Wednesday, June 24, 2009

counting days

This is starting to feel long to me. I've been here exactly 15 days, and I have 22 days left. There are four interns here right now, which is barely enough bodies to cover the shifts. So, we're all working hard, and taking our time off seriously.

Since we don't live in a very enchanting neighborhood, we have to walk, bus, or beg a ride to somewhere else when we're not working. Popular outings have included shopping (mostly for groceries, but also trips to various malls in El Paso), church, the movies, and exercising (walking, running or taking the community bike out for a spin). One of the interns, KD, has been very generous with her car, so I've been able to get out farther than I could go walking or on the bike that doesn't exactly fit me. I have 24 hours off starting tomorrow morning at 6 am, so I'm already plotting what to do during that time.

We had a flurry of babies when I first got here, and they've been trickling in ever since. We all feel a little like we're in the calm before the storm. We've had some late registrations (people coming in late in their pregnancy to register for care for the first time), so the numbers that are due are kind of building. We had such a late registration, that by the time she finished all the paperwork, the interview with the secretaries, and the exam with the intern, she was in active labor. So she came in to register, and ended up staying to have her baby. Pretty crazy, but also fun.

I do like that there's always something unexpected happening. There's never a "regular" day, really; there's plenty of opportunity to learn, to see and do, and to stretch and grow. I really shouldn't be counting days, but here I am doing so anyway.

What I'm going to do tomorrow depends a little bit at least on what happens tonight. I'm second on tonight. When you're second in the night, you can be in the intern house, but you have to be in scrubs the whole night so that if someone comes in laboring, you can head over to the clinic immediately when you're called. If nothing happens in the evening, you get to sleep. The duties for the second on person are rather limited, so once the birth happens and your chores are done you can go back to bed. All in all, you might end up being up for a couple of hours at most, but depending on when it happens, you could be needing some sleep the next day. So, I'm thinking that tomorrow may bring some sleep, some studying, some knitting, and a walk. Hopefully, I'll feel re-charged in case the storm of babies hits this weekend when I'm on for another 24 hour stint.

Friday, June 19, 2009

longing for green

I left Wisconsin just as spring was getting into full swing and my favorite flowers (if I actually had to choose one single type of flower as a favorite) were just beginning to bloom. There are no irises here in El Paso, or they've already done their blooming before I got here. So, I posted a whiney plea on FaceBook for someone, anyone to send some pictures of things green and growing. Here's what I got:

And the best of all. . .

I went hiking today in Franklin Mountains State Park in El Paso. This is the largest urban state park in the nation, and is nearly 37 square miles. I asked everyone at the clinic who lives in or near El Paso about the park, and almost without exception they all said, "what park?" Anyway, it's quite beautiful in a reddish brown sort of way. I hiked 1.2 miles uphill (some parts were pretty steep) to an Aztec cave. Since there are signs all over the park that caution you to watch for snakes, and since I'm pretty sure there were probably bats hanging from the ceiling in the cave, I just waved to it from the outside instead of going in. I rested a little bit, took some pictures, caught my breath and headed down the hill. The hike up the hill was quite aerobic, and the hike down was an exercise in quad strength to keep myself from sliding down the hill on my butt. I'm sure I'll be sore tomorrow. But it's a good kind of tired, and one that will hopefully help me to sleep well tonight for my next shift tomorrow.
Something about this landscape makes me expect a Tyrannosaurus rex to come around the next bend at any moment.
Not quite an iris, but a bit of purple in the desert nonetheless.

I really did do the hike, I didn't just scan in some cool postcards or something. Here I am all sweaty and red-faced to prove it.
I think that Opuntia cactus are pretty cool. You can find them on the menu in restaurants here. I've never tried to eat them.
It was soooo quiet here--no phones, no one talking in any language, no traffic. It was heavenly. I did meet two people coming up the trail when I was going down, but other than that it was just me and the birds. Nice.
The last few steps up to the cave. I stopped to catch my breath here, because it had been quite a climb.The entrance to the cave. I would have been interested to go in if I hadn't been alone. As it was, I didn't think my camera or my cell phone would help me very much if a rattler was lurking.

The view from the top was pretty impressive.

Wednesday, June 17, 2009


We've had a stretch here of a baby about every 12 hours. It's been crazy fun. Four of them were primary catches for me--yippee! There are three birth rooms here, and a fourth room that is a cita room, but could be a birth room in a pinch. So far, we've had the three rooms all occupied at one time on one day. That was a busy day, especially since we were also doing citas. I've never seen it so busy that we had to use the double duty room, but I understand that at times, the whole place here is filled with laboring women. They've done upwards of eighty births a month in this little place.

If I were only here for the "numbers" (meaning the numbers of births required for submitting your paperwork to become a Certified Professional Midwife, CPM), I could go home now. But, knowing that it would leave everyone here to pick up my slack I won't do that. Besides, my learning goals are pretty specific, and this visit really isn't about the numbers, but about repeated opportunities to practice hands-on skills so that I can really feel confident in them.

I'm at the end of my first week here and remembering last year at this time wasn't so fun for me. The great interns that I spent my time with here last year are on my mind as well, and I am re-appreciating the great gifts of understanding, wisdom, and friendship that they offered me at that time. I'm a lot more relaxed here this year--and even though I wish my Spanish was better, I'm confident in my skills and not so nervous about everything.

There's an intern here this year who reminds me of last year's version of me. Though her reactions to being here aren't as emotional as mine were, she is definitely frustrated and stressed out. All of the interns eventually get frustrated, stressed out and exhausted, but I think the problem is compounded when your skills are at such a beginning stage.

I've decided that it's my turn to give back the kind nurturing that I got from the other interns last year. "See one, do one, teach one," is what a doctor who visits the clinic told me last year. It only took me a year to get the wisdom of this statement. Observe, do, and then teach--my only caveat to this might be to see and do more than just one so that you can be a good teacher. It is in the teaching that your learning sends down deep roots into your brain and your muscles, and if you're mindful, you get more out of the act of teaching than your student.

Tuesday, June 16, 2009


Experience has a way of teaching you things you aren't likely to forget. It's so different than book learning. I would never say that book learning is irrelevant; I love books, I've learned a lot from them. And, especially as a health care practitioner, there are things you need to know but won't get very many chances to practice them because their occurrence is relatively rare. But there are lots of lessons that are well learned experientially.

Take knitting, for example. I taught myself the basic steps from a book. I particularly love the children's non-fiction section of the library for how-to books; they are full of color illustrations or pictures and simple language, just the ticket for learning a new skill. However, when I come across a confusing bit of pattern language, or a new little twist that I haven't done before, I rely on people who can help me make the next step, tuck the next skill under my belt.

I'm especially appreciating the teaching that happens at Casa this time around. I've caught two babies so far, both time with a patient midwife right next to me, taking my hands, showing me when to apply pressure and how much, when to back off. Simple clear language (in English) that helps me to really get this skill under my belt. They don't expect that since I've done it once, I'll do it perfectly the next time. The same patient respectful instructions are repeated as often as I need them to be, and the visuals (full color, real life), have been pretty unforgettable.

The lessons don't come in any tidy or orderly progression, either. A year ago, this really bugged me. I wanted the lessons to come in some kind of logical order, building one upon another. Now, while I appreciate that there are some things that you need to know and understand at the beginning, I realize that the logical order is each whole woman who comes to you. Each person's whole story instructs me, furthers my learning, and builds on what I already know. I need to understand what to look for in her prenatal care, what issues might be important for her and shepherd her through her birthing process, watchful of a new or already learned lesson.

The last year has been full of this kind of whole learning. The long labor lessons, the short labor lessons, the bleeding lessons, the breastfeeding lessons, the tiny baby lessons, the large baby lessons, the baby catching lessons, the suturing lessons have impacted the whole me--heart, mind and soul. I know that the lessons come because I need them, because I will use them, because they are working to turn me into a real midwife. And I am grateful for them, and all teachers who have helped me to learn them, pregnant women and midwives alike.

Monday, June 15, 2009

spanish, anyone?

I'm really wishing I had spent more concerted effort with my Spanish. As it is, I'm carrying around my intern handbook that has all the intern duties in it and what you could say to a client. I carry this little book into an appointment or a birth room and say "Mi Espanol es muy malo." (My Spanish is very bad) or with a gesture toward the book "Mi Espanol es aqui" (My Spanish is here). When I've misplaced this little book, I've even taken to saying, "Where did I put my Spanish?"

There are a couple of problems with this situation. The biggest for me is that I feel like I can't give very good care to these families when I'm not even close to fluent in their language. I always brace myself when I say "Tienes preguntas?" (Do you have any questions?). I know what I'm asking, but I rarely understand the actual question, and then I would have to somehow cobble together some bits and pieces to answer the question. The handbook is helpful, but it doesn't really help me put together my own thought, only hands me that of someone else.

The second problem is minor, really, as it's only about my ego. I know that people think that just because you don't know or understand a language that you must not be very smart. In my family of origin, Trivial Pursuit and games of strategy were practically aerobic sport. We really value our brains. So, knowing that my pathetic grasp of the language makes people think I don't know what I'm doing is very humbling. While I make a frantic mental search for what to say to people, they're rolling their eyes, or feeling frustrated, or feeling disrespected. Then I say something completely wrong, mispronouncing the words, and pantomiming to attempt to clarify. I rarely use verbs and when I do, I use the infinitive and don't even bother attempting to conjugate it. It's probably like trying to figure out what a toddler is trying to communicate to you. Sometimes I get my idea across, sometimes not.

Humor seems to be the best way to handle this situation. Though some of the situations I've been in the last few days have been anything but funny, at least we who are struggling with the language can laugh at ourselves. There is always someone here who knows more Spanish than I do, and as long as they know I'm trying to get it, they are willing to help.

I know for sure that in the future, I will try not to judge someone's intelligence solely based on the fact that he or she doesn't have a good grasp of the (only) language that I speak. I've met many people for whom English is not their second, but their third or fourth language. That's impressive, and shows a lot of mental flexibility.

I have a lot more practicing to do to get to feel totally comfortable, but it's definitely better than last year!

Sunday, June 14, 2009

jumping right in

I unpacked all my things, and claimed the same bed I had last year. There is an intern here who has a car, and she graciously offered to take me to Sun Harvest, the local health food store. I got all stocked up on yummy, healthy food. I've been eating my greens (chard and broccoli) nearly every day, and there were some really good cherries to be had as well.

Pretty quickly after I was settled in, there was someone in the clinic in labor. All right! This is what I came for. Though I wasn't scheduled to work the first night I arrived, I helped one of the newer interns do the "2nd on" job--the assistant at the birth. It may seem like a bummer to observe, but really it's not. You always learn something at a birth, and there's always something interesting happening. If nothing else, you can practice in your head what you will do when you get to be the "hands-on" girl.

Wednesday was a busy day, full of citas and birth. The "1st on" in the daytime is very new to midwifery, and the "2nd on" as well. I was "3rd on." After the citas began, we had someone come in laboring. The 1st on is responsible for monitoring the laboring woman, and continuing to help out with the prenatal and postpartum appointments. Then another woman came in in labor. This would also be the job of the 1st on if she were experienced, but the staff midwife decided to give the 2nd on this person to be her primary. That left me doing citas, which was pretty fine with me. I did most of the appointments that day, and began working on cleaning up the clinic.

Late in the afternoon, a third woman entered the clinic in labor. So, I was assigned her care. Since she was in early labor, I guessed that I probably wouldn't be primary at her birth. The rule is that if the birth is imminent at the end of your shift, you stay in the primary 1st on role, and complete 2 hours of vitals, and do her laundry as well. Honestly, it's kind of nice to be able to be off after a 12 hour shift, so I'm glad that I got to hand her over to the shift that came on at 6pm.

The incoming shift included an intern who's been here nearly a month and didn't have that many births. That was a bummer for her, so I was glad that she got to be first on when these ladies finally birthed. My time will come.

I observed the first birth that happened in the evening, but decided to go to bed before the second birth. Since I was pretty tired, and had only been asleep perhaps 30 minutes when the code was called (the students get paged when a birth is imminent so that they can choose to observe), I decided instead to sleep. My time will come, for sure!

Thursday is only a half day of appointments, and then the clinic gets thoroughly cleaned and restocked by the interns. We were very busy cleaning, sterilizing instruments, making gauze packs for sterilization. It was hot and sweaty work, but also satisfying to tidy everything up, make sure there is enough paper towels, tissues, and ky stocked in all the rooms.

Back to the intern house after the shift for some dinner and bonding with the girls. I think it's important to bond with the other interns, because sometimes this work is hard, and we have to be a team. We have to work together, regardless of how tired, stressed, overwhelmed, or cranky we are. Having a little fun together is priceless team building.

Thursday, June 11, 2009

leaving and arriving

This trip to Casa is different in a lot of ways than the trip last summer. I feel like I'm a completely different person. I have a lot more midwifery education and experience under my belt; I have some pretty specific goals for learning this time around. When I remember that I really only knew how to take a blood pressure and not much else, it's no wonder that the experience was overwhelming at times. I'm looking forward to this stay primarily because I'm feeling more confident with my skills.

But the last couple of days before leaving are feeling sad to me. I'll be gone 5 weeks this time. It's a long time. Short in the big scheme of things, but a long time to be away from my regular life. I'll be missing some births back home while I'm gone, and since they are clients I've come to know, that feels sad as well. My partnership with Andi in Appleton Community Midwives feels like it's taking on some inspired momentum, and now I won't be contributing much to that effort while I'm gone. I'm definitely measuring the trade-offs this year. The benefits of this experience are still out-weighing the drawbacks, but there is sadness there nonetheless.

So, 5/6 of the Farins drove to Milwaukee on Monday night. There we visited with cousins, and I stayed overnight because my flight left at 6 the next morning. Auntie Juj pointed out that my one, gigantic suitcase may not make the weight limit. We got out the bathroom scale and proceeded to shift my possessions around a bit while several people commented on the contents of my bags. I was trying to avoid having to ship a box this year, but it did make for some heavy bags.

My brother-in-law gave me an early morning ride to the airport through a bit of a mist. Awfully nice of him to wake up at 4:30 am to get me to the airport. Thanks, Steve! I like these early morning flights--they're cheaper, they're rarely delayed, and no one talks to you. It's my kind of flight. I had checked in via internet the night before, and it really made my experience at the ticketing counter a breeze. I was the only person in the web check-in line, so I literally cut in front of probably 30 people standing in line, handed them my bag, showed my ID and was on to security. Since there was a problem with their computers, it took everyone else another 45 minutes to check in.

The flight was uneventful; probably half of the travelers were sleeping. It was nice to fly over the clouds that have been so pervasive the last week or so at home, and to see the blue sky and sun out my window. As we descended into Denver, the plane slipped through a silky fog and we were once again under the blanket of grey clouds.

I had about an hour and 45 minutes to spend in the Denver airport. Food seemed important. Lunch at 9:30 in the morning is weird until you remember that you've been up for 5 hours already. And I decided that I wanted some reading material. I had planned on knitting during the flights, but in the great shuffle of my bags the previous night, not all of my things were in one place. Lunch first, then I set out to browse the tiny selection of books in the airport newsstand.

A bit of fiction was on my mind, something that didn't have anything to do with birthing babies. And it can't make my bags exceed the weight limit. Or be scary or violent. I feel like my heart has been cracked open wide by being a mom, and in my middle age has become a big mushy puddle. This situation is compounded by my chosen profession. I've met some seasoned midwives who seem like the kind who will hitch up their dog team and mush out to your birth in 20 degrees below zero, and perhaps kill something for dinner on the way there. Not me and my mush puddle of a heart, with tears brimming embarrasingly close to the surface at all times. I was pretty devastated by The Kite Runner and then The Life of Pi, read in quick succession some years ago, and I'm not sure I'm quite over it yet. I need my fiction to be gentle with me. A lightweight paperback of only 288 pages, The Guernsey Literary and Potato Peel Pie Society seemed to fit the bill perfectly.
My belly full, and my book tucked under my arm, I was soon boarding a small plane for the remaining leg of the journey to El Paso. I know many people don't like these smaller planes, but I think it's pretty cool to be able to see the land as I'm flying over it. A regular patchwork of rectangular farm fields and roads on the high plateau of Colorado gave way to the earth all crumpled up on itself and winding roads through the mountains. Greens turned greener as we passed over the mountains, and there were even some white capped peaks; eventually the colors became the unmistakable browns of the desert. Our arrival in El Paso was greeted by overcast skies and the the Bienvenudo a El Paso sign on the airport roof.

An eager cab driver grabbed my bags before I was totally aware that he wasn't intending to steal them, and we headed to Casa. It was lunch time when I arrived, so people weren't all crazy with citas. I met my fellow interns, only three others are here right now. One is getting ready to leave soon, and the other two have been here a week. No one is quite as green as I was last year. I understand that there are 30 births on the books for this month, and only one had happened before I arrived. I hope that all the 29 others and some from July will come while I'm here.

Wednesday, June 10, 2009

getting ready

The last six weeks or so of the school year are quite the whirlwind. There are numerous activites-- awards nights, concerts, fieldtrips. With four kids, the schedule is mind-boggling. I've been thinking about getting ready for my second trip to Casa, but not making terribly much progress towards that.

Additionally, there was the garden. I had great success with winter sowing this year, and had lots of seedlings to plant. Plus, we expanded our vegetable garden space nearly double from last year, so there was plenty of yard work to do.

Graduations and their ensuing parties are populating our calendar currently. Lots to celebrate for friends and family!

Jasper was invited to sing in a local production of "Carmen." In between soccer practices, we were running him to choir rehearsals. The show was great; it was a great opportunity for him.

There seem to be a lot of special projects at school during the last month of school as well. Food needed to be brought in at specific times, and prepared in specific ways. Liam's kindergarten teacher sent home a request for a picture of him at each age he's been so far. Is she serious? Does she think I don't have anything else to do? I'm not entirely sure I even have a picture of him at every age. As a fourth child (who is, of course, loved no less than his older sibs), there is a relative dearth of photographic documentation of his life. The morning I was to send this assignment in to school with him, I spent an hour and a half digging through photos. I was missing two years. Two whole years? Surely I'd taken some pictures for those two years. Where were they? I filled in with a photo from the fridge, and Elena did an excellent drawing of one that is framed. Oh, did I mention that the pictures were going to be destroyed in the making of the project? That little wrinkle made me a little less willing to part with the pictures.

Kids activities that I have no control over aside, then there were the things that I did have control over. Like starting some sewing projects. A summer top and skirt for El, some baby dresses for friends with new babies. I really didn't need to start another project, but somehow I talked myself into it. I do like the meditative quality of ironing and sewing, so I did get some good thinking done. I located the missing two years of pictures when I went on a failed hunt for my button collection. And one day, I even listened to some Spanish tapes.

Oh, yes, the Spanish. My goal was to be pretty fluent when I came back to Casa. I bought an internet program, and some birth Spanish tapes. I spent relatively little time with either of these tools, and found myself trying to "cram" the language during the last several weeks before I left. How silly! I feel pretty disappointed with that, but I think it will come a little easier this time. They say that you have to use a language, or you'll lose it. I believe that to a point. I have found some French vocabulary come out of my mouth when the Spanish just wouldn't come to me, and I knew I needed a foreign word. I haven't used that French since college. It's in there somewhere; just a little rusty.

Once again this year, I feel the support of my family and friends as I take this on. It's great to know that there are people who will bake belly cakes for me, loan me suitcases, and offer prayers and good wishes. It's especially nice to have a husband who is supportive and ready to be super dad again. Hopefully, it's a productive month!