Day Two

First: *SO* irritated that I missed the next "grade" level in Patho by 1 point. Literally 1 point. As in 1 more point on the exam and I would have made it to the next level for my final grade. I've come a long way since coming this close to failing the hard core sciences last year. LOL! Seriously.

New from the ACNM

The ACNM has issued a brief:

In America the burden of disease and premature, preventable deaths is borne disproportionately by politically disfranchised and economically disadvantaged communities. In all leading public health mortality and morbidity indices, there is a persistent gap between the privileged and the deprived that is euphemistically referred to as “health disparities.” Health disparities are “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”1 Even when access-related factors are controlled, such as insurance status and income, minorities still receive a lesser quality of healthcare.2 For African American women, the lifetime and generational exposure to institutional and interpersonal racism have been shown to affect pregnancy outcomes such as birth weight,3 as well as other health conditions.4

Read it in its entirety.

According to my Pathophysiology textbook,

"A person experiences stress when a demand exceeds a person’s coping abilities, resulting in reactions such as disturbances of cognition, emotion, and behavior that can adversely affect well-being....In the past decade, for the first time in history, it has been demonstrated that the interactions among social, psychologic, biologic, and behavioral factors are inherent in the causes and courses of many diseases...Physiologic stress may cause or exacerbate several disease states, including many of the diseases implicated as leading causes of death in the United States."

Here are a few of the diseases listed in a chart as being “Stress-Related Diseases and Conditions:”

Coronary Artery Disease
Hypertension
Stroke
Asthma
Ulcers
Type II Diabetes
Amenorrhea
Fatigue and Lethargy
Depression

And not in the chart, but in the ACNM document, PREGNANCY OUTCOMES.

These are only a few of many listed. Why did I pick these? Do they look familiar? They should. A lot of them are diseases for which black people disproportionately suffer morbidity and mortality. This is not new information. In fact my professors are quick to point these stats out at the institution. They will show and quote power points like this one from the CDC which tells of all the disparities. But what's always missing is context. Well here’s some: STRESS. Why doesn’t anyone say this? Why don’t they/haven’t they made the connection? It’s right here in the same damn textbook that they have been making us memorize for everything else. I want to say it as plainly as possible:

Experiencing RACISM, whether, overt, internalized, institutionalized, forgotten, ignored, debated, denied, or otherwise, is STRESSFUL. That stress manifests itself in many ways, one of which is poor health outcomes. THIS is one reason why it is so damn frustrating to be sitting in a classroom where we are supposedly discussing these inequalities in health care, incidence of disease, and health outcomes and NOT ONCE discuss racism as a factor.

I’m screaming at this point. I can’t help it. I thought that the reason they weren’t providing context was because they couldn’t, and that’s why I was trying so hard to provide it myself. But maybe the reality is that they don’t want to. It’s here. They’ve read it. You mean to tell me that my professors who are leaders in the field of nursing and midwifery have not read the 1999 article implicating the lived experience of discrimination and racism as having a direct effect on health outcomes for black women? Seriously? Not one of 'em? I don’t buy it. They read it, and chose, at the time of delivering the statistics to our class, to not mention it. Why? Because it’s easier to say “it’s lifestyle choices…poverty…living in congested spaces without fresh air, parks to play in, or safe food in the grocery store” than it is to say it is our history of oppression, racism, discrimination, abuse, brainwashing, disregard, disrespect, denial of humaneness, and good old fashioned hatred that created/perpetuated this. The lack of parks, clean air, and fresh food sounds more like an external “that’s just the way it is” or “we all need more of that” or “commercialism has ruined our society” factor…on the other hand, you suffer more heart attacks, maternal mortality, and type II diabetes because I raped your mother, stole your father, and worked your child into the dirt is just too damn hard to come to terms with…especially for those who can’t even come to admit to themselves that white privilege exists.

For those who wnat more details (I would, too) here's an example of how, physiologically, this thing thing plays out:

Obesity and Type II Diabetes: Cortisol (aka hydrocortisone) is a hormone of the body that inhibits the uptake and oxidation of glucose so that one has more glucose in the blood. Why would we need that? Because glucose is energy...energy needed to combat stress...the more stress you have, the more cortisol you produce, the more glucose you hold on to which leads to obesity...specifically, "cortisol-induced obesity," which they now think leads to Type II Diabetes. (p317)

I remember on another post emjaybe (no blog) asked something to the effect of “now what?”

I’m sitting here thinking about that. OK. You read the brief, looked up some of the articles, and are outraged. I’m crying and typing and trying to make a point. Now what? “Now what” is that the ACNM claims it’s ”striving to increase now underrepresented racial and ethnic groups among the ranks of our Profession” (I'm glad they said "now") Yeah ok. So let’s tell the truth about that right quick. What kind of midwife do you have to be to belong to the ACNM? Bellytales talked about it here. Ok, now exactly how many people who look like me meet these requirements? We have to get our children through high school first. Then undergrad. Then a friggin master’s degree. Who in the hell are you kiddin? Yeah, we’re coming but it’s a mighty slooooooow process, and honestly, by the time you get done beating me up and robbing me of my mind, I might not even have anything constructive to contribute to your damn Midwives of Color Committee. And by the time I get done experiencing the profession at my place of learning, honestly, the ACNM is probably the last place I’m trying to go…hmmm…more like the ICTC. Furthermore I think it’s safe to say that a lot of people who meet the requirements are already members of the ACNM…but acknowledging that CNMs to do not = the profession, the real question is do you want us in the profession, or in your academy? And is just any brown face you're looking for, or one who has had certain life circumstances or one who is committed to working on these disparities or one who is willing to be the poster child for your campaign? What exactly do you want from me?

“Now what” is more people talking about the shit that somehow stays buried. Stress. Stress from racism. Stress from invisibility, or in the case of crime prevention and the so-called war on drugs, stress from microscopic monitoring and existing while black. Stress. Talk about it. That’s what’s next. But more than that, write about it. Leave behind some proof that you acknowledged it and thought about it. Then what? (cuz I already did that) Scream about it. Don’t stop. Work through the fatigue. Type through the cramping. Make it your thesis, loving pecola. Your fuckin dissertation if necessary. One of a million platforms.

Now what?

Sleep. Sweet release, at last.

Day One of Freedom

A million things to say and no idea where to start. I feel like my head is going to explode with all of my thoughts. Common sense says "one thought at a time" but my thoughts don't emerge that way. My thoughts bounce around my skull, then they fight for my attention and the right to be first. My book list is long and overwhelming. I'm taking the pressure off of myself by saying even if I only read one book...one book chosen completely and entirely by me...I will have accomplished something. It's frustrating because after being crammed with junk from other people, it's harder to think for myself. It's like what do I say? About what? Why that? What can I possibly say that everybody else hasn't already said? That's what I would want to start with, but there's little of that left, I think?! What's for certain is that there should be no pressure involved in this undertaking of three weeks of freedom.

With that in mind, I've been tagged! I think already this tag before, but I'll do it again as an entry into my new found freedom!

I believe the rules are to post 7 random things and then tag folks.

1. My brother calls me "sister." I mean really. Like "mama" or "papa," but sister. As in never by my first name. Sometimes when I read characters in books who are called "sister" it seems so strange to think that that's what I'm called, too. I miss my brother. He's turning 13 on Sunday. I feel like I'm missing his whole life right now.

2. I love that navelgazing, and sagefemme, and darkdaughta post so many pics/videos on their websites. I'm jealous. I've been weighing my anonymity (what's left of it...which is very, very little) with putting it all out there so I can be creative, too. So far all I've convinced myself of is that I can post anonymous type photos, LOL. *sigh*

3. I watched Harry Potter last night and was disappointed with Hermione's character. I always liked her. She could be unappologetically smart and bold. But this time she had almost no role at all, except for a minute moment of critical thinking when she asked Harry "but what if that's what they want you to see?" Other than that, flat. So disappointed. But I did appreciate the whole "don't let the 'darkness' take over your mind, you must revenge against mind domination" plot of the movie, especially in light of my recent thoughts on the topic.

4. I am at the library and I am about to leave with "Growing Up Fast" by Joanna Lipper, "Promises I Can Keep" by Edin and Kefalas, and "Women, Race, and Class" by Angela Davis from the library.

5. My mama is coming to visit us in a week! I am *so* excited. Even if we don't do anything. Just to have her here. Just to lay around. Just to know that for almost week she will not have to lift a finger. Not cook. Not clean. Not even answer to "mama" if she doesn't want to.

6. I'm struggling with how I'm going to make a change in the world through midwifery. I worry that all of the things I want to do (teaching, clinical practice, and research) are not physically possible in the way I imagine them to be...at least not without taking a considerable (ie: unacceptable) amount of time away from my family. I know I can't plan for everything, but I'm thinking about it all.

7. My blog has been boring me.

End of the Semester

A WHNP classmate came into the room today where we were all about to take our Stats exam (the last final of the semester) and said:

"I just spoke to [our professor]; we all passed GYN."

You can imagine the excitement that produced. And the shock.

We took the Stats exam which was hard but not impossible, and then I went to find my teacher to ask her if I passed the primary care exam. I was thinking there's no way I want to leave here without knowing whether I'm done or not. She said yes you passed, everyone passed, and you can tell them so.

It's over.

Thank Gawd.

I can't believe I survived another semester.

I did it.

I did it.

Yes, uh huh, I did it.

GYN Final Exam

Usually I go through and mark the questions I don't know the answer to.

Today I marked the questions that I did know the answers to.

17.

Out of 58.

There was a massive vent session after the exam, which I did not participate in because I just didn't have the energy. I did look my questions though, which I don't always do after exams because it drives me crazy, but after a while I stopped looking them up because the answers were all wrong by some minor point. The general consensus is "well they can't fail everybody" but I don't trust my classmates. They always say this and then ace the damn exams. Right now I am venting because I have to get it out so that I can switch gears and study for Stats tomorrow...especially since I failed the last exam...after everyone swore they did so poorly and pulled in 100s, thereby fucking up the curve. After yesterday's questionable Primary Care exam, and today's joke of a GYN exam, I am stressed beyond words. I just wanna get it over with so I can hug the man, cook a good meal, and go to sleep.

1 more day.

1/2 Way...

through finals week.

2 down, 2 to go.

Patho yesterday was ok.

Primary Care today was scary.

GYN tomorrow is...is just...overwhelming? That doesn't seem to do it justice. I can. not. believe. how much material we've covered over this last semester...and now I have to take a test on all of it?

I dunno.

*sigh*

It's That Time Again

Finals are here, and I'm stressin, just a lil bit.

Deep breathing isn't really helping...but I guess it could be worse. I had my first ever panic attack last year, in nursing school. It was textbook; my heart was beating out of my chest, I couldn't breathe, my chest was hurting...I thought I was having a heart attack and that I was really going to die...shaking/trembling and feeling like I was going to faint. Yeah. It was bad. It was the day I received the "you're not cut out for nursing school" letter, which happened to be the night before a huge exam. That was my first and only attack, and really it has kept me from getting as stressed as I used to get about these exams because nursing school is not going to kill me. Nu uhn. I'm not having it.

I missed out on 4 hours of studying today because I had to take the shift of someone who had a final today. I usually get to study at work, but for some reason they gave me 3 hours and 20mins worth of work today. I could not believe it. Usually, when you are kind enough to fill in for someone...on a Saturday, they don't give you much to do and you can study. But not today. I wish I hadn't of taken this shift, but it's over in 15 blessed minutes. I have never had this much work to do at this job, it only takes me 45mins-1hr at the most. I'm working of my stress levels. It doesn't help that I have four finals this week, 3 of which are cumulative.

I will get through this week.

I will get through this week.

I will. Yes uh hun, I will.

My Commercial

Primary Care for Midwives textbook: $67

Salary of Primary Care professor: approximately $60,000

Food and drink each night while studying for Primary Care final exam: $4

Fighting hegemony by changing the name of the patient in your assigned case presentation for Primary Care class from Sarah to Keisha: PRICELESS.

There are some things that money can't buy, for everything else, there's Sallie Mae.

Random Bloggin on a Study Break

The list of things to do over winter "break" is piling up. As the emails come, and the advice and suggestions that are always contradictory is given out more often, I am trying to stay focused and push them to an unoccupied corner of my brain. "Get rest over break. Enjoy yourself," is what is said. "Here's the list of supplies and books to buy. You should read...before you return...you will be expected to know....and be ready to discuss during the first weeks of didactic..." is what the emails say - some from professors, others from upperclassmen who are trying to give us the heads up. I just laughed at a two page memo that came from the professor of one class. I started looking up the prices of the tools we're required to buy before school starts (suturing needles, forceps for holding the needles, etc) and had to stop. I wonder if you can use regular needles (ie: sewing needles) to practice suturing on chickens and foam? Why spend so much money on these supplies that are only temporary? (I don't think I'll be taking these supplies to work with me...the hospitals provide these things...so making an investment - like a homebirth midwife would have to do- seems silly and wasteful?) Maybe my real break will be the 5 days that my mama is visitin...especially since she insists that we do not go anywhere that jeans are not "allowed." And the rest I will just accept as a "test free period."



All of my conversation centers around this experience. I must be so boring to talk to right now.

My Mind

I have been out and about reading blogs on break. I am here to let the anger at not being able to write what I want and say what I want regularly out onto the page so I can move on. My mind isn't even my own anymore. Someone else tells me what to say. What to think. How to think, and then how to say what I think. As I sit here in a basement library, I memorize diagnoses and treatments irrelevant of whomever's history. I am supposed to construct these "plans of care" in isolation of the whole person...or rather, keeping the whole person in mind in theory but in reality fitting ABC and XYZ in a 10 minute appointment. I was thinking that midwifery was a way to melt the medical/biological information with the woman who is actually standing in front of you. A way to give the power back to women. But really, it's so much like medicine when you're here. Yes it has its pot lucks, and sisterhoods, and warm and fuzzy feelings...but the meat of it is the same. The physiology, the details, the stress. I am tired of memorizing. That's all. And I am tired of fighting the oppressiveness of this learning style. I know it's easier to give in to it. I've done it before, successfully. But success is relative. My grades were fine but my mental health was crumbling. I have been told that you just do what you have to do to get through it, and then you take your life back. I hear it. And I understand the wisdom of it coming from someone who knows it to be the only way she survived it. But I'm not sure if it's right for me. I keep trying to stop reading the stuff I'm not supposed to be reading...books and blogs about everything BUT what the hell I'm studying. But my mind is fighting with itself about what is important. I keep telling myself that this is only the stepping stone. This, too, shall pass. But in reality...this might be it. After this, there is more of the same. More school. More people telling me what is right and wrong with what I am saying/writing. More feelings of personal betrayal for not having the time...real time...full time...to write about what's in my head...for always responding and never really initiating. I have something to say and it's being stiffled by my education. And my time constraints. And my mental fight with anonymity. I have something to say and its choked up behind my tongue and I'm only realizing the full weight of the censorship right now as tears are being held hostage by eyelids. Only as I type this post am I realizing the real cost of this education. My time. My thoughts. My mind. My mutherfuggin mind. I signed up for this. I agreed to turn my mind over for the next three years. And I think it was an experiment. What happens when we apply this kind of education, in this kind of place, taught by these kinds of people...to this kind of girl... Why shouldn't it have been an experiment to them? It was certainly an experiment to me. Can I do this? Can people like me do this? Here? With what I came with? With who I came with? My hypothesis was that, YES, I can do this, even with all the constraints. But right now, in the analysis of my experiment I notice some variables that I had not planned for: mental exhaustion and guilt. Guilt at not doing this my way. Wait, this is my way...but it's the comprimised version. The version that took all the facts into consideration...the liability, the truth about which populations use which kinds of midwives, the resources available to those who choose to go the path of least resistance and of safety. The uncomprimised version allowed me to explore more. At my own pace. With other women of various educational levels. With respect for those who came before me in unknown towns with cotton lined dirt roads. I would not feel disconnected because I would BE connected. I would not have to wonder what it would be like to sit in a room full of women who look like me at a blessing of the hands ceremony. Wondering if I will be welcomed at in this community that actually does exist, and what my role could be. But mostly I am frustrated with my inability to really make all of this work. How come I can't learn what I'm supposed to...and what I WANT to? How come my fighting the assimilation that seems so inevitable is so hard? I mean really? I've been doing this all my life...it should be easier.

Drowning...Thinking...Remembering

It's not that I'm not coping well. I am. But I'm drowning all the same. It's a perpetual state of drowning, that is now making me very, very tired. I'm trying to study for finals without a dead week/reading week/study week. I don't know if they mean to kill us...or only make us think that we will die. How to give presentations and learn new material and go to clinical while also trying to synthesize what you've learned so that you can be tested...by a test that is worth almost half your grade...and comprehensive...seems a little...psycho?

I had to carry three bags to the library today. Three. A bookbag. My canvas midwifery bag (gift from faculty). Laptop bag. My back. OMG, my back. But all the books I needed for TWO classes would not fit in one bag. I started at noonish...it's 5:30. I took some mini breaks, but not too long. I'll be here until they turn out the lights...2:45 am.

I am so glad that I have this blog. To vent, to whine, to share, and move along.

Last night I had the pleasure of braiding my friend's hair and it immediately took me back to a good place. To a place where I am loved and supported. A place where I belong...even if it's only in the comparitive sense...meaning I belong there more/better than I do anywhere else. Hair can be so cathartic for me. It's girlfriend talk. It's remembering that I am good at something. That I belong somewhere...a place where hair gets "did" in kitchen sinks and at kitchen stovetops. Grease and picks and combs - the unbreakable afro kind and the perm kind with the pointed tip for parting. The smell of coconut grease. Oil sheen. Dookey gel. JAM! The twisting and winding of cornrows. The drinking, the smoking, the shit talking. The venting about these men, these kids, and these crazy azz white people. The love.

Ooooh. I remember.

Yes I do.

One day. One day soon.

We will go back there, and it won't just be for "break."

And maybe someone will lovingly pick the lint from my dreads...

My Community

Mixing and Mingling With My Peers

Moving on.

My patience is wearing thin lately. I notice it with the man, with my classmates, and with myself. A few posts ago, I said "maybe I'll come out and play, and maybe I won't." I think I'm done playing for a while. I agreed to do a group activity that's happening next week...how perfect would it be to just lay low from now until then? A kind of self-imposed hibernation for all things unmandatory.

There's this pesky blessing of the hands taking place this week. I had to send out an email about my disagreeing with it being so "religious." It went from a simple ceremony where we read a passage while pouring water over their hands (which are suspended over a bowl we each made/bought for our big sib that has a tea light candle in it) to an all out religious/spiritual (not saying those are the same - they aren't...only putting in writing the fact that people keep confusing religion with spirituality in this group!) affair, complete with a "shaman," blessing of the space that is to be kept "sacred," and the presenting of Tibetan scarves. Um. NO. I had to send an email. Firstly, because our group of big sibs expressly stated that they didn't want this kind of ceremony when they asked that we not do the whole "chanting" thing...they expressly asked for a PAR-TAY including immeasurable amounts of booze and dancing...and the very simple blessing of the hands that is tradition at our school - namely the reading of the passage, the fire (candle), and the water. I thought we all understood this. But apparently not. Second, having a shaman preside over the ceremony is inappropriate. Later this woman who was named as shaman refused, saying that she never agreed to this. I'm glad she spoke up, cause I don't think this is anything to be messed with. I am not trying to knowingly be in any room that has been blessed by someone/for something that I don't even understand, nor am I trying to be blessed with anything like holy water, sage brush, or anything else that, again, I don't understand (not saying these practices are done by shamans, saying that this is the feeling that was evoked). AND, I'm not trying to give worship to somebody's god for whom I have no understanding of, and if you participate in such rituals, aren't doing just that? Third, where the hell did Tibetan scarves from. I said, "please tell me *somebody* is Tibetan" in our group and that's why we're doing this...otherwise, especially as you've explained the significance of the scarves, I don't see how our cutting up some cloth is appropriate, not to mention the complete co-opt of someone else's culture to be used as we see fit. Um, NO. In my mind, this is Disrespectful with a capitol D. Lastly, how do we maintain a "sacred space" where talking and everything else is supposed to be discouraged...but then turn around and pass the booze in same said place? I understand that in some religions this is acceptable...but is it appropriate for Tibetans? Shamans? I don't know, and neither do they, and that's my point.

I bought an IKEA bowl for my big sib, and covered it with rub-on quotes of encouragement, perseverance, and words like miracle, cherish birth, beginnings, etc. Then I wrote our names in silver and red paint. It's beautiful and creative, yet simple. I also purchased a leather bound measuring tape as a gift to her. I liked my big sib, she was very supportive during my first year, and went above and beyond the call of duty. It will be my honor to participate in the blessing of her hands. And to pass the bourbon, Bacardi, or beer as long as she can take it because that's what she wants, and it is, after all, their ceremony.

And while I'm ranting...a while back labor payne said this in her comment to a post by Sage Femme:

"There is an unrelenting psychic weight to being surrounded by members of other classes and cultures who may assume that you don't measure up, aren't as smart, aren't even as attractive, aren't there on the same merit as them"

I want to add this: "And you feel that weight in a million different ways, even when you least expect it...like when you go to the potluck and everything is so. friggin. weird. (to you) that you're paralyzed by it." Sometimes I just stand there for a minute and look, trying to figure out what the hell I do want. Sometimes, rarely, I'm in that, "great! let's try new stuff" mood...other times I'm wishing that there's more than just salad that I recognize. Thinking how different it would be if the tables were always filled with food I eat on a regular basis? What if it were collard greens, fried okra, catfish, yams, hell....STEAK! Instead of tofu, hummus, edmame, and brie? Don't be confused, not all black people eat these foods, and the foods that fill the tables at our potlucks are not the domain of solely white folk. But, I'm saying, as for me and my house...ya know? I'm saying there's some stuff going on for me there, when I'm supposed to be relaxing, like you. I'm saying there's something wrong with the fact that because vegetarians "can't" eat meat, but meat eaters "can" eat foods that are vegetarian, everything on the table (except what I brought :o) is meatless. All of this to say, I am bringing a real dish (instead of an appetizer) to the ceremony. This dish will have meat. Lot's of it. And it will be RED meat. And PORK. Uh oh, double whammy! For once, I will make a heaping plate, and go back for seconds, like everyone else. And I will be full like every one else.

And my liqueur will be soaked up, like everyone else.

Blogsided...

by email.

by the dean.


*sigh*

4 GYN Cases

For a basic description of what happens during the annual exam, see this post. Below I am going to add things that are slightly different than normal.

Case A: 18yr old, in for an annual exam - her first. BMI 31. Family history of hypertension, diabetes, and hypercholesterol. Having casual sex for one year, using condoms "always." Wants to add oral contraceptives.

I always ask a general "how is everything?" and then a specific "how is school? how is home? how are things with your friends?" She's here for an annual exam, so that was first: because it was her first exam, I talk about the parts of the exam (external inspection, insert speculum, pap and STD exam, bimanual exam, etc) I show her the speculum. If she looks really nervous, I remind her that she does not have to have a physical exam to get birth control, and ask if she's still ready to have the exam. Then I tell her we can stop at any time. I ask all first timers if they want to see their cervix when I find it, and if they seem unsure I err on the side of them wanting to see it. She asked a few questions, and we proceeded.

I spent more time on nutrition and exercise counseling because of her BMI. I pointed out where her BMI falls on the chart, and what the number represents. I pointed out my BMI on the chart, and told her how I felt about my category, and then asked her how she felt about her BMI. She said she thought it was "too high," and so I made some recomendations. 1. Because she was only doing cardio twice a week, upper body toning once a week, and lower body toning once a week, I suggested that she up her cardio to every time she goes to the gym, which is about 4 times a week. 2. lay off the soda 3. switch her amounts of refined carbs with her amounts of vegetables (ie: less white bread, more green beans). I then talked to her about getting her cholesterol and glucose checked because of her BMI and family history. She agreed. Then we got to contraceptive counseling and safer sex conversations. I ask her again about her condom use. Turns out it's NOT everytime. Ok, so, now I suggest a full STD and HIV screening. I ask her to give me a scenario where she didn't manage to use any protection. ("Didn't have it with me, and we really wanted to") Then we role played what she could say and do next time. The main question...Do I want to bad enough to risk HIV? (or any other infection) But of course no one is thinking of HIV (or anything else) when they're trying to get to it, so the next question she can ask herself is can I wait 15 minutes? (hopefully that's long enought to find something) and if all else fails, "don't be rough (trying to avoid abrasions), make sure you're eroused (ie: 'wet') again with the abrasions, and withdraw." Last note: "Please be safe. We're here on Thursdays, if you want to talk." She left with a prescription for birth control pills.



Case B: 17yr old in for first annual exam, and full STD screening. Complains of vaginal itch and discharge. I notice on the chart that she came in last week for urine gonorrhea and chylamydia testing.

The exam was pretty much the same as the above, but without extensive counseling on diet and exercise or lipid/glucose testing. We talk to every woman about eating healthy and exercising in general though. Here's what was different for this woman:

I asked she was coming in only a week later for repeat STD testing? "I don't know I just feel like I should get checked."

"OK. Let's talk about it. Are you currently in a relationship, having casual sex...or how would you define your current activities surrounding sexuality?"

"I'm in a monogamous relationship."

"OK. It's excellent that you're trying to stay on top of your health by getting checked for STDs...are you using protection every time?"

"Yes."

"OK, well we do not normally recommend STD testing so frequently if your having sex, protected, with the same partner long term. But sometimes people, understandably so, don't completely trust the person they're with and would like testing more often and we can certainly test you...You were here last week...has anything changed since last week?"

"Yeah I have a different partner." ding ding ding. This makes me look at the chart where people list their sexual "numbers"...how many partners in the last year? Lifetime? Age when first had sex. I usually don't look at these numbers because I don't really agree with them being on the form in the first place...it seems like a way to be judgemental...and if the provider feels that it's important, they can always ask...this is another post...so anyway, I looked and she wrote that she had just become sexually active this year, but had already had 17 partners. Something else that stuck out in my mind was rape. Why? She was just here last week...a week later she thinks she might be infected...even though she was fine last week...she's being vague about the situation...she's drinking quite a bit on weekends (4-5 drinks in one sitting, 2-3 times over the weekend)...which puts her at risk simply becaus of the college campus environment and her behaviors. So I ask the hard question: "I'm going to ask you a question that I ask a lot of women I see...Have you been sexually assaulted?"

"No."

"Ok, do you feel safe with the people you party with?"

"Yes."

"OK. Well, I want you to know that if you ever want to talk about anything, I'm here. And when I'm not, the other midwives are here. And when we're not, there's free services at the mental health clinic next door - and people go there even when they just want to talk." And then the exam commenced. Her itch? Was really on the outer upper labia and mons pubis...from shaving. Her discharge? Normal. I looked at her mucus under the microscope to make sure there was no yeast (or not a lot of yeast) before I told her it was normal.


(BTW, This was new to me...that midwives looked under microscopes to diagnose STDs and other changes in vaginal flora...I had no idea before I came to school that we would be doing this!)

That's all I'm going to say for now for that day of patients, but I did want to say something quick about another patient I had on a different day:

This woman did not have anything out of the ordinary for her going on. She was a little stressed with school and work, but was doing ok. We talked a lot about her career goals because she is a junior in college, and considering graduate school. So we talked about that, and she asked me about the GREs and about what it's like to be in graduate school. It was such an unexpected conversation. But it made me remember that it's about so much more than pap smears, STDs, and pregnant bellies. Even though I say it on this blog all the time, I forget...sometimes you just want to see someone who looks like who's doing any smidgen of something you want to do....someone who says "YES! I took the GREs, let me tell you about it..." or "NO! you don't have to have had been on the dean's list the whole time to considered a good applicant...and YES! You can do this!" The reality is that this woman might not have known anyone who was trying to do what she's doing before coming to the clinic. It was good to be there.

I'm stopping now because something else has started to occupy my mind...