First Day of Community Health Clinical

We, the students, arrived at 8am. What time did our preceptor arrive?

9:20, all surprised that we were there. I was so frustrated. And then she tried to be sly and ask us what our understanding of what we were supposed to do on a daily basis was. Huh? We don't know, why don't you tell us! She was so unprepared. And then she said she would only see us for the first few days and then would be taking a vacation for the next couple weeks. I asked "So, you won't be here when we finish this rotation either?" Her reply? "No." She didn't even know the basics of our schedule.

How can this be?

Another nurse, an RN, who made a much better impression than she did, is going to help us. You know what I think? I think the RN should get the title of *Ivy* Instructor and the pay, too. This is an example of my school taking advantage of a nurse. They are paying our preceptor because she has the advanced degree - even though she is not going to be there at all...while the RN gets nothing for her time - not even the right to say she officially precepted students.

My classmates are all over the place, in the states, in South America, South Africa, and New Zealand to name a few. I am starting to wish I were, too.

The street's blocked off.
Fireworks are being shot into the air - illegally, cause that's just how it is in Omaha.
My family is gathered and eating BBQ.
One of my best friends called me (it's her birthday today) and her life is good.
And my brother is having a blast, I'm sure.

I can not call. It would make me crazy.

Somebody kiss them for me.

Community Health Final Exam...

is OVER.

Thank God.

This also means that

all of my academic exams for the year are OVER.

Thank God.

My lowest projected score for this exam is a 79%, which means I should pass the class. Of course I'll never know until the grades are actually posted, but my hopes are high.

High enough to PARTY as though I've already conquered my first year of accelerated nursing at ivy1. The Wii party is on and poppin' at 6pm. Imagine drunken, tired nursing students trying to concentrate as they play Big Brain Academy or Cooking Mama Cook-Off! Or try to maintain balance long enough to swing a bat, roll the bowling ball, or hit the tiny tennis ball! I forsee hilarity in my future - especially since we're all delirious and high on caffeine from our all nighters.

I am so. friggin. excited.

The End of the Road

Tomorrow is the Community Health final exam and I am so nervous. The information is just so broad and random. As it often does when you've been studying for a long time, it's all running together. Why would the professor make the midterm over four units and the final over eight? And why can't she ever answer a question directly? I went to every class, I hope that puts me over the edge this time. On top of it our papers were due today and I handed in a mess. I have some hope because I've been turning in the same stuff all year and it gets me excellent grades and so just like that my own writing standards have plummeted. And then there's the fact that my paper was missing large chunks because I refused to put in plagiarized parts from my group mates. But of course I didn't realize they were plagiarized until the paper was due, so my paper was a little incomplete and lacked good flow. And (yep there's more) I left off three sources in my works cited list because I simply ran out of time. My friend asked for an extension, but I just handed it over so I could get back to studying for the final. It really was a mess...but I also thought my annotated bibs were crappy and I got a 100% on both of them, so here's hoping to at least an 80%, but I won't be upset if I don't get it.

It's the end of the academic portion of the year and I feel it in every bone and muscle of my body. This exam is a true hurdle. I have no room for error. I've decided that tomorrow I am going to party like I passed even though I wont know for a while...so tomorrow me and the man are throwing a Wii cocktail party. Everyone has RSVP'd which tells me that everyone else feels it, too.

By this time tomorrow I hope I can no longer remember my own name.

What Can We Do?

I notice I grind my teeth. Badly. In my sleep, when I'm tense, and especially when I'm irritated and trying to bite my tongue. I went to happy hour Tuesday night and we (myself and 4 other girls) got on the topic of educating young girls about their bodies and sex. I am all for education, seriously, I am. But then folks began to talk about how we need to teach girls that their body is a "temple" and it's "sacred" and virginity should be saved and on and on and on. I just can't get with this virtue script. I prefer terms like "informed choice" and "responsibility" and "self-empowerment." I guess all of these can co-exist, but the more we talked the less I believed it. It seemed like the old abstinence vs. protection debate, and although everyone claimed that what they were saying had nothing to do with their religious beliefs, I continue to think otherwise. What was most irritating to me was their intention to take this message to the masses of folks living in impoverished environments. All year, hearing folks talk about the communities they want to work in has made me tense. It seems like such a good idea...after all, we have race in common. But then it doesn't because it is overwhelmingly obvious that we don't share too much more than that simply because our upbringings were so vastly different. So what you have is boarding school educated brown people with ivy league degrees trying to run primary health care clinics in the middle of public housing settings. This could work. It does work. But at the same time, I think it's problematic because the differences in lifestyle is definitely noticeable. There is so much judgement that people don't even realize they are passing, and I feel it even as a college educated woman. So how must the people in these communities feel? Does this affect "compliance" to the plan of care created by the provider? In class people actually suggest things like Morning Star chicken nuggets to these families. And I'd love for someone to show a single mother with five kids how to eat organic fruits and vegetables everyday on the food budget she has. And kiss my butt organic, whole grain, and fruits and vegetables aren't more expensive than hot dogs, wonder bread, and ramen noodles. I keep saying, somebody has to tell the truth. But today I realized that they can't tell the truth I'm talking about because it isn't their truth to tell. They just don't get it. They can't get it because they haven't lived it. This was really a revelation for me because it allowed me to forgive them. You can't be mad because somebody who hasn't walked a mile in your shoes doesn't know what it's like to walk a mile in your shoes. It only makes sense that people make comments, suggestions and judgements based on their life experiences...what else can they make them with? This is why we don't simply need people of color in health care provider roles, we need people from the communities that lack these providers to actually obtain the education to be the providers in their own communities. I gave my school much credit for the diversity of our class, but I soon realized that while they picked more people who picked a colored box on the form, we are still very much lacking the economic diversity among brown folks. Most of the brown people I know at school come from an environment of privelege, even if only middle class privelege and I tell you, that makes class discussions so frustrating.

Pediatrics Final

I just took the final exam and I'm glad it's over. There were 50 questions, 15 of which through me for a loop. Let's hope I get a quarter of those right and therefore pass the exam. I had a small buffer so everything should be fine. I still haven't gotten my annotated bib grade, but that should help, too. But let me tell you what didnt' help...text message from my cousin at 1230 this morning! Mo, I'm kill ya! LOL It took me almost an hour to get back to sleep!!!

One more final to go, next week - community health. I can't wait to get this crap over with. I have no buffer, in fact I have a deficit to make up for.

Stress.

When I Can't Sleep, I Surf

Random stuff I read (or re-read) on the internet last night...

~Michale Moore's new film, Sicko, has been successfully pirated and put up in its entirety on YouTube. But of course they keep removing it as soon as it's put up...but why? especially when Michael Moore had this to say:

"I don't agree with the copyright laws and I don't have a problem with people downloading the movie and sharing it with people as long as they're not trying to make a profit off my labor. I would oppose that ... I do well enough already, and I made this film because I want the world to change. The more people who see it the better, so I'm happy this is happening." (Full Article)

~In class today we (again) talked about poverty in Africa, Kenya to be exact. The topic was global health care and community health. All that was going through my head was...are there not any other poor nations in this world? And when does my lecture on domestic poverty come? I won't hold my breath. Look at this chart comparing the living wage vs. the minimum wage in Omaha, NE and then check it out for your city, too.

~I want my class, in the absence of real discussions on the topic, to just read this page for their own knowledge. What a nice, neat little overview. And if you have more time, check out the resources from which the page was created, especially this one which we never talk about.

~I forwarded this nifty little resource about racial and ethnic health disparities among women to my friends and one of my teachers. I have a friend whose research interests concern Asian/Pacific Islander women's reproductive health and the lack of research documenting it. So when I looked at this chart, what I immediately noticed was that there were no statistics available for this population. According to her, this is not unusual.

~Lastly, I was completely entranced by this article in the Miami Herald news paper. Notice that it is part 2 of a series of articles, of which parts 1-3 are currently available. I will try to remember to post a reminder when the remaining articles become available.

All of the pictures for this post come from these articles. I just love this last one!

Errors in Preparing for an Exam

I went to talk to my community health professor (you should always do this when you don't get a good grade on a test and you don't know exactly why) to analyze my test. Actually my friend and usual study partner went with me, so I'm going to tell you both of our errors when it came to this exam:

1. I read every article assigned and could have answered multiple questions on any of them. The problem was that she asked ONE friggin question about these (oh 10 or so) articles! It was such a waste of time in that these classes are only 6 weeks long, only 2 tests determine your grade, and all tests are only multiple choice. You really don't have time to study stuff that won't be tested. I should have spent more time on the lecture material. but how would I have known this? I asked her before the exam if we would be tested over the articles and she said yes. But as I was studying the lecture material I thought, this is so much information...the test is only 50 questions...the first thing the teacher would avoid on this exam are the articles because they don't produce multiple choice questions as easily. I thought all of that out, but then told myself that I was over-thinking my strategy! LOL I should've stuck with my gut!

2. Almost all the questions I missed came from one lecture. So, there was one lecture that I just didn't study enough...don't know how that happened really, I study them all the same length of time...now I gotta figure out what it was about that lecture. Maybe I was glossing over the definitions or something...

3. The other questions I missed were just tricky questions. Twice I had the right answer and changed it. Go with your gut, I guess.

4. My friend got mixed up on some definitions...like the difference between community-based nurses, public health nurses, and community health nurses...easy to do because they're so close and for some of the definitions it seems that only one thing separates them and if you don't know that one thing, you're screwed. Pay attention to the nuances between definitions that sound strikingly similar.

5. About objectives. Objectives are a mixed bag. Professors think they are really doing something when they give objectives, but sometimes their objectives pretty much tell you to know everything. Objectives that do not narrow down the study material are useless, I wish they would get that. Also, there were questions on the exam that were clearly NOT on the objectives, and when someone mentioned this to her she said "Oh, yeah I see that." WTF?! I guess my advice is to do the objectives, but only as a learning process - not as a method of narrowing down the info that you're going to study. (even though that's the point of objectives - to guide you to the important material)

I *SO* Hate School Right Now

As I was writing my annotated bib last night, a thought occured to me: these articles do not address the health care issues of children...and therefore the topic is not appropriate for the assignment. Arrrgh %$#(@).

In the June 4th post I mentioned an article that lead me to my topic. However, when a kid starts kindergarten is not a relevant health care topic (in hindsight, I say DUH). Last night after I realized my mistake I tried to make it work. I tried to tie into cognitive developement and mental health care but, alas, I couldn't make it fit - there were no articles that fit what I was trying to do. So, at 10:30 last night, I was forced to START ALL OVER. You know, from the beginning. It was a sight to see as I threw my adult temper tantrum - which, to my credit, was mainly internal and I did not take it out on the man who was, of course, supportive. He kindly got out of my way as I silently packed up my stuff and headed to school to start the 5 hour journey that would eventually lead to an annotated bib on the intersection of foster care and health care.

Sleep. Please. For the love of God, sleep.

Community Health Midterm

I spend a lot of my nursing school career at the bottom of the class. It's a frustrating place to be. For our community health midterm the scores ranged from 73-98. A 74 is passing. Guess who got the 73? Prime example of how going to class isn't what makes a grade - I go to this class every day, I hardly go to Peds and did 15% points better on that exam. I am not an auditory learner, in fact I think class is a waste of time when the teacher is reading from PowerPoint because I could read that whole lecture in 20 mins, and then start working on memorizing it and get a lot more bang for my 2 hours, especially since we don't have class discussions (which I like). My professor will be surprised by my grade because I am the person in class who actually reads all the articles. Twice before the grades were posted she said "I'm sure you did great!" I said, "the grade I get is never an indication of how hard I studied" and it's true. Yeah I know, it's not how hard you study, but rather how effectively you study. By the time I figure out how to study for each class, the class is over! But my grade on this test is the result of studying at the last minute (the last few days before the exam instead of the day the class started) and not knowing what to expect or study because I had never taken one of her exams before. Also, I didn't study for this exam with my study partner, and I think that made the difference.

It's moments like these when I think, there is no PhD in my future because I am just t-i-r-e-d of school. It's raining and all I want to do is wrap myself in a quilt and read something tinted black.

Student Group Woes

Starting a group on campus is very much like being a parent. You have these ideas about wanting to have a baby (start a group) and you look for a partner (a co-founder) who shares the same ideals. You do all the work of deciding to get pregnant, and how and where to give birth. Those are just logistics, but they matter. (You need a place and time to meet) You have values you want to instill, you know, stand up for yourself,be aware of where you come from, be cognizant of why you act the way you do. Be careful of your surroundings and those who inhabit them because wolves, too, come in sheep's clothing. You want to teach them the power of their voice,and encourage them to use it. Leadership, integrity, critical thinking. But at some point, as all parents know, you have to let them go. You lose all control over their ideas, their dreams, and their actions. You have to step back. Let them fall. And you can only hope that once they do, because they will, they will have the strength to get back up, and that they haven't made the kinds of mistakes that will make their lives much harder over the long term. So, here I am, a parent of this brown folks group, watching her children trample all over all of efforts she has made to give them a safe space to vent, to encourage, to remember who they are and where they came from - watching them learn hard lessons (and learning a few of my own) about what real leadership is, and the consequences of not stepping up to take control of your own life (and your own group). I wanted to say, you have invited a stranger to come in and tell you about yourself...but who knows you better than you know yourself except those who have been where you are standing? Is it possible to even have this conversation after I neglected to first teach you about internalized racism? How can I be disappointed that you allowed her to convince you that "race has nothing to do with it," when I did not prepare you for the possibility of such an articulate assault? Still, I give you some of the responsibility. You had the power to say "I disagree," but you didn't, and that is what bothers me most, worries me most. I'm thinking, "were you even listening when I said you have be sure of the purpose and mission of your life(the group)?" But what can I do? What can one do when their peers win the vote, when those with the least to lose, out-vote those who needed this the most? And what can I do if those who need it most don't yet realize they need it? It's like wanting poor people to vote when they don't even understand what they're voting for. All you can do is try to convince them that they need to speak up because their voices are so important, but you know that they're afraid to because they don't feel articulate enough, and, that, too, is your fault because you spent too much time teaching, talking, instead of listening as they developed the skill of speaking.

Tyranny of Choice, etc.

My community health professor used the following quote in class. I can not find the source to know more about its use in its original context, but I really like it.

"Personal behavior patterns are not simply 'free' choices about lifestyle, isolated from their personal and economic context. Lifestyles are, rather, patterns of choices made from people according to their socioeconomic circumstances and the ease with which they are able to choose certain ones [choices] over the others."
~Milio

I emailed my teacher to get the source.

I just found my topic for the annotated bib required for Pediatrics. This article was published in the New York Times yesterday, and I found it interesting. I found enough articles about kindergarten redshirting in some form or another, and so the work begins-half of which is learning APA format. Most of the few points I missed on my issue paper came from improper use of APA which I have never used before. (I used MLA undergrad) I guess I'll have to buy the style manual even though I don't want to spend the money on it.

What would have been nice is to be able to do an annotated bib on a topic related to my praxis/thesis but because I am in peds now I can't really do that because of my potential topics for thesis are clearly maternal newborn issues and my professor was anal about us not doing a bib that related to maternal newborn issues, my midwifery peers who are in maternal newborn right now are getting a huge jump start on their praxis projects. Why wouldn't you want all students to start working on things that really interest them and that help them with their praxis? It's just a little irritating.

On Neglecting My Blog

Yeah I've been neglecting my blog. I've been reading other blogs in the meantime. I'm also on my 11th straight month of school and completely burnt out. I have a community health midterm tomorrow and I haven't looked at the material because I just can't find the motivation. But I am going to cram today. ALL DAY. At least there's a fire under my butt now, and I went to most of the lectures in this class because they're interesting.

Top 5 things that I do instead of studying:
5. Read blogs, watch YouTube, or otherwise surf the net
4. Read magazines: I'm catching up on my O magazines (love them!)
3. Pour a drink and watch a movie: The Martini is my new drink of choice because after years of rum and vodka, I have learned that Gin does the job after only one drink, so cheers! to self-awareness, LOL
2. Read unrelated academic articles (this really is fun to me)
1. Read Fiction (right now I'm reading "How the Garcia Girls Lost their Accents," "Autobiography of my Mother," and I'm STILL reading (re-reading) "Sister Outsider." which continues to blow my exhausted mind)

I think I finished Nutrtion class...it was such a waste of time, I'm glad it's over. If it's over, it was so anti-climatic, the last day was just like any other. I always leave early, so I don't know if that was supposed to be the last class or not. But I have done everything in the syllabus, so I assume that that's it. Issues in Nursing is just dragging on. I got an H on my paper, so that was good, I think we have some sort of online test or quiz to end the class in a week or two. So, the main thing right now is Pediatrics and Community Health. I really like my pediatric preceptor and that makes the rotation wonderful. It's one of the most laid back rotations I've ever had. But, I really miss labor, birth, and postpartum.

I'm also not writing as much because I'm disappointed with the direction of my blog. I have a lot to say, and not just this day-by-day snapshot of my life - which really isn't a snapshot because if I wrote about everything I'm really thinking about this blog would sound millitant, angry, and depressing, LOL. But at some point I'm going to have to talk about more than just classes and clinicals, at some point I am going to have to get down and dirty about all this institutional beaurucratic BS that I'm witnessing, the state of our minds as my mind sees it, and how I really feel about things like racism, love, and religion. In fact, I think that's why I'm slack on the posting right now-what I have to say is not fun or funny or light, and who wants to read stuff that makes you uncomfortable?

A better question to pose to myself is why, in this anonymous setting, do I care what people think about what I am writing? Why am I worried about making them uncomfortable? Isn't it true that they can just turn the blog channel? Am I any less the angry black woman if I don't write it? No, because that is and always will be someone else's interpretation of me. Actually, it is my own, too, but the other day I figured out that I am not offended by this interpretation because it is true on many levels. I am angry, and I have a right to be. I wish it weren't a label that people applied to any woman with skin like mine, but I have no control over that. I've had soooo many good, interesting, conversations with folks lately that my head is spinning. Isn't this the place where I am supposed to be purging my brain so that I can make sense of its contents? Somethin' else...my mama reads this blog! LOL Really, she does. But she knows I'm a loose cannon verbally, so why does it matter that she reads it?


Anyway, the point is, when I read my own blog lately, it seems so superficial, and I hate superficial. That's one of the reasons I don't like "networking" or "mingling," because the entrie time I wear the mask, and it's oh-so-fake. Last night I went to see Pirates of the Caribean (#6 on the list of things I do instead of studying!) and there was this scene where the only? black woman in the entire film goes apeshit angry and there was so much power there. Maybe anger as power is merely an illusion, but in that moment I got chills because there she was, this giant (literally) black woman with dreadlocks and a bayou accent who opened her mouth and almost brought the entire world to an end with her voice.


Am I afraid of the power of my own voice?


I do want to add that this scene can also be viewed from another perspective...a very "embracing all of the stereotypes" view which I do believe in also. There is soooo much material here for critical dissection! There is so much that can be said about this character in this film and the previous Pirates (much of which has already been said in other blogs) and I hope that this scene that I am describing is the result of a director or screen writer who is conscious and, therefore, felt the need to let the audience know that this character knew the injustices that she was surviving and this is why she was kreening. In other words, "I know what you're doing, you f'd with the wrong (black) woman, now I'm angry, and now you will feel my wrath," etc. Others believe that this was a weak attempt at showing her power - they are not convinced that she had any power at all, and that the writers dropped the ball with her role, and, worst, they did after making a mockery of brown people and brown women's sexuality. All of which I also agree with.

Pediatric Midterm

We got our grades back the same day (today), that was nice of her. I am suprised that I did so well, considering I hadn't read the lectures. I had been told by previous students that the exam would be pretty much common sense. That was true...but I think I used a lot of previous knowledge (from the days when I had a day care and took care of children all day long) and that those who don't have any experience with children would not have thought those questions were common sense. Anyway, I got a HP and I'm so friggin happy about it! It was also nice because I rarely go to that class, or I read articles while in class.

Another day, another test, on to the next headache.

Exhaustion before Midterm

We went down south for a family reunion over Memorial Day weekend and I am exhausted. I didn't study one ounce of material, and I have a midterm this morning in, oh, 30 minutes. Why would she schedule a midterm the morning after the holiday, when it was our first break since spring break in March? This isn't going to be good, between driving 10+ hours each way over the weekend and very little sleep, and no studying, it's not looking too good...

Back on the Grind

Tomorrow I have class bright and early at 8am. Community Health, followed by Pediatrics, and then Issues in Nursing. I am not looking forward to it - it's too early in the morning. I'm losing steam because it's summer and I'm supposed to be out having so much fun, and not couped up in a windowless room for 7 hours a day. It's just tiring. So, let's have a few more moments of denial:

My neighbor (and good new friend since starting the program) is woman in my class, also in the midwifery specialty. Her husband is starting an accelerated nursing program at a nearby institution tomorrow morning. Isn't that amazing? They have similar backgrounds to my own (except they're Mexican American) and so I understand what this means for them to come from where they come from and be doing what they are doing, it's nothing short of miraculous. So, anyway, she had a surprise party for him tonight to celebrate his getting into the prestigious institution's nursing program and to wish him luck on his first day tomorrow by having all of their friends (both in and outside of nursing school) to come and offer support, encouragement and practical advice for succeeding in school. It was so beautiful, and he was totally surprised. I just kept thinking, love is a beautiful thing. Mexican American love exists, and it's beautiful, too. I hope I keep seeing these things happen around me, from people of all backgrounds; I think it does something for my soul each time, it's like having something greater than yourself to believe in...

She passed out a CD she made for all of the guests as we were leaving:

"Whatever Gets You Through Nursing School & Other Songs to Inspire"

1. Whatever Gets You Through the Night (John Lennon)
2. To Zion (Lauren Hill)
3. Feelin Alright (Joe Cocker)
4. Talk About the Passion (R.E.M.)
5. California Dreamin (The Mamas and The Papas)
6. Stayin Alive (Wyclef Jean)
7. Democracy (Leonard Cohen)
8. Wade in the Water (Various Artists)
9. My Own Two Hands (Ben Harper)
10. Crazy (Alanis Morissete)
11. Run On (Moby)
12. Talkin Bout a Revolution (Tracy Chapman)
13. Hope (Sweet Honey in the Rock)
14. Songs We Sing (Charlotte Gainsbourg)
15. Under Pressure (Queen)
16. September (Earth, Wind, and Fire)
17. Once in a Lifetime (Talking Heads)
18. Lizobuya (Amandala!)

Thank God for people who inspire and uplift you when you need it.

May 17th

Today is our 7th wedding anniversary.
It's been a long road, but it's more than worth it.
Black love exists, and it's beautiful, too.

Integrity in Nursing School

Integrity in this environment is a tough thing to have. I remember one of my first posts of nursing school being about this very issue. Well here I am again, and I am really trying to figure out what the hell is going on. This place is like corporate America, people do whatever it is they feel they have to do in order to get the job done - even if it isn't right. So, same scenario as the first time, we had an online exam, but this time it was open note and open book. That's great, but the questions were tricky - everyone agrees on this point. My grade? 68. (FAILING) Class average? 90. (HIGH PASS) Now, I'm routinely a little bit below average - like 5-10 points give or take, but failing when everyone else almost hit the honor's range?!? Never. So, of course, I ask around town what the hell is going on. What happened? How did you know that answer? I couldn't find it anywhere, etc. (We were allowed 2 hours to take the exam - I answered the last question with like 1 minute remaining - I could NOT find the answers!) Here's what happened:

1) They made it a "group exam," meaning they all got out their laptops and took the exam together, dividing the questions among themselves, and figuring out the discrepancies as a group - which we were specifically told NOT to do - in fact, we were also required to take the exam in the school lab (which is under video surveillance). Some of the advantages of this are obvious, but one advantage that I think might not be so obvious is that because you have all those people, you can do a more thorough search of the internet - which is what you had to do to figure out some of the correct answers because his notes were not clear on some topics...so people had to read articles they found on Pub Med, etc. to find the answers, which is doable when you have four people helping you look for the answer, but not when you are taking the exam alone!

2) They used last year's midterm, which had the correct answers for 75% of the questions. A midterm we obviously weren't supposed to have access to - even considering it was open note, open book.

Here I am again, pondering the question of personal integrity versus survival in nursing school. What good is personal integrity if I do not pass the class and therefore do not finish the program? Can one be a person of integrity in an environment where integrity does not exist? Or is this like the "it is dangerous to be sincere with insincere people" thing? Is the cost to the individual worth it? Am I willing to take a chance on failing Nutrition in order to maintain my basic level of integrity? I have worked really hard not to let this place, this experience, turn me into someone I am not, someone I (and those who look up to me) will not be able to recognize. Repeatedly people defend themselves by saying, "it's just the way the game is played." I don't buy that. There has to be some level of self-responsibility. Pass at what cost? But I also understand this: do NOT pass, at what cost? There is a real opportunity to pass this class without using the final exam that is floating around campus...but there is also a real possibility of failing it by one question - which I just experienced. Where is the conversation that should be happening among the other folks who failed this exam because they did not cheat (there are at least 5 others who I know of) No one is going to tell, because we are not the moral police, right? But where does that leave us? Failing. And I find it so ironic that this is all happening in an environment where we all sign an "honor code."

Hmpf, honor code my ass.

Stand

I stumbled upon these lyrics right when I needed them.
Maybe you need them, too.

"Stand" by Rascal Flatts


You feel like a candle in a hurricane
Just like a picture with a broken frame
Alone and helpless
Like you've lost your fight
But you’ll be alright

You’ll be alright

Chorus:
Cause when push comes to shove
You taste what you're made of
You might bend, till you break
Cause its all you can take
On your knees you look up
Decide you’ve had enough
You get mad you get strong
Wipe your hands shake it off
Then you Stand,
Then you stand

Verse 2.
Life's like a novel
With the end ripped out
The edge of a canyon
With only one way down
Take what you're given before its gone
Start holding on, keep holding on

Chorus:
Cause when push comes to shove
You taste what you're made of
You might bend, till you break
Cause its all you can take
On your knees you look up
Decide you’ve had enough
You get mad you get strong
Wipe your hands shake it off
Then you Stand,
Yeah then you stand.

Bridge:
Everytime you get up
And get back in the race
One more small piece of you
Starts to fall into place
Ooohhh

Chorus:
Cause when push comes to shove
You taste what you're made of
You might bend, till you break
Cause its all you can take
On your knees you look up
Decide you’ve had enough
You get mad you get strong
Wipe your hands shake it off
Then you Stand,
Then you stand
Yeah then you stand.
Yeah then you stand.
ohhhhhhhhh
ohhhhhhhhh
ohhhhhhhhh
ooohhhhhhh
then you stand

Link to the video

Maternal Newborn Clinical

It's so weird that I didn't blog about the Maternal Newborn clinical rotation...maybe because it went by so very fast. I had 4 weeks on a postpartum unit, and then 4 weeks on a labor and birth unit.

Postpartum: I liked the postpartum unit the best because it provided the most opportunity for education about breastfeeding, well woman care, and baby care. I took a lactation class, which was great and helped the lactation consultant on the floor with a mom who was having a really, really hard time (this was a two hour session with this mom and baby) and I learned more in those two hours than in all the lectures, classes and textbook material I've read about breastfeeding to date. The mom 1) could not recognize the baby's feeding cues early enough (by the time she noticed the baby was pretty much crying) which makes for a difficult latch (proper attachment/alignment of the baby's mouth onto the breast) 2)mom wasn't getting enough breast into the mouth, so baby was latching onto the nipple only = painful! and 3)because of the aforementioned, mom was exhausted from trying and baby was screaming. Eventually they got it together though, and I learned so much about positions and latching and how a frustrated mom can stop breastfeeding dead in its tracks. The basic organization of the rotation was that we took care of moms who had vaginal deliveries on Thursday and then moms who had cesareans on Friday, and we did head to toe assessments on their newborns everyday. It was the est rotation ever. My preceptor was phenomenal and very hands off (which I like...I don't like preceptors that hover) and she was very organized as far as what we could do alone and what we could not.

Labor and birth: of course I enjoyed it...but it's frustrating to be a nursing student when you want to be a midwife because there's so much you want to do and say but can't because it's not your role yet. You have to take a lot of orders that you may not believe in, and that's hard. It's also hard to watch women be shackled to monitors all day, unable to move and without an ounce of food. But I did see healthy babies born vaginally and by C-section and it was great. It was so amazing to be standing in the OR and watching what I've watched on TV for so many years. I mean really amazing. My last patient made my experience on L&B very memorable:


N.K. Podo (not her real name) showed up to the hospital on Wednesday for a nonstress test. They admitted her because she had lost her mucous plug and was spotting, and because she had SO MUCH going on that they didn't want her to go back home. They started to induce her instead (don't ask). What did she have going on? She was high risk because
a)she had gestational diabetes
b)pre-ecclampsia
c)isoimmunization with sensitization (I made the term a link, but it's complicated...in the most basic terms I can think of, the mom's immune system attacks the baby's blood while she's pregnant)
d)she had tested positive for the Cystic Fibrosis gene, and the father had not been tested
e)polyhydraminos (too much amniotic fluid)
f)measuring macrosomic (baby estimated to be 10lbs)
g)she was obese at 5'7" and 365 pounds, which makes monitoring the baby on a heart monitor much harder, and posed some increased risk in the the operating room
h)she had no support system present but myself

They (the attendings, residents, anesthesiologists, etc) "allowed" her to labor for three days...mostly because no one want to be the one to have to perform her C-section (they said as much) because of the excess adipose tissue and the risk factors with anesthesia (she was demanding general anesthesia because of her fear of epidurals). She labored until Friday afternoon without any food or drink or pain medicine because they would not give her narcotics by IV and she was afraid of the epidural. The reason they would not give her narcotics is because the baby's heart rate was not looking very good.

So what does this mean to a nursing student/future midwifery student? It means that instead of getting a new patient on Friday, after spending all day Thursday with her, my preceptor sent me back to her, which I was so grateful for because she was all alone. It means that a lot of labor support was needed because she was so tired and in pain and hungry and all alone and very, very scared. It means that I had to fight for the patent's right to refuse the epidural even in the face of serious bullying from the docs and her obvious pain. It means that I had to deal with the consequences of "talking back" to a doctor (because I said that maybe it would be better if only *one* of them spoke to her at a time and maybe, just maybe, we could wait until the peak of this contraction had passed?!?) This moment made me realize that I would never, ever, have a baby at a teaching hospital...to many people coming in to "consult" and "check" and "advise" and "teach" Just imagine two or three of every role, all in the room at once, trying to convince her that she wants an epidural (never mind that she's had 3 children, up to 9lbs 14oz without ever having had an epidural), trying to explain the risks and outcomes of all of these complications she has going on and an overall fat bias present from most of them on top of everything. It was a circus and I was trying to help create some calm because she was in tears and almost irate at the situation (as I would be).
There were no consequence from asserting my patients rights, other than the silent treatment form the docs, which I can live with until they get over it, besides...it will be a long time before I am on that unit again. I rarely left the patients side, but when I did it was because the nurse made me. She said the patient was "too attached" to me, and that it wasn't healthy. This really p'd me off. I mean, she had no support system...why wouldn't we want someone to help her through each contraction if it was feasible? And, she was my only patient...let me get this right, I am supposed to sit in the break room for two hours doing absolutely nothing instead of helping her? It goes against everything I believe in, and I told her so. The patient eventually went to the OR for C-section because the baby's heart rate was flattening, she wasn't making any progress at all as far as cervical dilation or station, and her water had been broken for a long time (it didn't help that everybody had there fingers up there all the time). I went to the OR with her but wasn't part of the care team (as we usually are by helping out when they need something or charting or whatever else the nurse is doing), instead I only had to sit at her head and keep her company and calm. Again, the nurse tried to make me leave because I was "off" (meaning, I was off work for the day) and again I said I was just fine where I was and would leave after we wheeled her into the recovery room, just as I had promised the patient (she had an epidural, not general anesthesia). Her baby was born, wailing! It was a beautiful sound. And she felt like 10 pounds to me. It was so great to see the baby, and to have the mom awake for it, after all she had been through. She said "I will never forget you and all you have done for me." I said "And I will never forget you and all you have allowed me to learn. I will never forget how strong you were, how strong you are." And I meant it. I will never forget this patient.

From my preceptors (1 for L&B and 1 for PP) final evaluation comments:
"If I were having a baby, I would come find you, even at the level you are right now. You're going to be a wonderful midwife...you're so intelligent...you know when to stand back at let be, and you know when to jump in and you don't hesitate when that time comes...seriously, you're great, and I can't wait to see you back on the floor as a midwifery student."

I almost cried. I struggle in class so much that I really wonder about all of this...it seems like it shouldn't be this hard. But I do not generally struggle in clinical when it comes to relating to people, especially women which really keeps me going. You never really know how your preceptor thinks you're doing in clinical until the evaluation comes... It wasn't a validation per se, but rather it was I know I am supposed to be a midwife...now other people know it too...and they know it not because I told them, but because they witnessed it.