Crunch Time/Class Descriptions

Starting next week, I have an exam almost every week, one test right after the other, sometimes more than one in a given day. It's crunch time, and I'm feeling it, but it's also about mid-semester, so I can say that I've survived the first half of a very challenging semester! I just read all of the required reading in the Patho textbook for the upcoming exam, and actually understood half of it (which is progress). This upcoming exam is all genetics. Enough said.

In keeping with the purpose of this blog, I want to say a little bit about what each class is like:

Monday

Stats: (1st class of morning) Self explanatory...about formulas to help you figure out statistics for studies you conduct, and help you understand the studies you read so that you know if they have real clinical significance or not. The professor uses power point for teaching, and the exams are open note open book - less calculation, more interpretation type questions. Survivable.

Clinical Conference: (1hr before lunch) Come talk about your clinical experiences, present a patient as a case study, turn in charting paperwork, learn about random things like prescription writing if it turns out that your clinical preceptor wants you to know how right now!

Lunch (and either brown folks group meeting or midwifery check-in)

Primary Care for Midwives: (2 hours) This is the class where you learn about things like asthma, immunizations, ears/eyes/nose/throat, respiratory issues, diabetes, endocrine problems (thyroid, etc), dermatology stuff and anything else you might end up dealing with as a primary care provider. These are the things that midwives often choose whether or not to manage...ie: You can refer most of this out if your patients have access to other services, or if you have FNPs/docs on site at your local clinic, or you can choose to manage a lot of the aforementioned because most of it is clearly within the CNM scope of practice. This class has a lot of case studies, so it's not always straight lecture.

Advanced Patho: (3hrs, into the evening) I keep including the advanced because we also took a patho course last year, and this patho course is a new requirement started last year. (ugh) This course is about the pathophysiology behind diseases. (I know you aren't supposed to use the word in the definition ;o) hmmm...so you learn things like the genetic basis of Downs Syndrome (instead of the signs, symptoms, treatments, etc that you would learn in something like general med surg) You learn all about cells and alterations of cells, immunity, etc. Details, details, details. 3 hours of straight lecture.


Tuesdays

Adv Physical Assessment class: (3hrs starting at 8 friggin AM) The lecture material about how to do a thorough full exam, ie: all that stuff your doctor does like look in your ears, mouth, and eyes with all those nifty tools, and listening to the heart and lungs, and every thing else you can think of. This class also has a lot of history taking and charting lectures. 3 hours of straight lecture.

Lunch 11-12

Physical Assessment Lab: (3hrs, Noon-3) The lab component to the above class, and lucky me I have the actual professor of the lecture portion as a lab professor. (Lucky = sarcastic, she's crazy, and new to the school as of September 1st) We practice all the stuff we just learned 5 minutes ago in a lab that has several beds that are set up like provider's offices are. You pick a partner for the semester and the two of you practice skills for 3 hours on each other. We all already know how I feel about that.

Research: (2 hours, 3:30-5:30) Basically you learn research methods and terminology. Surprisingly, you never read research articles. Isn't that crazy? Maybe it's coming up in the next half of the class, but it seems to me that we should be at least reading some research articles in this class from the very start. This class is set up differently than the other courses as it has a weekly quiz due before class, and every class period you have to get into small groups and work on some little exercise for the attendance credit.

Wednesday

Gynecology: (2hrs, at whatever time they tell us to be there, usually 3-5) This class is what other people probably think we learn all day long. It's how to do a gyn visit (general exams, pelvic exams, pap smears, birth control (or not), STD testing/diagnosing/treatment), dysfunctional uterine bleeding, fibroids, endometriosis, cervical cancer, etc. This is the class for which we also have a clinical rotation every Thursday where do all of the aforementioned.

Fridays we are supposed to be "free," but they always end up scheduling something, like special graduate teaching sessions for you to learn how to do a male genital exam or breast exam, or pelvic exam, etc. Why are midwives learning how to do a male genital exam? Isn't this out of our scope of practice? *sigh* But I try my hardest to keep my Fridays clear, even if it means I do these GTA session with other classes at different times. I need one day during the week to myself, to STUDY. Isn't that crazy, a student who has no time to study, absorb, learn.

Gynecology Clinical, Week Four

The following is the email I sent to "check in" with my midwifery/women's health friends at school last week. It's kind of funny, but also shows what it's like to be a student learning it all for the first time!

Today my preceptor did an "observation" of me where she just stood in the back of the room and watched everything I did for the first annual exam of the morning (after the first day we pretty much did the exams on our own and she only came in if we asked her to). I sweat *SO* bad she had to go get me some new non-wet-with-sweat gloves...seriously my hands were so sweaty I couldn't get the gloves on right. Then I almost did a bimanual with HAND SANITIZER instead of lube. Can you imagine? I caught myself but my preceptor was like "I should move this for you!" Then I said "I'm going to put the 'stethoscope' in now." LOL Then I had a patient with a yeast infection, but what was my diagnosis? "String" Yeah, when I looked in the microscope, I said "I don't see anything but *string*" It was yeast! Then I couldn't think of the treatment for yeast infection...I said "Bactrim" and my preceptor said "NO!" (but not in a mean way) and I said "ok, let me look in my black book"...but when I looked, I didn't have the the damn CDC guidelines for tx of yeast infection in my BB. *sigh* What is it? Friggin MONISTAT *duh.* Then I had to do a full exam on a woman who happened to be a doctor. She came in for DUB (dysfunctional uterine bleeding), and it took me a *while* to find the cervix because she had had a baby and so it didn't just "pop" into the speculum like the other cervices usually do. And she was from India* and very concerned about the draping of the sheet and not being exposed (she brought safety pins for the top part of the gown to keep it closed) so I was trying to hold the sheet down so it covered as much of her legs as possible AND do the exam. I was *SO* freaked out you guys *sigh.*

*I don't know if this cultural, but I wanted to make sure people pay attention so that they are conscious and respectful.

Even though this email might not sound like it, I am usually very comfortable in clinical (besides the everyday learning pains required to grow ;o) and I usually do just fine. Even though I was so nervous because my preceptor was watching, it all still went well. I'm glad she wasn't in there for the exam of the physician though because that was so unnerving without her in there. That exam went well and the woman said that physicians weren't as "gentle" or "patient" (regarding all of the draping, explanations of procedure, and "introduction of touch") in India because there are so few physicians and so many patients that they just don't have the time. It was nice to be able to remind her that I am a student midwife (I say it when I introduce myself) and feel so proud of the fact. Also, kudos to my school and preceptor and for teaching me how to do a pelvic exam that is kind, respectful, and gentle enough.

The midwifery students do a semi-weekly "check in" over the lunch hour at school. We talk about how everything is going, plan stuff if we need to, and talk about what we want relayed at the faculty meetings (2 students act as faculty liaisons and attend the faculty meetings to relay the students' concerns) But I am not so good with sharing at this "check in" because I don't feel like I know the women in my class very well yet, and I don't completely trust them yet. So I/we, my smaller group of classmates that I do know well and trust enough, are trying to also check in through email while we build some relationships in the larger group.

So that's gynecology clinical, week four. Next week I will try to post what the typical day of clinical was like (as far as what kinds of patients, what exams, tests, medications, etc) so that people can see what they might be doing on a typical day, and what information they might need to brush up on. If I don't remember, someone please remind me! (Someone did this for me and it was so nice to feel confident on the first day because I was able to at least look up some of the meds and procedures that I might encounter)

Anyway, off to study genetics for patho. Ugh.

One of My Favorite Poems

Go here to read it. Read it at a poetry reading once.

Adv Physical Assessment exam II went well enough today I guess. I don't like having a lecture 5 mins after taking a test in that very same class, but that's the way it goes. I just emailed one of my midwifery professors to move an exam so that we wouldn't have three huge exams back-to-back within a 24 hour period. I said I didn't care whether I had to take it earlier or not, just please not at the same time. We'll see what she says. Last night I studied for today's exam with a pitcher of strawberry pina colada, courtesy of the man, and I think that's how I need to study from now on. (well, maybe something a little less caloricious...I'm sure my half of the blender was about 600 calories!) I was so relaxed, and this morning I must have had a sugar hangover because I was in such a great mood and so "over" the test before it even began! I don't know, we'll see what my grade is, and then go from there...

We have an apartment inspection tomorrow (God I can't wait to own my own home) and I'm thinking about how much cleaning I'm willing to do. Do I really have to pretend that we don't keep piles of clothes (both clean and dirty) on the floor between washings? Or that I make my bed in the mornings, wash the dishes every night, and line the shoes up at the door? It's so fake. I hate keeping up appearances. But I also don't want anyone to think that I wasn't raised better. But even as a child I kept a messy room...I like to say messy...my mama is probably reading this and saying "no, not messy, nasty" LOL but why fight it, I am who I am. Nonetheless, I'm sure I'll clean tonight. At least I don't have to be to school early in the morning. Just take the man to work, come home and relax for an hour, then off to school. I will treasure that hour.

Note to Self

School...it is what it is.

Complainin about it aint gone make it go no faster.

Keep it movin'.

Review of the Week (Or Longer)

:: We had out intergenerational pot luck last week. I am a second year student. Our responsibility was to give the new students their welcome folder. We all have an incoming student ("little sister") that we're supposed to mentor and that's who we give the folder we created to. The folder has photos, poems, stories, etc. passed down from each class, plus a bios for each student of each class, and a letter written from them welcoming you to midwifery. I think I was the only one who contributed anything new to the folder this year, which I thought was sad. I included an excerpt from Toni Morrison's Beloved a small portion of which I will put up sometime soon, and this quote from Anais Nin because it made me think:

Man can never know the kind of loneliness a woman knows. Man lies in a woman's womb only to gather strength, he nourishes himself from this fusion, and then he rises and goes into the world, into his work, into battle, into art. He is not lonely. He is busy. The memory of the swim in amniotic fluid gives him energy, completion. The woman may be busy too, but she feels empty. Sensuality for her is not only a wave of pleasure in which she has bathed, and a charge of electric joy at contact with another. When man lies in her womb, she is fulfilled, each act of love a a taking of man within her, an act of birth and rebirth, of child-bearing and man-bearing. Man lies in her womb and is reborn each time anew with a desire to act, to BE. But for woman, the climax is not in the birth, but in the moment the man rests inside of her.

We also gave them a CD that we created by each contributing a song. My song was "I Believe" by Fantasia. The faculty then presented us with these bags they quilted us. And lastly the 3rd year students put on their performance which really was great. The made infomercials about products they made up (ie: a scratch and sniff card to diagnose BV) and did a dance they choreographed based on the movements you do for shoulder dystocia. What a great evening. Now we have to get busy planning the "blessing of the hands" for them.

:: School is kicking my behind. The first round of exams are out of the way, and the second wave begins this week with Adv Phys Assessment. I can't wait for this class to be over. Clinical is still wonderful but this week is a reverse observation week where our preceptor observes us all day. That makes me anxious. It's like now I'm going to forget to do stuff I always do, just because she's watching! Ack! I sent in an application for the new Johnson & Johnson Minority Nurse Faculty Scholars Program. I'll let you know how that goes. My expectations are low because I heard about it a little late and by the time I sat down to write my personal statement, I was speechless. Nursing school has really taken everything creative right out of my brain, and I haven't written anything like this in so long that I've forgotten how.

:: I visited Johns Hopkins last weekend to check out their PhD program. I really, really liked the school, but there were a couple things that turned me off...1) They only have guaranteed funding for the first two years, after that you have to apply for outside sources of funding. That makes me cringe. Not because I wouldn't be doing it anyway, but because I don't want to depend on outside funding to finish the program. I'd much rather be guaranteed funding all the way through. 2) The set up: just like many other prestigious medical campuses, it's located in the middle of a low income neighborhood (in Baltimore) and I am not sure if I want to do this setting again. (That's how my current school is) It's frustrating to study in places like these because you're conflicted about where you really belong, and it's hard to be in a position of privilege (through education at a prestigious university) and but feel like you're not really helping the people in the community. And yes, I feel that way even when I'm working in the community really helping people! It's weird. Maybe I'll articulate that better another day. But there were some issues with the trip. Me and the man went down with one of my friends, but ended up having to come back via train which cost us $225. I was pissed to say the least. Basically me and my friend had some issues and I thought "there's no way I'm riding home with you." And she didn't want us to anyway. I think she was very competitive about the whole visit to Hopkins and was stressed about getting into the program because it was her first choice school and she just took all of that out on me. She apologized profusely, but it takes me a long time to forgive such blatant rudeness. So, that's that for a while.

Ok. Back to work, studying for phys assessment.

Somethin's Gotta Give

Am I missing something? Do you folks take vitamins every day? I'm exhausted. Seriously. I don't think I can continue at this pace. I must be doing something wrong. Maybe my walking around campus and dancing around the house is not enough. Maybe I need to ramp up the exercise. I heard that helps. I already get quite a few hours of sleep, but maybe my bed isn't comfortable enough. I know I need to eat more regularly and probably better. But I really am exhausted. I think 6 graduate classes, plus clinical, plus a lab course is overload. plus my one night per week at the library turned into three this week.

Somethin's gotta give.

Happy Birthday

Breathing Again

I am finally able to come up for air. I passed my GYN exam from last week. And my physical assessment exam. I more than passed my Patho exam from yesterday. And my physical assessment lab exam today. My primary care exam ended being a "closed book take home exam" and I just finished that. It was so funny because a girl in our class just couldn't get the hang of this whole "take home" exam that was *still* "closed book." And I understand. It's weird. I already wrote about how I feel about the so called honor-code at this place and institutions like it. So, I won't go there again. But I will say it does have its benefits, and being able to study for another day was surely one of them. I broke down in that class when she gave us the news. I was soooo happy because I really hadn't studied as much as I should have because I was trying not to fail Patho! Some people were not happy at all because they had spent all kinds of time studying, and if they had of known we would have had one more day they would have studied something else instead (like Patho, for which we had an exam the next hour!) I understand their feelings. But, come on, this is a gift people. Be thankful, say thank you, and keep it moving. Besides, if you really wanted to take the exam right then (instead of at home) you could have. She said we could take any time we wanted, as long as it was under her door by 9 am on Wednesday...what about that says you can't take it today, right after class, and be done with it? Why didn't people do that? They said they now felt pressured to go home and study more. Hmph. I say w h a t e v e r.

Anyway, so my day started at 6:30 this morning when I met my friend/lab partner at school to practice for the phys assessment lab exam. (Did I say I almost puked during the exam? I was fully clothed in my jeans tennis shoes and wide shouldered tank top, so that was no problem, I was just so nervous feeling like I was going to forget anyone of the million things we had to remember.) And now I'm counting the minutes until I get off (18 minutes) at the end of which will mark a 16 hour day for me. Then I'm going to go party to celebrate surviving the week and my friend's birthday.

And tomorrow it starts all over again.

*SIGH*

I actually got through all of the Patho material for tomorrow's exam, but when I test myself, I don't remember very much. I am so tired of looking at it. I have studied. And studied. And studied. I can't study Patho anymore tonight. I am completely stressed out because this is one of those classes where they issue you one of those "you're not cut out for nursing school" letters if you don't pass the exam, and I already had that experience (along with a few others) in Biomed and I came *this* close to leaving (or being kicked out) the program. I can't deal with that again. It was too much the last time. But I've given it all I have today, I have to move on to my other classes. (I have 6 classes, not including clinical or labs)

I have started studying for Midwifery Primary Care and it's not too bad. I have the obesity lecture down and don't need to look at it anymore, and I almost have the immunizations lecture down. The dermatology lecture is KILLING me. Everything looks alike. The last lecture for this exam is the abnormal pap lecture which was very dense. I don't know what I'm going to do to study that one. At least that one feels relevant. I don't think I am going to be the kind of CNM that does a lot of "primary care" as far as non-gyn related issues. I hope to work in a setting that also has FNPs and MDs, because I am just not interested in ear infections, managing you hyperlipidemia, rashes, and mental health treatment. I want to talk to you about your issues, but if you "fail" the mental health depression screening, more than likely I'm going to refer you to a mental health specialist, rather than give you some meds. I don't even want to go there doing eye exams, ear exams, and asthma management. CNMs who read this blog: To what extent do youo provide non-gyn related primary care? (I don't think non-CNM midwives are technically "primary care providers, are they? Someone correct me if I'm wrong...)

Then I have to bring the man back to school with me tonight to practice my HEENT (head, ears, eyes, nose & throat), respiratory, and heart physical exams on him in the lab for my physical assessment lab exam which I am not even close to being ready for.

At some point I have to prepare for a lunch meeting tomorrow. Plus the annual midwifery potluck tomorrow evening. All three classes of midwives and their SOs, plus faculty, come to this potluck. 2nd year students give first year students folders that we make with encouragement for their upcoming midwifery journey (which I haven't made yet...it involves copying all the pages from the folder that was given to me and adding the new contents from my class and putting in a folder with some kind of decoration that I have not yet found) I also have to cook something for the potluck...where am I going to find the energy for this stuff?

I don't know.

Exhaustion & Delirium

I have been studying non-stop for what feels like months, but is really only weeks. I have a Nurse-Midwifery Primary Care exam and a Pathophysiology exam on Monday, and my physical assessment check-off exam on Tuesday. I'm so sick of studying. Especially Patho which never seems to sink in. Then I have to get ready for week 2 of clinical which is like a class all by itself, but still rewarding.

I'm tired. But I can't sleep because my mind is full of other stuff...also I think it's psychological...I hate going to sleep now because it always feels like I haven't slept for an hour before it's time to get up. You know that feeling you get when you fall asleep on the couch fully clothed and don't wake up until next morning and you feel like you've been cheated out of a night's sleep because you never really went to bed? That's how it's been feeling lately when I wake up. I hate that.

At least tomorrow I don't have to get up too early. But I should be out of the house by 10 though...I have so much studying to do.

First Day of GYN Clinical

I survived it. It was so weird. I got emotional, thinking, "this is it...this is what I came here for...I can't believe it." It made clinical feel like make-believe...a dream I was going to wake up from at any moment. This isn't me standing here in this lab coat (we have to wear it) with this speculum in my hand explaining to this 18 year-old girl that her discharge is normal. Can't be me who just found a lump (benign- "always been there" per patient, + preceptor verified it wasn't really a "lump," but great job feeling it!) on size G (yes, G) breasts on my first breast exam. Who found the cervix all by herself on her second patient of the day. And all of this on a day that was supposed to only be "observational."

Today was one of those days that made me realize all over again that there are certainly things we are meant to do in this life, and if you are lucky enough/work hard enough you might actually find yourself doing that very thing you were meant to do at that specific time.

I wish this for everybody because it feels so. damn. good.

I'm Not Taking My Clothes Off

I can't. I was all ready to give it a shot, but I couldn't do it. I had so much anxiety, I almost threw up. There are just some serious boundary issues involved when it comes down to me strippin down to my bra and boxers/biker shorts for class. Yes, it's because I'm fat in a program full of people who are skinny and judgemental. But it's also because I don't want to see my friend without her clothes on, and vice versa. My professor asked if we wanted her to be the model. I was thinkin' hell no, that's a boundary I don't wanna cross either. What is it about this...it can't just be me...I really, sincerely, think there's something wrong with this. It's like seeing your co-workers naked...examining/commenting on their breasts, their skin, and their ear wax...

So, I was reassured that we could do it fully dressed (without any points subtracted from my partner for listening to heart and lungs over clothes) if I wanted to.

I think I can manage with a tank top and some pajama bottoms...

Thanks for your thoughts on the previous post about this folks.

Addendum

I just wanted to add /clarify that we do have paid GTAs come to my school (similar to med schools) but you only get one practice session with them (which is REALLY helpful) but students usually also practice on each other in other faculty sessions to get more experience! (This for GYN class)

However, in physical assessment we practice everything else on eachother (head to toe exam, etc).

My First GYN Exam & Practicing on Eachother

My first GYN exam was mainly over the menstrual cycle and contraceptives.

What they told us: "It will be multiple choice where you fill in the bubble sheet and you will have a choice of questions to answer. We really want you to do a good job."

What they gave us: A 25-ish question exam that was entirely "short essay" in which you had to come up with the material all on your own.

LOL.

It's only funny because I still knew the answers and didn't need the prompting that the multiple choice questions would have given me.

Otherwise, I would have been pissed.

***

So, in midwfery school it seems to be the norm that students practice skills on eachother. This is also the case for nursing school in general...but it's different because in nursing school we aren't talking pap smears and pelvics! From day one I was clear that this was not OK for me. I decline the option of "sharing my body" as is my right. A few others did the same, but by and far most consented. Well, after the first few sessions there were some problems. Students felt that they weren't in control of the sessions (ie; who touched them where or did what, or how involved/physical the faculty were during the teaching) and so they made some complaints (as they should have) and all practice sessions were stopped.

I give our professors credit for how quickly, and sensitively theyhandled the concerns. However, I don't think these sessions should even be a part of the program. I'm not sure if it's just because of the kind of institution that I'm at that makes me feel this way, or if it's the process in general, but I don't like this practice. One issue is that my classmates are not the most sensitive people in the world. A lot of them are very judgemental, naieve, and clueless when it comes to anything outside of their posh upbringings. It is very clear by the statements made in class. So after people make comments about appropriate weight, shape, skin, and social histories that they obviously disdain, how am I supposed to feel comfortable stripping naked for this person to touch me? Some people don't mind doing this in the name of learning. And they are right to point out that people have to learn some way. But at what cost to me? If I am the only fat girl in class, does that mean that I should let everyone try to do a bimanual pelvic exam on me so they can see what it feels like? Should everyone look at my acanthosis nigricans so that they can know how it looks on dark skin? Why should I have to do more than anyone else? Why should my privacy be neglected for the sake of your learning- especially when there are 15 of you and only one of me?

And even when this isn't the issue...there is something creepy and inappropriate to me about practicing on your classmates...in front of your professors...I don't want my professors to see me without clothes on...just like I don't want to see them without clothes on...there's a boundary issue I think.

What do you guys think?

How, Where, and Why We Practice

This is a continuation of my comments to this post over at Navelgazing Midwife's place.

I am not saying that it is problematic that (new) midwives practice in communities other than their own. But ask yourself, why do they do this? Are there not any patients in their communities that need care? Is that people in their community would rather be cared for by someone with experience? Is that they feel drawn to help communities other than their own because they see that a need exists and they have the skills to fill the need? Are they coming to this community to stay, or to get their numbers? Why is there such a need in the first place? Why is that there aren't any providers/leaders from this particular community available to fill the need? I'm a midwifery student; if it's helpful to get practice in communities other than your own...how come aint nobody ever sent me to the ritziest part of town to practice for clinical? I understand going to Casa, I really do. I have always wanted to go there. But let's tell ourselves the truth. There's a reason why there is no equivalent to Casa in Beverly Hills.
It is true that if providers from other backgrounds pulled their care out of these neighborhoods, even if it were only two or three years of care in the first place, many, many people would be without care. Dr. Jen asked: "Would taking training programs out of these communities help, or make it worse? Is there anything we, as outsiders, can do to encourage leaders to rise up within a community?" and NM asked: "If we didn’t move outside our own communities, isn’t that forcing women to travel outside their own neighborhoods to obtain care?" Can I say something radical? Withdraw your care. Maybe if you did, our community would find another way. I mean, we wouldn't have a choice, would we? When doctors and nurses would not care for us in the past, we cared for our damn selves. (we built the institutions to train and provide care) When we could not go to "your" schools, we educated ourselves (again, we built the schools and educated our children), and contrary to popular belief, we did a better job at it. Ahhh, "but this is two steps backwards", you'll say. "That's segregation" you'll declare, abhorred. I agree, it is. But I'm not convinced that what we have right now is any better, especially if you're already thinking that if you don't do it, no one will. (forcing women to travel out of their communities for care...maybe instead of coming to find you, I would support my local 18 year old who wants to apprentice, or my soon-to-graduate-college neighbor for a CNM program)
NM asked: "Wouldn’t it be a much kinder and more respectful move to get off our asses and set up shop in their areas of town, acclimate to their culture and offer them the fabulous care they deserve?

My answer: NOPE. What I want is a way to give this "fabulous" care to my damn self. I want midwifery/medicine to stop being this barely attainable career path for people like me. I don't want to have to wait until you feel inclined to give me care. After I have managed to make this possible for people in my community, then YES, certainly, come join me. Let me learn from you, and you learn from me. You're more than welcome to set up shop, but it shouldn't be because the system that leads to this possibility is rigged in your favor. When most of the providers are from one background and most of patients are from another...the learning exchange doesn't feel quite equal...

Lastly, NM asked about the future of midwifery and how people can be inspired by anybody, regardless of race. I agree. However, if it were oh-so-simply about just being around the professional in question- and race didn't matter...wouldn't we have more professionals of color already? I mean, after all, we encounter a lot of professionals that don't look like us already. NM, do you know how very few of us there are? I mean really. Do you know I prayed that I would not be the only black person in my class like my friend in the class above me? After you think about it, ask yourself again if it is not enough to simply have any midwife/primary care provider in front of you. I can tell you with absolute honesty that when I was a child, seeing someone of color in a particular profession absolutely made that profession seem more feasible for me. It is the same principle at work when colleges and universities set up mentorship programs linking ethnic faculty to ethnic students - they do it because they know it makes a difference. The whole reason I have a blog in the first place is because I know this to be true. I have lived it. I gotta write this stuff down because someone wants to know if they can do this. I wanted to know...are you hearing me? I was looking for a black, nursing student blogger from my kind of neighborhood...a black CNM blogger who had done what I wanted to do...it was like I needed proof that it was possible...it's hard to imagine college if you don't know of anyone intimately that has done it....it's hard to imagine medical school/nursing school/law school if you don't know anyone who has done it with your circumstances. Let me tell you what that low-income girl sitting in front of you is probably thinking, even without trying to think it...she's thinking I'm not good enough, smart enough, to do what she's doing...you have to be really smart to do that/be that...this is for white people...she's thinking it even when she doesn't realize it because those are the words and images she gets all damn day long. Does that sound crazy? Let me give you a comparison. You know how we are so very careful to tell our daughters "you can be anything you want to be... a firefighter, president, an astronaut" and everything else? Why do we do that? Because we know that for a very long time women were conditioned to believed that these were jobs only for men - and usually they thought this because women rarely (if ever) held these positions. Well, it's the same for black people. We have to take the time to spell it out..."you can be a CNM, a neurosurgeon, presdient." Why? for the same reason that we tell our girls, because this whole time we have been led to believe...lived in a country that told us/showed us...otherwise. Now think about the impact seeing Hillary Clinton and Barack Obama run for president is having on our children. Sure, we have told our daughters thay can be president...but doesn't SEEING Hillary make it seem that much more possible? THAT is why it's so important to see professionals of color from your neighborhood in your neighborhood-because they are a walking, talking contradiction of the bullshit you've learned about yourself from day one. No longer is it just someone telling you that it's possible, you have proof.

NM would "like to believe that [we] can leap over the color/race/culture hurdle all on [our] own without someone leading [us] by the hand."

It's not a hurdle. It's my existence. There's no getting over it NM. I might be able to work something out by going around it, but that's about it. And I'll tell you, it damn sure ain't no ways easy to get around it without some help. Someone did lead me (through this racial identity process) by the hand, and I intend to lead as many as I can by the hand, too. Why? Because it is nearly impossible to do it alone. It will drive you crazy. Yes anyone can be a role model. But what happens when racism smacks me in the face? Do I really want to have to convince you that this was about race, or would I rather go into the office of someone who already "gets it" so I don't have to relive it by explaining it?

I really, truly, appreciate people who put their thoughts out for everyone to see in a blog. It's a vulnerable position, to share your opinions, questions, and thoughts. I hope we never stop. Thanks for continuing/being a part of the conversation NM, Sage, and DrJen (and everyone else)

I'm out of steam and I have my first GYN exam in the morning.