Brave Woman

Adventures of a future nurse-midwife

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Graduation and Silliness

Posted by Lucille on September 20, 2016 at 5:35 PM Comments comments (0)

After counting down with excitement to graduation all year, I suddenly found myself clinging to the last few weeks of the program with anticipatory nostalgia. For one thing, I had hoped to feel competent in the role of a nurse by around the midpoint of the term and felt frustrated when my progress did not match my expectations. And then right around week 8, something clicked. I didn't take over the entire nursing role- I still stepped back to observe and do emotional support during pelvic exams, epidural insertions, and the births themselves- but I started to feel marginally competent in routine labor and postpartum care, and like within that scope I was making an active and reliable contribution to the team. After a year of always moving quickly to the next new thing, the breath of confidence the repetition offered was intoxicating. I'm obviously thrilled to get to jump into learning more new things in the midwifery program, but I found myself wishing that I could postpone graduation, just by a few more weeks, to savor that delicious sense of competence.

But as time does, it flew by despite my objections. I ended my practicum with a beautiful birth. Love and gratitude flowed out my eyes as I said goodbye to the team that had welcomed me and the unit where I had learned so much.

And a few days later, I sat in a room full of graduation decorations and empty chairs as I waited for my classmates and our families to arrive to celebrate our completion of nursing school. I felt oddly melancholy. Because I would be coming back to class in a few weeks, it hadn't sunk in yet that I was graduating and felt more like I would be coming back for just another term but with half my friends missing.

I could not have asked for a more rad group of people to go through nursing school with. You are going to be amazing nurses, all of you. Go knock some patients' socks off! (Then put non-slip socks on them instead. Fall prevention for the win!)

I recently reread some of my posts from last year, written from a place of uncertainty and on setting intentions for this next chapter. A phrase I repeated often was, "There is no point of arrival." I think what I meant by this was that there is no point without struggle. There is no point where you realize that you have finally arranged your life perfectly, so that it can play our from that point with the smoothness of a script and with nothing more to do, learn, say, or fight for. Struggling as I was, I needed that reminder that struggling is an omnipresent part of life and not an indication that I'm doing it wrong. If I could write back to myself as I set intentions for nursing school, I would say, "You're right! Struggle is ubiquitous and you're not going to arrive at a struggle-free destination any time soon. But some struggles will wear you down while others are the ticket price for a journey that feeds your soul. In short: darlin', you have arrived."

I've written before about the sense of fit I feel with nursing and midwifery in general, so I won't reiterate that here. To my surprise, my favorite memories from this program have nothing to do with nursing.

People have joked hat I never actually went to college, because my college experience (at least socially) did not follow our cultural script. In fact in many ways it mirrored the theme of my journey to midwifery, in terms of doing things backwards, jumping straight into the deep end and then filling things in from there. If Brave Woman doesn't work out for the title of my eventual memoir, I think I'll go with Doing Life Backwards. Or maybe I'll make a birth pun out of it with The OP Midwife or something like that.

Anyway, if I was to completely oversimplify our cultural narrative of the young adult hero's journey, it would start out with a group of close friends doing silly and maybe-a-little-reckless things together, involve a period of uncertainty and anxiety around Life Choices Capitalized, followed by forming adult relationships, and then partnerships and eventually families. Instead, I met Travis in my very first class at PSU and jumped straight into learning how to be a part of an adult relationship that evolved into a long-term partnership. We finished college and navigated the uncertainty of Life Choices Capitalized together. We both landed in a position to go into our careers of choice, which I realize in this economy means we are absurdly fortunate. And yet, my college experience was overall pretty isolated, and I did feel like I had missed out on part of what college is supposed to be.

My favorite memories from this program are of outright silliness. Of going with my cohort on hikes and room escapes. Of Harry Potter trivia and board game nights. Of doing charades under a blanket while laughing so hard I could barely breathe. Of indulging in selfies and pokemon. Of being maybe-a-little-bit reckless, walking home from karaoke at midnight and waving to the hospital that I would be starting a shift at in just a few short hours. Of getting carried away modeling labor positions with an empathy belly for a school project, when we realized that the photo series felt incomplete without a birth and the lack of available newborns meant we had to improvise.


I showed these pictures to a non-nursing friend, remarking that it felt so good to get these pieces of the college experience I never had. She told me my notion of a 'normal' college experiences is hilarious.

Normal is obviously overrated.

I'm so happy it's over, AND- I am really going to miss nursing school.

For the High Schoolers

Posted by Lucille on September 13, 2016 at 1:35 PM Comments comments (0)

I was at a karaoke night with friends from school the other day when a song came on I'd never heard before. I didn't catch what it was called. It had something to do with spinning in circles. And the music, the way music sometimes does, took me straight back to a different time in my life. I found myself remembering a particularly painful night in high school that I had all but forgotten about with crystal clarity.

I was at a school dance. I couldn't leave, because my family was hosting a foreign exchange student and all of the host students were required to accompany them to the dance. I would never have attended this dance of my own accord. It was so loud and crowded. The foreign exchange students ventured enthusiastically into the throng of jumping people, but I hung back, feeling sensorily overwhelmed. Also there was a lot of grinding going on and I was afraid of being groped. So I hung out at the endge of the room, in a corner, by myself, and from that vantage point I realized that the person I was in love with but had been rejected by was also at this dance. Kissing someone else. Unable to leave, and unwilling to join the crowd, I started spinning in circles, because blurring the scene in front of me was as far away as I could get from it.

I will always be someone who feels things deeply, but I think there is a unique, all-consuming potency to the things you feel as a teenager, including everything from joy and sadness to numbness. As I recall, this night felt a lot like being stabbed through the heart repeatedly.

It was more than half a decade ago, and I don't know any of the people involved anymore, and yet sitting here at a joyful celebration full of singing friends, just the memory of the piercing loneliness and insecurity I had felt took my breath away. One thing I remember is that in that transitional period between my childhood and adult self, it felt like everything I experienced was not just a situation to navigate, but a predictor of who I was going to be as a person. Being the trapped, rejected girl spinning in a corner felt less like a situation I was experiencing and more like my destined identity.

I remember several teachers coming over to check in with me over the course of the night. Let us gather around and lift up the teachers. I could dedicate the rest of my life just to going around and thanking teachers and it would never be enough. It is an insult to all of us that they are as undercompensated as they are. Let us come together to honor them and advocate for their being paid what they're worth.

Anyway, one particular teacher stayed longer than the rest. She was not one of the 'cool' teachers. Decidedly not. She insisted on drawing attention to me in class, and frankly, I didn't like her that much and I didn't want to be seen with her at a dance where I already stood out. She kept talking to me about something weird and irrelevant that I don't remember. Probably about clothes she was knitting for her cats. (You know, the sort of thing I'd happily chat about for hours these days but that seems like a scarlet letter when you're in high school). I was polite, but she picked up on my discomfort. She turned to go, but as she left she gave me a warm, knowing smile.

And I loved her and hated her for that smile.

"What do you know?!" I wanted to scream. "Tell me!"

But there are some things you have to learn for yourself.

So now I'm interpreting that knowing smile, half a decade later.

Someday you will have a dream about high school where the piercing insecurity and loneliness will be enough to wake you up. You will open your eyes in the middle of the night, look around you, and relax as you remember that you are home. You will sense someone you love sleeping next to you, and warm mammals curled up by your toes. You will think to yourself, "I never, ever, have to do high school again," and you will smile contentedly to yourself as you roll over and drift back to sleep.

I want to be clear that I don't mean to say my experience in high school was terrible. Not in the least. There were exquisitely joyful times and exquisitely painful ones. But high school can be distinctly up, down, and sideways emotionally, and I know I, at least, could not comprehend how little impact these events that felt so all-consuming at the time would have on my life and identity overall.

My little brother is starting his second year of high school. I was having a soap box moment with him about this the other day, talking to him about how this night had been so painful at the time but had completely faded in my memory until a piece of music brought it back. He stopped me, laughing, to say that I was making it sound like the things that seem painful in high school fade in your memory because of the perspective you gain, like, "Kid, you think this is bad? Just wait until you're an adult, then you'll really know how terrible life can be!"

Clearly, I have a long, successful career as a motivational speaker ahead of me.

What I meant is that life is longer and more full than I can comprehend, and much longer and more full than I could comprehend as a teenager. Your identity is so much richer and more fluid than it can seem. Don't spread and don't buy into the myth that high school/college will be the 'best years of your life'. Do not burden anyone, including yourself, with the belief that if you don't enjoy one particular phase of your life, you will have missed out permanently on the best times your life has to offer. High school had some of the best times of my life, and some of the worst, and lots that was mixed up in between, and I expect that will remain true about every phase of my life going forward. Life is long. You are more dynamic and resilient than you give yourself credit for. I guarantee it.

While y'all are out there hugging the teachers, hug a high schooler for me, okay? Remind them that struggling is normal, that asking for help is a sign of strength and courage, and that the best times of their life are still to come. Buy them an ice cream or something. Then pat yourself on the back for surviving your teenage years (thus far or altogether) and buy yourself an ice cream, too. (Or a pumpkin spice latte. Whatever. You do you, babe.)

All my love, you wonderous maelstroms of human vitality and resilience. Carry on.

Practicum

Posted by Lucille on September 2, 2016 at 5:30 PM Comments comments (0)

Because I had to reapply to the midwifery program, my admission was last-minute as far as the nursing practicum placement process goes, and for a while it looked like I wouldn't be able to get a spot on maternity. I braced myself for spending a summer in the NICU, but at the last moment, a spot came through at another hospital- the same hospital where my brother and I were born. I was thrilled. And to make it even better, it was within biking distance, and the sunrise and sunset times would line up perfectly so that I had daylight for my ride to and from the unit all summer long. I felt like I had been waiting all year (and possibly all my life) for this.

The unit culture at this hospital was completely different than at my school, and I was fascinated by trying to analyze the factors that contributed to this difference. For one thing, my school is a high-risk teaching hospital. Many of the patients on labor & delivery are actively sick, and the nursing staff are extremely skilled at managing medically complex pregnancies and births. There is also a midwifery practice, and my impression was that it can be challenging for the nursing staff to switch gears from providing high-risk, medically complex care to supporting normal birth. The midwives seemed to fill in more of this support role. The physical structure of the unit does not promote strong interprofessional relationships. The labor & delivery unit and postpartum unit are separate, on separate floors, and on labor & delivery there are separate computer bays for the nurses, midwives, and doctors. I didn't see a lot of interaction between people from different professions unless they disagreed on the plan of care, and this limited contact despite physical proximity seemed to contribute to relational tension.

The unit where I did my practicum, on the other hand, is a low-risk combined unit, which means that they have labor & delivery, postpartum, and gynecology patients all on one floor. Patients who give birth get to stay in the same room for postpartum care, and will likely have the same nurse some of that time. There is no NICU, so patients with high-risk pregnancies were transferred to one of the two local hospitals with a NICU available. (Interestingly, the two hospitals in my area with a NICU are also the two with separated delivery and postpartum units, and are the two that I have heard have difficult unit cultures. I would love to know more about whether the tension in the unit culture is more related to a higher collective burden of vicarious trauma from seeing mostly high-risk births or from the siloed physical layout of the units.) Even with this filter, I got to be a part of caring for patients with a wide array of situations, including perinatal loss, substance abuse, hemorrhage, protective custody, and preeclampsia. There is a single unit station where all of the nurses, doctors, midwives, and other professionals congregate. I remember feeling frustrated on other units when nurses would sit around at the unit station, chatting about their kids, but I've come to see this as an important part of the job. It is relational maintenance. A few times this term, I got to see the team go from joking at the unit station to leaping up to help manage an urgent or emergency situation at the first sign of a problem. And though the situations may not have been as acute as those at my school, I got to witness the team manage them with a cohesive teamwork and trust.

Because my preceptor works part time, I got to work with a lot of different nurses on my unit, and while I certainly felt self-conscious, challenged, and even frustrated at times, I also felt universally welcomed and supported. As elbow-deep in learning as I was, I might not have recognized the significance of this support if it hadn't served as a point of contrast to the experience of some of my peers. My practicum experience was appropriately challenging and overall quite positive, as it should be. I would happily go back to work at this hospital. I wish that this experience of welcoming, encouragement, and teamwork was the norm for students' practicum experience. It should be, and getting to experience the benefit of being welcomed into a team as well as hearing how different this was from the experience of some of my peers made me even more interested in someday becoming a preceptor myself.

And on the subject of things that should be normal but are made exquisite through contrast: at the start of this term I would have said that I wished for an incredible, empowering, life-changing birth for all of my patients. I felt challenged a few times this term by having more enthusiasm for someone's birth than they did themselves-- where I was moved to tears by the smooth, loving, beautiful progression of someone's birth, and their experience seemed to be more along the lines of, "Humdeedum, I guess this is how babies get here. I can't wait to finally eat sushi later." And of course, the opposite, when someone experienced what to me would have been a traumatic birth, and instead they had the same "humdeedum" response. It was a humbling reminder that while birth might be my passion, it is, at its core, normal. I am learning to value the times that a patient with a beautiful, natural birth does not feel exultant or triumphant, not because their birth experience wasn't positive, but because they always assumed they could do it. For some, the ideal birth is not one that is overtly incredible or life changing, but one that is, at the end of the day, not a big deal.

I wish that at the start of this year, someone had asked me to draw twenty vulvas, so that I could repeat the exercise now and look a tthe change. The vulvas I would have drawn a year ago would have varied only minorly from each other. Being invited into such an intimate space to care for people is an awe-inspiring experience, and it has deepened my appreciation for the 7 billion versions of the normal human body. Vulvas are so much more diverse than I would have imagined a year ago. Different skin tones. Different types, lengths, and patterns of hair. Labia that might be shorter or longer, wrinkly or smooth. Some vaginas have more rugae than others. Some urethras hide under the clitoris, and others are all the way down inside the vaginal opening. Some vulvas have exra features like moles, scars, varicosities, piercings, or tattoos. Infine versions of normal, and of course this applies as a metaphor for every other aspect of people and their bodies, too. All of these different normalities of the human body and mind, engaged in the everyday miracle of bringing new life into the world. And I get to jump in to witness and support their process. How freaking cool is that?!

Birth, beautiful in its diverse normality. This is how babies get here.


Sage Femme

Posted by Lucille on July 15, 2016 at 3:30 PM Comments comments (0)

I get tension headaches regularly and always have. I've noticed that I almost always get one in the hour before a birth, and I have to consciously relax my neck and shoulders through the anticipation of a mom pushing. (This might actually be a super power. I'm like a magic birth predictor.) It came as no surprise that I got a fierce headache the day I supported a family though unexpected loss, or that it diminished gradually as I processed all I had been a part of. The surprise was that it didn't continue diminishing after that. Days after I felt like I had done the emotional processing I needed to, the tension just stayed, behind my heart between my scapula and my spine, pulling on my neck. It was low level but constant. I had been planning to buy myself a massage as my graduation present in August, but I decided to take this headache as my body letting me know that this was the right time.

I looked up a bunch of places and then made an appointment with Rachel Owen over at The Nest (http://thenest.massagetherapy.com/) because it was in my price range, close by, and I liked that I didn't have to choose between the different modalities she practiced. On top of that, I wanted someone with experience in prenatal/postpartum massage because I thought I would be able to communicate more easily about the vicarious grief I was feeling with someone who also felt drawn to maternity care. (Strong recommendation! She's fabulous. Also we figured out afterwards that I went to middle school with her daughter. I think I sold her a guinea pig. So clearly this family is pretty cool and you should give Rachel a call the next time you or a friend need a massage!)

I looked at her bookshelf on my way in and laughed at how many books we had in common. We talked a bit about what had brought me there at first, and then I let my mind wander and tried to consciously help relax my muscles. The massage felt good, but my attention flitted to the cars outside, to the floorboards creaking, to a dog barking in the distance. I expected to cry, because I was there to release something I was carrying, and tears have always been a part of release for me. I had already cried about this birth, of course, but I had given myself this time to release whatever was left. I thought about the tragedy and grief in everything I had seen and gave myself full permission to cry, to feel all of it...but that well seemed empty, so I let my mind wander again.

I thought about a patient I cared for last winter. She had dementia, and she thought that I was her granddaughter. All day long she wanted nothing more than to tell me over and over how proud she was of me. She was one of the most loving people I have ever met, and it was a delight and an honor to care for her. My mind wandered to school and other things, and then back to this patient. Then to other things, and back to this patient. For the better part of an hour. It started to get annoying. Why did I keep thinking about this patient?

The thought came to me, "Because I miss my grandma."

Tears dripped onto the table, and after a few moments the knot spasmed and released under the massage therapist's fingers, and my neck relaxed to the side in a way I hadn't felt in months.

And then I felt confused. I know experiencing grief can bring up past loss, but my grandma died more than a decade ago, and it felt like this had come out of nowhere.

One of my current projects is digitizing my parents' (substantial) photo collection, which includes a lot of pictures of my grandparents, of my brother and I playing with them when we were little, and of their funerals. Looking back it seems ridiculous that I expected to be able to go through these photos one by one without feeling an emotional impact from them. My favorite things to do with my grandma were decorating cakes (which usually turned into me acting out an entire story on the top of the cake with the cake decorations), hunting easter eggs (this was a year-round activity), and looking at her necklace. She had a necklace that had a multifaceted piece of glass that would shoot rainbows across the room if it caught the light the right way. I would sit in her lap and make rainbows dance around the room for hours. She wore it every single time I came over.

As I thought about my grandma and rolled the emotion of missing her around in my mind, I realized it was also more than that. I miss the grandma in me. Midwifery as a profession is embodied by a grandmother archetype, so much so that the word for midwife in French, sage femme, translates as wise woman. I have felt a connection to this archetype for most of my life. As a much older sibling and professional babysitter, I miss having little kids underfoot. My baby brother is a foot taller than me and thriving as a teacher at an art camp this summer. I am ridiculously proud of him, and I miss him being small enough that I could pull him into my lap to read him stories. I miss being the mama hen in my social group. Being the youngest in my class is new and different. And perhaps more than that, I miss feeling like I know what I'm doing. I am learning so much so fast, and I know so much more than I did a year ago, and for everything I learn my sense of what I have yet to learn expands threefold. We talked a lot at the beginning of the program about the expert-to-novice transition of going back to school. I didn't really struggle with that at first, perhaps because I started nursing school straight out of college, or perhaps because at the start of the year I expected not to know what I was doing. That challenge has only emerged for me towards the end of this program. I expected to feel a sense of mastery or at least competence by the time I was weeks away from graduation, and have struggled with realizing that I still don't feel like I know what I'm doing and instead continue to be engaged in full speed learning. I didn't expect that starting a program to become a wise woman would make me feel so much like a child. Holding the full truth that this program is exhilirating and exactly what I want to be doing right now, and also that there are things I miss deeply, brought a sense of release. Loving so many different things that I am perpetually missing something is not a bad way to live.

I pictured myself in my grandma's lap, with another person curled up in mine. This isn't true for all midwives, but for me the desire to be a nurturing presence for families in my community and the desire to nurture children of my own feel deeply connected. I pictured a current of love flowing from my grandma's arms into mine, and through mine to the child in my lap. I remembered the patient whose baby had died and imagined that chain being unfairly broken. But that wasn't quite right. Although it doesn't change the reality that someone precious and irreplaceable was lost, love is not something that is passed down solely through a chain of motherhood. Love passes through a web of nurturance. I became part of that web by caring for this patient through her loss. Everyone on the unit became part of it. The chaplain that arrived to support the family and the healthcare team was part of it. My friends and family who supported me as I processed what I had been a part of were part of it. The massage therapist, by caring for me as I cared for others, was connected to it too.

I needed to feel that web--not just know it was there, but feel it tangibly. I needed to feel it with the solidity of being prone before a fellow healer with her thumbs in my back.

After the massage, I started shivering uncontrollably, the way people do after giving birth. I know that in birth that is a side effect of a hormone shift. I don't actually know for sure which hormone causes this, but I pictured it as a flood of golden oxytocin molecules chasing the adrenaline out of my shaking fingers.

In a way, getting into the midwifery program was the end of a five year journey. Starting this term on the same labor and delivery floor where I was born also brought a sense of coming full circle. I expected arriving at this last term of nursing school to bring a sense of conclusion. Instead, seeing as many births in the last few weeks as in the year before that, and starting to talk about licensing applications, the NCLEX, and schedules for next term (the first term of the midwifery program!) feels like making a steady climb in a roller coaster up to the precipice of a brand new adventure. Another new beginning, and the painted ponies go round and round.

Touching Stardust

Posted by Lucille on July 12, 2016 at 5:10 PM Comments comments (0)

I finally put that painting timelapse from my time as a SARC advocate into a video. That had been on my to-do list an entire year! Enjoy.

https://www.youtube.com/watch?v=hONAWe9pZXA

Holding Space for Loss and Vicarious Trauma

Posted by Lucille on July 10, 2016 at 6:25 PM Comments comments (0)

My blog has felt eerily prophetic in the last few months, what with writing about looking for the helpers right before the shooting in Orlando, and now writing about intentionally looking for the postitive in the midst of intense and/or traumatic situations only to have that intention tested a few days later with holding space for pregnancy/infant loss.

I can't share details for obvious reasons, so I will simply say that I helped care for a family experiencing perinatal loss, and that the situation was awful. Impressively awful. It was the level of tragic where if I had read it in a story, I would have said, "No, the author went too far. Any one of these pieces is tragic, yes, and tragic things do happen to people every day, but all of this? In one day? To the same family? No. It's just too much. It's just not believable." And in the same week as the shootings of Alton Sterling, Philando Castile, and the officers in Dallas. In the same week that a nurse from the unit I am on died unexpectedly.

It felt like everyone in the whole damn world was grieving.

The act of holding space itself was a reshaping of things that I have already practiced in other contexts. Still, in the face of the tragedy playing out before me, I felt paralyzed by the depth of my helplessness. Like at the code a few months ago, it felt like there were a thousand ways to do the wrong thing. When a family member walks past the nurse's station, is it more insensitive to stare or to avoid eye contact? I knew of several things that it was important not to do, which included saying nothing, minimizing the situation in any way, and making assumptions about the family's beliefs. I can at least say that I avoided doing those three things. I acknowledged what was happening and tried to validate their experience. I wish it had felt worth more. The truth was that I didn't want to be holding space. I wanted to have a magic wand that would somehow let me fix the unfixable. But I couldn't do that, so I poured everything I had into holding space and hoped that it counted for something.

The more challenging part turned out to be holding space for my own vicarious trauma/grief when I got home. Watching myself experience things I had learned about in the classroom felt like starring in a slow motion video called This Is Your Brain on Vicarious Trauma. Sometimes I felt numb. Sometimes I cried. Sometimes I would feel perfectly fine, and then a sound or image would pop into my head without warning, and I would burst into tears in the middle of making a Star Trek joke. More and more, the whole thing would feel surreal, like a horrible what-if scenario that I made up in my head and was stressing over for no reason.

One of the things I have learned is that brains on vicarious trauma are untrustworthy. Along with the sounds and images that periodically jumped into my head, thoughts would occur to me that l had a feeling weren't as reliable as I would like my thoughts to be. It occurred to me that self care was useless, and that maybe the entire concept had been a lie all along. How the hell was a bubble bath supposed to fix this? It occurred to me that someday I would see one too many tragedies, or burst into tears one too many times, and Travis would throw his hands up and walk out the door. Also that this would probably happen tomorrow. Then it occurred to me that if I had seen this at a lower acuity hospital, and most people in my cohort were at a high acuity hospital, then they were probably seeing perinatal loss every other day and handling it just fine. My mood swings were probably unrelated and were a sign of some rare but serious disease. It also occurred to me that asking for support would just look like a plea for attention, because most likely none of my friends like me anyway and they've all just been pretending this whole time. And that one of these days OHSU is going to figure out that I only got into the midwifery program because of a computer error.

I have pretty solid evidence against most of the things that occurred to me, so I made an executive decision not to take anything I thought that day too seriously and drew up a bubble bath.

I have been thinking about what advice I would give someone in my place, and I'm not sure I have any besides practicing self compassion. Remember that self care is not about fixing the way you feel, but being tender with yourself through feeling it. And remember that your self care does not have to fit into anyone's definition of 'good' self care, including your own (though obviously you should refrain from anything overtly destructive). My self care included declining an offer for a ride in order to bike home in the rain because it suited my mood, drinking a lot of wine, taking a bath, going out to see Finding Dory in the middle of the night, working out, having ice cream for breakfast, staying home from an event I'd RSVP'd to in favor of solitude, and reaching out to friends and family. It doesn't have to be all kale and yoga, though feel free to go for that if that's your thing. Remember that no matter how much you've read about or heard about supporting families, and vicariously yourself, though loss, this is new and you don't have to be good at it the first time. Remember also, as a kind nurse warned me, that it might not be easier the next time and that's okay too.

Travis has a family member who was an OB, who used to say that he had the best job in the world except for the days when it was the worst job in the world. I'm not sure I agree with that. Supporting families through pregnancy/infant loss is something I want to do, it's just that wanting to do it doesn't make it easy.

And when I looked for them, the silver linings were there. This unit has the best unit culture of any I've been on. A few weeks into the term, I found out that some of the people I had taken for nurses were really doctors and midwives the whole time, but I hadn't noticed because they interacted with the nurses without any sense of division. On this day, the patient experiencing loss felt like everyone's patient. Everyone grieved. Everyone comforted each other. Some helped by taking over care for other patients, to make sure that their needs were not minimized by the contrast. Others ran towards the fire and put their energy into helping to coordinate the web of services and departments that had suddenly come into play, while offering breaks so people could step back to take care of themselves when they needed it. Everyone found a role and did what they could together.

I was caring for a couple the other day that were very curious and wanted to learn about every detail of their care. I joked to my preceptor that by the time their child was born they'd be qualified to be labor nurses. She replied that she hoped not, because that would mean they'd seen more emergencies than could possibly fit into one birth. This is the dark side of birthkeeping, and it is work I want to do, even when it breaks my heart wide open. The best thing is that I am not doing it alone. I am joining an entire community of crossing guards.

Gambia, 5 Years Later

Posted by Lucille on July 5, 2016 at 1:10 PM Comments comments (0)

This post has been on my 'to write' list for over a year, and I think it's finally time to admit that I will never feel ready to write it and that there is nothing left to do but sit down and write it anyway.

At the start of this summer, my blog turned five. It has been five years since I went to Gambia. Five years ago, I lay in a hut, scribbling in my journal by lanternlight while rain poured down outside, and wrote, "New plan. I am going to be a nurse-midwife. As soon as I get back, I'm going to train as a doula and go to births while I get my degree, then apply to the nurse-midwifery program at OHSU. I want to support women and families in whatever reproductive choices are right for them every day forever. This work shouldn't be radical, but it is. It is needed and it is where I am needed. I am going to be a nurse-midwife." There were a couple of twists and turns in there, like graduating from PSU instead of Berkeley, volunteering as a sexual assault support advocate for a few years before my schedule could accomodate doula work, and needing to reapply to the midwifery program, but overall the dream I came up with by lanternlight in Gambia has held true. Going to The Gambia changed my life in ways I couldn't have predicted. It was also a journey I struggled with.

Interestingly, most of this struggle did not happen in Gambia, but in the aftermath. It is worth including that the semester before I went to Gambia, I reached a state of burnout where I needed to drop out of the IB program and half my classes to keep (or recover) my sanity. I will be forever grateful to my past self for making that act of self preservation and giving me a chance to catch my breath. Regardless, I can never know how I might have experienced my summer in Gambia differently if I had gone into it with a deeper reserve of physical and emotional resilience. In the same way, I will never know how my experience might have been different if I had come home and had a chance to process and reintegrate everything I had experienced, rather than heading off to college a week later and taking on another brand new world (then doing the same at PSU three months after that), not to mention getting knocked off my feet by a misdiagnosed illness somewhere in between. Not all of those experience were negative, not even close, but there was no recovery time.

I feel exhausted just reading that paragraph, and notice that nothing in that paragraph is about Gambia. Every experience is shaped by the experiences surrounding it. I tried to process everything I had seen and been a part of in Gambia while I was burnt-out twice over, sick, and juggling new experiences as fast as I could manage. My perception and understanding of everything I experienced in Gambia is inseparable from the lack of recovery time. Looking back, of course I struggled with some of those experiences for far longer than expected. All we have of experiences is memories, and so the lens through which we view memories becomes part of the experience itself.

There is one exception: writing.

I spent a LOT of time on that trip writing. I went through the journals I had brought with me within the first week. I couldn't not write; it just wasn't optional. Still, I knew that there were once-in-a-lifetime experiences I was missing out on because of how much time I devoted to journaling, and I worried that I would regret it. So here's one for past me: Thank you. Thank you for listening to your instincts and writing everything down. You couldn't have known how much the next few months would shape your memories, but thank you for giving me a way to reconnect with those experiences directly and gain insight into the way I perceive and interact with the world. Reading through everything you wrote down in the moment has been so valuable.

One year ago, at the start of nursing school, I started going back through the posts I'd written in Gambia, scrubbing them of others' private information so that I could put them back up on the blog. Reading through them was incredibly powerful. The most notable part, for me, was how much my memories of experiences had been skewed from how I had written about them firsthand. I remembered the handful of things that were most acutely distressing with crystal clarity, and they had been inflated in my memory to the point that they felt like a major period of time on the trip. Reading through my own account, I realized that all of those moments together would add up to a day, maybe less, out of an entire summer. And more than that, there were countless little magical moments- fresh mangoes, playing soccer with laughing kids, exploring a mangrove forest, being struck with awe at a mother's love and power- that my memory had minimized, if not glossed right over. There were magical moments recorded in my journal that I do not remember at all.

Now, with two years as a trauma-informed support advocate under my belt, I have a framework for understanding how the brain, my brain, filters information when it is in a state of trauma, or any state where it experiences an onslought of new experiences faster than it can process them. My brain's primary objective is to protect me, so it prioritized the experiences that were the most distressing, preserving and analyzing those experiences while some of the magical moments slipped by, in an effort to help me stay safe. I understand why that wiring is there. I appreciate it. At the same time, once you recognize that filtering, you gain the ability to influence it.

It felt serendipitous to be reading back through my own writing and realizing the profound effect of my brain's filtering at the same time that I was starting clinicals in nursing school, jumping into another onslought of new experiences. I started tuning in closely in clinical and noticing how my attention was drawn to everything that didn't seem right: a nurse being impatient, a doctor being unreachable, supplies being misplaced, a delay in care, etc. It was easy for me to see what not to do, because everything out of place seemed to jump out at me. I made an effort to direct my own attention and tune in to everything that was quietly going right, to watch everything that the team did well and learn what to do as well as what not to do. Both are important, but paying specific attention to the good helped me feel comfortable on the unit and connect with the team, and thus reach a deeper understanding of the factors contributing to the things that seemed wrong. I've found that I tend to need to re-learn important bits of insight over and over again, but I hope this is one I can hang onto. Brains should come with a sync function where you can go through and sort what you want to hang onto with clarity. Maybe in the next upgrade.

While I now recognize that the lack of recovery time and my brain's own filtering were significant parts of how I struggled with my experiences in Gambia, it should be obvious that my experiences in Gambia were a major part of that, too. I make sense of the world through stories. Before going to Gambia, I had heard exactly two narratives about volunteering in Africa. There was, "I went to Africa and found this terrible problem and I've got a way to fix it. Donate now!" and, "I went to Africa expecting a hell hole of war and disease, but instead I found resilient people and vibrant culture and look at all the smiling children! Cultural differences are superficial because we're all human!" Where is the narrative between them? What do you do when there is war and disease AND joy and resilience? When cultural differences are huge and real AND we're all human? A story needs a focus. How do you include all parts without minimizing others? Telling this particular story is made more complicated by knowing that as a white person talking about my experience spending a summer (just a summer!) in an African and Islamic country, my narrative may reach a wider audience than the lived experiences of Gambians themselves.

I am getting better at telling my own stories. In my first application to the midwifery program, I talked about my summer in Gambia the way I would describe it on a resume: I spent this much time in these units doing these things. In my second application, I wrote this:

"Before I left for Gambia, I met with someone who had recently returned from volunteering elsewhere in Africa and asked for her advice. She said, “Africa is intense, on both ends of the spectrum. You will see the most beautiful things you’ve ever seen in your life, and the most harrowing things, and neither will cancel the other out.” This remains the truest way I can sum up my time in Gambia.

On the one hand, I fell absolutely in love with supporting women in labor. I got to reach out across cultural barriers to support women through their births, each one incredible and unique. I was amazed by how intimately I could connect with women in this time without sharing their language. I loved matching their rhythm and moving with them as they showed me whatever style of labor was right for them, using my body language to tell them they were amazing, safe, and free to take the lead. I built incredible friendships with my team and with the local nurses and midwives. At night I read books on midwifery in a hut by lantern-light while rain poured down outside.

On the other hand, I was the barely-18-year-old in a group of graduate students, and I was not ready for everything I would see there. I had come prepared to witness extreme poverty but not the violence that came with it. This included obstetric violence and an imported industrial model of care. I suspect that many, if not most, of the births I was a part of were traumatic for the mothers. Multiple layers of public health issues, both outside and inside of the health center, contributed to a high infant mortality rate. That summer, I developed a complex understanding of systemic poverty and learned to see the ways that post-colonialism was present in cycles of institutionalized trauma and abuse.

My journey as an aspiring midwife has been a little backwards, in the sense that I jumped straight into the deep end of volunteering in a developing country without a lot of prior experience, but I wouldn’t change a thing. I have had the benefit of discovering my calling early and being able to go through the next few years knowing the skills I needed to develop to get there."

I've been reading some of Brene Brown's works recently, and she talks a lot about how often the pain we associated with struggle is not from the struggle itself but from the shame we feel about struggling. As the barely-18-year-old on the trip, it seemed like everyone else in the group could magically anticipate, understand, and adjust to things that were happening while I had to scramble (and/or journal frantically) to try to keep up. You don't know what you don't know, and so I couldn't understand the years of life experience they had to draw on, and compared myself accordingly. The longest I'd been away from my parents at that point was two weeks! How different would it be if I were to go on a similar trip now? I had spent so much energy assuring everyone that I needed to do this and that I could handle it, that when I ended up struggling, I felt like I had not lived up to being the person I wanted to be. I couldn't understand the benefit, then, of doing things backwards, jumping in the deep end, and seeing some of the realities of healthcare without the haze of cultural familiarity. I wanted things to fit into a nice little narrative box right away, but it took circling back, seeing how similar forces are present in healthcare here, to understand the unique benefit of jumping in with the eyes of a child, witnessing everything, and worrying about academic frameworks later.

Some of my classmates recently spent a month as health volunteers in Nicaragua for our Populations class. It was a relief to hear, on their return, that some of them were struggling with their experiences there and were still processing them. I offered that it was okay for it not to fit any preconceived timeline: that I had done a similar trip (albeit on a different continent) and was still struggling with aspects of it, five years later. This was the first time (five years later!) that I considered that maybe not-struggling was not the goal. Maybe struggling with my experience in Gambia was fine and proper, maybe even right. Afterall, aren't economic injustice, sexism, violence, trauma, moral distress, racism, prejudice, xenophobia, and colonialism things that should be struggled with? Isn't that the whole point?

I wonder how much of the popular narrative of Africa as a hell hole of war and disease comes from volunteers who take a front row seat to suffering in developing countries that they do not take in their home countries. Economic injustice is happening here. Violence, including violence in healthcare, is happening here. Sexism, racism, and intergenerational trauma are happening here. Yes, the scales and details are different. But these things are happening everywhere, and they should be struggled with.

Removing the names, faces, and stories of other people from my blog accounting of my time in Gambia fundamentally changes the story. The names, faces, and stories of other people were in many ways the most meaningful part of the trip. Now there are a lot of photos of me, sometimes with a horde of anonymous smiling children behind me. On the surface it looks a lot like every other oversimplified narrative of internaitonal volunteering. But I'd rather tell part of my story than none at all. The story is mine, the parts that are mine to tell, and it doesn't fit into a nice little narrative box. All the more reason to share it.

So here's the plan. I'm going to be a nurse-midwife. And I am going to struggle against economic injustice, sexism, violence, trauma, moral distress, racism, prejudice, xenophobia, colonialism, etc., to support people in whatever reproductive choices are right for them, every day forever.

On Orlando

Posted by Lucille on June 13, 2016 at 9:15 PM Comments comments (0)

I am as safe as it is possible for a queer person in the US to be.

I have all the advantages of being a cisgender person dating someone of the opposite sex. I have experienced discrimination, but never from anyone important. I don't spend a lot of time in queer-identified places simply because I'm an introvert and have never needed a sanctuary other than home. I don't even have a coming out story. As a kid, I went to my parents for support when the girl I liked didn't like me back, because it had never occurred to me not to got to my parents for support. I didn't even know what sexual orientation was until they explained it to me. Then they bought me books on LGBT+ issues and offered steadfast encouragement while I started a school QSA.

I say this because for all that, I am scared and grieving. There are queer people I love (and millions more that I haven't had the joy to meet) who do not walk around with the same privileges I do and who are wrestling with fear and grief and trauma today that I can't imagine.

It is not just that there was a massive attack against the queer and Latinx communities fueling another surge of Islamophobia. It is the way in which it felt inevitable. Mass shootings are an epidemic. Homophobia, transphobia, and racism are epidemics. As a country, we knew something like this was coming. We knew. And we didn't stop it. This isn't about a rogue mass murderer. This violence is so built into our society that gay men in Florida couldn't even donate blood for their fallen comrades and a presidential candidate's open endorsement of hate and violence is treated as a funny personality quirk. Police brutality is already being reported at some of the vigils happening across the country. But it is also about how the next shooting already feels inevitable. The blood has barely dried on the ground and I already feel resigned to something worse.

The future feels so potentially apocalyptic that I actually find it comforting to remember that my parents grew up doing nuclear drills in school, and yet we are still here.

I am furious for so many reasons.

At the same time, I am awed and humbled by the outpouring of love I have seen today. Social media was a flood of solidarity. People are reaching out to each other, bearing witness and offering connection. There are a lot of barriers to creating the policy changes we so desperately need, but I see people taking those challenges on, and even more people resolving to do what they can to foster compassion in their own communities.

For myself, I am resolving to build intersectional feminism, informed choice, cultural humility, and trauma-informed care into every aspect of my work, to donate to organizations pushing for the change I want to see in the world when that is within my means, to be more open about my identity as pansexual and a member of the LGBT+ community, to love my people hard, and to be gentle with myself in the aftermath of this tragedy.

If anyone for any reason wants to reach out today, I am here. My door is open. You are important, worthy, and loved.


Ride Along

Posted by Lucille on June 11, 2016 at 9:20 PM Comments comments (0)

As part of working with the fire department this term I got to do a ride-along with the fire team. A friend who had done a ride along the day before mine witnessed a code, so I went into it pretty nervous, but my shift turned out to be idyllic: we rescued ducklings from a storm drain and reunited them with their mama, then went back to the station to hand out hats and stickers to a group of preschoolers!

Weeks later, I went with a firefighter to take a client home, and then we went out to frozen yogurt with the rest of the team to celebrate the end of a great term. Afterwards, the firefighter was driving me back to the station (where I had parked) when a voice came on over the intercom announcing a CPR code not far from us. The firefighter turned to me, grinning, "Want to go to a code?" I blinked in surprise and nodded, and before I'd wrapped my head around what was happening, the lights and sirens were on and we were racing down a back road many, many miles higher than the speed limit. The firefighter chatted with me about the frozen yogurt party while I gripped the edges of my seat every time we pulled around a corner. I remember thinking that it was like driving in Gambia, except for the paved roads and seat belts.

And the next thing I knew, I was at a code. The team was using a Lucas machine to do compressions, which I hadn't seen before but which seemed much safer and more effective than the manual method. They were performing respirations and had just inserted two interosseous IVs, but the pressure bag was being finnicky, so a paramedic handed me the bags of fluid and told me to squeeze them as hard as I physically could.

I had expected to find a niche in the dance of the code by offering emotional support to the family, but there was a language barrier, and I found myself feeling afraid that anything I did could be misinterpreted. If I offered someone a hug, they might take that to mean that the patient was dying. If I offered an encouraging smile, they might take that to mean that the patient going to be fine. I tried to look comfortingly neutral, and decided pretty quickly that that is not a thing. It felt good to be given the fluid bags and to have a concrete way to help, not to mention a physical outlet for the adrenaline as I crushed the fluid bags against my chest like the patient's life depended on it, which, of course, it did. They got the pressure bag working, stabilized the patient enough for transport, and took off for the hospital. I listened as the remaining team went through the brief and informal, but almost ritualistic, check-in after the code where they confirmed for each other that it had been a good code, smooth and by the book, and that everyone had done their job and worked together well. They chuckled at my insistent curiosity about whether they thought the patient would make it (they were hopeful). And I marveled at the concept that they see codes regularly and often never know the outcome. For them, the code was smooth and by the book, and that is all they could ask for. If you have any firefighters/paramedics/EMTs in your life, go give them a hug for me. The work they do is outstanding.

There were children there who spoke English, and I tried to approach them to provide emotional support, but withdrew because I could see I was making them uncomfortable. Then a father from a neighbor family watching from across the street came forward with sidewalk chalk and sat down with the kids. They obviously knew him and his family. He let the kids know that their family might be stressed tonight and that if at any point they wanted to come over (with their parents' permission), his family's door would be open. They could stay for dinner, or even rent a movie and spend the night if needed. They were welcome. I don't know how much the kids understood about what they had just witnessed, but you could see the comfort this man's words offered.

Given everything in the news about rape culture, political fear mongering, and violence, I have been thinking a lot about positive models of masculinity and global citizenship, including https://norasamaran.com/2016/02/11/the-opposite-of-rape-culture-is-nurturance-culture-2/" target="_blank">this wonderful article about rape culture and nurturance culture. This father's action was a shining example of what I yearn to see more of in the world. Some heroes show up in uniform, and others show up bearing chalk and an open door, reaching out to the 'other': the child, the girl, the person of color, the non-English speaking family, the immigrant, etc. and saying, "I see you. You are welcome. You are welcome. You are welcome."

My first code was exciting and scary. I'm looking forward to and simultaneously dreading our code day simulations next term. And while heart-wrenching, it was also deeply uplifting to see a family in crisis and so many people banding together to help, all in their own ways. Mr. Rogers was right: you will always find people helping.

Abortion Support Training

Posted by Lucille on June 11, 2016 at 8:30 PM Comments comments (0)

One of my favorite things about working out of the hospital this term was that because we were tracking our own hours rather than adhering to a schedule, we had the opportunity to get clinical hours for attending outside events if we showed they applied to caring for populations we expected to work with. I took advantage of this to attend the Oregon Midwifery Council conference, with speakers addressing how to care for transgender clients, clients with hyperemesis gravidarum, and clients with a history of miscarriage, among others. I also attended a three-day doula workshop on supporting clients accessing abortion care through the Cascades Abortion Support Collective.

I wasn't sure how much I would learn in the workshop, because the basics of emotional support and comfort care tend to be consistent across contexts, and because I considered myself well-briefed on the basics (including the different kinds of abortion- medical and surgical- and the many barriers posed by the current political climate). I learned TONS. We covered 9 different types of abortion: two combinations of medications including all of the different possible routes of administration, manual and vacuum aspiration, dilation and curettage, dilation and evacuation, dilation and extraction, induction of labor, and herbal abortion. We explored barriers to accessing safe abortion that I'd never considered and worked through several eye-opening exercises for confronting our own biases. We learned a lot about how to advocate within the system to help clients have the most supportive abortion experience possible, including small details I wouldn't have thought of. Although I still have much to learn about abortion from the healthcare provider perspective, I'm so glad that I got to start a foundation from the perspective of doula support, and I would strongly encourage anyone who expects to work with people accessing abortion care to take advantage of a similar doula training if one is accessible near you.

With that said, commiting to a conference and a three-day workshop in the first weeks of the term was overly ambitious. I came home utterly exhausted, and stressed about how I was falling behind in school and at home. Then I walked in the door to find that Travis had taken time out from his own work to take over the household tasks that are normally my responsibility, as a surprise to make sure I could attend the training without falling behind in school. I feel enormously grateful for everyone working in abortion care, in the broader sexual & reproductive health field, and in the still-broader helping professions...as well as all the friends and family supporting their loved ones behind the scenes to help make their work possible.


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HIPAA Disclaimer

Sometimes I have the privilege of being a part of intimate, powerful moments in other people’s lives. I cannot and would not share these stories, because they are not mine to tell. However, they touch my life and become part of my own story. When I share these moments here, you can trust that I have not broken anyone’s confidentiality. The characters are invented. They are not real, but could be. I take creative license to communicate the essence of my experience while respecting the privacy of others.