Hunger

Today is Yom Kippur. The Day of Atonement. Or, if you prefer At-One-Ment. As a child, I remember being dragged to temple multiple times during the year for various holidays without any real understanding of why. I remember the smell of that place, the way the voices echoed in the lobby and the back of the sanctuary. I resented having to sit and be quiet for what felt like hours. I still remember almost all of the songs, but more, the revoltingly operatic voice in which the cantor would sing them. I remember, even then, at 5 or 6 or 7 years old thinking how poorly decorated the temple was. Walls made out of different colored rugs, multicolored stained glass… Not understanding any of the Hebrew, my eyes would always wander to the walls and the ceiling and the cantor's horse-like teeth and I would think, “Why, why?”

Growing up, I never fasted for Yom Kippur. And neither did my father. My mother did but as I later found out, she made a lot of allowances for herself:

“Well, I have to have a cup of coffee in the morning. But just the one. With cream. No sugar. I have to or else I’ll get a headache! And I need gum. Just the gum though, no food. Throughout the day. Or I’ll get sick. I get so nauseas when I don’t eat! And water. I let myself have water. Just to, you know, keep my mouth from getting dry when the gum wears out. Does that count?”

As an adult, I do try to fast every year. Unfortunately, I forgot to ask for the day off today so I had a full panel of patients waiting to see me in office. So, I semi fasted, allowing myself some miso soup and a mini container of hummus so that I was not mean to my patients all day. And, I confess, midway through the day when the office manager came around handing out homemade gingerbread whoopee pies made by one of the other midwives in the office I guiltily stuffed one in my mouth right before I started my initial OB visit with yet another pregnant teen. Does that count?

So, yes, a little sustenance was needed as I welcomed 3 more teens into the world of pregnancy this week. And each story seems worse than the last.

Teen #1 has on dark eye make-up and a purple leopard skin bustier. She, like most of the teens I “take care of”, gives me one word answers to all my questions. She seems indifferent at best about…everything. She has a significant personal and family history of substance abuse and mental illness. Her parents don’t know. She doesn’t have a job. The FOB is currently incarcerated for what sounds like violent acts against the patient. She has a restraining order against him. Her neck is covered in hickies.

Teen #2 is living at home with her mother and father and is not worried that they will throw her out when she tells them that she is pregnant this afternoon. The FOB is aware of the pregnancy. He is in college but the patient does not know the name of the college or where it is.
“You don’t know where your boyfriend is right now? Like, the state or the city? You have no idea?”
“Um, I guess not.”

Teen #3 has come with her mother. The two of them are sitting in the room when I enter, the mother on a chair, the teen, slumped way over on the exam table. I shake both of their hands, ask a few initial questions and then say, “So, this pregnancy was unplanned?” and the mother says to her daughter, “Excuse me??!! You’re pregnant??!!”
“Let’s back up here.” I said. “You are here for your initial OB appt right?” I look at the pt and her mother, waiting. The mother apologizes, “I’m sorry, I’m just so sorry. It’s just that I’m in so much shock these days, with her being pregnant. My daughter, contributing to the cycle of poverty. Her grandmother was a social worker and she would be so disappointed that her granddaughter went and opened her legs like that.” She turns to her daughter. “Why would you do that? Why would you go and open your legs like that?” Her daughter shrugs and rolls her eyes. “And that ring you have on your finger? Probably out of a candy machine. Cost a nickel or a quarter. Do you even have a boyfriend? Do you even know his last name? Probably not. He’s probably with some other girl already.” Her eyes were closed and she was swaying back and forth and her hand was on her forehead.
I took a breath. I was angry. Angry at the mother, angry at the daughter. Angry for the daughter. But, I held myself back and asked the pt if she would like her mother to stay in the room. I said it was clear that everyone had a lot of emotions around the issue. I advised the mother that she might want to consider seeing a therapist herself. She didn’t respond. Just sat with her head in her hands.
“So, your last menstrual period was when?” I asked the pt.
“April I think.”
“April? It says here you told the medical assistant it was in July. Our visit here today will be very different if your last period was in April. Have you had any bleeding since April?”
“Yeah.”
“Okay, like, bleeding like a period?”
“Yeah.”
“Every month?”
“Yeah, I think.”
“Okay, when was the last time you had bleeding like a period?”
“August 21st.”
“I’m confused. So, you may not have missed your period at all?”
“I don’t know.”
“Let me understand something. What did you expect to get out of this visit today?”
“To confirm pregnancy.” She said. It was the longest sentence she had offered.
“Why do you think you might be pregnant if you’ve had bleeding every month?”
“I’m having pregnancy symptoms.”
“What symptoms?” I asked. And then, as if she had read it from the internet-
“Increased appetite. Breast tenderness. Back pain.” She paused. “And baby kicks.”
“Baby kicks? I’d be surprised.” I said. “You’d have to be pretty far along to feel your baby moving. Did you take a home pregnancy test?”
“Well, no, it was at my friends house, not at home.”
“Okay, that counts. A home pregnancy test does not mean you have to do it at your own home. Was it positive?”
“Yes.”
I stepped out of the room to run the pt’s urine through our office pregnancy test which is essentially the exact same thing as a home pregnancy test but it allowed me some time to escape the space and for some reason both the pt and her mom wanted to know what our test said. Positive of course.
We finished up the talking portion of the visit with minimal interruptions from the mother and thankfully, the pt asked her mother to leave the room for the exam. When she left, the pt and I spoke briefly about her choice to keep the pregnancy.
“I just couldn’t deal with it emotionally, y’know, having an abortion.”
“Do you think you are emotionally prepared to be a mother?” I couldn’t help but think of the shitty role model she had.
“Yeah.” She sad. I resisted the temptation to scold her. To try to change her mind. To tell her that she was wrong. To give her all of the reasons why, in fact, she was not ready for motherhood. But I told myself it wasn’t my place. Instead I promised that I would take good care of her if she promised to be honest with me, to ask questions, to let me know if she was having problems with her mom, and to take care of herself.
She lay down on the exam table and it was clear that no matter how much I had tried to convince her, it wouldn’t have mattered. This girl was very very pregnant. Her belly was huge. I hadn’t noticed it because she was so slumped over and because the gown was so baggy on her.
“You’re very pregnant, aren’t you?” I asked
She nodded.
“Let me go get my doppler.” By measurements she was 25 weeks. She certainly had been feeling baby kicks. And as soon as I put my Doppler on her belly a rushing fetal heartbeat filled the room. She looked at the ceiling.
Her chart said she had had a previous termination at 17 weeks last year. And that her mother had called the school prior to that saying that she had tried to kill herself. There was the possibility that she had been abused by a friend of the family. She is currently positive for Chlamydia. The list goes on and on and on.

And when I try to find a social worker to be involved with these patients’ care, I am again reminded that our resources are minimal. Our social worker can send me a packet of information to give to them but she can not always call them and she can never meet with them in person. Rumor has it that there is some sort of “alert list” I can get these girls’ names on so that someone will come see them in the hospital and tell them in person about the organizations that may be able to provide them with some support. They can assess their home situation, make sure it is safe for the baby and the new mom herself…But it is not enough. If I give any of these patients a packet of information about WIC and Jewish Family Services it will instantly become a coaster when they get home. They won’t make the phone calls, they won’t fill out the forms.

So even after I came home from work and broke my Yom Kippur fast with more food than was good for my shrunken belly, I was still angry and still hungry. I feel constantly torn between wanting to provide these teens with non judgmental care and wanting to convince all of them to terminate so that they don’t have to be a mother before they are even an adult. Singlehandedly, I can’t keep them from getting pregnant. I can’t keep them from wanting to have a baby. That’s of course their choice and not mine. So I’m left with this wrenched feeling in my stomach, this frustration that there isn’t even better care for these girls since they need so much more attention and education than others. I come home every day and think about how hard my job is, how difficult it is to see these girls especially, with their growing bellies and their one word answers, how I am left with this sense of hunger for easier days, more time, better resources…

But then, I think, they’ve got to be way more hungry than me.

Anniversary

Last Tuesday marked my one year anniversary at my current midwifery practice. One year later I certainly feel more competent on many days. I don’t cry as much. I get slightly less panicked the day before a call shift. I know which nurses I have to sweet talk and which ones I don’t in order to feel respected. I speak up more at meetings. I started a newsletter and have precepted medical and nursing students. My leadership skills have definitely been recognized by others in my group and I am almost always nominated to head up creative endeavors and any community organizing that needs to be done. The director of a local advanced nursing program has invited me to teach an elective class to her students on literature and medicine. I guess when you write it all down like that, there’s lots to be proud of.
But to be honest, there is still something missing. And I can’t quite put my finger on it. As always, I’m not sure how to tease out the dissatisfied feelings that are coming from my life in general and which are coming directly from my job. I do think, on many days, that I would be happier if only my practice started less inductions, if less women demanded (sobbing and decompensating and pounding their fists into the mattress) epidurals in early labor, and if I was not as responsible for what feels like medical issues that are often outside of my scope of practice. On other days, I am certain I could live with a little more philosophical compromising if I felt the group of midwives I worked with was more cohesive or if my boss was more supportive. And some days I feel like none of this would make any difference at all. That I was not meant to have a full time back breaking job that demanded all of my emotional attention and where sometimes my intuition is rewarded and sometimes it is resented. I think, on those days, maybe I’m supposed to find a way to be a full time artist or videographer or dinner party holder. But then, I know myself better. And I know I am very very willing to give a lot of time and energy and emotion to work that feels right and satisfying. Plus, you’d have to do so much clean up if you were a full time dinner party holder, right? And I hate washing dishes…

I haven’t written for a while and I’ve been thinking a lot about why that might be. I certainly don’t feel nearly as compelled to come home from a call shift or a day at the office and “get it all down” as quickly as possible. Maybe it’s because, as I move further and further into the day to day experience of being a midwife the ability to break up each day into these little vignettes or anecdotes is more challenging. I mean, I still think the stories are unbelievable-I’ve had 3, yes 3, IUFDs, an inverted uterus that came all the way out of the vagina and into my hands and I was lucky enough to catch the baby of one of my best friends and watch her labor and push and make the sounds a woman is supposed to make when she is having a baby-but as time goes on, as I see more patients and deliver more babies, the stories do run together as a whole lived experience; As, my life, really. And writing it all down in a few paragraphs feels like I am compartmentalizing or trivializing it. At the start of my career (and believe me, I still think I am at the start) writing down everything that happened, telling stories, holding someone’s attention and making them laugh…It worked as such a great coping mechanism for all the emotions and hardships one has to deal with in this field. And now, I don’t know. Sometimes, writing about my day feels more like I am giving it away than doing a cathartic sharing.

It reminds me of one of the last monologues in the John Guare play Six Degrees of Separation that Stockard Channing delivers so well as she is sitting at a lunch party with her husband recounting to the other diners the last segment of the story of a homeless man who both lies to and befriends her. It dawns on her that this story she was telling was more than that, more than an anecdote. It’s her life. And as I sit down to write about pregnant teens or self-righteous nurses or unhelpful doctors I can’t help but relate.

Her character says, “…And we turn him into an anecdote, to dine out on, like we're doing right now. But it was an experience. I will not turn him into an anecdote. How do we keep what happens to us? How do we fit it into life without turning it into an anecdote, with no teeth, and a punch line you'll mouth over and over, years to come: "Oh, that reminds me of the time that impostor came into our lives. Oh, tell the one about that boy." And we become these human jukeboxes, spilling out these anecdotes. But it was an experience. How do we keep the experience?”

I’m trying to figure that out.