Brave Woman

Adventures of a future nurse-midwife


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Notes for When I'm a Preceptor, The Sequel

Posted by Lucille on September 11, 2018 at 5:30 PM Comments comments (0)

I wrote a post at the end of nursing school about specific things that were helpful from preceptors, to help me remember for when I have the privilege of teaching others. Most of what I wrote held true in midwifery school, but I have a few things to add.

A midwifery call shift is different from a nursing shift. You might be running between patients all day, or, you might have significant down time. If you have downtime, talk about it out loud. If you want to sleep or work on your own project, say so. Offer your student the chance to do the same. Consider offering for them to take call from home. If you're up for anything, give the student the choice. Ask if there are any experiences they've had they'd like to debrief. Ask if there are any skills they'd like to review. Students don't always have the chance to debrief and ask questions in the moment on busy shifts, so slower shifts, even if it's with a different teacher, can be a great time to do this.

On busy shifts, remember that you are modeling not only how to do midwifery, but how to be a midwife. Take care to eat, pee, and sleep. Strategize together. It's totally fine to ask your student to do something (right a note, watch the strip...) while you take a break, but make sure your student has a chance to take a break too. Use the teachable moment to talk about how you like to juggle things when the day fills up. If an emergency or other intense situation occurs, debrief. If a student wants to debrief something but there are pressing patient care needs, come back to it at the first opportunity. Everything is newer and scarier as a student, and you are not only teaching them how to respond in the moment, but also showing them that their emotions and experiences matter, and teaching them how to tend to them. And then, talk about how you transition to the next thing. Stretch, shake it out, watch a funny video, tell a story about resilience, or eat some chocolate together. Taking the two minutes to acknowledge and process emotions (even if the 'intense' event hasn't felt intense for you since you were a student) will make the whole shift better, and will set up your student with things to try the first time they're shaken on their own.

Proactively create safety. I don't know if this is true universally, but I felt much more afraid of hurting someone as a student midwife than I did as a student nurse. Acknowledge this fear as part of the work. Talk about the difference between mistakes and risk-modifying care (such as different positions or techniques for reducing the risk of perineal tears). Talk about how you deal with the knowledge that you influence a patient's risk for complications, and acknowledge how much is outside of your control. And if a complication occurs, talk about ways you might have further reduced the patient's risk together, but do not imply that the student was at fault. Create a safe learning environment by telling your student straight up that you will not let them actively hurt anyone, and that if you see a risk that is not being addressed, you will step in. Follow through.

Make sure your critique is constructive. Be specific, and phrase your comments as feedback on behaviors or thought processes, and not as a statement about the student as a person. Whether positive or negative, making statements about who you perceive your student to be as a person is not actionable feedback. Negative personality typing is just hurtful, and positive personality typing risks the student feeling like they have lost something if they do not have that positive quality all the time. The words 'ahead' and 'behind' are similarly non-actionable, as they promote comparisons with peers, and ignore the non-linearity of learning. Good alternatives are, "You did a good job with xyz skill today," or, "You seemed to struggle with abc skill today. Let's talk about it."

Ask socratic questions, not quiz questions. In particular, questions that end in, "Right?" are clearly asking the student to agree with you, rather than leaving room for them to think through it. Be genuinely curious, especially about their learning process. For example, if you have given a critique, ask, "Do you think this is true in general for you, or was this an overcorrection? What about this situation did you find most challenging?" Consider the difference between "Are you practicing at home?" and "What are you doing for practice at home?" Phrasing is powerful. The same question can be a checkbox on an evaluation, or a socratic invitation to consider ways to strengthen their own learning.

Midwife it up. Offer a hug and a high five. Give not only technical compliments, but also compliments from the heart. Tell your student when you see a glimpse of the midwife they are becoming. And don't be afraid to get silly! Some of my favorite moments with teachers were goofing off, looking up birth videos or puppy videos, and telling stories together.

If you are in a practice where students float between midwives, try to remember something about your student that you can bring up on your next shift with them. Ask if their cat is feeling better or how that one concert was. If you need to, take notes after a shift and read through them before you work with the student again to jog your memory. Sure, it's kind of cheating. But just like with patients, it shows your student that they matter to you as an individual, and that can mean the world.


Posted by Lucille on December 20, 2017 at 11:00 PM Comments comments (0)

When I opened this page to write, I could not believe the date on my last post. Nine months. The length of a pregnancy. The number of months that I've been catching babies.

So first, a few life updates. I really, truly don't have cancer. The 'normal' mammogram had a big dsclaimer at the bottom saying that I have the tissue type that is hardest to see on a mammogram, so the breast specialist recommended I get an MRI and ask my mom to do the more extensive genetic screening. Everything returned normal, which means I'm back to being a person with a significant family history who also, unrelatedly happens to be a fertility goddess. The whole process was a serious emotional trip, but at the end of the day, I'm back where I started with more information and more reassurance than before.

In the spring, I started catching babies. You start with 'four-handed' deliveries, first your hands over your teacher's, and then their hands over yours. I worked evenings as a nurse in memory and end-of-life care, literally catching babies by day and tending the dying by night. I still don't have the words to articulate how profoundly the two apply to each other. If I wasn't going to be a midwife, I have no doubt that I would be a hospice nurse.

Travis and I got married at the start of the summer. We had been planning to wait until after I graduated, but realized that changing my name between getting my degree and taking my board exams could complicate getting my license, so we moved things up by a year. We had a small ceremony with just our parents and brothers at a local lavender farm. My dad officiated for us, and it was even lovelier than we had imagined.

My plate this year has been incredibly full, mostly of good things. The shift work of days, evenings, and nights in no particular pattern was hard on my body, and I often found myself processing work experiences at school, and vice versa. After talking about a challenging day at work with a close friend, she kindly prompted me about how I cope with times I need to work outside my comfort zone, and I replied, "I'm not sure I have one of those. I mean I love what I do. But I'm also uncomfortable literally all of the time." Relunctantly, I admitted to myself that I was just spread too thin. Even though the number of shifts I took at work was flexible, I needed to have my whole brain in one place. I gave my notice at work in order to give my full focus to the last year of the midwifery program. I had a "dry spell" of births on my shifts over the summer, and was privately grateful that the times I got to take call from home helped me stay afloat until my last day of work.

The hardest thing about fall term was the expectations I set for it. I thought that with the extra time from not working, I would feel better and have more energy. Instead, I felt just as mind-numbingly exhausted as before, no matter how much I slept. I had thought that the "dry spell" of births over the summer would end with a flood of fall babies. Instead, the dry spell continued, totaling 4 months between births, which my faculty felt sure was some kind of record. Unsurprisingly, I fell behind, and when I finally did have a birth on my shift, I felt as anxious and unsure as if it was the first birth I had ever attended.

Being "the behind student" felt extremely vulnerable. My feedback from preceptors became more problem-focused, and somehow even more inconsistent than before, because each shift was a snapshot experience with a new person. One preceptor would tell me that 'my problem' was that I was too concerned about what a patient was feeling during procedures, and thus taking too long and prolonging the exam unecessarily, when it would be kinder to 'get in there and get it done'. She also encouraged me to act more confident, as patients might be more likely to decline to have a student involved in their care if they could tell I was anxious. The next preceptor told me that my problem was that I was too focused on successfully completing a procedure regardless of the patient's comfort, and that I needed to be more deferent, as patients were more likely to decline the care of an overconfident or task-focused student. Each patient interaction felt like an overcorrection, each snapshot teaching moment felt over-extrapolated, and I continued to go weeks between births and to fall further behind. I felt pressured to take extra shifts, or to stay late into the next shift when I felt dead on my feet already, in order to catch up. When I insisted that my shift was done and I needed to leave, knowing that I was too tired to learn effectively and was no longer the right person to support the laboring family, preceptors told me they were surprised that I would decline learning opportunities under the circumstances.

I reached out to my program director, and in hindsight, I wish I had done so sooner. We reviewed my experience of the last two terms and it was a relief to feel like someone other than me was keeping track of the big picture of my learning. We agreed that the main issue was that I just needed more births. She had heard about how I had been declining learning opportunities, and I shared how I had decided to leave my job precisely because I recognized that I needed more energy for school, but that despite two months going by, my exhaustion had not budged. It felt like a jacket of bricks that I could not take off. I could barely sustain my energy through my regular shifts, and the idea of doing extra, at least during the term, was overwhelming. She reminded me that the studies of chronic sleep deprivation show that it takes 3 to 4 months (MONTHS!) of sleeping to saturation to feel a sustained increase in energy, and of course the life of a student midwife hardly counts as sleeping to saturation.

I cried. The validation that this exhaustion was expected, and not a sign of a lack of commitment to midwifery or to my own learning, softened the "fake it til you make it" act that I had been wearing around my vulnerability. What followed was a rewarding conversation about introversion, midwifery, and the student-preceptor relationship. She noted that when a student becomes 'officially behind', it can shift the preceptor-student relationship toward one of evaluator-evaluatee. She encouraged me to stop trying to guess what my preceptors wanted from me, and instead take charge of my own learning, practice thinking out loud, and ask directly for the types of teaching and support that I needed.

My next clinical placement was going to be at a busier hospital, possibly the same one where I would do my integration term, so I wanted to set myself up to succeed there. We agreed that I would not take any extra shifts in the rest of term, but that I would come "back home" to OHSU over the winter break to get more birth experience with the faculty. I asked how many shifts she wanted me to do. "It's not about a number. This is your time to take charge of your learning. You'll tell me when you think we're ready, and then we'll check in again."

On my first shift of winter break, I was literally shaking in my scrubs, and I told my teacher so. The day started out light, so we spent the first two hours talking about my learning, my skill levels, and what types of teaching and support I felt I needed in each area. The universe delivered an ideal shift, and we had one patient, and got to manage her care together from start to finish. It was the most 'midwifed' in my learning I had ever felt. My teacher pushed me, practically catapulting me toward the level of practice I was supposed to be at, but she did so in a way that was kind and respected me as an adult learner. She also protected the patient's confidence in me. We stepped out regularly to check on our 'other' patient (who didn't exist) so that we could confer privately. It gave me the chance to ask questions, check my thinking, and share my fears and what-ifs separately from the calm and supportive energy I maintained in the room. It set things up so that when there were decisions that needed to be made, no one was trying to read anyone else's mind. This labor teetered on the edge of normal, but with a few interventions and the mom's incredible perseverance, at long last her baby slid into my hands, and her gasp of victory turned into loving coos as I lifted her newborn up to her. Back in the call room, my teacher gave me a high five and a huge hug. We had the luxury of time, so I got to soak in my success and talk through all of my fears, uncertainties, and excitement before we sat down to chart. Despite being tired to my bones, I floated home.

And then I came back, every other day. I was sometimes selective about which teachers I worked with, and I only took day shifts, but on each shift, I stayed until all of my patient's in active labor had delivered, even if that meant not going home until the next morning. Although this was supposed to be our break, Travis was understanding about the fact that his wife had basically moved onto labor and delivery.

I attended a term worth's of births in the next two weeks, and it was a perfect variety of deliveries: OP, hands and knees, OP in hands and knees, and waterbirth. I even had a mega-delivery (what we call it when more than one life-threatening emergency happens in one birth), and while it was intense, I was glad that I got to experience my first mega-delivery as a student, with a teacher at my back and the time (since classes were on break and I could choose which days I came in) to do the processing I needed to afterwards. With so many births in short succession, it was exhilarating to be able to see my own growth from shift to shift. Finally, I had a gorgeous, totally normal birth, where I acted as the primary midwife the whole way through. I gave report to my program director at the end of the shift, and told her that I felt ready for the next term. She gave me a big hug and said, "Then consider yourself officially caught up, and enjoy the rest of the holidays."

Being a student midwife is 1000 times more vulnerable than being a student nurse. As a student nurse, there were things that I didn't feel I needed to perfect, because I knew they didn't apply to my work in the longterm. In midwifery school, it is ALL important. You've been dreaming of the privilege of being part of this work for years. Your teachers, at least initially, are on a pedestal, and are humanized quickly by working one-on-one together, eating and sleeping in the same room for twelve hours at a time, in which you are both learning and being evaluated. The feelings of vulnerability can be extreme. The idea of being 'officially behind', and being asked to do extra shifts, is scary. So I just want to throw out there for any student midwives who may read this: those two weeks of extra shifts were my favorite two weeks of the entire program. Being singled out is scary, but the focused teaching that resulted from it was needed, and the momentum in my learning from my 'winter break intensive' was exactly what I had been craving.  Here's to a new year and a new term.

Cancer Scare

Posted by Lucille on March 27, 2017 at 3:15 PM Comments comments (0)

(Spoilers: I'm totally okay, just magic.)

Spring break was a more anxious time than I anticipated.

I finished writing my last post about how relentless this term was and decided that before I started studying for my last final, I should take a bath. (Procrastination is a personal strength.) So I drew up a bath and got in and relished in putting off thinking about all the studying I had to do for an extra twenty minutes, and then I felt a weird twinge in my chest and looked down, and saw a drop of milk drip from my left breast into the water.

I think I just sat there for a few minutes before it really registered what I had just seen, until I finally blinked and reached up to squeeze my breast, and another drop of milk dripped into the water. Nothing from the other breast. And then I burst out laughing, and said out loud to my cats, "Of course. Of fucking course. Relentless, I tell you." And then I sat there for another few seconds until the shock wore off and my brain started working and setting off alarm bells and I leapt out of the bath and grabbed a pregnancy test, paced around for a minute, and got an invalid result. So I sat down naked on the edge of the tub and called my doctor. And left a message. And called Travis, who was taking a final, so I left a message. And then I threw some clothes on and walked across town to buy another pregnancy test.

I went through the self-checkout line trying to be discreet, but then the person in front of me walked out without paying, so the attendant had to come over to type an override code. She glanced at what I was buying and kept her face professionally neutral after a brief sympathetic flash of, "Oh, honey." And I almost laughed thinking that I must be the only college student with wet hair buying just a pregnancy test to check out while thinking, "Please, please just be an unintended pregnancy and not cancer."

The on-call doctor called me back. I was talking really fast but she was kind and patient as we went through the checklist to confirm that I had no other symptoms. She asked if I felt any lumps. "Tons, as usual, which is the problem," I said. "I don't think any of them feel different than the others but my mom had breast cancer at only one year older than I am and had to do a double mastectomy and a year of chemo and I know that unilateral milk production in a non-pregnant person is a sign of cancer because it's on the final exam I'm taking tomorrow and I'm kind of freaking out."

There was a long pause, and then she said, "Right then. We want to see you first thing in the morning." I asked if I should call back with the results of my pregnancy test and she said, "Call if it's positive. Otherwise we're just going to move forward with this being a cancer workup." (It was negative.)

I called a friend, who came over to keep me company until Travis came home. I was actually able to focus enough to do the studying I needed to. The next morning, I went straight to the doctor's. I was meeting with a different doctor than I normally see for the purpose of getting me in asap. They said that the three things on the table were hypothyroidism, pituitary tumor, and breast tumor. Of those, breast tumor was way more likely because of my family history and the fact that it was one breast and not both. She ordered blood work to rule out the other two. Regarding breast tumors, she said generally ultrasounds and mammograms show different things well, but that mammograms aren't usually done in people my age because it's hard to distinguish anything in denser breast tissue. I told her that because of my family history, my doctor had ordered a baseline mammogram a few years ago, so that if something like this happened we might be able to notice subtle differences that wouldn't be picked up without the comparison. She said, "Damn, you're on top of it! Okay, let's order both." She also put me on "breast rest", meaning I wasn't supposed to squeeze my breast or try to feel for lumps because stimulating the tissue could alter my hormone levels and throw of the blood work to be done in a few days.

I called to schedule the imaging and was told they couldn't work me in for more than a week. Technically, though, I could go to any imaging center in-network. It didn't have to be the one at the same hospital as my doctor. So I started calling around asking the different imaging departments about their earliest available appointments. I thought I was calling different schedulers at the different hospitals, but it turns out the schedulers were all together in an office somewhere, so when I called the third hospital, I hadn't gotten all the way through my question before they said, "Wait, are you the same person who just called the other two hospitals a few minutes ago? Yeah, we don't have anything within the week either." I blushed so hard. I think you're allowed to be impatient when you're having a cancer scare though, right?

I went straight from the doctor's office to my last final. I had asked about delaying it by a day, but that would only have been an option if the appointment was actually during the exam time. And two hours later, I was done with the hardest term I'd ever completed.

My classmates and I went out for drinks and I basked in seeing my exhaustion from this term and triumph at having finished it reflected in their faces. We made a toast to our own resilience and to never having to do that term again. I struggled with how to bring up what was going on. What do you say? By the way I might have cancer?

Turns out it came up on its own. We were passing around a friend's adorable baby when someone joked that the 12 of us should apply to adopt a baby together and then do our theses on collective breastfeeding traditions. "I know most of us have never been pregnant before, but I read somewhere that you can still induce lactation. I mean, all the tissue is there, right?"

I almost spit out my drink. "Way ahead of you," I said, and then shared everything that had happened in the last 24 hours.

As always, I felt grateful and humbled to be surrounded by such badass and fiercely loving humans. They enveloped me in support with both sincerity and humor. One person joked that if they had known what was going on they would have started a picket line in front of the classroom and all refused to take the final until I was ready. I laughed out loud and hugged everyone twice.

The hardest thing was knowing that most likely, spring break would come and go before I knew anything. I was emotionally all over the map: sometimes elated at finishing this term and coming back to catch babies in a week, and sometimes having loud anxious thoughts that spiraled away from me. I had deliberately planned for spring break to have lots of time to do nothing by myself, and quickly decided that doing nothing by myself was the surest way to let my anxiety get out of control. I did my best to stay distracted with spring cleaning, date nights with Travis, seeing friends, and a day at the zoo with my brother. When not distracted, I grieved the chance to breastfeed my future babies, wondered if I would need chemo and if that would mean needing to stop school, and looked through designs for mastectomy tattoos. I realized that my brain was getting way ahead of what I knew medically and wondered if I should be coping better, and then decided that should-ing myself was not a good coping skill and went back to distracting myself by building a laundry fort for the cats. (I mean, folding laundry. It's totally the same thing.)

More than a week after this all started, I went in for my mammogram and ultrasound. I had the same tech as last time, and since I still hadn't seen my own doctor in this whole process, it was wonderful to see a familiar face. (They weren't giving out bags of pink m&m's like last time though.) They scanned my boob every which-way and then the radiologist came back to tell me that everything looked perfectly normal. No breast tumor. This was confusing to me because hypothyroidism and a pituitary tumor had both seemed really unlikely. And then I got the lab results back a few hours later: all normal.

My body is just REALLY eager to feed non-existent babies, apparently.

I asked my doctor if there's an ICD-10 code for being a fertility goddess and she said there's a code for idiopathic unilateral galactorrhea.

I think fertility goddess has more of a ring to it.

Apparently this might continue indefinitely, go away and never come back, or come and go on monthly cycles. I'm looking into doing further genetic testing. (Mom is BRCA negative, but there are others.) I don't want to have another scare like this when there's a 50% chance I don't have whatever gene runs in our family in the first place. In the meantime:


I know we're all burnt out from this political nightmare, but please consider giving a donation to Planned Parenthood if you can. Access to mammograms is important for people of all ages and genders and literally saves lives. And if you're in a place where you can afford to make a donation to a good cause, please also consider donating to this GoFundMe for a friend of mine from Sunday Assembly to help him access a promising brain cancer treatment:

I know the world is super scary right now but WE ARE THE VILLAGE and we're looking out for each other.

Much love and thoughts of spring!

I woke up at 6 yesterday to go to my first lecture on intrapartum midwifery care. Six years since I first learned about midwifery, I'm really here. Even the sky seemed to be celebrating.

Crawling to Spring

Posted by Lucille on March 21, 2017 at 4:40 PM Comments comments (0)

I have one final exam left. Spring break is so close I can taste it. We actually made it through this term. Alternative titles for this post include Holy Shit, Y'all and It Feels Like I Just Drove Through a Car Wash with the Windows Down.

So two and a half months ago when I last wrote, I promised there would be a post soon with pictures from DC. I haven't even put those photos on my computer yet. I got stuck in DC due to ice on the runway, made it to Portland a few days later on a different flight, and got snowed in again at my parents place. I'm not sure I would have traded getting to explore the winter wonderland with my brother for anything, but being snowed in for so long without my computer or books meant I basically showed up in week 3 without having seen the syllabus yet and I've been trying to get caught up ever since. This term was relentless. I asked for twice as many extensions this term as I did in all of nursing school and every time I felt like I was almost caught up, something else seemed to come out of nowhere and throw me a week behind again. Two months later we headed into finals week and I still felt like I hadn't gotten my legs under me.

Because I'm so confident that this program is the right place for me to be right now and I worked so hard to get here (and know that I so easily might not have gotten in), a part of me thinks that I should be in perpetual Hermione-mode, soaking it all in and reveling in every learning opportunity even on the most exhausting days. So in the spirit of saying hard truths out loud: that was not fun. There were joyful moments for sure but overall this term was freaking hard and never having to do it over again will be too soon.

I think the part about this time that will be hardest to remember years from now is the sheer pace of it all. A sampling: I did perimortem nursing care by myself at work for the first time, had my first experience of listening for a fetal heartbeat that was no longer there at an early prenatal appointment, got to be at a friend's birth for the first time, and inserted my first IUD. That sounds like enough new learning experiences for a term to me, and that was all within a week. Five days, technically. These were all profound experiences that I was privileged to be present for, but there was just so MUCH week after week with no time to rest that I wore through my resilience.

Last week all three midwifery cohorts gathered to celebrate the second year midwifery students who are headed out into the world for their integration term. The second years, first years (my cohort), and the nursing students who will start the midwifery program next year sat in a circle and and shared what we are excited about, what we are nervous about, and any words of wisdom for the cohort below us. I think we might have scared the nursing students. Right before finals week of this term wasn't the best timing for this event if the goal was for us to inspire confidence in the next generation. When it was my turn, I shared, "I'm so excited to start catching babies in two weeks but mostly I'm scared because this term was brutal and I don't have the stamina to do another one like it next term. Also we just put together the call schedule and my calendar looks like a random hodge-podge of day, swing, and graveyard shifts and I don't understand when I'm supposed to sleep."

And then it was the second years' turn, and the next four people to speak all told us that the term we just finished had been the hardest term for them of the entire program, and that was without starting it two weeks behind. I sat cross-legged on the floor and cried in relief. I didn't understand how that could be true when we haven't started taking call yet, and they reminded us that the 12 hour call shifts are called call for a reason: we won't be moving from one 20-minute appointment to another like we have been in antepartum this term. There may be some shifts that busy, but there will also be shifts where nobody is in labor and we get to hang out in the call room and sleep, study, or get other stuff done. Also, we will be catching babies!!!!! And even if some shifts are scary and draining there will regularly be births that fill us up and remind us why we're doing this in the first place.

The most frequent advice from the second years was for us to lean on our cohort. This term got so busy that a lot of our interactions were limited to beleagered nods of solidarity, and joking that if we were going to be drowned in powerpoints, at least we're drowning together. It's a strange feeling to know that I would trust any of these women with my life but that for the most part, I have no idea what's going on in their personal lives. Luckily I know I'm not alone in hoping we find more time outside of school going forward.

This term physically hurt. I have bags under my eyes. I've been reaching for caffeine and alcohol both more often than I would like and I don't remember the last time I went to the gym. I got fed up with elastic biting into new stretch marks around my hips and replaced my entire underwear drawer. I'd been doing really well with body mechanics at work until I slipped on the ice and landed on my knee, then tried to favor my knee while it healed and strained my back. I think it says something about how draining this term was that I'm feeling it so much in my body, when I'm young and healthy! Grateful for my family's health, too, though Travis is still bummed that he has to carry an epipen around now. This term didn't need anything extra to be hard, and I know many of my peers lost grandparents or had other family emergencies. But we made it. One final to go and then I will be off school for an entire week, and get a fresh start for next term.

We're deliberately planning a staycation for spring break. I'm planning to spend a lot of time lying in bed reading with my cats and if I don't leave the apartment all week that will be just fine.

And then next term I get to start catching babies! Eek!

Resistance, Day 30

Posted by Lucille on December 29, 2016 at 2:25 AM Comments comments (0)

Dec 8th marked 30 days after the election, and 30 days straight that I've completed and posted a daily act of resistance. I didn't commit to daily acts of activism at the outset, I just started doing it- it didn't feel optional, and honestly I mean that less because of moral obligation and more because contributing tangibly to the resistance was necessary for my own sanity. I have been so full of anxious/angry energy this month that daily activism has been imperative for my own grounding. Although I didn't have a particular goal or plan at the outset, once I had done it for a week or so and saw that my posts were inspiring others, it was an exciting challenge to see how long I could keep it going.

About two weeks post-election, I wrote: "Some people I love have reached the depression phase of all of this. I still have one foot back in anger and one in bargaining. "Fine, he can be president, but how about if I commit to doing one act of resistance every day and then we DON'T blow the arms off of peaceful protesters?!" Nope, see there I am back at rage. So I have been thinking about rage, where I feel it in my body, and what to do with this heat and energy. I have heard a lot of people talk about anger as something toxic. "Anger is like drinking poison and expecting the other person to die." I don't agree. It's an emotion like anything else, and the fact that it's stressful to feel doesn't mean that it's pathological. In the face of obscene injustice, anger is fucking appropriate. It's even necessary. This fire is fuel, and I need enough fuel to power me through the next four years, minimum. So I refuse to put my anger down, but I also refuse to grasp onto it and let it burn me up. I am finding meaning in my name today: Lucille means light bringer, and I'm going to let my anger run through me like a lightbulb and turn that fire into light I can shine on injustice and heat I can use to help cauterize the world's wounds, one day at a time."

I won't repeat all of the resistance acts here, but here are some general categories and highlights:



- Midwifery (and really all professions in sexual & reproductive health) is inherently political, so I counted some of my most relevant or exciting experiences in school. Learning how to insert IUDs was a definite highlight!

-Extracurricular events designed to raise awareness about specific issues included an event on queer youth in foster care and a documentary screening about abortion care in Portland and Kenya.

-I'm now a co-leader of OHSU Nursing Students for Sexual & Reproductive Health, and helping to organize an educational event with a presentation by the Cascades Abortion Surpport Collective.


-Post-election protest

-Rally against the Dakota Access Pipeline

-Women's March Against Hate with awesome friends from nursing school


-Set up a meeting with Commissioner Fritz to talk about nurses in politics

-Went to some grassroots organizing meetings

-Tried to hold space for dissonance, uncertainty, and nuance in inviting conversations with friends around issues we might disagree on

-Offered our couches up for friends traveling to a resistance-related workshop

-Online organizing: I've been doing a lot of activism housekeeping in this area to try to stay connected without overwhelming myself with redundant content. Email subscriptions, sites, and online groups I've found useful include Wall of Us, Weekly Action Checklist, Flippable, the We're His Problem Now calling sheet, Action Together Oregon, Badass Women PDX (secret group- a friend in the group to add you), and Local Love Brigade.


-Planned Parenthood. Even more fun when you do it in Mike Pence's name!


-Compassion Collective

-Signed up for a recurring donation to Sunday Assembly Portland. Secular and radically inclusive community spaces are going to matter in the days to come.

-Standing Rock, both $ and first aid supplies

Consumer Activism

-Updated my computer and phone security

-Went through our groceries with the Buycott app, and made changes accordingly

-Signed up for the PGE renewable energy program

-Switched my finances over from Bank of America to a credit union. This was definitely the most involved act of resistance and I'm so excited to call it done!

Political Advocacy

-Countless petitions, surveys, and calls to politicians and other officials. Going forward, I'll be cutting back on the petitions and focusing more on political calls. These have the most effect when they're part of a group call to action (see above for some good online groups to join).

Supporting Targeted Communities

-Dad officiated and Travis and I served as witnesses for a friend's wedding.

-Local Love Brigade is a good group to be a part of to counter local hate speech with letters of support.

Supporting and Engaging in Artistic Expression

-Went to see my high school's production of Les Mis

-Loving this sparkly uterus ornament made by a friend

-Added resistance-inspired songs to my playlists. Currently humming Utah Phillips's Ship Gonna Sail to myself as I type.

-Writing, including Facebook and blog posts, and also this poem:

Self Care

-Adding some good news to my media feeds.

-Making time to cuddle and be silly with family and friends, including a Thanksgiving cosplay photo shoot.

Current favorite caption possibilities for my River Tam cosplay include, "I can kill fascism with my brain," "Keep your tiny hands off my patients," and, "I can't find the craft blades, will these work?"

I felt a shift around the 30 day mark. I finished my last final for the term, came home and slept for a few hours, then took a hot shower. It felt like my whole body took a deep breath. I felt some of the survival mode I was hanging onto to get through finals week slip away, finally cried with a sense of release, and stepped out feeling softer. This has been my first term of midwifery school and my first month working as a nurse in dementia and end-of-life care, on top of everything going on in national and global politics. I'm thinking about how to balance staying engaged with making sure that I use this break to rest and refuel as fully as I need to. Considering I'll be working and traveling a lot over the break, I'm letting go of the resistance posts as a daily commitment, but I'll still post any particularly exciting acts. I'll be visiting Washington D.C. for the first time in a few weeks, so there should be some new resistance posts pretty soon!

Vignette: My Brother's Birth

Posted by Lucille on December 29, 2016 at 2:10 AM Comments comments (0)

My mom had a tubal ligation after I was born, and by the time I was 7, she was in her late 40s and perimenopausal. Then she started getting nauseous, a little bit at first, and then throwing-up-every-day nausea, complete with swollen feet, headaches, and a whole host of other things. Her doctor did lots of tests, moving from testing for more common things to progressively rarer and more serious things. Mom thought she had cancer (not an unreasonable conclusion, considering that she had already survived breast cancer once in her 20s). Four months later, her symptoms had lessened with medication but never completely gone away, and she still didn't have an answer from her doctor. She thought she was going to die.

In frustration and desperation, she switched to a new doctor, bringing with her an entire stack of the tests and reports from her old one. They took a blood draw to redo some of the tests. Later that night, she got a call at home.

"Hi, this is Dr. Newguy. I'm working through the reports from Dr. Oldguy to make sure I have everything straight before we make a plan for how to move forward from here. I'm not seeing a report for one here so I just wanted to check...someone gave you a pregnancy test, right?"


"A pregnancy test. Just to make sure we've ruled that out."

"I haven't had a period in a year. I'm in my late 40s. I had a tubal ligation, for Pete's sake!"

"So, you don't remember being given a pregnancy test?"


"Tell you what. I have some of your blood down in the lab for those other tests, so I'll just add that on to the other tests they're running tonight to make sure we've ruled it out. I'll call you when I have the results."

He called a short while later.

"Where are you right now?"

"At home."

"Is your husband there?"


"I'd like you to sit down. Carefully. ...Are you sitting now?"

"Yes, what's going on? Did you get the results back? Is it cancer?"

"You're pregnant. Given the tubal ligation, there's a high risk of the pregnancy being outside of the uterus. When that happens, there's a risk that the pregnancy could erode an abdominal artery, which could be a life-threatening emergency. That risk goes up as the pregnancy continues, and given how long you've been experiencing symptoms, you could be as much as 5 months pregnant. I've already sent an ambulance your way. I'd like you to stay where you are until they arrive. Don't make any sudden movements. Just try to stay calm. I'll meet you in the emergency department when you arrive."

They were in the emergency department a few minutes later, staring with absolute shock at an ultrasound machine that showed my wiggling brother, not only in the uterus, but with the placenta implanted right in the center of the back of the uterus with absolutely ideal placement. And later tests confirmed that the tubal ligation was still in place, leading them to conclude that an ovum had slipped out of a microscopic tear on one side of the Fallopian tube and into the freedom of the abdominal cavity, and then BACK through a microscopic tear on the other side to nestle into the perfect place in the uterine lining. Obviously, my parents were very concerned that the fetus might not be healthy, considering Mom's age and that she hadn't been following any pregnancy precautions, including all the medications and tests she'd been given. All I know about the decision making process from there is that Mom said they went over the risks, that it mattered that she had a choice, and that she chose to go forward with the pregnancy.

Spolier alert: my brother came out absolutely healthy. He is our local miracle child.

Once they were decided that they were going forward with the pregnancy, they chose a time to tell me. They sat me down in the living room and said they wanted to tell me something important. I remember that they both looked very serious. They were worried that I wouldn't respond well to learning that I wouldn't be an only child anymore. They had been shielding me from as much of their anxiety as they could, but I knew enough to know that Mom was sick, that the doctors weren't sure how to make her better, and that Mom and Dad were scared. So when they told me that not only was Mom NOT dying, but that I was going to get a baby brother, I exploded into ecstatic joy. My parents sat open-mouthed on the couch while I ran, dancing and singing, through the house for two hours straight. Without understanding the science of it, I understood that he had come to us unplanned and against all odds, and I was sure that the universe had sent him especially for me.

I immediately wanted to know everything there was to know about babies. We went to the bookstore, and loaded up on books about babies, puberty, pregnancy, and newborn care. We had a baby shower, and I wore my 'big sister' shirt like a crown. I don't actually remember any discussion about whether I would be at the birth. It didn't occur to me that I wouldn't be there, and if Mom and Dad did ask me, I'm sure I gave an enthusiastic yes.

My principal (a stern, older French woman) got wind that my parents were planning to allow me at the birth and asked my parents to come meet with her in the office. She explained that this would be highly frowned upon, because I would talk on the playground and then other kids would go to their parents with questions and she would have to deal with the fallout. Dad responded that they were of course getting me all of the books I wanted and answering all of my questions so that my peers would receive accurate information, and that he understood what she was saying, but there was no need to thank them, really, because after all they were just doing their jobs as my parents. He offered that if the class would like for me to put together an educational presentation, he would be happy to assist.

My principal was speechless, and didn't try to interfere in my mom's birth plans again.

I timed my mom's contractions, and when they started to come consistently 5 minutes apart, we headed to the hospital. The hospital's policy was that there needed to be an adult whose sole job was looking after me, so a family friend met us at the hospital to fill that role. As an 8 year old, being given a day with an adult whose only job is to entertain you was like Christmas come early. There was more waiting involved in labor than I expected, so we went to the park for a while and I got to pet a dog. We checked in on Mom periodically, explored the hospital, and hung out with my grandparents in the waiting room. A nurse gave me a free popsicle. Mom had a fever, so they started Pitocin and she got an epidural. We settled into the room after that, and in the early hours of the morning, I fell asleep.

They woke me up as my little brother was crowning, and I saw my first birth. These first two pictures were taken about 10 minutes apart. It's not every midwife that gets to have photo documentation of her first-ever birth high!

I was so proud of my mama. And I still feel like this kiddo found his way to us especially for me.

Resistance, Day 1

Posted by Lucille on November 10, 2016 at 5:50 PM Comments comments (0)

So much time has passed in the last day.

On the evening of November 8th, I remarked that I was nervous, but excited. Excited to witness the election of the first woman president. Excited to be done with this surreal reality show of an election. Excited to, sometime soon, watch an entire news cycle that didn't include Trump's latest violent obscenities. I remarked that there was literally nothing Trump could do that would surprise me. He could murder someone on camera and it would not have shocked me. It wouldn't even have shocked me for him to do that and then somehow be excused of all wrong doing, even praised by some people on the right. But I was wrong. There was one thing left that Trump could do that would still shock me. He won the election.

When we sat down to watch the results come in, analysts were giving Hillary a 75% chance of winning. And then Trump's numbers slowly rose. When it first rose above 50, we started pacing. We called family and friends. It dipped back below 50%, then started climbing again, and as it kept climbing, we stopped pacing and settled in front of the screen, motionless, numb with dread and horror. And then he hit 270. He did not win the popular vote, notably. But in spite of this, Trump was suddenly smiling and waving on the screen as he gave his acceptance speech.

The 24 hours that followed have been surreal.

Understand that this is not about losing an election. This is not about someone being elected who was not my preferred candidate or who has policies I disagree with. This is about electing a fascist whose policies are founded in a mentality of us vs. them, of weeding out the less desirable members of the community, of literally and figuratively building walls at every level possible. This is about electing someone who openly promotes violence against women and LGBT, Muslim, and Latinx folks, both personally and politically. I am as scared of the interpersonal violence Trump validates as I am of his policies. And he has a conservative Congress and Supreme Court with no one to hold him in check. It is not remotely an exageration to say that people will die. People, particularly in the aforementioned communities, will die as a direct result of this, both through hate crimes and through oppressive policies. The terror and rage people are feeling is real, valid, justified.

There is an order to these things. It is funny how you can know this without having lived through the opening sequence of a dystopian novel before. There is an order. First, you publicize yourself as an open door for those needing support, especially those in the communities that have been and will be most targeted. People will recognize the need for acute mental health support in the immediate aftermath of this, showing up on hotlines, in health centers, on street corners. Some of them will be professionals, others teenagers. Send them all your fierce love and pride. Send fierce love and pride, too, to everyone who recognizes their own need for support and does the brave, brave thing of seeking help when they need it.

Then, you tend to yourself. You may already see messages asking for unity across political lines. You may not be there yet. I am so sick of the false equivalences that have characterized this election. I am not in a place yet to reach for empathy for any of the people who actively or passively contributed to this disaster, and that's okay. You may already see messages expressing fear, rage, and promises of resistance or solidarity. You might not be there yet either. You might still just be numb. That is okay too. Meet yourself wherever you are. I was numb and the only thing I could feel in my body was the tension that precedes a migraine. I took my migraine pills and went to bed. Self care is radical. Should anyone start putting together an instruction manual for joining the rebels under a dystopian regime, let it be known that the Lucille-approved Step 2 is take your meds and go to bed.

Morning came, and I remembered that this had not been a nightmare. Still numb, I dragged myself to my reproductive health class. I had no energy but I went through the motions of getting to the bus stop because I felt more grateful than ever to be in school. Looking at the demographic breakdown of the election drove home the need for affordable education more than ever. It is about so much more than an individual's career aspirations or even the ability to benefit from a highly specialized profession when you need one. Affordable higher education effects our entire future as a country. 

There was a stunned, eery silence as we gathered in the classroom. Our teacher had been elevated to tears before she arrived and she thanked us for being there and opened the first part of the lecture for us to acknowlege our needs in light of recent events. We talked about what this might mean for us as future healthcare providers, including future abortion care providers. We shared our fear and horror and grief, and our resolute determination. We passed around tissues and chocolate and started plotting the revolution.

We made a plan for how to take care of ourselves while covering the content on pathophysiology effecting the menstrual cycle. It was hard to focus, but I was more successful than I expected, because continuing to learn how to empower people in their sexual & reproductive health felt like Step 3 of joining the resistance.

I came home. It had been 12 hours since Trump was elected.

There is a chunk of hours here I have trouble accounting for, and a good chance some of it was spent staring numbly at the wall, contemplating the surrealness and profound uncertainty of the future. A good portion was also spent on social media, sharing feelings and ideas, listening and serving as a mic boost for others, joining groups, signing petitions, marking down events. News reports were already coming in of hate crimes and sexual assaults across the country. I went through the motions of consuming food, then spent more time staring at the ceiling. 

In the early evening, there were sounds of helicopters and small explosions from outside. Alarmed, I pulled up the local news and saw that some people had been setting off fireworks in protest. I remembered saying before the election that if Trump won, I would protest in the streets. I had not anticipated such a profound feeling of numbness and exhaustion.

I went out onto my balcony for fresh air and looked out over my city. I have a view of the freeway where it crosses the river, with cars streaming in both directions. And then all traffic suddenly stopped. I knew, without being able to see or hear them, that that meant there were protests happening, and with enough people to shut down the entire freeway. And I suddenly knew I had to be there. Travis and I headed out.

We didn't catch up to the protest until they were back in downtown. We filed in and joined the chanting, peace signs held high. The protest joined up with a second one downtown, and then set out to make another loop across the river. We met up with friends from nursing school, marching together and yelling "Not my president," "No trump, no KKK no fascist USA," "Black lives matter, "These streets are our streets," and "Immigrants are welcome here," among others. I am enthusiastically embracing #notmypresident, not because I think disliking the outcome of an election makes it invalid, but because I honestly believe this was not democracy. Without the FBI violating the Hatch Act, without extensive gerry-mandering, without Fox News deliberately and persistently lying to voters, without widespread voter suppression, we would not be here. And moreover, I can't count the number of things Trump has done that should have immediately disqualified him.

For those who think that protests are stupid and don't accomplish anything except mass inconvenience by blocking traffic, consider that this protest was not for you. It was so that everyone who is terrified for the future and watching the coverage of hate crime after hate crime on the news will have that sequence interrupted with footage of several thousand people marching through the city, loudly and defiantly pledging their support. And it was also for ourselves. Shouting myself hoarse, my arms aching from holding peace signs over my head, my feet pounding against the pavement, I felt myself starting to slip back into my body. I moved with the current of thousands of people pledging their support for the people in their communities and their resistance against everything that Trump stands for. If protests are not for you, take care of yourself however you need to, but please understand that for thousands of people, at that moment, nothing was more important.

The protest was powerful and well orchestrated. By making a loop through downtown and across the river that included a short segment of freeway, we got to keep moving and take the freeway repeatedly without stopping any particular traffic for very long. People honked their support, raised peace signs out of their windows, and offered us high fives as we passed. Many were crying. Only twice, we passed cars who shouted racist, sexist, and homophobic slurs at us as we passed, and people were quick to remind everyone to ignore them and just keep moving forward. I also want to acknowledge the great work that the Portland Police did last night allowing us to protest safely. They helped to coordinate traffic and I never saw any of them harass the protesters. Only one person was arrested, and it was because he assaulted someone and protesters waved the police over and asked for their help getting him out of there.

I am damn proud of my city tonight.

I came home more tired but more present than I had been in the 24 hours since Trump was elected.

I have no idea what the future is going to look like, but we will face it together.

Vignette: My Name

Posted by Lucille on November 3, 2016 at 12:10 PM Comments comments (0)

My maternal grandmother, who died before I was born, was named Lucille. But both of my parents insist that I was really named after B.B. King's guitar. And B.B. King named his guitar after a bar fight that started over a hot waitress named Lucille that ended up burning the bar to the ground. So technically I'm named after a hot waitress. I can work with that.

Also at my little brother's birth, they were talking about potential baby names and Dad made a joke about how Lucille and Lucifer sounded nice together (they didn’t actually name my brother Lucifer, don’t worry). The nurse started praying fervently and backing out of the room and suddenly a new nurse came in and took over their care for the rest of the birth.

So now I have a comeback when my brother gets into me for absorbing my twin. At least Lucille means bringer of light, not bringer of darkness.

Ooh, he just pointed out that that was probably the name of my reabsorbed twin, which explains my dark alter ego.

I am my own evil twin.

Vignette: My Birth

Posted by Lucille on November 2, 2016 at 8:35 PM Comments comments (0)

My parents met in an evening French class. Both of them had been in a previous long term relationship and both wanted kids, so when they fell in love they didn't waste a lot of time before getting married and trying for a pregnancy.

Four years later, Mom still wasn't pregnant, time was ticking by, and medical tests hadn't found any causes of infertility. Dad came up with a theory that the issue was stress, so-- the way I heard it-- he showed up at her work with flowers and said, "I just quit my job, you're quitting yours, and we're moving to France and not coming back until you're pregnant."

I was conceived in France two weeks later.

Given mom's age and difficulty getting pregnant, they opted in to the available screening tests. One of them tested for a spinal protein as a way to screen for spina bifida. It came back truly off the charts. The doctor said he had literally never seen a result that high, and that for that much spinal fluid to be in the amniotic fluid, my spinal cord would have to be completely open along the full length. A repeat screening was still super high but lower than before, and all of the ultrasounds looked fine, so they encouraged my parents to be cautiously optimistic.

Mom hadn't gone into labor by my due date (Valentine's Day) and was starting to develop pre-eclampsia, so her labor was induced, on the same hospital floor where I just finished my nursing school practicum. As she started to push, a whole host of staff piled into the room- nurses, doctors, students, even an anesthesiologist- so many that they couldn't all fit and had to pile up outside the door, ready to rush me to the OR if my spine was open. And then I came out, and I was perfect. They put me on my mom's belly so that everyone could see my back. My mom knew I was okay because the emergency crew suddenly vanished, and she reached down and ran her fingers back and forth along my perfectly intact spine. In Dad's words, I was born, and I was loved, by so many people that it was two full weeks before I slept outside of someone's arms.

The final theory about the spinal protein is vanishing twin syndrome. Usually vanishing twins vanish very early, but my twin must have stuck around just long enough to start developing a spinal cord, and then been reabsorbed just in time to not be there on ultrasound. Dad likes to credit my intelligence to breathing in my vanishing twin's spinal fluid for months, and says that if only we could synthesize that protein and add it in to amniotic fluid we could breed a new generation of ultra-intelligent super humans. It gave my childhood imaginary friends a spooky factor and gave my little brother the ultimate closing argument- if I ever try to chastise him for something, he likes to remind me that at least he didn't reabsorb a sibling.

Here's my parents and I with the nurse who was at my birth. I got to talk with her this summer and send her these pictures! I attended births in this room and probably monitored little ones' heart rates with this same stethoscope.

Meeting my grandparents for the first time.

I love the triad of women in this photo: my mom, her nurse, and our family friend/doula who is also a nurse- passing on the birth knowledge and welcoming me into the world together.

Introducing: Vignettes

Posted by Lucille on October 26, 2016 at 4:10 PM Comments comments (0)

I am a storyteller. I take stories in and breathe them out, not as a hobby but as a fact of my being. It is a privilege to be going into a profession where I will get to hold listening space for many people's most intimate stories, and a challenge and responsibility to honor their trust as the gift that it is by protecting their privacy with HIPAA-level vigilance. I know some nurses and midwives accomplish this by creating a boundary around their work life and resolving not to talk about their work outside of it. To me, that sounds like trying to hold my breath for the next 50 years. Instead I'm opting to take the messier route of untangling the thread of my story from all the others woven with it.

Right now the thread of this story, at least according to this blog, starts rather abruptly at the end of my senior year of high school. Almost everything that has happened in the 5 years since then has been dutifully chronicled, without ever filling in a prologue. So I'm starting a new series of blog posts, vignettes, to share some of the most colorful snapshots of my childhood, especially those stories that get trotted out at every family gathering, growing into legends with lives of their own. Given the living nature of stories, I can't promise that these vignettes will be accurate depictions of events, but they will be an honest accounting of the way I remember or heard of them. At a certain point the way a story has shifted and grown over time holds more truth than the original spark.