(Note...for those who, for whatever reason may be reading this blog, and think that I'm in a mass "catch up" mode because it's been waaaay too long since I've made any entries...you would be correct ;-) ).
A couple of weeks ago I was going through my email and opened a notice from a national list that I belong to. In one entry, the poster left a url to her Utube documentary of moments during her pregnancy and birthing. Lo and behold, when one picture captioned "My midwife" came across the screen, I actually clapped and cheered (a little...I mean, I was sitting alone at a keyboard in front of a computer monitor...didn't want to look like I was...emotionally challenged).
The picture was of a very special woman...a midwife who I met nearly 10 years ago when I was a brand new L&D nurse, and she was a "vet" nurse, having been on L&D for over 20 years.
That job was one of the most miserable jobs I have ever had. I had just put in my obligatory year of med/surge nursing where I had been very very successful, fresh out of college, when I transferred to where I had planned to be all along, labor and delivery.
First day out of the gate, I went into a total state of shock.
This was the late Nineties...I had "come of age" in the Seventies, in the era of "Our Bodies Ourselves", Ina May Gaskin, fighting for our rights in the hospital to have our partners at our side, to birth our babies naturally, without the fog of Scopalamine or Demerol, of immedate bonding and breastfeeding, of Bradley, Lamaze, and VBAC. Although I didn't give birth myself until nearly fifteen years later, I totally absorbed that mind set. I had pretty much gotten what I wanted when I gave birth for the first time in the late Eighties. I had no idea how much things had changed (read that regressed) in the "Self Empowerment in Birthing" school of thought. I was stunned at all the planned inductions, the "epidural as norm" attitude, and the relative ease with which the decision to perform a Cesarean Section was made. Honest to God, I even remember a physician sitting on the edge of the bed of a newly admitted, beautifully laboring multip, with a history of two vaginal births , then a c/section, and finally a successful VBAC, trying with all her might to convince the mother that it was too dangerous to "attempt" another VBAC, and that she should immediately prepare for surgery! She didn't, thank God, despite what was essentially a temper tantrum by her physician...the same physician who had attended her VBAC!!!!!
Needless to say, things didn't go well for me. I was simply aghast that mother's seemed to just accept drivel like this, few if any took childbirth preparation classes, or if they did, they managed to squeeze them in during an 8-hour marathon Saturday class, and that most of them wanted to "stop being pregnant" by 39 weeks, so they gladly scheduled their inductions, and the first question out of their mouths upon arrival was not "How soon can I breastfeed my baby", but "How soon can I get my epidural"? My sense of shock must have come across loud and clear, because I was not a favorite of the Assistant Nurse Manager or the Nurse Trainers on that floor. We butted heads over and over again. The Nurse Manager and I got along well...she knew where I was coming from. She was a woman who truly cared about both the patients on her unit, as well as her staff, but even she was struggling. Turns out that Ms. Assistant Nurse Manager had applied for the job, but had not gotten it because she didn't have the required Master's degree. The Trainers were her "homies" from years and years of working together. Together, they had as their mission in life to make the Nurse Manager's life miserable. Did I say I hated that Job? I hated, hated, hated it!
Three months into the job (I don't know how I even lasted that long) I was diagnosed with a serious surgical problem, and took a long (about another three months) sick leave post op. Somehow I managed to drag myself back to the unit after my leave, only to learn that, in my absence, the Nurse Manager had left for a position in the hospital I now work in, and Psycho Assistant Nurse Manager had inherited the job because no one else was willing to even apply for it!.
Crap. No, make that Shit! Shit, Shit, Shit! Sometimes, there's only one word that fits, and this is the one!
It took about three days before I was a complete basket case. PNM (Psycho Nurse Manager) decided that I needed to be "reoriented", since I had barely finished my orientation to the unit before I became sick. In other words, she wasn't going to let one of her predecessor's allies stay on her unit if she could help it. At the same time, she was making life miserable for her other "targets", many of whom decided to resign, and with each new space that opened, she brought in one of her "homies" from her former employer, a decrepit unit downtown that still practiced like they were in the dark ages. It was becoming a unit of battleaxes.
I don't know why I kept fighting. I'm very stubborn. I keep thinking that if I just try one more thing I'll be ableto "fix" whatever is going on that is not working. I have an uncanny way of making myself (and anyone close to me) nuts that way. Stupid, I know.
Enter K...othewise known as, "She Who Introduced Me to the Sanity of Hope and Knowing Myself".
One long, late, dark night on the unit I was working in the newborn nursery all alone (for of course, all mothers were encouraged to "rest" by leaving their newborns to cry it out in the nursery all night). I had just managed, as a new L&D nurse, to get the entire nursery (that night about a dozen babies) bathed, vaccinated, fed, tucked in and charted for the night (I came to find out later that this was both unheard of and discouraged for nurses of my level of inexperience, but PNM was working very hard to get me to dig myself into a hole, and she didn't care if she put any or all of the infants on the unit at risk to do it). As I stood looking out over the parking lot from the (now quiet) nursery's window, K. walked up beside me, put her hand on my shoulder and said "nice job...you're going to be good at this...if you can stand it much longer".
I almost (almost...I'm too stubborn to otherwise) cried.
As we continued to talk, I learned that K. was as unhappy with what she was doing as I was...I remember breathing a huge sigh of relief hearing her say she hated seeing women being "treated like cattle" - finally someone acknowledged how I felt!. When I asked her why she was still there, she told me she was apprenticing as a Direct Entry Midwife, and wouldn't be there much longer. She had thought about going back to school for a CNM, but she knew that she would be forced, in that capacity, to work within this system, and the system stunk. She was willing to give up her nursing license to do it.
That morning when I got home, I did my usual "tears on the pillow" dance with my husband, who had finally had enough. He demanded that I quit the job. When I said we couldn't afford it, he pretty much threw a temper tantrum. "God Damn it, I just got the rest of your life handed back to me back on a surgeon's knife, and I'm not going spend it with you miserable. You should have learned by now that life is too short, and not to put up with crap like this. Quit! We'll manage!"
I quit the next day. Took a letter into human resources regarding the situation, and got them to agree to let me use my vacation in lieu of notice (heard later that PNM got nailed for some of the behaviors I described in my letter...I was also congratulated on a "very professional" resignation letter - I had included rebuttals to demands that had been made of me regarding standard of care, and backed them up with references to research articles, quotes from the State Board of Nursing, etc...typical for me, couldn't just write a simple, one-page resignation letter...had to write a tome...but it worked for me). When I went back to my unit to collect my things from my locker, not one head lifted from whatever they were doing...the experienced nurses because so many of them were the complicit cronies of PNM; the new nurses because they knew not to piss off PNM by seeming to sympathize with me; certainly I got no acknowledgment from my new (or old) Preceptors, or the unit Trainers, and absolutely not from PNM; but I did get a warm, tearaful hug from K. "I'm happy for you, honey. You've made the right decision. You'll be a great labor nurse when you find the right fit. Keep the faith. Go be happy."
That soft, warm hug kept me buoyed for weeks until I landed my next job...which was wonderful, and which led me to my current job. I did keep the faith, because K. had faith. No, things have not been easy...I "live and learn" every day. PNM isn't the first "Nurse Ratched With an Agenda" that I've had to deal with...and she won't be the last...but each time I come up against one, I recognize them earlier, and quickly beat them at their own game. I now practice on my own terms, those that are supported by good research and established Standard of Care.
K. is now a practicing Certified Professional Midwife. The state board of nursing has made a few underhanded threats about taking her nursing license from her for "practicing medicine without a license", until finally she gave up that license...something she had worked very hard for...something she was rightly proud of...and that was valuable to her...so that she could not be challenged by them any longer.
Unfortunately, K. and so many other midwives like her have more to fear than the state board of nursing...but they keep the faith. They support my faith. K. supports my faith. I have the opportunity now, to run in to her from time to time when she transfers a client, or when we attend the same event. It is always wonderful to go get my next "hug" from her.
Thank you, K. You are a blessing among blessings,
Tuesday, August 19, 2008
Speaking of Communication...
Some people are just more skilled at (or creative about) it than others.
I am a very concrete thinker, and that comes across, sometimes too bluntly, in my communication style. Tact is not one of my finer skills...and that gets me in to hot water when I'm working with friends and families of laboring mothers.
We have a "three visitor" rule where I work...by policy, we allow only three people in the room during labor and birth. We're a major high risk referral unit...that floor is absolutely hoppin most of the time, and with a lot of our patients, it means we have to move fast at times...and there are a lot of us in the room doing it...so we can't exactly have everyone from Great Grandpa, down to big sis's latest newborn progeny in the room...either someone's gonna get trampled, or precious minutes are going to be lost that can mean the difference between a good or poor outcome. BIRTH IS NOT A SPECTATOR SPORT. For those whose hackles I raise when I say this, let me tell you that, at nearly every labor I have attended where a huge conglomeration of family and friends hung around during labor, most, if not all of the crowd were gone...vamoosed...as soon as Junior or Juniorette made his or her way past Mom's perineum...seriously...most people seem to just want to get a goggle at the emergence of this little alien from the mother's body, and then the show's over...they are out of the room before Mom is even out of stirrups (yes, they use them where I work, I hate it, but it's just how they do it), leaving her and her partner (if there is one...I have often see a family leave a mother totally alone) still dazed about what has happened to them. So, I don't think I'm being unreasonable when make that statement...because, more often than not, that's exactly how the onlookers are treating the situation.
It's also difficult to enforce this policy when Mom is sick. For example...when Mom has preeclampsia. The high blood pressures that a mother can experience with this illness can deprive her brain and nervous system of oxygen...when we treat a mother for preeclampsia, we're only buying time until we can effect a cure the only way that it can be effected...by ending the pregnancy (more specifically delivering the placenta, which is where current thought leads us to believe the problem originates, and of course, if the placenta is coming out, so is baby). In the mean time, Mom is at risk for seizures; so we keep the lights and noise down in the room, so as not to add to the problem of an already overstimulated nervous system. It doesn't help things when there are half-a-dozen or more family members, some of them with cranky toddlers in tow, coming in and out of the room, talking and laughing, eating, schmoozing, switching on the lights and television, and in general, acting like they are at a social event.
Over and over again I've explained to families, as gently as I can, why we need to keep the room clear of debris and extra bodies, so that, if need be, we can move fast...or so that we can keep Mom calm and resting. Things will quiet down for a while, and then, little by little, people tend to drift back in, and the noise level drifts back up. What gives? How many times can I explain things? How many signs do we have to post? Do they not believe that the risks I am pointing out to them exist? Maybe it's one of those "for other people not us" frames of mind. I can only guess. Anyone have any suggestions for Nurse Ratched here? I think I'm being nice when I explain. I try to be!
But those are my complaints. Patients and their families have legitimate complaints as well (doh). Sometimes they just aren't "meshing" with their nurse...or worse, the nurse is being a "b*&%$"...it's been known to happen...we all have our bad days (nights), and some of us seem to just hate our job, pure and simple (why these people stay in the job, I'll never be able to understand...I mean, nurses are among the most employable workers I know...there has to be something out there that they would rather do). There have been times on our floor when a Mother or family will ask (pleasantly or not so pleasantly) for another nurse; and we try to accommodate them...but it's not always easy...and sometimes we, probably because we've been asked in a way that we've allowed to get our defenses up, will allow ourselves to believe, and attempt to convince the family that, this just isn't possible (due to staffing, etc).
C. to the rescue...some people are just gifted in this way. Her advice to her Doula clients when a personality conflict (or worse) comes up...send someone out to the nurses station, ask to see the charge nurse, and with a smile and complicit sort of tone, say "I'm sorry to have to ask this, I know you are busy...but...this is so awkward...our nurse looks exactly like (my ex wife or, my abusive mother-in-law, etc.)
Of course, while C. is suggesting this, everyone in the room is roaring with laughter...but how could it not work? I'd move Heaven and Hell to relieve my laboring mother of her current nurse if I thought this was the situation.
Like I've said...some people (unfortunately, not me...I'm still [hopefully] evolving...are just plain gifted.
If only we could all be.
I am a very concrete thinker, and that comes across, sometimes too bluntly, in my communication style. Tact is not one of my finer skills...and that gets me in to hot water when I'm working with friends and families of laboring mothers.
We have a "three visitor" rule where I work...by policy, we allow only three people in the room during labor and birth. We're a major high risk referral unit...that floor is absolutely hoppin most of the time, and with a lot of our patients, it means we have to move fast at times...and there are a lot of us in the room doing it...so we can't exactly have everyone from Great Grandpa, down to big sis's latest newborn progeny in the room...either someone's gonna get trampled, or precious minutes are going to be lost that can mean the difference between a good or poor outcome. BIRTH IS NOT A SPECTATOR SPORT. For those whose hackles I raise when I say this, let me tell you that, at nearly every labor I have attended where a huge conglomeration of family and friends hung around during labor, most, if not all of the crowd were gone...vamoosed...as soon as Junior or Juniorette made his or her way past Mom's perineum...seriously...most people seem to just want to get a goggle at the emergence of this little alien from the mother's body, and then the show's over...they are out of the room before Mom is even out of stirrups (yes, they use them where I work, I hate it, but it's just how they do it), leaving her and her partner (if there is one...I have often see a family leave a mother totally alone) still dazed about what has happened to them. So, I don't think I'm being unreasonable when make that statement...because, more often than not, that's exactly how the onlookers are treating the situation.
It's also difficult to enforce this policy when Mom is sick. For example...when Mom has preeclampsia. The high blood pressures that a mother can experience with this illness can deprive her brain and nervous system of oxygen...when we treat a mother for preeclampsia, we're only buying time until we can effect a cure the only way that it can be effected...by ending the pregnancy (more specifically delivering the placenta, which is where current thought leads us to believe the problem originates, and of course, if the placenta is coming out, so is baby). In the mean time, Mom is at risk for seizures; so we keep the lights and noise down in the room, so as not to add to the problem of an already overstimulated nervous system. It doesn't help things when there are half-a-dozen or more family members, some of them with cranky toddlers in tow, coming in and out of the room, talking and laughing, eating, schmoozing, switching on the lights and television, and in general, acting like they are at a social event.
Over and over again I've explained to families, as gently as I can, why we need to keep the room clear of debris and extra bodies, so that, if need be, we can move fast...or so that we can keep Mom calm and resting. Things will quiet down for a while, and then, little by little, people tend to drift back in, and the noise level drifts back up. What gives? How many times can I explain things? How many signs do we have to post? Do they not believe that the risks I am pointing out to them exist? Maybe it's one of those "for other people not us" frames of mind. I can only guess. Anyone have any suggestions for Nurse Ratched here? I think I'm being nice when I explain. I try to be!
But those are my complaints. Patients and their families have legitimate complaints as well (doh). Sometimes they just aren't "meshing" with their nurse...or worse, the nurse is being a "b*&%$"...it's been known to happen...we all have our bad days (nights), and some of us seem to just hate our job, pure and simple (why these people stay in the job, I'll never be able to understand...I mean, nurses are among the most employable workers I know...there has to be something out there that they would rather do). There have been times on our floor when a Mother or family will ask (pleasantly or not so pleasantly) for another nurse; and we try to accommodate them...but it's not always easy...and sometimes we, probably because we've been asked in a way that we've allowed to get our defenses up, will allow ourselves to believe, and attempt to convince the family that, this just isn't possible (due to staffing, etc).
C. to the rescue...some people are just gifted in this way. Her advice to her Doula clients when a personality conflict (or worse) comes up...send someone out to the nurses station, ask to see the charge nurse, and with a smile and complicit sort of tone, say "I'm sorry to have to ask this, I know you are busy...but...this is so awkward...our nurse looks exactly like (my ex wife or, my abusive mother-in-law, etc.)
Of course, while C. is suggesting this, everyone in the room is roaring with laughter...but how could it not work? I'd move Heaven and Hell to relieve my laboring mother of her current nurse if I thought this was the situation.
Like I've said...some people (unfortunately, not me...I'm still [hopefully] evolving...are just plain gifted.
If only we could all be.
Communicate, Communicate, Communicate...
But do it well...do it honestly...and allow for the inevitable misunderstandings.
This I learned (or relearned, as I will forever continue to), a few days ago when I had the opportunity to attend a meeting of our local ICAN (International Cesarean Awareness Network) group. The group met in a room at the offices of the midwives I referred to in my last (and much too distant) post. I had the opportunity to spend time with one of the midwives.
My friend C. was with me. Ever the diplomat, C., after the meeting was over and we had a few moments to gab after the meeting ended, was able to gently approach the topic with the midwife. Interestingly enough, the news was just that...news to them. Even more "interesting" was her comment that the physician who they had been collaborating with was continuing to do so, long after the partners had decided that they no longer supported the collaboration.
So what is the solution? I'm not sure there is one that will make everyone happy. I'm more than a little frustrated that the collaborating physician doesn't seem to be more up front with his partners...a little passive aggressive perhaps? Who knows? Not an unheard of trait in the All-American-Male. The midwife feels that she and her partners have been as diplomatic as possible when transferring care...and I believe her...I've trusted her judgement and skills for years, and nothing has changed that for me; but a mother in labor and her family are not always in the most reasonable state of mind during a transfer...they don't always hear what is being said..and they are not always able to respond completely rationally...labor takes us out of the corporeal world and places us somewhere between earthly ground and some other plane; and perhaps that is where the misunderstandings began to originate...again, who knows?.
What I do know is this; that there are so many underlying prejudices, memories of past experiences, and motivations that lead us to understand or respond to a situation in whatever way we do, that trying to predict how any particular exchange of communication is going to turn out is, well, unpredictable. The only thing we can do is try very, very hard to listen when someone is speaking to us, and not let our own agenda ("I must have a vaginal [natural, unmedicated, monitor-free, {whatever}] birth", or, "If they wear scrubs, I'm not sure I can trust them") get in the way of what is being said. On the other hand, we can't let it (that agenda...and we all have one, to some extent) color what we are saying ("This is my decision, I'll do/say what I think is appropriate" - [despite the fact that life doesn't always cooperate with our plans]).
Do I think that this is what ultimately conspired? To some extent, yes; to just how much of an extent I can't know...I wasn't there, and I don't know all of the participants well. I'm glad though, that because of C.'s amazingly effective way of getting her point across without triggering the defenses of the person she is speaking to, that the midwives, their clients, and the physician in question just might be a little closer to forming a collaboration that can continue.
I know I said this once before...but, I can hope, can't I?
This I learned (or relearned, as I will forever continue to), a few days ago when I had the opportunity to attend a meeting of our local ICAN (International Cesarean Awareness Network) group. The group met in a room at the offices of the midwives I referred to in my last (and much too distant) post. I had the opportunity to spend time with one of the midwives.
My friend C. was with me. Ever the diplomat, C., after the meeting was over and we had a few moments to gab after the meeting ended, was able to gently approach the topic with the midwife. Interestingly enough, the news was just that...news to them. Even more "interesting" was her comment that the physician who they had been collaborating with was continuing to do so, long after the partners had decided that they no longer supported the collaboration.
So what is the solution? I'm not sure there is one that will make everyone happy. I'm more than a little frustrated that the collaborating physician doesn't seem to be more up front with his partners...a little passive aggressive perhaps? Who knows? Not an unheard of trait in the All-American-Male. The midwife feels that she and her partners have been as diplomatic as possible when transferring care...and I believe her...I've trusted her judgement and skills for years, and nothing has changed that for me; but a mother in labor and her family are not always in the most reasonable state of mind during a transfer...they don't always hear what is being said..and they are not always able to respond completely rationally...labor takes us out of the corporeal world and places us somewhere between earthly ground and some other plane; and perhaps that is where the misunderstandings began to originate...again, who knows?.
What I do know is this; that there are so many underlying prejudices, memories of past experiences, and motivations that lead us to understand or respond to a situation in whatever way we do, that trying to predict how any particular exchange of communication is going to turn out is, well, unpredictable. The only thing we can do is try very, very hard to listen when someone is speaking to us, and not let our own agenda ("I must have a vaginal [natural, unmedicated, monitor-free, {whatever}] birth", or, "If they wear scrubs, I'm not sure I can trust them") get in the way of what is being said. On the other hand, we can't let it (that agenda...and we all have one, to some extent) color what we are saying ("This is my decision, I'll do/say what I think is appropriate" - [despite the fact that life doesn't always cooperate with our plans]).
Do I think that this is what ultimately conspired? To some extent, yes; to just how much of an extent I can't know...I wasn't there, and I don't know all of the participants well. I'm glad though, that because of C.'s amazingly effective way of getting her point across without triggering the defenses of the person she is speaking to, that the midwives, their clients, and the physician in question just might be a little closer to forming a collaboration that can continue.
I know I said this once before...but, I can hope, can't I?
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