Thursday, June 26, 2008

it's raining babies here in the desert

We went through a little bit of a dry spell after the three baby day from last week's post, but the last two days have more than made up for the dry spell. One of the interns who is leaving today, Kelly, lucked out because she got two babies on her last shift. The fantasy that we all have of someone arriving on the front steps, cervix at 10 centimeters dilated, and ready to push became Kelly's dream come true today. It was pretty awesome, and a lovely birth.
Shannon and Kelly with the ubiquitous can of cola.

Shannon, Kelly, and Judy in our "spot" in the office where we've asked questions, gotten into lots of conversations about birth and life, had our convictions challenged, and watched many a movie on long nights when there weren't any babies being born here.
Shannon, Kelly, me and Consuelo in that intern couch mentioned above. Consuelo is a visiting midwife who has also been a patient and respectful teacher.
Kelly mopping up after one of her two births today.
Well, the story goes like this. We all remember Charlie's Angels (some of us are so young that we only remember the movie), so we had to pose like the Angels sin pistolas, con specula. It doesn't seem to matter how old you are, when you mix fatigue, chocolate, and cola you come up with some pretty goofy behaviours.
Shannon and Judy. Judy's taken to parenting Shannon. She's the youngest one here, and Judy is the mother of us all, but especially Shannon.
I'm not sure I really want to explain this picture. I'm not sure that I even can.
So, the goodbyes have begun. I said goodbye to A'Maya last week, because she left for vacation and won't be back until after I leave. She's been a good and patient teacher, and a whole lot of fun and support. When I come back next summer, I'll be sure to watch the Kill Bill II movie with her.

Today, we all said goodbye to Kelly. She's kept us all laughing, especially when we're all dead tired. She's going to be an awesome hardworking midwife in California, and we all wish her well.
Tomorrow I'll work my second to last shift. I said goodbye to Gina and Cynthia today, the secretaries who do so much to keep this place running. They not only manage all the administrative tasks, but also pitch in and do citas when they have a new batch of interns or we've had a birth and are overwhelmed with duties. Luz does secretarial work, citas and teaches childbirth classes as well, and I hope to say goodbye to her on Sunday. They all have to put up with new batches of interns all the time, teaching everyone the ropes every other week. It's crazy, and must make for a stressful workplace.
Even with all the hard work, and the fatigue, and the challenging situations I've faced while I've been here, I am really looking forward to back next summer to work for another month on my internship. I'm also really looking forward to going home and sleeping in my own bed, and seeing all my family and friends again.

Thursday, June 19, 2008

a three baby day

I got roused out of bed this morning at 3:00. I had told one of the other intens that I would take a shift change baby if she got one so that she could sleep, since she was working on 48 hours with hardly any z's. It turned out that no one was really having a baby, so I went back to bed until 5:50 a.m. when I started my crazy first on shift.

Thursdays aren't supposed to be crazy days. The clinic is only open for citas in the morning, and then we get to deep clean in the afternoon--wipe everything down, sterilize tools, make birth kits, etc. Today was very different from that. It became clear pretty quickly after the start of my shift that two women were in big time labor. Since I'm first on, I'm in charge of getting their vitals, checking heart tones, labor coaching, and checking in with the staff midwife about their progress. One labor is a big enough job, but two is another story altogether. That kept me hopping for a couple of hours until it was obvious that these two were going to have their babies pretty close together. Because of the relative inexperience of both me and the second on intern, we each took one birth as first on.

After the excitement of the births, there's the two hours of vitals, the discharge of the client, and then there is the clean up. Laundry is totally crazy after a birth, perhaps I've mentioned it before. Of course, the laundry from both of these births was really soiled. I had just enough time to scrub and soak and get a load in the washer before another client came in in labor.

A birth that happens 20 minutes before the end of your 12 hour shift is yours until the first two hours of vitals are done. By the time I'd finished those two hours and all the paperwork, I was finally sitting down for dinner at about 9:00 p.m.

I'm grateful for all the lessons learned today. It's rapid fire repetition when you deal with three births in a day, because there's always something to learn from each birth, and there's always something to remember from your last experience, even if it was just 2 hours ago. I'm totally grateful for the great bunch of interns I'm with right now--most of them were rousted out of bed to pitch in for a while today, and everyone helps with the laundry and the clean-up. I like the "we all pitch" in attitude. I hope that they feel that I pitch in for them when they need it.

Anyway, I'm second on now from 6 p.m until 6 a.m., then I'm off for 12 hours. I can honestly say that I'm hoping that no one is born tonight at Casa.

Buenas Noches!

Wednesday, June 18, 2008

an English cita?

I had a client yesterday who spoke fluent English. It was fun, and a good confidence builder, because I actually understood her questions, and actually had a few answers. But, ironically, I found the Spanish for the cita coming to my brain before the English. I chuckled with the client about my inability to do a prenatal check-up in anything other than broken Spanish. As someone who has spent some time thinking about education, this is an interesting phenomenon to me. I learned all these new skills along with some rudimentary Spanish at the same time. The language and the skills became linked in my brain to where now I have to re-think how I communicate in English during an appointment.

I've always been interested in other languages, but mostly have just played around with words. Everyone who has become fluent in a language other than their first has told me that you have to be immersed. I think that's true, since after only 2 1/2 weeks I have a rather functional grasp of the language. I probably speak like a two year old, though--with no articles, wrong conjugations of verbs, and a sprinkling of English thrown in. The motivation to continue to learn, though, is high when you are required to communicate. So, I've started moving beyond the statements in my handy-dandy Spanish handbook for Casa, and asking the secretaries if they can help me to understand some other things. And it's feeling more like a fun challenge, rather than something stressful. I think I'll definitely spend a lot more time studying Spanish before I come back here next summer, though, so I'll sound less like a toddler.

Sunday, June 15, 2008

hellos and goodbyes

At Casa, maybe more than other places I've been, the cycle of hellos and goodbyes is at the forefront of everything. We are always welcoming people, and then saying goodbye. Welcoming babies, and then sending them off with their parents to become a family. Welcoming new interns and sending them off to continue their learning elsewhere. It must be hard on the staff here to have so many hellos and goodbyes. Yesterday two new interns arrived. Sometimes (all right, a lot of the time) the hellos here consist of a genuine welcome followed very quickly by a request to don scrubs and jump right in. We all have to make the most of our short time here, so we don't linger too long on the hellos.

Today we said goodbye to Marcie. Marcie had a car, and was very sweet to take us all grocery shopping, and running other little errands as well. She is very generous, and didn't want money for gas or anything. She has a good way with laboring moms, and she and I have lots of things in common--we both have more kids than most people think we should have, and we both homeschooled. She will be missed.

When you spend so much time living and working with people, you get to know them pretty well. And when you spend so much time working as hard as we all do, the time moves pretty quickly. The interns almost all have families at home, so there is the additional need to connect with each other. So, already, I'm feeling a little twinge of sadness because I'm suddenly finding myself half way through my stay here, and I know that the goodbyes are coming.

Here are some good things that I can take stock in: my skills really are improving; my Spanish is still a comical mix of sign language and English words with "a" or "o" clumsily tacked on to the end, but it seems to mostly work; I've made some good friends; and I've learned that there's lots that I still need to learn. This is all good.

The current crop of interns is pretty fun, as well. We all were rolling on the floor laughing about our Spanish the other night. When you find yourself trying to talk to a mom about her pechos (breasts) because you think that she asked you about the red parts on them, only to discover that she was trying to ask you about her baby's diaper rash, the best strategy is really to just giggle about it with friends. Sometimes the addition of the "a" or "o" onto an English word really doesn't work, either, as one intern discovered. She told some bewildered parents that they didn't really need to wash their baby with sopa, a word that she thought meant soap, but really means soup. And we all very much enjoy the Spanish word for your bottom, pompis. The Spanish grammer isn't coming together as quickly as individual words, and we are often so tired sometimes it's hard to come up with words in any language. Our current Spanglish joke is "lift up your pompis, please," as one intern requested of someone needing a change of chux pads. It's probably funnier in person.

So, we're all working hard, learning lots, and thankfully we're getting a chances to laugh with each other. And even though I'm really looking forward to going home and not wearing scrubs anymore, I'm not looking forward to all the goodbyes.

Tuesday, June 10, 2008

el paso

After last Friday's meltdown, I spent much of Saturday and Sunday exploring El Paso. Since I seem to have trouble formatting the pictures with the words, this post is mostly pictures.

There's some great murals on buildings here. Is this the Virgin Mary holding a US flag?
A downtown El Paso park. The palm trees surprised me here, since I think of them as tropical.
The border between the US and Mexico. You can cross the bridge for a toll--pedestrians are $.35 each. Even though the price was right, I don't have the right documents, and the border guard told me that it's not terribly safe right now anyway.

A building in the historic downtown.
Another picture of the downtown park, in case you're getting seasick with my experimental angles.
This mountain overlooks the part of town where I'm staying. I'm told that it's quite pretty at night at the top because you can see all around--New Mexico, Mexico, etc.
Mata's fruit store right on the border. Since I couldn't cross, I thought I'd go in and experience the culture there. I was the only white girl in the store. And, Mata doesn't sell a whole lot of fruit, but there were some fresh tortillas, and some yummy looking pan dulce, or pastries. It was enormously crowded, and people "stand" in line at the check out by putting their basket down and then going off to find other things to put in it. I started standing in a line that I thought was pretty short, only to discover that I had "cut" in front of 4 other baskets that were on the floor.

This is pretty much what I expected most of the buildings here to look like. They are mostly not like this, though.

Some of the houses in a neighborhood not far from Casa. I like the desert "lawns," mostly rock or pavement, with a few artfully placed desert plants. It seem so practical to not have to water much of anything here. I am missing the green of home, though.

Saturday, June 7, 2008

a weepy day of success

It turns out that my Thursday evening weepiness lasted almost all of Friday. I really thought I had it all together, and that I was up for whatever I needed to do. Friday is a high paced day here, plus a new intern arrived and the paid staff is stretched thin. So, I started taking citas, because now I can mostly do them on my own.

One of my first clients was one who needed a vaginal exam. I'm totally nervous about this, and really don't have a clue. The staff midwife, Allie, said not to worry, she didn't really care about what this woman's cervix was doing, but that I should just go in and check it out. OK, I can do this. I did do it, and didn't really get her cervix, but managed to present my chart.

The next woman who came in also needed an exam. I sucked in my breath and stumbled through the Spanish explanation of this part of the exam. She was getting undressed when I was called into the birth room to do a birth. This is the craziest roller coaster ride ever. The birth was quick, and I didn't even get a chance to do heart tones, but there is still all the charting for the second on to do. Throngs of people are in the sala waiting for citas, most of the staff and interns are in the birth room, and I'm thinking of the poor woman sitting on the exam table waiting for her vaginal exam. I asked someone to go check on her, and finished up my duties at the birth.

Allie told me that they just let the woman go so that she wouldn't have to wait. Perfecta, I'm thinking, got out of that one. Anyone else ready to give birth here?

My third or so client was a 36 hour check, and I was at their birth, and the dad spoke English better than I speak Spanish. All was going well until the heel stick for the newborn PKU. The baby didn't bleed well, and I couldn't fill up all the dots with blood like you're supposed to. There are five circles on the form and they need to be completely filled with blood in order for the test to be accurate. The baby is wailing, and I managed to fill up three of the dots with his blood, but he started just producing tiny little drops that I knew weren't going to get the job done.

Time to call in a staff midwife. "Allie, please save this baby from me," I pleaded. She came in and had to stick him again. And then again. Then I didn't feel so badly, if someone with as much experience as Allie had to poke him two more times after I did.

So, I finished up the appointment and went to present the chart to Allie for her signature. Allie was so kind about the whole thing, that the tears and emotions from the night before, as well as the stress of the day and my tension about doing vaginal exams spilled out again. Intellectually, I know that this was not a horrid mistake, that I'm bound to make mistakes, that it was something that even Allie had to do more than once. Emotions are not intellectual or rational, and sometimes once the floodgates open, there's just no closing them again. "Maybe you could just call Marcie in, and she could take my place today?" I was told that Marcie already was in the clinic working on her day off. OK, I told myself, let's get it together here, there's enough work here today for ten people, and there are only 4 of us, plus a brand new intern.

I did citas until lunch time, then told Allie that I was going to go for a walk at lunch. Since I was second on, I put my cell phone number on the board so that they could reach me if someone came in for labor. No such luck, so back to citas.

I was doing fine until a registration came in. This is a new client, and she requires the cabeza to pies exam that I was crying about on Thursday. I went to get the Junior midwife for help. She said she would talk me through it. Her Spanish is fluent, and her way with clients is wonderful, she's a great model and patient teacher. She helped me with the whole thing, and started talking me through the vaginal exam when I started crying again.

It's the most embarrassing thing when you can't control these emotions that just keep exposing themselves, like crazy exhibitionists or something. I turned by back to the client, gathered myself and whispered, "I really don't want to do this." Seeing my distress, she said OK, she'd just do it and talk me through it. I watched carefully and paid attention to all the details, knowing that I really would eventually get over this and be able to do all of the duties I'm expected to do. Relieved and grateful, I thanked her for her understanding and went on to the next client.

My next cita was a postpartum check, 5 days. I like these, because you get to hold the babies to weigh them, and the parents are tired and happy. And I'm comfortable doing all of the things I need to do for these appointments. I do have to do a finger stick on the mommy, but I've done a lot of blundering on those already, and managed to figure it out. Now I know, for instance, to take my gloves off before I deal with the band aid, or the band aid will be on me and not on the client.

This was another stick with not a lot of blood. I didn't even get enough blood to get a reading on the Hemocue machine. Well, maybe I can let this one pass. I went to present to a different staff midwife, and she said that there's no excuse for a bad stick, and that I should get the Junior midwife in there and do it again.

Ordinarily, I would totally agree with her. I would own my mistake and try to make it right. OK, go get the Junior and tell her what happened. By the time I found her, I wasn't just weeping, I was sobbing, gasping for air like a distraught child. This was so not about a bad finger stick. I just can't get it together today, I just really need to leave I told her. We're nearly at the end of the day anyway, I just need to leave. By this time, there had been plenty of opportunity for all of the interns to have witnessed me crying at some point in the day. They all graciously picked up my slack while I went to lie on my bed and cry.

Everyone here has been so patient and understanding. They all said that they had a day of crying, too, that it's pretty typical for interns to be overwhelmed at some point. I can honestly say that everyone who's path I have crossed has had something to teach me. I learn what I want to be like, or what I don't want to be like, some new information or way of doing things, or I learn something about myself. I think this has been so hard because all of that learning is happening right now, at a break neck speed, in a different language and without my family around me.

One of the interns here, Judy, is warm and wise. She's been practicing midwifery for 26 years, has been a nurse for 30 years. She's from Georgia, and possesses a southern practicality that's hard to argue with. Confident in her knowledge and skills, she doesn't need to tell anyone that she's right, but she also respectfully speaks her mind. I am blessed to share my time here with her.

Interns Terah and Judy
She came in to hear about my day, listened patiently and then told me what was true. Girl, you don't have nothing to cry about. This wasn't a day of failures, this was a day of success. What are you going to do next time a baby doesn't bleed when you poke him? You're gonna stick him good and get it over with. You're not gonna forget that. What are you gonna do when a finger stick doesn't work? You're gonna lower her hand and squeeze her finger, and you're not gonna forget to poke her deep.
Well, I can't hardly argue with that.
I got some good information and insight from one of the staff midwives about the vaginal exams. I told her that I just don't feel prepared to do that, like I don't totally understand. She gave me a textbook and some really good thoughts as well. Listen, she said. You're not a lesbian, you've never been a lesbian, and you're probably not interested in being one. You get here and in less than a week we're telling you to do a vaginal exam--it's totally weird! And, as a woman, you know that they are uncomfortable so you are compassionate for the client.
She has a point. Finger sticks, not personal. Blood pressure, not personal. Temperature, pulse, respirations, heart tones--all not very personal. Vaginal exams are pretty darn personal. So, today, I'm sitting with my textbook, and figuring out the instrument, and learning the Spanish so that I can do this very personal thing as carefully and compassionately as possible.
Today I went walking downtown. I walked to the bridge that goes into Mexico, but learned that without my birth certificate I would have a hard time getting back into El Paso. The last thing I need is to have trouble getting back into the States. So, I headed back toward downtown and noticed a parade of some sort heading down the street. Wondering if there is some kind of Mexican holiday happening, I stopped to check it out. Within a few minutes, I was chuckling to myself because I'd found myself in the middle of the El Paso Gay Pride Parade. God has a very good sense of humor.

Friday, June 6, 2008


Well, I hit a wall yesterday. I'm not exactly sure why, since my shift yesterday was a pretty easy one. Casa is only open until 11:30 on Thursday mornings for citas. Then we take our lunch break and afterward the interns do deep cleaning. We re-stock all the cita rooms and the birth rooms, while wiping down all the shelves, doors, and drawers with disinfectant soap. There were only 5 citas scheduled in the morning, and cleaning and re-stocking is a no-brainer job that offers some time for reflection. Maybe it was the reflection part that caused me to crack a little.

I did a postpartum check on a family who's birth I was at as second on. The father spoke fluent English, so for the first time since I've been here, I was actually relaxed with a client and could share the information that I actually do know about postpartum and breastfeeding. I did have a moment when I couldn't come up with the word "colostrum." Pretty basic stuff, and since I don't even know the Spanish word for it, it's a little pathetic that I couldn't come up with the English. This was probably my best cita yet. I didn't do the newborn heel stick for the PKU, but got a good training on it, and feel a little more confident that I could do it.

So, we're going on our merry way, having a pretty relaxed day, when in comes two unscheduled citas toward the end of my shift. Since most of the interns had already disappeared by this time, I took both of them. The first one was ok, though I did need to say "voy a preguntar a la patera," (I am going to ask the midwife) and get some help. The second appointment was a registration, meaning a new client, so we are required to do a complete exam, from cabeza (head) to pies (feet). A very patient and helpful staff midwife, walked me through the whole thing, by my side the whole time. She explained everything in Spanish to the client, and in English to me, helping me to do the exam. This, as you might imagine, took some time. Registrations are longer appointments anyway, but with the new kid on the block, and doing it in Spanglish, it ended up being a hour. I'm grateful that it was such a slow day, and the gift of this whole situation was that there wasn't anyone waiting in the sala for a cita, so we actually could spend this time. This is the first time since I've been here that I've felt like my learning could be a little leisurely, so this is all good.

We set the date and time for the next cita, then LaVerne (the staff midwife who was helping me), started taking me through all that we have to do for the client's chart and the paperwork. I just burst into tears, saying "how will I ever do this exam on my own?" It all just got to me in that moment--learning so much all at once, missing my family, the fatigue.

Lucky for me, midwives are good people. LaVerne didn't even miss a beat and she was hugging me, and offering up tissues. Another intern came by and asked if I'd like to join the night crew for dinner. Since the cita took so long, it was now an hour past when I should have been off, and I was starving. I gratefully accepted the invitation, and had a lovely meal of mashed potatoes, chicken and roasted garlic. Everyone told funny stories, and it felt like family. We had cookies for dessert, three rounds. God is good.

So, I guess the biggest lesson for the day isn't really how to do an initial appointment, or how to re-stock the birth rooms, but rather that this is hard, and I'm not alone.

Wednesday, June 4, 2008

more experience. . .

Who needs dinner, anyway? I got off my shift at 6 p.m. (really almost 6:30), made some beans and rice and sat down to rest and check my email. Another intern got called into the birth room, but she went out for the day with her sister. Being the keener that I am, I just put down my bowl of beans and headed over to the clinic. The intern you paged isn't here right now, can I help? Whoo--hooo. I was solo second for two births happening within 20 minutes of each other. Totally crazy, and fun, and I got to work with a different staff midwife than I have so far, so I'm just swirling with thoughts and on a little bit of a high right now.

Seconds don't have much responsibility after the birth. I just clean up some of the tools, wipe down the counters in the lab, and re-assemble the "birth bowls" that contain all the supplies we need for a birth. So, by 10:30, I'm done with those extra responsibilities and back in the house. Not quite ready to sleep, though. There are some things I want to look up. But, I do have to be on call by 6 a.m. tomorrow, and working another day of citas by 8 a.m. I'll go to bed soon.


A day full of citas today. An internship here is sink or swim. From not knowing how to do much of anything, to speaking some rudimentary Spanish, doing finger sticks, doing prenatal appointments; and by the end of the day, I was even brave enough to attempt a newborn heel poke for PKU. It didn't go very well, and the poor thing had to get poked again. I'll be better next time. Tienes preguntas (do you have any questions?) gets me in trouble about every time. I'm pretty relieved when they say no.

I was second on today, but ended up missing the opportunity to serve at both of the births that happened today. The first one happened at a shift change, so the previous shift first on was there, and the current shift first on as well. So they ending up doing the birth, and I got to observe. The second birth was happening in the middle of my not-going-so-well newborn PKU test, and the staff midwife pulled in another intern. I did make it to the birth just as the head was coming out, so it's another observe. I had a conversation with another intern who thought it was useless to be an observer. I think that there's lots to learn as an observer, even if it's just watching how another midwife does things. And you never know when something really interesting might happen. I've decided that it's best not to just shrug off a birth as "just another birth." That's not how I want to be, even when I'm really good at all the skills and not having to think about each step.

I'm going out for a walk tonight, and taking the camera. So, hopefully, tomorrow night I'll figure out how to put pics on the next post.

Buenes noches!

Tuesday, June 3, 2008

24 hours on, 24 hours off

I worked as shadow to the second on yesterday during the day. That means that I followed the second around doing citas all day from 8:00 a.m. until about 5:30 p.m. I'm getting an idea of what it means to run a cita, but I still wouldn't be totally comfortable running one. Tomorrow I'll be running citas with a staff midwife. More Spanish studying tonight to get ready.

I was the second on (not shadow) last night. That means that I worked at the birth that happened at 6:30 p.m. Then, I was "on call" until 6 a.m. on Tuesday. I'm getting a wee bit confused about just what day it is. After a day of citas I was pretty tired, so I was glad that the birth happened fairly early in the evening. I helped with the clean-up of the supplies, etc, then was told that I could sleep. I fell into bed at what felt like midnight, but it was really only 10 p.m. And since there were no births last night, I got to sleep until after 7 a.m. I really can't complain too badly, since the two interns who are currently working as first ons are both pregnant--one is in her first trimester and feeling queasy, the other is in her third trimester and feeling huge. They are real troopers, both.

I'm learning about taking heart tones during the pushing part of birth. And since I'm clumsy about all of this, I'm working on getting coordinated with taking the heart tones AND doing the charting. I feel pretty comfortable charting, taking the notes, paying attention to the times. I'm glad to be working on something I'm not so comfortable with.

Some exploring was on my agenda today, on my day off. I walked to downtown El Paso, and I tried to do it while it was still only in the 80's, and not when it got to 100 degrees. I forgot to bring my camera along, which is my plan to eventually upload some pics of where I am. I got to walk through a residential area that is pretty. I'm appreciating the fact that the majority of the homes here have desert scapes for landscaping, rather than water consuming lawns. Looking at the yards with rocks and pavement, I did wonder where the children play (and I was hearing that Cat Stevens song in my head). I guess when you live in a desert, it's just one big sandbox.

About an hour and a half later, I arrived back at Casa, only to be told that a birth was imminent and that they wanted me to take heart tones during second stage. Always learning, taking every opportunity, even on a day off. I'm getting a little better about handling the doppler, remembering to turn it on after it's in position, and off before I remove it. There's this horrible static-y noise that happens if you don't remember to do that. I wasn't expected to anything other than this, so it didn't take too long before I'm back to my day off.

The story of how Casa de Nacimiento came about is a good one, though long. If you're interested, you'll find it here. The history of midwifery is interesting, too. There have always been midwives at births, but at times in history this has been threatening to someone, and they have often been the subject of persecution. There are present day persecution of midwives as well. Linda Arnold, the founder of Casa, was persecuted by the local medical community. She's clearly a woman of strength and has created what is now a well-established clinic, and an internationally known training center for midwives. I was loving paging through the intern contact book and seeing all the different places people were from. And I'm loving being part of that larger community of women.

Well, I'm off to study for my test that I need to take on Friday, and to try to learn more Spanish.
Spanish words and phrases that come in handy:
lo siento: I'm sorry
bebe es precios(o)-(a): baby is precious
tienes preguntas: do you have questions (I have to use this one carefully, because I'm sure I won't understand the questions if they do have them)

Sunday, June 1, 2008

a day of rest. . .sort of

I went to church today. There is an Antiochian Orthodox church about 5 miles from here. It's a little too far to walk in 101 degrees, but one of the interns has a rented car for her stay and she graciously offered to drop me off. I left the worrying about the return trip up to God.

It is a lovely building, only about five years old, and the people there received me warmly. Many are of Syrian descent, and their music reflects their middle eastern heritage. The choir today was a sweetly enthusiastic group of children, the oldest perhaps ten. They were singing some pretty challenging tunes and they did all right until one little boy was attacked by an infectious bout of the giggles during the Cherubic Hymn. This, during one of the high points of the Holy Service, is a total bummer. And, as one who has been attacked by the giggles while singing in the Divine Services, I had complete and total compassion for the choir and their enormously patient director.

It's been a while since the only work I've had to do during a church service is pray. I enjoyed it enormously. I prayed for all of my family, especially for Dave and the kids. I miss them lots, and I know that Liam doesn't really understand how long I'll be gone. Dave will have his hands more than full, and he's already sounding tired. I prayed for strength for all of us, that the Lord will be with us during this trying month. I also spent a lot of time praying for the gift of humility, as I know that it is not my strength, and that I will definitely need it while learning all these new skills from so many different people.

Fr. George offered a lovely thought during the homily, and I'll probably paraphrase it all wrong. He said that the Lord tells us that disadvantage doesn't come as the result of sin on the part of the disadvantaged; it comes instead so that God's grace will be manifest for all. I'm watching and trying to stay in tune with the grace that I see offered here everday.

A new mother and her sweet baby boy were churched this morning before the Divine Liturgy. Their family offered up snacks during the coffee hour, and I was invited to participate. I did meet some very nice people, and one of them even offered to drive me back to Casa. Aha, another bit of grace offered up. . .

I've been to three births so far since I've been here. Due to HIPPA laws, I cannot share anything about these experiences publicly. Because I've been deemed a "keener" by the staff midwives, I've been scheduled to be "second on" tonight when I work from 6 pm to 6 am. The "second on" does much of what I've already done at home during a birth, with the addition of heart tones for the baby during second stage. Even though I'm nervous and feeling not quite ready for this, I'm accepting the challenge and looking at it as adding one more skill in my repetoire. But, because I'm scheduled as "second on," I've done a little extra duty to get ready for it. I attended a birth last night shadowing the second, and this afternoon as well. Luckily, I can sleep, as long as I wake up when I'm needed. So, I'm going into this night with not very much sleep already. I'll try to catch up a little at least with a cat nap here or there. Wish me luck. . .

Saturday, May 31, 2008

the first day. . .

is quickly coming to a close. It's been a long one. I worked a 12-ish hour shift shadowing the "first on" intern. The "first on" is an intern who knows the ropes, can run a "cita" (appointment) and would be the lead on a birth. She has to have her work checked by a staff midwife, and is still learning how things go here, but all the first ons know lots more than me.

The language is an issue for me. I'm going to study my quick guide to Spanish at Casa tomorrow afternoon. The "me llamo Anja" conversation only goes so far, and is totally unhelpful when dealing with someone who is in labor and needs your help. I need some good words for that situation, so I'm going to try to get them as quickly as possible.

Many of the women who come to Casa live over the bridge in Juarez, Mexico. They come here to have their babies, and give them a U.S. birth certificate. Some are not so lucky, and end up delivering in the car on the bridge. The immigration officials are mighty fine birth attendants, I'm sure, and they end up sending them back home.

There is a lot to learn here--so far I've managed to master the garbage. Garbage is trickier than you would think. There is garbage that goes in the regular trash, the recycling, and then there is the red bag garbage labeled "biohazard." Any yucky bodily fluid containing trash goes in the red bags, and in an outdoor can that is in a locked cage. A special garbage contractor picks it up. You have to know the code for the locked cage. And you have to know how to work the lock. And you have to know that you should probably take your gloves off before you attempt to work the combination on the lock, as you will only end up shredding them anyway while you work the lock and try really hard to remember the code without having to go back into the building to double check for the third time. It's complicated, really. Interestingly, the bathroom garbage (to which I alluded in yesterday's post) is not biohazard garbage.

Many of the people here are doing really amazing things with their skills. Training traditional midwives in Africa, setting up missionary clinics--I'm in awe of the gifts that these woman are offering to the world. The PBS show Nova just did a show addressing some of the issues for birthing women in Africa. It is heartbreaking. But the issues of poverty and pregnancy are not so far away. They are here in El Paso, and I'm sure they are at home, too. It would be lovely if I could figure out a way to help this situation at some point. The poor are always among us, offering us an opportunity to serve.

Well, 10:00 p.m. is about as late as I've ever eaten dinner. I'm going to finish up and head to bed.

p.s. for those of you who were having a hard time posting comments, I think that you may have to get a login in, or use your gmail account information to log in and post comments.

Friday, May 30, 2008


I arrived this morning in El Paso. The flight was pretty un-eventful, a little rain in Milwaukee, a slight delay in Denver. All in all, not too bad compared to horror stories you hear about air travel these days. I liked flying on Frontier (their tag line is "A Whole Different Animal," and they have all these animals on their airplanes.); their service was good--my bag had already gone round the carousel a time or two by the time I got there.

So far, I wouldn't call El Paso a beautiful city. If it is, I'm not in the beautiful part of town. It's quite warm here today (99 degrees), but a lot of things are blooming, so that's encouraging. It's definitely a desert here, and the mountains in the distance look like giant piles of dirt, with very little green on them.

A $20 (fifteen minute) cab ride got me to Casa de Nacimiento. You can take a virtual tour of my digs here. Think college rental, not the expensive ones, either. There's a little sign near each of the toilets that says "do not put toilet paper in the toilet." I must say that I was rather mystified. Where to put it, exactly? And, even though I had visited the facilities in each of the airports I was in this morning, I was needing to do something that would require toilet paper. Just a wee bit awkward. Hmmm, should I wake the sleeping intern and ask? No, I don't think so. I'll just see if I can figure this one out on my own. I'll be sure to keep you posted.

Feeling a little hungry, so I walked just a couple of blocks away and got a pretty good, pretty inexpensive Chinese meal. Then to the convenience store to face all my food snobbishness head-on. The cold beer section of this little grocery store is about twice the size of the dairy cooler. Not a lot here in the way of produce, and there was nary a slice of bread that I wanted to buy. I decided to stick with the basics--lettuce, eggs, pasta, a little cheese, bananas and tuna. I'll figure something out here, too.

I had a pretty curt introduction to Casa from one of the current interns. Don't let your food storage exceed the designated space, or someone will eat it. Clean up after yourself. Don't leave your stuff lying around. You're expected to do chores, and keep the kitchen clean. (See, kiddos--I'm telling you, this is the stuff of life. No matter where you go, folks appreciate you if you can take care of yourself, and pitch in to help others, too.)

So, I'm already missing the life I left. I was thinking this morning, though, that I really needed to just be removed from that wonderful, busy life to be able to make this dream come true. I think I would always be able to find another load of laundry to wash, another email to send, another dinner to cook, and I would always end up putting this idea on the back burner. I'm very grateful for all the folks who are helping me to make this possible, especially my dear husband and sweet children. I'll do my very best to make sure that it was all worthwhile in the end.