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.

1 comment:

juj said...

Anj, hope you're not still weeping as you can dehydrate in a place like that. No seriously, you are learning some pretty amazing things at a pretty intense speed so don't be so hard on yourself. We're all amazed at your strength and wisdom all the time. Keep up the good works. Sophie wants to teach you some Spanish. She can converse, but she doesn't usually talk about vaginas, so I don't know if it would help. Everyone says "hi" except for Charlie who said "happy birfday". We're all proud of you for what you are doing. Love you and see you soon.