that interesting to look at (healthy vaginal epithelium, for example, just sort of sits there, whereas real live trichomonads actually swim around and wiggle! …). Vaginal exams: uh…well…good in theory, but I really have no idea.

It’s amazing how much of midwifery is in the dark. So little of your knowledge is gathered and assessed with your eyes; you “look” with your fingertips. Thing is, my fingertips are absolutely blind right now. They know nothing. I’ve done maybe three vaginal exams in my entire life. We talked for a good long while about effacement (the thinning out of the cervix) and dilation, and how to assess both, and how difficult it can be to even tell where the cervix is when it’s 100% effaced and paper-thin. Our instructor kept describing scenarios to us where we’d need to know to look for this, or know to check for that…where the outer os of the cervix might be open, but the inner os closed, how we’ll know that what we’re feeling is ruptured membranes versus intact membranes with the water displaced behind the head—she talked so confidently, and with such assurance, and she spoke as if it were all so simple.

Yet how can she lecture to us about the subtle differences between rim and fully dilated when we’re probably not even going to be able to tell the difference between 2 cm and 7 cm, or 50% and 100% effaced? It’s all a Mystery to me. Staring at my professor today was like staring at someone across a great gulf: I could see her there on the other side, brimming with her hard-won knowledge, talking matter-of-factly about things that seemed so straightforward to her, but to me, the uninitiated, it seemed like I’d never get to the other side. When I examine a woman’s cervix, let me assure you: I have no idea WHAT in the blazes I’m feeling! I have no idea when vaginal exams are going to start to make sense: 6 months from now? Two years from now? When will I be standing on the other side of the canyon, explaining the subtle differences between 0 station and +1 station? I have a feeling it will be a bit like learning a new language: you struggle, and struggle, and struggle, and then, one day, you overhear two people talking on the subway in that language and realize you just understood every word they said.

But first, the struggle. Clinicals are going to be a blast, aren’t they? You gotta love it when the learning curve is an 85% incline, straight up.

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