Brave Woman

Adventures of a future nurse-midwife

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Tedium and Tenacity

Posted by Lucille on June 11, 2016 at 7:30 PM Comments comments (0)

My clinical placement this term was with GreshamCARES, a new program that is a collaboration between the school of nursing and the fire department. A surprising proportion of 911 calls are for frequent callers. This creates a call burden where firefighters have to leave the station frequently (making them unavailable in the event of an emergency) to attend to a non-emergent patient need that doesn't address the underlying issue. As an example, imagine a situation where a fire truck from a different station that is further away has to respond to a heart attack call, because the team that should have responded was busy picking up an older adult who had fallen. The older adult had been falling frequently, and falls are preventable, but because they were never injured and never transferred to the emergency department, their doctor never knew they needed fall prevention. That's where the student nurses come in: firefighters refer frequent callers to us, and we follow up to identify the underlying issue and connect the client to more appropriate resources. The firefighters are relieved of the non-emergent call burden, the underlying client issue is addressed, and everyone wins!

It is a beautiful theory. The fire station is currently working on getting funding approved to hire a full time nurse and I would love to see collaborative programs like this become the norm.

In practice, being in this placement was a little more complicated. Working in the community is different from any other type of nursing I've done before. Because of system failings and arbitrary barriers, care coordination has an inflated effort to outcome ratio, where it seems to take at least 10 times more work than would be reasonable to get anything done. The program operated somewhat like a call center, where we all sat at a desk with a phone, talking over each other as we made calls to clients, doctors, etc., and then waited (sometimes for weeks) to hear back.

By the halfway point of the term, I was exhausted and frustrated. I didn't feel like I was helping anyone, and trying to tune out the noise in the room to call people who may be in crisis (or in some cases to have the phone answered by their newly grieving spouse) was really wearing on me. I wanted out, and frankly if I'd been offered the opportunity to just skip the rest of that term, I would have taken it.

Then I was given a new patient in acute crisis. I was told that if I didn't get through to them that day, they would be dead by the time I came back next week. I felt thoroughly unprepared and tried to pass the client off to someone else. I went to my teacher and explained that I didn't know anything about the underlying issue (not shared because HIPAA). I wanted to scream, "Moms and babies, you guys! Helping healthy parents and babies stay healthy, that's why I got into this, now how on earth did that lead to me being here?" She told me that I didn't need to know anything about the underlying issue because I knew how to be a nurse. At the time, this felt like being punted out of the nest and off a cliff.

So I went, and I drew on every single thing about 'how to be a nurse' I could think of. I stayed for hours. I got the client's full life story, then the backstory of their current crisis situation, then gradually moved into motivational interviewing, harm reduction, and safety planning. Then I went home, and spent a week not knowing anything. When I came back, my client was doing better than I could have imagined. I got to dive in deeper and ended up spending every clinical day for the rest of the term working with this client directly. One of the things I learned was that the support systems that were supposed to be available to them were thoroughly tangled up, and when I started going around to government offices to try to unravel them, every one of them told me, "I can fix this issue easily as soon as you fix all of the others." I found a tenacity I didn't know I had. I stopped waiting for people to call me back and started showing up at their offices and offering to stay there until they found something I could work with. I got help from peers, firefighters, other members of the wider interprofessional team. My client rallied with the same tenacity, and at the end of the term, they were invited to share their experience at our end of term presentation to the city manager as a shining example of what a collaborative program like this can accomplish.

Travis started joking that I was beaming so much he was going to have to start wearing sunglasses inside if I didn't tone it down. After all the tedium of the first part of the term, my least favorite clinical placement ended up being the most rewarding.

I've started feeling an intense meld of pride and humility so often in this program that I've stopped conceiving of them as separate emotions. They are one thing. Prumility. An awestruck, "Look what we did."

It is hard, after working so closely with a client, to pass them off to the incoming team of students knowing they will be in good hands, but that I will most likely never see them again. Still, I'm excited about where I'm going. Because my admission to the midwifery program was last-minute in relation to the months-long process of nursing schools vying for practicum placements for their students, I was told that finding a mother-baby spot for my practicum this summer was extremely unlikely. I started bracing myself to spend the summer in NICU, when something pulled through at the very last moment. Not only am I on mother-baby, but I am on day shift at a lower acuity hospital, on the labor and delivery unit where I was born! Talk about coming full circle.

Finally, after four terms of stretching into areas of nursing I knew I would never work in, I have circled around to learning how to support normal birth. Healthy moms and babies, here I come!

I have been waiting all year for this.

Notes for When I'm a Preceptor

Posted by Lucille on March 26, 2016 at 4:35 PM Comments comments (0)

I know I will have a lot more experience working with preceptors before I'm ever in the position to be one, but in case some of my observations about what works well in promoting a good student-preceptor relationship are specific to working with students who are just starting out and haven't worked within student-preceptor relationships before, I wanted to get my thoughts so far written down. Here are some of the things preceptors have said or done in this first half of nursing school that were particularly helpful.

"Fill me in. What do you know, what are you learning, what will you not be doing today, and where do you want to go with all of this?" I was surprised by how many preceptors simply nodded when I was assigned to them and then went about their day as if I didn't exist, and it made me appreciate the preceptors who created this moment proactively, especially those who went beyond a basic introduction to show interest in my long term goals. Even if it is only a few seconds long, it is really important that an introduction happen at the start of the day, before you go in a patient room. Ideally, the student will initiate it, but students can be nervous and preceptors can be intimidating and the most important thing is that regardless of who initiates it, this exchange happens. This is because knowing your student's scope effects patient safety. For example, one preceptor that I had was obviously in a rush and I struggled to find a moment in the midst of handoff to insert my introduction, one of the pieces of which was that I was not permitted to mobilize patients by myself. We got a patient up and then paused at a bench in the hallway for the patient to rest, when the nurse got a Vocera message calling her to another patient room. She left immediately, leaving me and the patient stranded, because she assumed that finishing the walk and getting the patient back to their room would be well within my scope. It's challenging for preceptors to keep track of what their students can and can't do when our scope changes every week (I mean, I can barely keep track, and they may be working with several cohorts of students from several different schools). I worked to be more assertive about introducing myself after this incident, but it can still be challenging, and ultimately making sure that this exchange happens is a shared responsibility.

"Tell me about your experience with (blank)." This is in contrast to, "Do you know how to (blank)," "Have you covered (blank)," and "How many (blank) have you done?" At least for me and my learning style, performing a task/intervention in class and performing it with a patient feels like two different things entirely, and I could practice it a million times on the mannequin and I would still go blank the first time I tried to do it with a real patient. Furthermore, I've found that my improvement in skills is not at all linear. I've had the opportunity to insert a lot of catheters so far, more than most students I've talked to, and even got the nickname 'catheter queen' from one of my clinical groups. With that said, the more recent catheter insertions I did were the most embarrassing. My preceptor asked how many I had done before and I answered that I'd done more than a dozen. I suddenly felt pressure to do things perfectly and got a lot more nervous, at the same time that my preceptor assumed that I wouldn't need help and positioned herself to offer distraction to the patient instead. Things went downhill from there. The best experiences with practicing new skills that I've had so far came when preceptors instead asked, "Tell me about your experience with (blank)," because it elicited a lot more information from me, acknowledged that the same task can be different with different patients or under different circumstances, and gave me permission to share that I was nervous (even if I'd performed the skill successfully before). For example, for catheter insertion, this question might elicit information about whether the previous catheter insertions I'd done were on men or women, whether the men had benign prostate hyperplasia, whether the patients were numb or had full sensation, whether any infections were present in the immediate area, etc. This information is much more useful to the preceptor than a number would be, and it helps build rapport between the preceptor and student on top of it, because as a student I felt like the preceptor had a good sense of my needs and a genuine interest in supporting my learning.

"You're practicing learning while nervous." This is in contrast to, "You'll feel more confident next time." Because what if the student doesn't feel more confident next time? I'm more than halfway through nursing school, and the list of nursing skills that don't make me nervous is still a blank page. One of the best things a preceptor said to me this year was "Great job learning while nervous. That's a really useful skill, and one you'll never stop using!" A reminder that I don't have to be perfect tomorrow, or even 20 years into my career, really helped normalize my nervousness and put me more at ease.

Specific praise (of literally anything you can think of) is so valuable. I do not know a single nursing student who isn't their own worst critic. Everyone loves a confidence boost, it builds rapport, and your student will remember it for weeks. Perhaps more importantly, a lot of the time I really don't know what I'm doing well, and reinforcing positive behaviors with praise is a great learning tool. I imagine that part of the challenge for preceptors is thinking to compliment behaviors that are so routine you no longer think about them. Praising good nursing behaviors early and often also makes it easier to give (and for the student to receive) constructive criticism later on.

"What did you see me do?" This is really useful when a student is shadowing you or just watched you do something they are learning or might not have seen before. Repeating what they saw helps commit it to memory, and it gives you a chance to add things they might not have noticed, or explain your reasoning behind doing it a certain way.

"Let's talk about what you're going to do when we get in the room." This is a great defense against students going blank when faced with a patient. It also creates room for the preceptor to give more focus to effective patient distraction, or to observing the student and giving more specific feedback.

"Let's talk about what you just did. What did you think went well and how could it have been better?" I like this phrasing because it gets into the specifics rather than asking for an overall impression, and it encourages reflection on the part of the student before any additional feedback is given.

Narrate your clinical judgment out loud. This is a difficult skill, but it is one of the most helpful learning tools, even when the clinical judgment is not responding to something critical but just looking over your patient assignments and making a rough plan for the day. The step between getting information and implementing a response is often invisible, and getting a peek into your thinking is probably the single most educational thing I've experienced so far in clinicals.

Introduce your student, and introduce them as your student, not as your 'special friend'. I have no idea why nurses keep introducing me as their special friend but it always reminds me of creepy characters in horror movies introducing the doll/puppet/mannequin that will later come to life and eat people. If you're worried that the patient will object to having a student, follow it up with a joke about a two-for-the-price-of-one nursing special, but do not try to hide the fact that I'm a student. It feels icky, it's not informed consent, it doesn't fool the patient, and it undermines the rapport I haven't even had a chance to build yet.

Keep your ears open for learning opportunities elsewhere on the floor. I love it when nurses say, "Hey, I heard there's going to be an XYZ happening, do you want me to see if it would be okay for you to go and watch?" Not only do I get a great learning opportunity, but everyone in my clinical group will learn about it from me later, I get to see advocacy in action, and it shows me my nurse wants me to have the chance to learn as much as possible. Winning all around.

Understand that your student will be anxious and exhausted. Just being in such a high-intensity learning mode is exhausting, even when I don't appear to actually be doing anything. When I'm hanging out at the nursing station, I'm watching and absorbing everything around me. Where do the nurses sit? How much time do they spend there? Where are the other healthcare professionals? How much do they talk across professions, and how much of that is work vs. social? What are people talking about? How do they talk about it? What resources are they accessing? What are they wearing to work? Who are the housekeepers and what are they doing? What are they happy about and what's a source of frustration? How do the nurses interact with each other? With the charge nurse? With the CNAs? What's that alarm and how did people respond to it? How is this similar or different from the other units I've been on? After a few hours of this, without even doing anything or asking any questions, I'm ready for a break, and that's without accounting for the fact that I was probably exhausted from all my other classes before I got to clinicals and that most of my time is not spent at the nursing station, but in patient rooms doing even more rapid/intense learning. This is just to say that if your student is yawning, spacey, messing up, or needing information repeated several times, they will really appreciate being offered the benefit of the doubt.

Model self care. I can't even imagine taking care of four patients at this point, much less having four patients and a student. Sometimes you will be exhausted, anxious, and frustrated too. Please remember that you're allowed to be. Letting us into your struggle can be a wonderful teaching moment if you show us how you cope with the demands of your work. Furthermore, model the everyday routines that are evidence-based for building resilience, not just coping. Take lunch. Take your breaks. Drink that cup of coffee you made. Even if you can't make it happen every time, show us that self care is something worth carving out time for in the real world, and you will help usher in a resilient new generation of nurses who are confident in their worth and the value of the work they do.

I have been tremendously grateful for the preceptors I've gotten to work with so far. In the deluge of new experiences that is every day at clinical, it's challenging to find moments to adequately express my gratitude. When I have found opportunities to let preceptors know how much their mentorship and teaching means to me, all of them (but especially the most exceptional preceptors) seem to grossly underestimate their own skills and impact. So, for any preceptors reading this, please know that you are appreciated. You are so, so appreciated, even when your students struggle to step back from the flood of new experiences long enough to let you know.

I'm curious to hear what other students would change or add to this, and if any preceptors have thoughts about the most helpful things students can do.

Checking My Midwifery Privilege

Posted by Lucille on March 26, 2016 at 3:15 PM Comments comments (0)

I was catching up with someone I don't get to see often and told them about my midwifery admission. They asked a question that I don't exactly remember, and although it was polite and certainly not as callous as this, the underlying question seemed to be, "Midwifery? Isn't that one of those new hippie trends that sounds cool until it gets people killed?"

Without thinking about it, I went for the easy defense, explaining that my midwifery credential would be a master's degree in advanced practice nursing from a major teaching hospital. The effect was immediate, and they nodded and smiled and congratulated me. It took me a moment to realize what I had done-- that by defending my midwifery by emphasizing the ways that it was similar to medicine (and our broader cultural ideas of what makes a valuable profession), I had revealed the divide within midwifery and implied that the brand of midwifery I would learn was better, more real, than those 'other' midwives.

I quickly backtracked, and explained that there were many kinds of midwifery, including some that were passed on through apprenticeship and practiced out of hospital, and that many friends I admired had chosen to go that route. My friend recalled a story he had read in the news, about a baby who had died during a home birth because the midwife didn't recognize the need to transfer to the hospital when there were signs that a complication had occured. I shared my conclusion from my thesis on models of maternity care and acknowledged that I think the direct-entry midwifery system is definitely in need of improvement (for example, I'm wary of uncredentialed midwifery and would like to see the direct-entry midwifery system unite around the CPM credential). I also shared that it concerns me that questions about the flaws of the medical system revolve around ways to improve it while conversations about the flaws of midwifery tend to question whether midwifery (or out of hospital midwifery) should be allowed. It is hard for a profession to work on self-improvement (and believe me, no one is more invested in improving direct-entry midwifery than the direct-entry midwives I know) when you are constantly defending your profession's right to exist.

I'm sharing this story mostly as a form of accountability to my goal of working within the system to promote midwifery in all its forms, and to support improvements in the healthcare system, in or out of hospital, as I am able-- ideally while empowering my colleagues, or at the very least, not inadvertently throwing them under the bus. I'm curious to hear from other student or certified nurse-midwives about their experiences with promoting interprofessional collaboration in this context and any strategies they have found useful.

Acute

Posted by Lucille on March 25, 2016 at 9:40 PM Comments comments (0)

I meant to write this post around the halfway point of the term, to celebrate being halfway through nursing school, so it should convey something about the nature of this term that instead I'm writing it in the last days of spring break. The cohort ahead of us had warned us pretty unanimously that acute was the hardest term of the program. It was true that this term contained a steep learning curve. A lot of new information was introduced this term, but perhaps more importantly, the different areas of knowledge we'd been building up to this point (pharmacology, pathophysiology, clinical judgment, leadership, emotional support, etc.) developed to the point where they started to brush against each other. As our classes illuminated gaps in our knowledge of topics we had already covered, we invented more time to fill them in and tie different aspects of nursing together. I remember reflecting earlier in the term that without noticing it, I had crossed that invisible line between feeling like a nursing student and feeling like a student nurse.

My first clinical placement was in surgical oncology. I loved this placement. The nurses were leading several programs to strengthen the unit, with goals to eliminate falls and release time to care. On the abdominal floor last term, going back and forth between immunosuppressed patients and patients on contact precautions, I had been told to never sit down in a patient's room if I could help it. Furthermore, every patient was nauseous and the bed controls were finnicky, so I was told to avoid raising the beds. This meant that almost every conversation I had with a patient was brief and involved looking down at them from above (and I often went home with a back ache). On oncology, every nurse I worked with encouraged me to take time to just interact with a patient, with no task-oriented goals other than to get to know them. Pulling up a chair with a patient and getting to hear their story was wonderful. Despite taking hours out of every day to just be with patients, my confidence in my task-based skills still soared as I shifted from assisting with to taking responsibility for tasks like assessments and charting, DVT prevention, intake and output, etc. The funniest part was that in the entire oncology placement, I never had a patient with cancer. The unit had a lot of overflow from other parts of the hospital and I took care of several postoperative patients, patients with different kinds of dementia, and patients with different problems related to substance abuse. On one occasion I got to finish the day by going in with the doctor to tell my patient the mass had been benign, and then join the family in the dance party that followed.

My second clinical placement was on maternity, which actually involved rotating through labor & delivery, mother-baby, lactation, and the NICU. I had expected to feel the most confident in this placement because of my experience as a doula. This turned out to be far from the truth. Rotating through different units made it difficult to develop a sense of the normal routine, and I found that the nursing role on these units differed more from the doula role than I had expected. In three days on L&D, I attended five cesarean births (which included getting to see an intraoperative Mirena placement and an intraoperative tubal ligation), observed one cerclage procedure, and saw one vaginal birth (just for the five minutes in which the baby was born). I also assisted with several patients in labor, though none without epidurals. Partially this was because moms who wanted to have a natural birth were more likely to request not to have students involved in their care, so the births I attended as a student nurse were a skewed sample. I also had to realize that the births I had attended as a doula were a skewed sample, too, for being made entirely of the sort of families who hire a doula, had natural childbirth as Plan A (though were open to other plans if they seemed beneficial), and were all reasonably healthy. It surprised me how many of the patients I worked with or heard about had truly high risk pregnancies.

The nursing culture, too, was different than I expected. My first day on the unit, I saw several awesome advocacy moments and several moments that concerned me. I imagined that the nursing staff was a combination of nurses who had approached birthwork from more of the doula/midwifery side of things and nurses who had approached it from the medical side, and that their attitudes differed accordingly. In later days on the unit, I realized I was wrong. More often than not, the person who advocated beautifully for one patient and the person who casually undermined another were the same nurse. I don't mean that one nurse in particular seemed to flip flop between different attitudes, I mean that I saw this from the majority of nurses I worked with. It confounded me. Tuning in closer to what came up in the clinical judgment process, I noticed that the first question asked when one nurse asked another for advice about a patient was almost always, "Are they midwifery or OB?" And the answer seemed to inform their response. On multiple occasions, I saw nurses try everything they could do avoid an intervention for a midwifery patient, and then start preparing for an intervention before the topic had even come up for an OB patient. I raised my confusion about this in our leadership class and it prompted a discussion on internalized oppression in healthcare. By treating "midwifery or OB?" as a proxy for "how commited is the mom to a natural birth?" it seemed that many of the nurses unconsciously or consciously prioritized the providers' goals over the patients'. Whether despite or because of these challenges, I learned a lot, especially on the postpartum, lactation, and NICU floors where I had less experience, and I got to work with some wonderful preceptors.

Buoyed by the massive ego-boost I got in the middle of this term, I sailed through the normal crunch around finals, and before I knew it, it was spring break. Travis and I normally travel to see his family on school holidays, but because he was studying for an engineering exam, we stayed in town and I even spent a couple of nights at my parents' and brother's place. We had originally talked about going to the coast for a few days, but ended up deciding to do a staycation and explore some events around Portland. We went to a St. Patrick's day party, the zoo, a magic show, and a tulip festival. We also spent a lot of time relaxing at home. My brother and I had made several deals over the course of the term to try a book/show/youtube channel/podcast if the other person would return the favor and we both enjoyed trying out each other's recommendations. I made promises to come back to a few of them when I have more free time. Which, now that I'm in the midwifery program, should only be about three years from now.


Grateful for a quick breath of rest and family time before we dive in again!

The Rainbow after the Storm

Posted by Lucille on March 3, 2016 at 12:20 PM Comments comments (1)

The other day I was taking the tram down from the hospital when there was a huge gust of wind that sent the tram swinging, accompanied by a sudden cloudburst. Hanging high above the city, we got to see the transition, the line that was the first drops, as the rain descended like a screen being lowered over Portland. A few minutes later, the tram landed, and the rain stopped just as suddenly as it had started, leaving the ground glittering in the sun. The mass of people unloading from the tram looked up at the sky and their mouths fell open. We all started gesturing for the crowd of people waiting in line to turn around and look up. There was a huge, bright rainbow, as clear as if a giant had painted with one giant brushstroke across the sky. This is the picture I took. I didn't even notice the second rainbow in the picture until later.

I've been checking the mail as soon as I get home every day, waiting for my admissions packet. It finally came! They gave me a week to send back the paperwork, so I sent it within ten minutes just in case.

As my admission to the midwifery program has started, slowly, to feel more real, it has raised some questions of meaning. To cope with the persistent uncertainty, I had decided to assume that I hadn't gotten into the program and begun to plan out the bright sides of a detour into nursing. Finding out I was admitted to midwifery required some sudden revisions to the story I had been telling myself. I found myself feeling unsatisfied with the new story-- not the ending, obviously, but the plotline.

I was rejected from the program, tried again, and got in the second time. It sounds like a story about self-improvement and perseverance, except that I will start the midwifery program with the same amount of experience that I would have had if they had admitted me to the nursing-to-midwifery route in the first place. And yet the first time, I was rejected without an interview, and the second time I was admitted above others who were experienced nurses. As glad as I am to be admitted, that makes no sense to me. I think it says more about the surplus of qualified applicants, the national shortage of nurse educators, and the difficulty of trying to judge people's suitability for a program with such little information. It is both comforting and scary to think that decisions that affect the entire course of your life could, at the end of the day, have rather little to do with you. Of course I played my part, in being qualified for the program and in representing myself well. I am meant to be a midwife. But I know because it happened to me that many qualified people represent themselves well and are rejected, because of system factors outside their control. They are no less meant to be midwives.

I am beyond thrilled to have gotten in, but I found myself wrestling with the hows and whys of the story. Reapplying involved a storm of uncertainty, imposter syndrome, and self doubt. Where does it fit into the story, what meaning does it have, if I was going to start midwifery school at the same time I would have if I had gotten in in the first place?

A lovely meeting with another future midwife helped me find some new perspective on the story. Although I will start the midwifery program with the same quantity of experience, the qualities of my experience were different.

For one thing, experiencing nursing school from the viewpoint that I might work as a nurse for several years may have helped me to be more present for the experience. I got to try on nursing as an identity as well as a prerequisite to midwifery.

Having my goal to become a midwife be challenged helped me to see midwifery as an inherent part of myself, rather than as something conferred by a credential, and made my identity as a midwife feel much more solid.

Had I not been rejected from the program, I would not have experienced the utter magic of being so proactively welcomed and included by the midwifery crew.

Had I not needed to reapply, I would not have gotten to receive the news of my admission surrounded by the joy of my cohort. People kept wishing me luck, but still I didn't quite realize how invested my classmates were in my application until I got to see the room explode in celebration on my behalf. I'm getting teary just thinking about it. That day alone was worth it, and will stay imprinted in my memory as one of the best days of my life.

When I started nursing school, my peer mentor put me in touch with someone who had gotten into the midwifery program while in nursing school (the first person to get in through that route). Hearing from someone who had been in the same place I was in meant a lot to me. Now, a year later, I got to talk with several future midwives who didn't get into the program on their first try and are aiming to follow the same path. It felt so cool to be able to pay that kindness forward, and use my experience to encourage others. Midwifing the future, as a friend called it.

It would certainly have been nice to be admitted to the midwifery program the first time and to have not had to wade (again) through all that uncertainty and doubt. A lot of that process wasn't fun, but without it, I would have missed some truly spectacular rainbows.

Future Midwife, At Your Cervix

Posted by Lucille on February 22, 2016 at 8:20 PM Comments comments (0)

The wait to hear anything after the interview lasted forever.

My friends in the program had told me that accepance would come by phone and rejection by email, so I jumped every time my phone made any kind of noise. My heart leapt any time I saw it ringing with an unknown number (curse telemarketing calls!), and I ended up looking up the admissions office number and entering it into my phone so that I would know for sure if they were calling.

After not hearing anything for two business days, I considered ways the admissions team might have become accidentally locked in a closet somewhere, and contemplated sending a rescue party.

A week after the interview, my phone started ringing while I was in the operating room observing a cesarean, dressed in a plastic full-body suit that left me no access to my phone. I silenced it through the suit and hopped anxiously from foot to foot, trying not to imagine how it would feel if I stepped out of the OR to find a voicemail welcoming me to midwifery school. Then my phone started ringing again. I silenced it, feeling confused. A few minutes later, it rang again. Now I was worried, as three calls in a row is a signal my family uses for emergencies. I left the OR and stripped off my suit to see that the ringing was an alarm I had set to remind myself to take a pill. I suited back up to watch the rest of the birth, and then at lunch I ordered a pedometer that connects to your phone over bluetooth so that I'll be able to see and silence notifications from my phone without stepping out of the OR in the future.

At almost two weeks after the interview, I was tired of being in limbo and of jumping at every sound from my phone, and I was starting to accept that I had not gotten in. There were only a handful of applicants interviewing for two spots, and every applicant but me was an experienced labor and delivery nurse. I didn't think it could take them this long to reach a decision. I figured that they must send out the rejection emails for all the programs at once, and that I would get my email in a few weeks when they finished interviews for the nursing program.

In the meantime, I wanted to move forward. So I did my grieving. It wasn't pleasant, but it was better this time around, because I knew the alternative and knew that it would still be carrying me toward midwifery, albeit on a different timeline. I shifted focus and started deliberately warming myself up to the backup plan. I talked with labor and delivery nurses (one of them said she had always intended to be a midwife but gave up on continuing her education once she had kids, which was not the most comforting). I toured the NICU where I would likely do my practicum and talked with the students currently doing their practicums there. I found a nurse residency program that would help me get a job in labor and delivery straight out of school and started making preparations to apply.

Two weeks after the interviews, I sat in a lecture on liver disease, my attention drifting a little because we had just finished taking a midterm. And then my phone started ringing. My heart leapt, and I pushed it back down, tired of getting my hopes up with every single call. I pulled my phone out of my pocket. It said OHSU Admissions.

I ran from the room and answered my phone. This particular class was across the hall from the admissions office, and there was an awkward moment as the person on the other end of the line realized she was unexpectedly talking to someone right outside her door. I went down the hall a little ways, already feeling tears well up with anticipation.

And then she offered me a position in the midwifery program.

I said, "Absolutely!" before she'd finished the question, and she laughed and told me to look for an admissions packet in the mail.

I went back into the classroom, stunned, my whole body shaking. The way I had dashed from the room had apparently given the situation away, and the class looked up at me with anticipation.

"I got in," I said weakly.

It was like Gryffindor winning the house cup. The room exploded into applause and I was surrounded in a giant group hug that felt like it lasted an eternity. Wiping away tears, I stepped out to call my family, and found that my hands were shaking almost too much to dial.

I sent out an announcement over Facebook that read, "I GOT IN I GOT IN I GOT IN I GOT IN I am going to be a midwife if anyone needs me I'll be doing somersaults across the ceiling."

I don't remember much of the rest of class. I ran home to find that Travis had come home early to meet me, and for the next little while, I was a mess. I let the structures I had built around the uncertainty, the imposter syndrome, and the fear of rejection all crumble, and I crumbled with them. I alternated between surges of energy, euphoria, disbelief, and exhaustion. I cried (a lot), giggled hysterically, ran around in circles, collapsed on the floor, and then started the cycle over again.

I looked up at Travis, wondering if he could possibly understand everything I was feeling.

"I know," he said. "Remember when we were talking about the lottery?"

We had been talking about how our lives and careers would change if we won the Powerball, and he had talked about how he would leave engineering immediately to try out less dependable but more creative careers. He had asked where I would want to travel first. "You mean after I finish nursing school?" I said, "That would depend on whether I get into midwifery, wouldn't it?" He was surprised. "We're talking about if we won the lottery. You wouldn't even have to work at all if you didn't want to. Our grandkids wouldn't even have to work if they didn't want to! What would you want to do if you could do literally anything you wanted in the entire world?" "Midwifery," I had answered without hesitation, "I don't know what the overall arc of my career would look like, but midwifery is absolutely where I need to start."

I remembered the conversation. Travis hugged me as my tears leaked into his shirt. "I get it," he said, "I'm so proud of you."

When I had exhausted the waves of energy, I ran a bath, my mind whirling with a strange sense of vertigo. I had done my grieving and refocused, and so jumping back into a path I thought had closed was a drastic change in the story I had been telling myself. It felt surreal, so much so that I worried it somehow hadn't really happened. I had imagined being accepted and rejected so many different ways that this felt like it could easily have been a fantasy. Thank goodnesses there had been witnesses. Still, I found myself entertaining fears that this had to somehow be a mistake, that the admissions office had dialed the wrong number, or mixed up my name with another candidate...

A few times, I was so focused on a task at hand that I actually forgot. My phone beeped, and I thought to myself, "That'll be the rejection email..." before remembering, and then a new surge of relief and joy overtook me.

Most of the midwifery people had not been in that class, so on Monday, I got to relive the moment all over again. Their earnest excitement for me made everything feel more real than anything else. Some of them shared that they too, had worried that their acceptance had somehow been a mistake, and I laughed trying to remember when exactly getting into nursing school had started to feel real. I'm looking forward to having something tangible when my acceptance packet arrives in the mail.

The euphoria has been coming and going in waves. School, relationships, and adulting are still complicated in their own ways, and joy is an emotion, that like all emotions cannot be sustained for any uninterrupted length of time.

What is the word for this other thing, then? The sense that all the daily ups and downs fit together into something bigger, that even the heartbreaking parts are part of exactly where I want to be and the life I want to live?

I thought about my intention from last year, belonging, and my intention for this year, becoming, and I felt a deep sense of coming home.

Interview

Posted by Lucille on February 6, 2016 at 5:05 PM Comments comments (0)

The short version is: it was awful. Scratch that. It felt awful, because it was weird and stressful, and incredibly short considering I'd been imagining those twenty minutes for the last five years and they will have a determining impact on the course of the next five. What it was remains to be seen.

The interviewers sat at the end of a long table, with me at the other end. They read the questions one by one off of a script in front of them and then stared at me blankly while I answered. Even knowing that this 'neutrality' is a practice sometimes employed in interviews in the name of fairness, I found it incredibly unsettling.

Suffice it to say that I now have eloquent, insightful answers to all of their questions composed, and that they feel like well-worn stories from all the times I've pored over them in the last few days. Those are the answers I came up with while lying awake the night after the interview. They are not the answers I came up with on the spot in the real thing.

There were several questions where I went off in a direction that I don't think was at all what they were looking for. Several questions had many parts, and I would finish my answer only to have one of the interviewers raise her eyebrows and ask if I would like to address the rest of the question. I wouldn't feel as bad about that if it had only happened once, but it probably happened every third time. There were two moments where the interviewers broke out of their careful neutrality. The first was when they let out a short laugh as I recounted my process of figuring out how to take care of myself as a doula, and I told them I had tried every caffeinated drink and protein bar on the market before discovering what worked best for me: food and water. The second was when I shared an example of a neonatal death I had witnessed in Gambia, and one of the interviewers made a choice to go off script and thank me for sharing my story. I appreciated this gesture, but was caught up in the feeling that the story had somehow come out all wrong.

After a brief blur of trying to think quickly while second guessing myself, it was over. The interviewers thanked me for my time with blank expressions that seemed more like frowns, and that was it. That was the interview I'd been working toward for the last five years. It was done. Although I'm sure there were some questions I answered well, my gut feeling as I walked away was that I had just thrown any chance I had at getting into the program out the window. Everything had come out wrong. I hadn't been able to think fast enough. In the buzzing silence of the hallway, the answers they'd been looking for suddenly seemed clear to me, and had little resemblance to what I'd actually managed to say.

I walked outside, found a quiet place to sit, and observed that I felt ill and could feel my heart pounding and my breath catching in my chest. It's kind of amazing, really, that our emotions can produce such intense fight-or-flight symptoms despite a lack of any physical danger. I didn't cry, and my numb brain noted that as a point of concern. I cry at everything. Joy, sadness, anger-- it all comes out my eyes. My therapist last year would open every session with asking me to close my eyes and bring my attention to my breath, and no matter my mood, simply shifting my attention in this way would bring tears to my eyes. A lot of the time I found it annoying. She called it a sacred release. One of my favorite bloggers, Laura Parrott-Perry at In Others' Words, wrote earlier this year about the value systems inherent in the phrase 'reduced to tears', and I vowed to say 'elevated to tears' from then on.

I couldn't cry. So I brought my attention to my breath in a different way, and started taking my vitals. As soon as I finished counting, I wrote down the number and started counting again, then again, and again. I watched as the numbers gradually settled back toward normal, as my breaths came more easily and I had to put my hand on my chest to keep feeling my heart as its beat became slower and more even. I called my dad and gave him a brief update before my phone ran out of battery.

I still had more than an hour before the evening meet-and-greet. I came up with a lot of great answers to the interview questions in that time. A lot of things I would have done differently, and will do differently next time if it comes down to it. A year seems like a long time to wait.

The meet-and-greet was better. It was fun getting to meet the other applicants, and a relief to interact with the faculty as people and midwives rather than as interviewers. I took a soapbox moment as we went around and introduced ourselves to share that I'm an advocate for reapplying. I told the applicants (most of whom were applying for the AccBac-to-midwifery option, and would thus start the program I'm currently in) about how everyone I met at the interviews for the AccBac program last year would have made great nurses, and the limited number of spots in the program didn't change that. (Did you know that to become nursing/midwifery educators, clinicians have to earn an additional degree and then accept a significant cut in pay? Right now the limiting factor on these programs is the shortage of teachers and preceptors.) I'm still not sure this soapbox moment was a good idea. I hope the faculty didn't see it as me trying to show off in any way. But everyone who had introduced themselves before me had such rich background experiences and so clearly deserved to follow their passion in midwifery that it galled me that as many as 3/4 of them would be turned away. It doesn't mean they aren't meant to be midwives, and in case they don't have family and friends cheering them on the way I do, I wanted to make sure they heard it from someone.

One of the faculty members thanked me, elaborated a bit about the shortage of spots in the program, and encouraged everyone to reapply if needed. I could have imagined it, but I could have sworn she held my gaze for a long moment when she said "if this isn't your year".

I ran into a few friends on the way home and then reached out to my people over Facebook. The solidarity and votes of confidence meant the world to me, especially from my friends who are admitted to the program. A few of them shared that their interview experience had been similar, in the sense that they felt intimidated by the scripted interactions with faculty and then left feeling like everything had somehow gone horribly wrong. This was probably the most therapeutic thing of all, as it reassured me that my intuitive sense of doom might not be an accurate measure. They obviously did something right, so if my goal is to follow in their footsteps, I will check 'feel awful about the interview' enthusiastically off the list.

I am trying to remember that getting a job as a nurse after this would not be the worst thing in the world. It wouldn't even be a bad thing, not in the slightest! I am going to be a nurse! And experience as a labor and delivery nurse would be a wonderful thing (not to mention earning my first real paycheck!). The drawback is purely that a detour into nursing isn't my first choice, and it feels painful to have such an important crossroads in my life be outside of my control. Also I would love to go through midwifery school with the peers I've already fallen in love with. But based on the people I met at the interview, I'm going to trust that incredible women aspiring to be midwives are not in short supply.

At this point I'd just like to know either way, even if the answer is that this isn't my year. I just want to be out of limbo. Based on this, I think the most likely outcome is that I will be waitlisted indefinitely.

But on the bright side, I start on the mother-baby unit next week! More to come.

I GOT AN INTERVIEW!!!

Posted by Lucille on January 24, 2016 at 11:10 PM Comments comments (0)

It's on February 4th. Keep your fingers crossed for me. Also, I saw a screening of the Mama Sherpas today and highly recommend it!

The Secret Club

Posted by Lucille on January 24, 2016 at 10:40 PM Comments comments (1)

Because the building I live in is close to the hospital, a lot of clinicians live here and I pass them in the lobby and hallways from time to time.

I came home tired from a long day at clinical last week. I had taken in a lot of tragic stories that day and my eyes were red from releasing them through tears on my drive home. I got in the elevator and an older man stepped in behind me. As the doors closed, I saw that he was wearing scrubs, too, and that his eyes were red from crying. Our eyes met and at the same time, we started to laugh. Laughing dislodged what I thought I had carefully packed away before leaving the car, and tears started sliding down my face again, which only made me laugh harder. He wiped new tears away as we both moved in for a hug.

"You're doing great," he said.

"You too," I said, "Take care of yourself tonight."

And then he got off at his floor, and a few minutes later, I got off on mine.

It wasn't until I related the story to Travis that I realized I hadn't learned the man's name. In a real way, I didn't need it. There's a beauty to unplanned human moments that doesn't need to be spoiled with the details.

When the Patient is a Nurse

Posted by Lucille on January 24, 2016 at 10:20 PM Comments comments (0)

A surprising number of the patients and families I've worked with have been clinicians themselves. It's a special experience to work with them because I can tell they see themselves in me, and they invite me to step outside the role of therapeutic presence and share a bit about my own experience.

I got to watch a dressing change of one such patient last week. I prepared myself to keep my face neutral as the dressing was removed. After the clean dressing was in place, the patient looked up and said, "I know that's probably the biggest wound you've seen by a lot, so tell me honestly. What did you think?"

I grinned. "Honestly, it looks fantastic. There was blood but no pus or discharge, no odor, lots of bright red granulation tissue, and fresh scar tissue that tells me it's a lot smaller now than it was before. You're healing great!"

She grinned back at me and said, "Now that's a nursing answer if ever I heard one," and her whole family offered me high-fives.

I left the floor glowing.


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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.