Apologies in advance for the long post…will keep them short henceforth.
Well first day on the job—check. 6 hours it took to recover using every trick I know to calm myself down—check.
I went in for my first day…and to be fair, I had been told “you just show up, and they put you to work!” But I didn’t fully grasp the meaning of that statement. Until it was my turn. I threw the variety of things I thought might come in handy in my backpack. The Things Midwives Carry…our next book? I learned today that I have been spoiled rotten in a thousand ways. Sue for example, always has extra pens. Tally for example, tends to put things right where we need them. Jane, for example, has been my partner in this work for as long as I can remember and is always just, well, there. If not in person, then by text or hurried phone call with hushed tones or on the speaker phone listening to me catch a baby solo. And she is definitely always there to debrief with. She takes my side, without fail, and listens to my stories a thousand times until I have made sense of it and we can all agree on the outcome we want next time. I, for example, leave work and my colleagues and I come home to Sports Center (which amazingly, I miss!), my children, my husband…the good stuff of the life we have built together. So today, when I did what I did in this new world, and had to unwind and debrief, and it was midnight in Seattle, it took a little figuring out.
I came back to my room and wiggled out of the scrubs plastered to my body thanks to gabillions of humidity today (yes, that’s a technical weather term), and I changed. I put on my flip flops and headed out into the world, over to the other side of the island and the town. I walked the market. I purchased a cucumber-like thing for breakfast tomorrow. I walked along the water and through the dusty busy thoroughfare. I listened to my ipod—happy music, sad music, angry music, belly dancing music. I looked up and noticed the sun setting and saw the moon. It is so bright white here—it looks different than at home. I haven’t ventured out at night yet so now I was kind of excited to see the stars I have never seen before. One big star popped out. I decided to head over to where a crowd of excited locals stood talking and laughing and watching the ocean. I almost got to them when I noticed some stairs up and a sign promising air conditioning and a bar. I made my way up and was ahead of the crowd so had the attention of the waiters and waitresses who all came to chat and say hi and see who I am and where I am from. As we were talking I looked out the full glass wall and saw below hundreds of fish of all sizes. There was a large light shining on the surface of the ocean and the locals were feeding the fish. The thing that amazed me is that if there are 7 crumbs in the water but 3 fish try to get one crumb, hundreds of fish fight for that crumb while the other 6 morsels float nearby untouched. I ordered a drink and sat by the window watching the fish do their thing. This ocean doesn’t seem like the one in Hawaii—this one seems much more wild. I have nothing to base that on other than my observations tonight of thousands of welfare-fed fish but it just seems different. I thought I saw someone lighting a match in the window—smoking is allowed everywhere here—but then there was another flicker, and another. Soon the sky was filled with sparkler type flickers. I asked one of the waiters—“what is that?!” and he explained to me in a long detailed way what they are. Unfortunately he was speaking in Bislama so I have no idea what he said. But I replied, “ooooh, like Fireflies?” to which he heartily nodded and proceeded to consult a few of his co-workers “Fireflies?” “Yes, yes, blong Fireflies”. It was really magical. I have promised Julia that I will try to capture a picture of this flickering, fish-feeding frenzy when I return there next week. It was a really nice calming escape from the rest of what I will be doing here and I have promised myself one night a week out with the flickering flies and a drink. I came back to my room dripping, literally, sopping wet in sweat—despite the fact that I didn’t think I had any more in me—and skyped with Julia for a while. She was up studying for finals, a convenience for me as it felt really really good to hear about her day and her life.
So…I know…you want to know WHAT could have happened today to send me down a six hour desperate search for a little calm and comfort! Here Goes:
The oft-spoke of short cut to the hospital from where I am staying has been cemented over and the back gate to the hospital is locked tight. So even though I left here after a long swim and feeling fresh and clean, by the time I ascended Chicken Road (not the real name, but that’s what I’m calling it due to the copious amounts of chickens who reside there) and walked toe-to-heel along the “sidewalk” at the front of the building and found the hospital I was already drenched again. There were bunches of people sitting on the grassy knoll underneath the trees with coolers and blankets and fans and all manner of household items. I have to assume they have family members in the hospital for one reason or another. The hospital is a series of corridors in a row shooting off to the right and the left of a central outdoor corridor that runs the length. I found the one marked “maternity” and walked in. I walked all the way down to one end and all the way back without seeing anybody who looked like they work there. On one end there was a big open room with 8 or 10 beds and what looked like mostly postpartum moms and babies in them. There were several smaller rooms all filled with women, a desk with lots of paperwork on it but no workers. Hmmmm….I went back to the beginning and out of a room came a woman who had the look and feel of a midwife. She raised her eyebrows at me and I introduced myself.
She nearly hugged me as she went on about how busy they are and the lack of staff and the tendency for the locals to take 2 hour lunch breaks now that she taught them about this concept and insisted that they delegate their work so that they could engage in self care throughout the day…on and on…suddenly she was giving me a tour of the building and the paperwork and the people. If I ever uttered a word about redundant paperwork I apologize retroactively…I had never met redundant until today. It is hot everywhere in that building. There are fans and even an AC in one room which I got turned on but waaaaay too little, too late.
The midwife told me something about how she is keeping stats so we need to carefully make “tics” in certain columns so she will easily see which ones go into which spreadsheet…then there was a meeting with the Dr. Elias Fan Club. There was a rousing cheer for me since I know him and even more clapping and laughing and oooohing and awwwing when I told them I not only knew him, but he is a dear friend and I was with him just the day before I left Seattle. AAAAAAHHHH! I was suddenly the bringer of joy and good tidings and as one of the midwives was checking a mother for dilation she was chattering about Elias and soooo happy. The mom was nearly complete and it was a little awkward to be having this conversation while she was clearly in transition. I’m not in Kansas anymore. I got a tour of the pediatric area where I was introduced to the doc who works with babies under a year and we chatted a bit about what I know and can do there. We walked down the corridor and I saw the moms layed out on the beds with their children and I definitely had thoughts of Sam and laying on the bed next to him…these women had the same look as I’m sure I did. They are doing the thing they can do best which is just to be right there for their children. It is an action that transcends cultures, space, and time.
There are a lot of issues here with congenital heart disease due to improper nutrition–someone had the bright idea to give newborns powdered milk several years ago, which fills them up and gives them no nutrition whatsoever. This has led to a group of children with respiratory and heart failure. Breastfeeding is now so important here it has its own two forms for the midwives to document the teaching and initiating of breastfeeding.
We went for a tour of the Nursery which is their NICU, a small room with old rusty incubators and four babies who looked to be premature. There were issues with the pump which they pulled me in to resolve and then promises to have me back to help them with these fragile babies, which I am really pleased about as I might be a neonatologist in a midwife’s body and this will give me the opportunity to work in that area.
Then someone asked me to go work with a laboring woman who was in a delivery room (two beds per room, two rooms actually connected to each other btw). There were parting words along the lines of, “if the contractions aren’t close enough, just increase the syntocin”. As if I’ve ever done that before! Inductions are the property of the big hospital on the hill where I come from, not homebirth midwives! But I decided to be here, so here I am and I will be doing things I have never done before. Clearly. Long story short, this mother starts screaming at me in Bislama “You Kutum Me! You Kutom Me!” Aha! This labor stuff is the same in any language—she wants me to cut the baby out so she doesn’t have to do this anymore…”No.” I say. “Strong Mama. Strong Baby. Relax…Relax.” Her eyes popped wide open and she had me in The Stare. The one where they trust you to help them and make it alright. The one that says, “Ok—I’ll do this! But You’re Going Down With Me.”
I worked with her for a half hour and had her dancing and stomping which she loved and the local midwife was very shocked by but did not contradict me. The nurses aide came in and told her to get on the bed so I could check her. Huh? Ok. I acted like that was all normal. I didn’t feel the need to check her, I could tell from her body and her words what was happening. But I had the voices of my senior midwives in my head “when they tell you to do exams, do them…you’ll really get to understand this in a new way”….yes, there was Star-Trek music playing in the background of my mind. I checked her and she was a soft 8 with an anterior lip of a cervix. I wanted her on her hands and knees to help her dilate that bit that was left. That was more than the locals could take so I settled for asking her to lay on her left side. But everytime she jumped up and asked for a “walkabout” I encouraged her to do it while the nurse looked at me like I must be a specialist in coloring books or joke telling. But she progressed quickly and I saw from the beady sweat on her upper lip that she was ready to push. Sure enough with the next contraction she pushed at the peak. She was still standing up and I helped her to stomp until the urge was great and she would push at the peak again. The nurse finally got her on the bed but then she left and I was there and the baby was born with the perfection they are because birth really does work and I placed the baby immediately skin-to-skin and whispered to the mother “strong mama”. She looked up at me and gave me a big beautiful toothy grin.
I waited for the cord to stop pulsing before cutting it, and waited for the baby to initiate the breast crawl—which it did, of course. The rest of the day was all about postpartum care for that mama and shots and vaccines for babies. They had me bathe the baby and give her shots and as I wrapped her up I noticed a particularly foul green goo coming out of her eyes. Well that is bizarre. I spent the better part of two years rewriting the code in Washington State regarding the eye medication that is used to prevent infections that occur from STD’s from the mother. I know a lot about it. But have never seen it in person. I thought I was seeing it but took the baby to the midwife to confirm or look like an over-eager fool. She went to the prenatal forms and confirmed the mother has had Chlamydia…and we got the medication for the baby and installed it in the eyes and hopefully that will be the end of it. They told me they haven’t seen such an infection in over 18 months. It felt good catching something that really does need to be treated and is a solvable problem.
The original midwife who had given me the dizzying tour had me fill out all of the paperwork and then kicked me out. She told me to sleep in tomorrow and see how I feel then come in when I want to tomorrow or the next day and we’ll set a schedule.
It is hot hard stinky work in that hospital. My sensory overload was beyond measurement. I walked back down Chicken Road, the heat of the evening making the air thick to walk through. The boys were celebrating and had made a banner, “NumbaWan Soccer Team 2010-2011”. I found my room and that is precisely where this all started…and where it will end as I am about to drop onto my pillow for a little reprieve…