This place has the strangest effect on my sense of time; I never know what day it is, only the date and the time... could be Monday, could be Thursday: Who knows?
It's been interesting. I have been here for almost a month, I think... there goes that sense of time thing again. I can say that it took me about 3 weeks to really find my feet here and feel like I know what the hell I'm doing. And now that it has been 32 days (but who's counting?) I feel like my skills have the bump I was hoping they would be for me to be a more confident midwife back at home.
Yeah, I came here for some numbers, I won't lie but I also came here for some confidence.
That being said, I freaking WANT TO GO HOME. I have 15 days not counting today which is technically just getting started. I was second on last night and I got called to the birth center at 3:30 for a birth that didn't take place until 7:30 so I was up for several hours and now I am first on tonight. Already there have been 3 births (all of which I missed due to the timing of shifts) but two of which I had to do postpartum vitals and discharge and then clean the rooms, do all of the trash, and handle the laundry. I'm not going to lie and say it doesn't suck to have to do hours and hours of work after someone else gets the catch but the general feeling around here is what goes around comes around.... I have yet to be able to hand over one of my postpartum clients though I am looking forward to that happening someday!
Anyway, back to wanting to go home; I have all of my numbers that I needed except for 1 newborn exam. Yay! I will still stay until October 15th unless they seriously don't need me in which case I would so love to go home a few days early. I know it will be over soon but I cannot wait to get back to my kids and husband. I am one of those people who doesn't enjoy being out of her comfort zone and this has been about 90% out of my comfort zone.
My advice to anyone coming here is to just put one foot in front of the other and try not to look at the big picture... keep it small. One day at a time, etc. If I sit here and look at the schedule of the next two weeks I will feel overwhelmed so instead I just look at it one shift (sometimes one hour) at a time and that makes it seem more manageable.
Wednesday, September 30, 2009
Sunday, September 20, 2009
Waiting
You would think after 3 weeks here I would stop believing that Sundays at the (closed) clinic are going to be boring. Far from it... one transport this morning, two 36 hour postpartums (including PKU, ouch) and now I am waiting on a mom with suspected SROM.
My nerves are kind of frazzled, working with the new midwife and still trying to gather what it is she wants from me and how she likes things done. Ah well... I hope if this client is in labor she goes before my shift is over!
My nerves are kind of frazzled, working with the new midwife and still trying to gather what it is she wants from me and how she likes things done. Ah well... I hope if this client is in labor she goes before my shift is over!
Friday, September 18, 2009
In case you all are wondering...
those of you playing the numbers game as I am here are my stats thus far:
En La Casa:
36 prenatals (and there were probably more I neglected to write down)
4 births
4 newborn exams
6 Initial visits
9 postpartums
8 births as an active participant
And, to be fair, I don't need all that much, I did come in with a decent amount of numbers and all of my skills already signed off. I am staying for 6 weeks and you will definitely NOT get all of your numbers in 6 weeks... you may not get them all in even 3 months. I also came not needing continuities so if you can avoid having to do that here you will be in better shape. And if you are doing the kind of program that requires Well Woman care you may or may not get some of that here.
The thing is that you might have three births on your shift as first on (as I did last night) but when you catch a baby you must then complete two hours of postpartum vitals and do 100% of your paperwork before you can catch another one or it goes to the second on. If they had a slightly different system I would have had all of my catches in two weeks, no doubt. I would have caught 6 babies in two days on.
En La Casa:
36 prenatals (and there were probably more I neglected to write down)
4 births
4 newborn exams
6 Initial visits
9 postpartums
8 births as an active participant
And, to be fair, I don't need all that much, I did come in with a decent amount of numbers and all of my skills already signed off. I am staying for 6 weeks and you will definitely NOT get all of your numbers in 6 weeks... you may not get them all in even 3 months. I also came not needing continuities so if you can avoid having to do that here you will be in better shape. And if you are doing the kind of program that requires Well Woman care you may or may not get some of that here.
The thing is that you might have three births on your shift as first on (as I did last night) but when you catch a baby you must then complete two hours of postpartum vitals and do 100% of your paperwork before you can catch another one or it goes to the second on. If they had a slightly different system I would have had all of my catches in two weeks, no doubt. I would have caught 6 babies in two days on.
Care package
Today I got a huge care package from my awesome husband and it could not have come at a better time; I had spent about an hour boo-hooing about how much the recent changes here have made me want to go home. Also, I have horrible PMS and that helps nothing.
So, after I discovered that my brand new bottle of eco-laundry detergent had walked off when someone recently departed (ahem, it was $8 and unopened) I splashed nasty ass birth water in my face while I was scrubbing birth laundry (got drenched with bloody peroxide water in my eyes and mouth - yum) then I discovered my clothes got a little bit bleached in the stupid washer. I was in a FOUL mood especially considering I am on tonight 6-6 for the second night in a row.
Anyhoo, it was then that I realized I had a huge box in my room and in it was:
A box of Godiva truffles
A copy of Bust magazine (my fav)
A copy of Kathy Griffin's new book
A picture drawn by Stella
A tub of cotton candy
A bag of Peppermint Patties
Some ghost marshmallow peeps (picked out by Stella)
Some Pocky cookies
Season one of Battlestar Galactica
The last two discs from The Wire I was watching before I left
Season five of 6 Feet Under
An awesome Where the Wild Things Are shirt from Urban Outfitters
A freaking new pair of New Balance shoes (because my feet are ruined)
Insoles for my new shoes
And a damn MP3 player loaded with a David Cross show and a Stephen King book.
I think that's it... it was the single best package I could have possibly received on the shittiest day of my Casa experience. My husband is the best, he knows EXACTLY what I need and I miss him so much I am seriously considering leaving early right now. I hope this feeling will pass but if it doesn't I'm kind of thinking I will leave as soon as I get my numbers solid.
It's just about to be the end of week three and I am seriously homesick. I was warned this would happen so I'm hoping it will pass. I mean, people live through all kinds of things and if this midwife doesn't like the way I do things and criticizes every move I make there isn't anything I can do other than get through it and not give two shits what she thinks of me.
So, after I discovered that my brand new bottle of eco-laundry detergent had walked off when someone recently departed (ahem, it was $8 and unopened) I splashed nasty ass birth water in my face while I was scrubbing birth laundry (got drenched with bloody peroxide water in my eyes and mouth - yum) then I discovered my clothes got a little bit bleached in the stupid washer. I was in a FOUL mood especially considering I am on tonight 6-6 for the second night in a row.
Anyhoo, it was then that I realized I had a huge box in my room and in it was:
A box of Godiva truffles
A copy of Bust magazine (my fav)
A copy of Kathy Griffin's new book
A picture drawn by Stella
A tub of cotton candy
A bag of Peppermint Patties
Some ghost marshmallow peeps (picked out by Stella)
Some Pocky cookies
Season one of Battlestar Galactica
The last two discs from The Wire I was watching before I left
Season five of 6 Feet Under
An awesome Where the Wild Things Are shirt from Urban Outfitters
A freaking new pair of New Balance shoes (because my feet are ruined)
Insoles for my new shoes
And a damn MP3 player loaded with a David Cross show and a Stephen King book.
I think that's it... it was the single best package I could have possibly received on the shittiest day of my Casa experience. My husband is the best, he knows EXACTLY what I need and I miss him so much I am seriously considering leaving early right now. I hope this feeling will pass but if it doesn't I'm kind of thinking I will leave as soon as I get my numbers solid.
It's just about to be the end of week three and I am seriously homesick. I was warned this would happen so I'm hoping it will pass. I mean, people live through all kinds of things and if this midwife doesn't like the way I do things and criticizes every move I make there isn't anything I can do other than get through it and not give two shits what she thinks of me.
Waiting
I am first on tonight with the traveling midwife who is here to fill in for Jenny who left to go on vacation. I miss Jenny; at first I was kind of intimidated by her but I grew to really like her style and her quiet sense of humor. I am the kind of person who spends a lot of time trying to understand what is below everyone's surface (especially in a situation like this where you are under DIRECT supervision) and I finally felt like I had a grip on the midwives here...
Anyway, I am here from 6pm to 6am and I was seriously hoping no one would come in. Of course the phone rang at 10:00 ( there are a lot of rules regarding phone calls and also just a lot of responsibility - I would never forgive myself if I misunderstood critical client information because I don't understand Spanish ) with a primip contracting q15 (lasting 20 seconds)across the border in Juarez, Mexico. The traveling midwife doesn't speak Spanish so even though it is in direct conflict with the phone rules she makes you handle the calls. I will be honest and tell you that this responsibility is horrible to me. If you think you don't speak Spanish face to face wait until you see how much you don't speak it over the phone.
If I were back at home and a primip called me contracting q15 I would tell her to go to sleep and that I would see her in the morning but here because there is crossing the border to deal with we have to have them come to the clinic.
Anyway, I did a labor check, had my skills quite thoroughly questioned, and as far as I think right now nothing is going on. I am seriously hoping to send her out to sleep and see her in a day or so. I feel seriously uncomfortable in my current clinical setting.
Anyway, I am here from 6pm to 6am and I was seriously hoping no one would come in. Of course the phone rang at 10:00 ( there are a lot of rules regarding phone calls and also just a lot of responsibility - I would never forgive myself if I misunderstood critical client information because I don't understand Spanish ) with a primip contracting q15 (lasting 20 seconds)across the border in Juarez, Mexico. The traveling midwife doesn't speak Spanish so even though it is in direct conflict with the phone rules she makes you handle the calls. I will be honest and tell you that this responsibility is horrible to me. If you think you don't speak Spanish face to face wait until you see how much you don't speak it over the phone.
If I were back at home and a primip called me contracting q15 I would tell her to go to sleep and that I would see her in the morning but here because there is crossing the border to deal with we have to have them come to the clinic.
Anyway, I did a labor check, had my skills quite thoroughly questioned, and as far as I think right now nothing is going on. I am seriously hoping to send her out to sleep and see her in a day or so. I feel seriously uncomfortable in my current clinical setting.
Thursday, September 17, 2009
Decisions
When you're second on at night you can go over to the intern house and sleep; they will page you when you are needed. The only problem is that when they page you you are needed immediately and if you are not there in one minute they will page you again. If you can, sleep in your scrubs and have your stuff ready to grab as you run out the door.
They code for second on when the client starts second stage. You will get used to breathing stinky morning breath on clients and fellow interns, I promise. When you are second on you're (usually) not needed for very long... about one to two hours. You chart the second stage, take FHTs, keep the time of birth, cord cut, and placenta, hand the instruments, and call for Apgars - kind of basic early apprenticeship type stuff. After the placenta is delivered you get the midwife a bowl of betadine water (oh, and as a special treat each midwife likes their water a different strength so you will have to learn who likes what) then clean and restock the birth bowl. If you're feeling generous you can clean the instruments but that is technically the role of first on. I always ask the midwife and the first on if there is anything else I can do and then I'm off... either to sleep or to run citas like a mad woman.
Today four births occurred directly before prenatals and it was absolutely hellish running citas non-stop without breakfast, coffee, water, or even a pee break. I did 4 registrations with the LM... Which reminds me: Those of you doing the PEP and attempting to avoid the QE skills exam need to be sure of who signs your paperwork! One of the midwives is an LM and not a CPM so if she signs anything you can no longer do the secondary assessment of skills and avoid the skills exam.
Also, you will observe a lot of births (they code almost all of the births for everyone to come and observe) and these count for nothing other than you got to watch a birth. I know, I'm jaded after having been in this for 7 years but I no longer want to get out of bed at 3:00am to just stand and watch a birth... also, sometimes it feels voyeuristic to stand with 3 or 4 other interns at the foot of this woman's birth bed and stare at her crotch. But, you still get to see cool stuff so it is worth trying to make it to as many observes as you can. I don't even know how many births I have been to in 2.5 weeks... at least 15.
They code for second on when the client starts second stage. You will get used to breathing stinky morning breath on clients and fellow interns, I promise. When you are second on you're (usually) not needed for very long... about one to two hours. You chart the second stage, take FHTs, keep the time of birth, cord cut, and placenta, hand the instruments, and call for Apgars - kind of basic early apprenticeship type stuff. After the placenta is delivered you get the midwife a bowl of betadine water (oh, and as a special treat each midwife likes their water a different strength so you will have to learn who likes what) then clean and restock the birth bowl. If you're feeling generous you can clean the instruments but that is technically the role of first on. I always ask the midwife and the first on if there is anything else I can do and then I'm off... either to sleep or to run citas like a mad woman.
Today four births occurred directly before prenatals and it was absolutely hellish running citas non-stop without breakfast, coffee, water, or even a pee break. I did 4 registrations with the LM... Which reminds me: Those of you doing the PEP and attempting to avoid the QE skills exam need to be sure of who signs your paperwork! One of the midwives is an LM and not a CPM so if she signs anything you can no longer do the secondary assessment of skills and avoid the skills exam.
Also, you will observe a lot of births (they code almost all of the births for everyone to come and observe) and these count for nothing other than you got to watch a birth. I know, I'm jaded after having been in this for 7 years but I no longer want to get out of bed at 3:00am to just stand and watch a birth... also, sometimes it feels voyeuristic to stand with 3 or 4 other interns at the foot of this woman's birth bed and stare at her crotch. But, you still get to see cool stuff so it is worth trying to make it to as many observes as you can. I don't even know how many births I have been to in 2.5 weeks... at least 15.
Wednesday, September 16, 2009
My day to want to go home
One of the midwives here told me that all of the interns have a day where they cry and want to go home; mine is today.
Some days I feel OK telling myself to just put my head down and get through it, it's not that long, people do things that are MUCH harder than this. Today isn't one of those days and part of that is because I have PMS but another part of it is that I love midwifery and a lot of this isn't similar to the midwifery that I love... if that makes sense. The midwives here are great... it isn't that, it's the damn pace of this place. The pace can be crazy and there are always going to be people that you cannot please no matter what you do and that is the point at which it is OK to admit to yourself that you are here for clinical experience or numbers and not to learn to please every staff member in the building. I am not here to please midwife so-and-so and I, frankly, don't give a damn if she likes the way I write the dates on my charts or not... my allegiance is to my future clients and I'm here to learn as much as possible and I know that the staff midwife's only intention is to help us become the best midwives we can be.
I have two night shifts in the next two days which in some ways is good... I don't want to run around again tomorrow like I did today but also I need initial visits and postpartums. Oh, I did 4 initial visits today that I can't count for my numbers (because of the LM who signed off on them) and I need a handful more but if I don't have to look at a speculum for a day or two I'll be happy.
I'm in a terrible mood. I just went to the store with Christy, who is hilarious and awesome, and I bought a bunch of feeling sorry for myself candy... because, you know, gaining 8 pound will make me feel a lot better.
I want to go home, I miss my kids and my husband. I could barely look at the Halloween stuff because I want to be at home being Halloweeny with my kids. Wahhhhh.....
Some days I feel OK telling myself to just put my head down and get through it, it's not that long, people do things that are MUCH harder than this. Today isn't one of those days and part of that is because I have PMS but another part of it is that I love midwifery and a lot of this isn't similar to the midwifery that I love... if that makes sense. The midwives here are great... it isn't that, it's the damn pace of this place. The pace can be crazy and there are always going to be people that you cannot please no matter what you do and that is the point at which it is OK to admit to yourself that you are here for clinical experience or numbers and not to learn to please every staff member in the building. I am not here to please midwife so-and-so and I, frankly, don't give a damn if she likes the way I write the dates on my charts or not... my allegiance is to my future clients and I'm here to learn as much as possible and I know that the staff midwife's only intention is to help us become the best midwives we can be.
I have two night shifts in the next two days which in some ways is good... I don't want to run around again tomorrow like I did today but also I need initial visits and postpartums. Oh, I did 4 initial visits today that I can't count for my numbers (because of the LM who signed off on them) and I need a handful more but if I don't have to look at a speculum for a day or two I'll be happy.
I'm in a terrible mood. I just went to the store with Christy, who is hilarious and awesome, and I bought a bunch of feeling sorry for myself candy... because, you know, gaining 8 pound will make me feel a lot better.
I want to go home, I miss my kids and my husband. I could barely look at the Halloween stuff because I want to be at home being Halloweeny with my kids. Wahhhhh.....
Monday, September 14, 2009
When it rains...
So I was first on Sunday which means being at the closed clinic from 6am-6pm... I was totally expecting a boring ass day so I packed my knitting, an episode of Lost on my iPhone and I got over there and did all of my stocking type work right away so I would be done. Of course the more stuff you bring to do the busier you will be. If you show up with nothing to do you would sit for 12 hours and stare at the wall.
I was on with staff midwife Laverne who can't sign off anything for my NARM stuff because she is an LM and not a CPM and I am trying to do the Secondary Skills Sign Off. Anyhoo, I'm not too jazzed about taking experiences from interns who could actually count them so I always hope for a slow day with Laverne. Nope. A woman shows up with SROM and I end up spending the entire day working her labor and since I'm off at 6 (and Laverne is off at 5 to be replaced with Jenny with whom I CAN count my clinicals) I'm pretty sure I will have to turn her over to the next intern on shift.
I don't know if I have mentioned it before but Laverne is pretty much awesome. I don't even care that I can't count stuff with her because she has taught me an insane amount of clinical skills. If I were on a deserted island and my baby was coming out shoulder first I would want Laverne to be my midwife. She is sweet and friendly to the clients and her clinic style is much more like what we think of for a homebirth midwife; she takes a lot of time with people. Laverne can make ANYONE laugh, she has a gift for connecting with the clients. I know I am going to miss her when I leave.
Here if you are first on with a laboring woman who is not imminent (within the hour) you have to turn her over when you go off shift.
Also, it is worth reiterating here to anyone who is green and thinking of coming to Casa... labor can be a messy messy event.
Long story short I got my 3rd catch in two weeks of being at Casa. Yay. Then I had to stay and do all of the postpartum stuff and paperwork which can feel REALLY oppressive if your training has been homebirth as mine has. You do vitals on client and baby every 15 minutes for two hours and then every hour for 6 hours. Also you have all this paperwork that I am still trying to understand with regard to the American birth certificate. Then you have to discharge them (when they're ready) and clean the room, do the laundry, take out the biohazard, etc. It is EXHAUSTING in a way I did not previously understand.
I got up at 5:00am, caught that baby at 6:40pm, discharged them at 12:42am, did laundry until 2:00am and then I went to bed. Except I was second on and another client was in labor so I got paged to come back at 4:00am. I was so disoriented I couldn't remember my job.
I finally got back to bed at 6:00 and after dealing with 2 phone calls from home about kindergarten sadness I got to sleep at 6:46am and slept until 3:00. Now I'm starving and I'm about to walk to the Q.
I hate to sound like a cliche but this place really is bootcamp for midwives... and not just in the birth sense, in the sense that you will get no sleep, you will do manual labor, you will do things you really don't want to do... oh, and you will pay thousands of dollars to do it. :)
I was on with staff midwife Laverne who can't sign off anything for my NARM stuff because she is an LM and not a CPM and I am trying to do the Secondary Skills Sign Off. Anyhoo, I'm not too jazzed about taking experiences from interns who could actually count them so I always hope for a slow day with Laverne. Nope. A woman shows up with SROM and I end up spending the entire day working her labor and since I'm off at 6 (and Laverne is off at 5 to be replaced with Jenny with whom I CAN count my clinicals) I'm pretty sure I will have to turn her over to the next intern on shift.
I don't know if I have mentioned it before but Laverne is pretty much awesome. I don't even care that I can't count stuff with her because she has taught me an insane amount of clinical skills. If I were on a deserted island and my baby was coming out shoulder first I would want Laverne to be my midwife. She is sweet and friendly to the clients and her clinic style is much more like what we think of for a homebirth midwife; she takes a lot of time with people. Laverne can make ANYONE laugh, she has a gift for connecting with the clients. I know I am going to miss her when I leave.
Here if you are first on with a laboring woman who is not imminent (within the hour) you have to turn her over when you go off shift.
Also, it is worth reiterating here to anyone who is green and thinking of coming to Casa... labor can be a messy messy event.
Long story short I got my 3rd catch in two weeks of being at Casa. Yay. Then I had to stay and do all of the postpartum stuff and paperwork which can feel REALLY oppressive if your training has been homebirth as mine has. You do vitals on client and baby every 15 minutes for two hours and then every hour for 6 hours. Also you have all this paperwork that I am still trying to understand with regard to the American birth certificate. Then you have to discharge them (when they're ready) and clean the room, do the laundry, take out the biohazard, etc. It is EXHAUSTING in a way I did not previously understand.
I got up at 5:00am, caught that baby at 6:40pm, discharged them at 12:42am, did laundry until 2:00am and then I went to bed. Except I was second on and another client was in labor so I got paged to come back at 4:00am. I was so disoriented I couldn't remember my job.
I finally got back to bed at 6:00 and after dealing with 2 phone calls from home about kindergarten sadness I got to sleep at 6:46am and slept until 3:00. Now I'm starving and I'm about to walk to the Q.
I hate to sound like a cliche but this place really is bootcamp for midwives... and not just in the birth sense, in the sense that you will get no sleep, you will do manual labor, you will do things you really don't want to do... oh, and you will pay thousands of dollars to do it. :)
Saturday, September 12, 2009
Friday Night
I was first on last night with Laverne. When you are first on at night you have to be at the clinic... you can sleep but you have to do it there. And when I say sleep I mean curl up in a fetal position on a circa 1985 mattress on top of the coverlet and try desperately to squeeze an hour or two of sleep. Because Laverne is really entertaining I stayed up until 1:45 chatting with her and then the doorbell rang at 2:00 with a woman in labor. I checked her, did the basic prenatal stuff, got her settled and about an hour later it rang again with another laboring woman.
What sucks is that if you are first on they are your clients until the shift change and then if they are not imminent you have to turn your charts over and leave. So, you spend their labors with them and do all that stuff only to have to give them up in the end. Conversely if you come on shift and a woman has had her baby you will have to take over vitals, paperwork, discharge, and cleaning and laundry even if it wasn't your catch. There are a lot of elements about this experience that are going to make homebirth seem so much easier, hell, they're going to make my everyday housework load seem like a boring piece of cake.
So, at 6:15 I came back over here to the intern house and crashed so hard I missed the code to observe the birth. When the head is crowning they will call a code to whichever birth room the client is in but when they coded it all I heard was "blah blah blah" so I knew I was probably too tired to stumble over there. I slept until 12:30 and then Katie and I went thrifting and out to lunch. It was awesome to get off the grounds further than the Q grocery store.
I'm off tonight but first on tomorrow which is kind of sucky because we are closed on Sunday maybe I will get some registrations - I desperately need initial visits for my paperwork.
What sucks is that if you are first on they are your clients until the shift change and then if they are not imminent you have to turn your charts over and leave. So, you spend their labors with them and do all that stuff only to have to give them up in the end. Conversely if you come on shift and a woman has had her baby you will have to take over vitals, paperwork, discharge, and cleaning and laundry even if it wasn't your catch. There are a lot of elements about this experience that are going to make homebirth seem so much easier, hell, they're going to make my everyday housework load seem like a boring piece of cake.
So, at 6:15 I came back over here to the intern house and crashed so hard I missed the code to observe the birth. When the head is crowning they will call a code to whichever birth room the client is in but when they coded it all I heard was "blah blah blah" so I knew I was probably too tired to stumble over there. I slept until 12:30 and then Katie and I went thrifting and out to lunch. It was awesome to get off the grounds further than the Q grocery store.
I'm off tonight but first on tomorrow which is kind of sucky because we are closed on Sunday maybe I will get some registrations - I desperately need initial visits for my paperwork.
Weekend
Since my last post I have caught two babies, both with Jenny. Both were nice and simple, I got to learn some new techniques which is always a plus. The after care is the hardest part and one of the times when I miss homebirth the most. The clients can stay for as long as they need to and my last one stayed for 8 hours post birth which meant 8 hours of vitals after I had already been up all night long. I'm just going to have to throw my feet away; you are on them non-stop when the client is in labor and then for the postpartum. Oh, and then you have to still do your First On chores and that is probably when you will ponder to yourself why you paid thousands of dollars to bust your ass so thoroughly.
One thing I have seen, and will now have a better understanding of how to estimate and deal with, is blood loss. If you are coming here be prepared to see losses that well exceed what you are used to in homebirth. It's good though; while I still have my healthy respect/fear of PPH I'm significantly more confident in my ability to handle it.
One thing I have seen, and will now have a better understanding of how to estimate and deal with, is blood loss. If you are coming here be prepared to see losses that well exceed what you are used to in homebirth. It's good though; while I still have my healthy respect/fear of PPH I'm significantly more confident in my ability to handle it.
Tuesday, September 8, 2009
Tuesday
I have been off for a few days and trying not to get discouraged. I didn't come here catch-hungry because I know that is a sure way to fail but I do seriously need some catches and sitting around the intern house for 3 days isn't instilling a lot of confidence. I'm first on tonight so I might get a catch but it is with the staff midwife I fear the most so I'm nervous about that.
Anyhoo, C left and I am truly going to miss her. Her help and little secrets and tips were invaluable to me and her hilarity helped a lot too. She's one of the only people who could say to me, "I love Sarah Palin" and have me not throw up on them.
Last night we sat in the office with A'maya and chatted and watched a crappy (uber-crappy) movie while we discussed herpes protocols and HIV/AIDS conspiracies. The movie was Aeon Flux and it hurt my former film student soul to watch even 5 minutes of it it was so bad.
I made a teeny felt bear from The Cute Book for Stella instead of watching.
It's cool to hang out with everyone but I have a large personal time requirement. You have to do what you have to do to keep your sanity here, know what I mean? It's awesome to talk birth and babies all day and into the night but you have to make sure you take a breather and do some of the things you did in your old (pre-Casa) life or you might start to feel crazy. I have been watching Lost (OK, I'm obsessed) and I brought knitting projects and these awesome little felt projects to make for my kids and Stella, who is 5, has been thrilled to receive little felt bunnies and kitties in the mail.
It's kind of strange how attached you get to your meager possessions and personal space here. I mean, you'd cry for me if I showed you a picture of my bedroom space but to me it's like heaven at the end of the day.
Anyhoo, C left and I am truly going to miss her. Her help and little secrets and tips were invaluable to me and her hilarity helped a lot too. She's one of the only people who could say to me, "I love Sarah Palin" and have me not throw up on them.
Last night we sat in the office with A'maya and chatted and watched a crappy (uber-crappy) movie while we discussed herpes protocols and HIV/AIDS conspiracies. The movie was Aeon Flux and it hurt my former film student soul to watch even 5 minutes of it it was so bad.
I made a teeny felt bear from The Cute Book for Stella instead of watching.
It's cool to hang out with everyone but I have a large personal time requirement. You have to do what you have to do to keep your sanity here, know what I mean? It's awesome to talk birth and babies all day and into the night but you have to make sure you take a breather and do some of the things you did in your old (pre-Casa) life or you might start to feel crazy. I have been watching Lost (OK, I'm obsessed) and I brought knitting projects and these awesome little felt projects to make for my kids and Stella, who is 5, has been thrilled to receive little felt bunnies and kitties in the mail.
It's kind of strange how attached you get to your meager possessions and personal space here. I mean, you'd cry for me if I showed you a picture of my bedroom space but to me it's like heaven at the end of the day.
Sunday, September 6, 2009
Saturday night
After the craziness of the morning nothing else happened all day; C and I restocked and cleaned and then just sat around and chatted. I love her despite the fact that we are POLAR opposites on pretty much every possible level. She's pentecostal and I'm a heathen, she's pro-life and I'm fervently pro-choice, she voted for Sarah Palin and I threw up in my mouth a little just typing that... but I love her and she totally doesn't mind hanging out with me even though I'm going to burn in hell for all eternity.
Last night C and I actually left the birth center and went for Chinese food and it was the first time I had worn street clothes in a week. The Chinese place was even a teensy bit sketchy and I didn't care because I was so happy to be eating food not from my teeny little 4" of fridge space (my fridge space was recently upgraded). I wanted to take her out to thank her for her invaluable help during my first week here; were it not for C I might have wanted to give up and leave. Instead, she was so unbelievably welcoming to me and she gave me every little tip and secret she could think of, didn't ever get irritated when I asked her the same question twice or acted like packing the sterile OB kits was beyond my capabilities. I shadowed her my first day and as a result I picked up her upbeat, funny, bedside manner and now when I'm nervous about doing something to a client I just met (exa; they do vag exams on all clients weekly starting at 36 weeks) I just pretend I'm her and it works every time.
Plus, she is completely hilarious and I am so going to miss that; she has had me spewing liquids out my nose every day.
After we got back from Chinese (we also walked to The Q and I got some evil evil Diet Pepsi) a new intern arrived and so we sat and chatted in A'maya's office until it was decided we were going to practice blood draws on each other. Awesome. I'm pretty good at blood draws, I have never missed but you know, there is always a first time. So we go to the Jungle room (not the Creepy Clown room because that room was designed by Satan's personal decorator.... you will see when you get here... shudder) and I climb up on the table (they have exam tables here, hard to get used to when you are used to couches and beds) and we're all giddy and hysterical K wants to get checked off on on catheterizing someone, everyone is cracked up and leaning over me and I feel like I've been abducted by alien midwives bent on practicing their skills. Blood draws go fine all around.
We tried to force C into a pap and a blood draw but she escaped our clutches. You get a group of midwives together overnight and some kind of clinical haymaking is going to go on.
Last night C and I actually left the birth center and went for Chinese food and it was the first time I had worn street clothes in a week. The Chinese place was even a teensy bit sketchy and I didn't care because I was so happy to be eating food not from my teeny little 4" of fridge space (my fridge space was recently upgraded). I wanted to take her out to thank her for her invaluable help during my first week here; were it not for C I might have wanted to give up and leave. Instead, she was so unbelievably welcoming to me and she gave me every little tip and secret she could think of, didn't ever get irritated when I asked her the same question twice or acted like packing the sterile OB kits was beyond my capabilities. I shadowed her my first day and as a result I picked up her upbeat, funny, bedside manner and now when I'm nervous about doing something to a client I just met (exa; they do vag exams on all clients weekly starting at 36 weeks) I just pretend I'm her and it works every time.
Plus, she is completely hilarious and I am so going to miss that; she has had me spewing liquids out my nose every day.
After we got back from Chinese (we also walked to The Q and I got some evil evil Diet Pepsi) a new intern arrived and so we sat and chatted in A'maya's office until it was decided we were going to practice blood draws on each other. Awesome. I'm pretty good at blood draws, I have never missed but you know, there is always a first time. So we go to the Jungle room (not the Creepy Clown room because that room was designed by Satan's personal decorator.... you will see when you get here... shudder) and I climb up on the table (they have exam tables here, hard to get used to when you are used to couches and beds) and we're all giddy and hysterical K wants to get checked off on on catheterizing someone, everyone is cracked up and leaning over me and I feel like I've been abducted by alien midwives bent on practicing their skills. Blood draws go fine all around.
We tried to force C into a pap and a blood draw but she escaped our clutches. You get a group of midwives together overnight and some kind of clinical haymaking is going to go on.
Saturday morning insanity
Saturday we had no second on because of some scheduling mix ups and I was scheduled to second Saturday night. So, when I got paged at 7:00 am on Saturday I was a little confused and disoriented. I jumped out of bed and threw on the nearest scrubs I had (you can observe a birth in a lab coat but since I didn't know what I was doing I put on scrubs) and bolted for the birth center. I forgot to put on a bra which is something I can barely tolerate; I have big C/small Ds and I hate letting them run wild and free but I thought, 'eh, the baby will come and I'll run back over here and grab a bra.' Wrong, of course.
Two babies were born within 5 minutes of each other and within 5 minutes of that the entire days worth of appointments showed up in the front. The resident and the other intern were doing the postpartum business with the births so I (literally) ran appointments for 4 hours without stopping once. I'm the kind of person who HAS to eat protein, drink coffee, and have a big glass of water in the morning and by 11:30 I had not had a single drop of water or even the chance to pee. It was fun though, I so totally did not care that I was a wreck, boobs all over the place under my scrubs, dehydrated and about to pee my pants because I did 7 visits in 4 hours. And of course, that was the day that all of the clients needed extra counseling and since I can't speak Spanish I was having to go get the staff midwife all day who was pretty busy herself.
I honestly don't know how the staff midwives keep up this clip. The birth center can never be unoccupied; a staff midwife has to sleep there every night. When A'maya (by far one of the coolest midwife I've ever met) is on she brings her little girls and they sleep there with her. On the one hand I feel like homebirth practice might seem a little dull after this I cannot imagine living with the pace they have here.
Two babies were born within 5 minutes of each other and within 5 minutes of that the entire days worth of appointments showed up in the front. The resident and the other intern were doing the postpartum business with the births so I (literally) ran appointments for 4 hours without stopping once. I'm the kind of person who HAS to eat protein, drink coffee, and have a big glass of water in the morning and by 11:30 I had not had a single drop of water or even the chance to pee. It was fun though, I so totally did not care that I was a wreck, boobs all over the place under my scrubs, dehydrated and about to pee my pants because I did 7 visits in 4 hours. And of course, that was the day that all of the clients needed extra counseling and since I can't speak Spanish I was having to go get the staff midwife all day who was pretty busy herself.
I honestly don't know how the staff midwives keep up this clip. The birth center can never be unoccupied; a staff midwife has to sleep there every night. When A'maya (by far one of the coolest midwife I've ever met) is on she brings her little girls and they sleep there with her. On the one hand I feel like homebirth practice might seem a little dull after this I cannot imagine living with the pace they have here.
Thursday, September 3, 2009
Habla ingles?
"Mi espanol es muy malo, lo siento."
I say that 30 times a day. I do not speak Spanish and if you did speak Spanish it would be a boon to you here... but you don't have to. They give you a booklet with the phrases you'll need and you actually only need about 50% of what is in there. You will cling to that booklet like your life depends on it. Woe to the intern who finds herself in the middle of cita-mania without her booklet for she will be doing a lot of charades. I have picked up a lot from the other interns who don't speak Spanish because the ones who do speak so quickly I can't catch anything.
What happens is that you get your little prenatal or postnatal phrases down and you ask them stuff... but then they answer and you have no idea what they're saying. At this point there is a lot of mutual charades going on and a lot of being looked at like you're crazy. If I ask them what they have eaten today there's a good chance the only thing I will understand is eggs and beans. They are so nice and so understanding of my ignorance, in my experience they have all been very patient while I fumble for words. And when you get one that speaks English you want to jump for joy. Honestly, I find a little levity during the visits goes a long way in making everyone feel more comfortable.
It's so much more clinical than homebirth is but that has actually not been that hard to get used to... to be honest it is kind of fun to get to do the things that most homebirthers waiver out of. That sounds bad but it's true... midwives are experience junkies.
Tonight will be my first birth with Laverne, I'm so psyched I like her so much and she is such an awesome teacher.
I say that 30 times a day. I do not speak Spanish and if you did speak Spanish it would be a boon to you here... but you don't have to. They give you a booklet with the phrases you'll need and you actually only need about 50% of what is in there. You will cling to that booklet like your life depends on it. Woe to the intern who finds herself in the middle of cita-mania without her booklet for she will be doing a lot of charades. I have picked up a lot from the other interns who don't speak Spanish because the ones who do speak so quickly I can't catch anything.
What happens is that you get your little prenatal or postnatal phrases down and you ask them stuff... but then they answer and you have no idea what they're saying. At this point there is a lot of mutual charades going on and a lot of being looked at like you're crazy. If I ask them what they have eaten today there's a good chance the only thing I will understand is eggs and beans. They are so nice and so understanding of my ignorance, in my experience they have all been very patient while I fumble for words. And when you get one that speaks English you want to jump for joy. Honestly, I find a little levity during the visits goes a long way in making everyone feel more comfortable.
It's so much more clinical than homebirth is but that has actually not been that hard to get used to... to be honest it is kind of fun to get to do the things that most homebirthers waiver out of. That sounds bad but it's true... midwives are experience junkies.
Tonight will be my first birth with Laverne, I'm so psyched I like her so much and she is such an awesome teacher.
First day as second on
Last night I made the muy malo assumption that I was off duty and I went deeply deeply to sleep only to have my name paged over the intercom at 12:30. Apparently it was my learning experience about the role of second on during a birth. Basically, for anyone who has apprenticed, being second on is like being the apprentice. 2nd on charts during active labor, takes FHTs, notes the times, apgars, etc. The thing is that here at Casa they are SO particular and each staff midwife is particular in her own way that whether you have charted at a million births your first experience charting at Casa might as well be your first experience ever. I'm not exaggerating when I say that I felt like I had no idea how to take heart tones which is something that I have done, literally, hundreds of times.
But I did get to do a birth with Jenny, one of the staff midwives, and she was really great.
But, today I was second on for citas (appointments, in case I never mentioned that) but it was a slow day. Thursdays are only 1/2 days at the clinic and then you're supposed to clean and restock until you're off your shift. So, I got to run my own appointments without anyone standing right over me and it was awesome. I remembered that I actually do know how to do stuff which I had pretty much forgotten since my first day here... some of the folks (Ok, just the one resident and since I will never see her again I will from here on refer to her as Mavis) here will treat you like you have never written your own name.... seriously. I was so happy and relieved that all of my findings were confirmed, it was a nice boost to my wounded confidence. My palpations and cervical checks were all correct. Whew. I did have a debate with a student who has 3 months of experience about whether or not effacement is subjective if you're going to base it on the length of your finger. Um, hello, my fingers are like twice as long as yours, but whatever.
I'm trying to think of what will be helpful for anyone coming here... You might want to bring your own silverware as there are no f-ing forks. The fridge space is severely compromised and I have about 2" of space and that is really not hyperbole. Oh, and don't believe the hype that there is a grocery store in walking distance... I mean, yeah, there's a store and if you're not picky about stuff like eating expired food it could possibly get you through a couple of weeks and you might only come away with scurvy. I don't think The Q could get me through 6 weeks but if I get desperate I could go grab pasta or a box of cereal there; they also have a lot of tortillas and canned stuff and also meat but I wouldn't touch the meat with a 10 foot pole. Also since I have been here I haven't exactly been wanting to cook. I can cook for my family when I'm at home; while I am in the Casa I want to chill and just worry about myself and what I'm doing. I have yet to figure out where the bus runs from but admittedly I haven't tried that hard, I would kill to go to a movie or something.
I'm sure I have mentioned not to expect much from the intern house... it's pretty gross. The front room is loud but is better ventilated, the back room is really quiet but seems stuffy to me. There's a lot of closet space but not a lot of drawers. The showers are actually OK and I am super picky about showers. It's probably just my age and level of comfort at home, how set I am in my ways, that makes me think this house is so foul... if I were 19 or 20 it probably wouldn't phase me in the least. In fact, I'm pretty sure my first apartment was about on this level.
There's a woman in labor now but I have a feeling it will be a long night.
But I did get to do a birth with Jenny, one of the staff midwives, and she was really great.
But, today I was second on for citas (appointments, in case I never mentioned that) but it was a slow day. Thursdays are only 1/2 days at the clinic and then you're supposed to clean and restock until you're off your shift. So, I got to run my own appointments without anyone standing right over me and it was awesome. I remembered that I actually do know how to do stuff which I had pretty much forgotten since my first day here... some of the folks (Ok, just the one resident and since I will never see her again I will from here on refer to her as Mavis) here will treat you like you have never written your own name.... seriously. I was so happy and relieved that all of my findings were confirmed, it was a nice boost to my wounded confidence. My palpations and cervical checks were all correct. Whew. I did have a debate with a student who has 3 months of experience about whether or not effacement is subjective if you're going to base it on the length of your finger. Um, hello, my fingers are like twice as long as yours, but whatever.
I'm trying to think of what will be helpful for anyone coming here... You might want to bring your own silverware as there are no f-ing forks. The fridge space is severely compromised and I have about 2" of space and that is really not hyperbole. Oh, and don't believe the hype that there is a grocery store in walking distance... I mean, yeah, there's a store and if you're not picky about stuff like eating expired food it could possibly get you through a couple of weeks and you might only come away with scurvy. I don't think The Q could get me through 6 weeks but if I get desperate I could go grab pasta or a box of cereal there; they also have a lot of tortillas and canned stuff and also meat but I wouldn't touch the meat with a 10 foot pole. Also since I have been here I haven't exactly been wanting to cook. I can cook for my family when I'm at home; while I am in the Casa I want to chill and just worry about myself and what I'm doing. I have yet to figure out where the bus runs from but admittedly I haven't tried that hard, I would kill to go to a movie or something.
I'm sure I have mentioned not to expect much from the intern house... it's pretty gross. The front room is loud but is better ventilated, the back room is really quiet but seems stuffy to me. There's a lot of closet space but not a lot of drawers. The showers are actually OK and I am super picky about showers. It's probably just my age and level of comfort at home, how set I am in my ways, that makes me think this house is so foul... if I were 19 or 20 it probably wouldn't phase me in the least. In fact, I'm pretty sure my first apartment was about on this level.
There's a woman in labor now but I have a feeling it will be a long night.
Wednesday, September 2, 2009
Miercoles
Today was my 3rd and final day observing and being observed. Although I have not yet been checked off on all of my required skills to start doing my own visits tomorrow I'm on the schedule to go ahead and start. No big deal... at least the physical act of performing prenatals and postpartums; the hard part is following the Casa protocols. I swear, the protocols here have me feeling like I don't know how to do anything. Combine that with being observed (sometimes hostilely) and with trying to speak a language you in no way speak and it can make for a pretty discouraging and tense (to say the least) day.
Today the staff midwife was Laverne and she is so awesome I can't describe it. She's hilarious and more experienced than any midwife I've ever worked with. I was doing a prenatal while she was observing and I was starting to sweat a little because I could not palpate the baby's head... so of course I start thinking my palpation skills suck even though I have not been wrong before. The mom had a kind of pendulous abdomen and I was having to dig. Anyhoo, I confess to Laverne that I can't locate the head in the maternal pelvis (mom was 35 weeks so el nino should have been head down) and that I am feeling pointy parts on both sides which I don't normally feel. Turns out the baby is straight OP and I do not suck after all. Also, because Laverne's palpation skills rock so hard she helped me feel the baby's freaking chin.
Tomorrow I'm supposed to be second on which would technically mean doing visits on my own... I don't feel like the resident I have been working with thinks my skills are up to snuff even though I have been doing this for 7 years and she has been doing it for exactly 3 months... but I digress. Yesterday she double checked my application of a diaper so I don't think she has a lot of faith in my abilities.
The way that they do visits here (or "citas") is different; they just schedule the visits for either morning or afternoon anytime between the hours the clinic is open. So, these women cross the border from Juarez and if the bridge is backed up they all show up all of the sudden at one time and it gets crazy. It's especially crazy when you have not yet managed to learn how to say "Please pee in a cup." The secretaries are usually helpful (although they do not socialize with the interns) and they will get the women through weight check and urine dip for you.
We had a woman in labor today but she just transported for failure to tolerate labor. Oh well.
Today the staff midwife was Laverne and she is so awesome I can't describe it. She's hilarious and more experienced than any midwife I've ever worked with. I was doing a prenatal while she was observing and I was starting to sweat a little because I could not palpate the baby's head... so of course I start thinking my palpation skills suck even though I have not been wrong before. The mom had a kind of pendulous abdomen and I was having to dig. Anyhoo, I confess to Laverne that I can't locate the head in the maternal pelvis (mom was 35 weeks so el nino should have been head down) and that I am feeling pointy parts on both sides which I don't normally feel. Turns out the baby is straight OP and I do not suck after all. Also, because Laverne's palpation skills rock so hard she helped me feel the baby's freaking chin.
Tomorrow I'm supposed to be second on which would technically mean doing visits on my own... I don't feel like the resident I have been working with thinks my skills are up to snuff even though I have been doing this for 7 years and she has been doing it for exactly 3 months... but I digress. Yesterday she double checked my application of a diaper so I don't think she has a lot of faith in my abilities.
The way that they do visits here (or "citas") is different; they just schedule the visits for either morning or afternoon anytime between the hours the clinic is open. So, these women cross the border from Juarez and if the bridge is backed up they all show up all of the sudden at one time and it gets crazy. It's especially crazy when you have not yet managed to learn how to say "Please pee in a cup." The secretaries are usually helpful (although they do not socialize with the interns) and they will get the women through weight check and urine dip for you.
We had a woman in labor today but she just transported for failure to tolerate labor. Oh well.
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