Looking Back: Week 1 of Integration

This is pulled from my electronic journal. This is how my first week went:

Monday: L&D 8 to 11:15PM. Triaged three women in the AM with the same due date who were all post dates, 2 were teens in active labor, and the other was not in labor but wanted to check on her baby. One of the teens kept getting into it with the nurse (who was not nice to her and so I really didn't blame her) but the final straw was when she kept asking her to take her to the bathroom (she was hooked up to IV) and the nurse kept avoiding her (She admitted that she didn't like going into the patients room because the "little girl" had a "very bad attitude and an even worse mouth") and this girl just got out the bed, stood next to it and peed all over the floor. I could not believe the whole thing. I went in to talk to her and she said "I was not going to pee on myself, then she woulda left me in the bed laying in it." It was just a crazy situation. I was laughing with the nurses saying "well, welcome to integration hospital!" and they said "oh you aint seen nuthin yet!" and I thought, omg. I ended up delivering her and the other teen from the morning triages. (15 and 16yrs old) The lady who was also post dates and wanted to check on her baby was from the continent and lives with her cousin and his wife while she takes her last class here in the US. The entire rest of her family is back home. She did not want to be induced, but ended up staying for induction. She cried and cried and cried because her family back home was telling her not to be induced, to leave the baby alone and let it come on it's own. But then while she was hooked up to the monitors she was having decels, so of course we wanted to keep and induce her. I felt for this woman. Here she is, her cousin's wife dropped her off at the hospital, no one was going to be with her in labor or for the birth. She hadn't eaten since 5pm the previous day. She did not want to be induced and could recite the cascade of interventions that she was worried about, and I couldn't even pretend that it wouldn't happen. But, it was so nice to see the midwife and the doctor work together to help this woman. They are from the same part of the continent and so they came in together and talked about cultural customs and how they understood the pressure she was under. They talked about tradition vs the American way of doing things, and helped her figure out what to say to her family back home. The conversation happened in English, French, and their native tongue. The four of us in this tiny room together going over the risks/benefits of induction, still birth info, showing her the strip, asking about her needs, reassuring her that we weren't going to leave her, and just an overall understanding that were in this together. I was so happy to be able to witness it and be a part of it. She delivered vaginally the next day.

The other lady I delivered was a multip who came over from the clinic at 6cms. She was 5'2" and having her second VBAC. The baby came out fine, but then the placenta stuck. After about 30 minutes, she started to look a little shocky- basically pale, and we realized that her last H/H was like 8.9 and 25! We opened fluids, lowered the head of the bed , and called the MD stat. The MD tried to see if she could get it out (light manual removal) but couldn't (and the woman didn't have any pain med left- she was feeling everything!) and so then there was this big rush to get an interpreter phone because the doctor couldn't take her back to OR without informed consent for the anesthesia and hysterectomy she thought she might need (basically the doc felt that the placenta was probably stuck on the old c-section scar and she was going to try to really manually remove it but she would have to anaesthetise the patient, and if she couldn't get it out, she would have to have a hysterectomy) This probably would have been a lot scarier if we hadn't have just passed off the patient and went straight to our other patient who was pushing in another room! I had also done postpartum rounds during the shift, so by the time 11pm rolled around I was exhausted and ready to cry.

I was also upset that I really hadn't been prepared, like didn't have the experience of managing more than one patient at a time. Everything had to be done so fast and there were so many women to check on and strips to read and details to keep straight that I was really overwhelmed.

Tuesday: All day in the clinic connected to the hospital. Another long day. 34 patients showed up. The midwife said that it was a lot, even for her, so she called over to the hospital to ask the midwife on call if she could come help. Well she had three women in labor so she couldn't leave. I felt a little better knowing that the midwife herself felt a little flustered. I don't like how the clinic operates, but I guess this is what it's like at a high volume place. Women are given a number and called back by that number, never their names. She said this is not how midwives like to practice, afterall, this is why we went to midwifery school in the first place, to not practice this way! But this is how it is, you just have to work with it. The RNs do all the teaching- you write in the plan of the soap note what you want them to teach the woman before she leaves. You only have time to do leopolds, fundal height, and fetal heart tones. Also paps, GBS, etc.- the clinical exam stuff. Everything else, the nurses do. The MAs stay in the room with you and hand you everything so that it goes faster, and basically rush you to keep you on schedule. By the end of the day, again, I was exhausted. The midwife apologized for having to feed me to the wolves, but basically I was in shock. We both saw patients at the same time (she in her room, me in mine) and other times I saw patients with her in the room if it was something I didn't know how to do or couldn't find. It was crazy, and I did not feel like I was giving good or safe care, but I do know that I was doing the exact same thing she was doing. Also, almost every patient speaks spanish only. I swear I just can't get away from this. I'm telling myself that there's a reason this keeps happening. The only good thing is that they have multiple translators on site, and they come to you literally within a minute of asking for them, much better than those damn phones!

Wednesday: similar to Tuesday, except it was all GYN/Family planning and I only had a half day, which was lovely.

Thursday: Call- similar to Monday, except I had even more PP rounds to do, and one of my births was in the birth center!!! It was actually almost a waterbirth but she had light mec on AROM and you can deliver in the tub if you have mec stained fluid. So, she delivered in the bed and something funky happened with the cord after it was cut- blood sprayed everywhere! (even though both clamps were still on) The midwife said the cord snapped, but I couldn't tell how or where. It was really nice to see a birth in the center with the woman laboring in the jacuzzi. It was so much calmer, and the midwife seemed so much more like a midwife. It was also a beautiful birth because of the woman. She was this dreadheaded woman with this dreadheaded man for a partner. She was spiritual and really into symbolism. She had prayed the whole pregnancy that this particular midwiwife would be on when she came in (the practice has 'double digits' of midwives in it, so you never know) so she was really happy to have her there. Plus she was in nursing school and wanted to go to midwifery school so she was actually happy to have me there too and we talked about what midwifery school is like. Then, her partner had a friend who was struck and killed by a truck the night before, so they had talked about how with death comes life, and her partner's best friend was having a baby at the same time in the other part of L&D. The woman was also excited that she was having her baby on MLKs birthday in this year of Obama. It was just really good energy all around. Again a room full of women of color (the nurse was from India) feeling the love. As you can see, there have been good moments mixed in with all the scariness.

But it has been scary.

I feel underprepared by my school, and this doesn't feel like IP at all. All of a sudden my hand skills at birth SUCK. And per usual, they ask me stuff I feel like I should know but dont. Plus I really miss electronic charting- writing soap notes fast has been rough. Plus I think I work too many hours. I can see myself getting burnt out here very quickly.

Early morning tomorrow, again, going to bed!

Mondays Are Always Long

My day started off with the pleasant surprise of hearing "we no longer bulb suction babies."  It was music to my ears. It has been a real struggle for me to remember to bulb suction babies on the perineum or after delivery, especially when they are already crying. 

When I arrived on L&D this morning, there was a multip near fully.  I and the midwife introduced ourselves and informed her that were going to take care of her because her doctor was in the middle of a c/section.  She was happy with that, as she was a VBAC and thought she had a better chance with us. (Even though she was already almost fully, there was still possibility for a c-section because we were worried about shoulder dystocia- her last baby was 8lbs 2oz and born by c/s after she couldn't push it past zero station... I don't know if they tried a vacuum or not... but the point is my EFW was 9lbs for this baby, and the mom agreed that it felt bigger than her last baby... so, in short, we weren't out of the woods yet.)  Her doctor popped in after finishing the c/s and stayed to help with the delivery.  This was my first time catching a baby with a doc instead of a midwife.  Mom and doc joked about how the doc said she wasn't going to get to VBAC, but the patient had insisted all along that she would wait till very close to delivery to come in and that YES, she would be having a VBAC and yes she would be able to push out this baby.  She arrived at the hospital at 8cm. :o) She said she was not getting an epidural because she wanted to be able to "push right." I love determined women!

Eventually she gave birth to a 8 pound 12oz baby over an intact perineum, without any sign of a shoulder dystocia.  This particular doc did a lot of perineal massage and puckering, which was hard for me to be get into, but it went smoothly.  The patient and doc joked some more about mom getting her way, baby latched on soon thereafter, and I cleaned up mom and headed to my other mama.

My other mama also had a "big" baby, and this time the baby did get a little stuck.  We ended up having to do McRoberts and suprapubic pressure... but didn't call it a shoulder dystocia. That happens quite a bit it seems... midwives hesitant to call SD... instead saying snug shoulders or mild shoulder, etc.  Lately it seems like often women have been completely quitting their pushing efforts after they deliver the baby's head... I have been told to put gentle downward traction on baby's head by the midwife, only for her to try it herself and see that the baby isn't coming- even in the cases where it isn't a shoulder dystocia, the body isn't coming because the mama has quit pushing!  We end up practically pulling these babies out.  This baby was also over 8 pounds.

My last patient was a woman was a nearly AMA primip I admitted but would not be delivering for a while.  She was just getting into active labor when I left: 5-6cm/80%/0 station. She had a questionable pelvic shape, so everyone began watching her closely, I look forward to seeing how it goes for her.

I then had 2 postpartum patients to round on.  Both were well and breast-feeding successfully. :o)

I've caught a lot of babies since integration started.  I usually average 2 per shift.  When I think of the suggested number of catches for competency, I am so shocked that I've surpassed them.  There are people who graduate with the number of babies I've caught... how scary! 

Today the midwife told me that the goal for my last week before spring break is for her to stop gowning and gloving up.  She expects to sit back and watch me do the deliveries... by myself... "postpartum hemorrhage, shoulder, whatever."  

No pressure.

Sigh.

Integration: Week 1

This is post 1 of my 14 in 14:

ETA: oh man, it didn't work... theres something wrong with the friggin formatting of my journal entries... sigh.

I'm going to repost in a new page...

Stunted. The Cure: 14 in 14

I am a stunted blogger.  

I remember searching for so long for integration blogs.  I wanted to read about what integration was like before I stepped into the fire.  I found like, one, which didn't turn out to be much about integration at all.  I had grand plans of being that blog.  "I will write it" I told myself... so that when someone else looks, they will find it.  Well, I've written hardly anything.  Maybe that's what a real integration blog looks like.... empty space.  Space where one would write if she could think.  Space where one would tell all her birth stories, and glorious tales of crazy times in L&D and the clinic, if only she could find the time.  Space where one could purge her fears and accomplishments, if she actually had time to really process them. Space where one would give helpful hints and tips, if only she could find the confidence to think she had something worth sharing.

Oh if only there were the energy.  I am now convinced that anyone who has time to maintain a blog while in integration is a wonderwoman.  So Morag should be considered SUPERwonderwoman because she's doing it while also nurturing a baby in the belly. She just finished her "integration" and I enjoyed reading about her adventures.  You'll enjoy reading from beginning to end. 

I am trying to commit to 14 posts in 14 days... basically a post a day for the rest of February.  I don't want to look back on integration and not have a record of what I did.  I have been writing about it off and on for personal use, but I want something here, too.  I'm going to de-identify some of the stuff I already wrote and post it as part of my 14 in 14.

Paperwork

I'm drowning in it.  There's a mountain of paperwork required for my class every week, and it's soooo... ugh.  There's also a massive amount of paperwork involved in being a hospital midwife, too.  It seems... outrageous!

Maybe it will be slow enough for me to write a little something more substantial later...

Thesis, What Next, Recession

I have a rare Wednesday off and lucky me I get to work on my thesis. (sarcasm, folks) I used to love it, but now I hate it.  I have a few more people to interview, that always brightens my feelings about the project. Maybe I'll start with that. Mostly I'm sick of writing, sick of reading, sick of looking at it as it barely exists.  It's also very frustrating to keep writing something that people critique so closely.  That's all I can say about it.  It's so entirely frustrating.

People in my class are starting to look for jobs.  I started a long time ago.  It's how I chose my integration site.  I picked a place I wanted to work at.  I don't think they'll be hiring this year though because they just hired someone who will start next month (she just passed her boards, yay for her)  So maybe they'll want me, maybe they wont.  Maybe I won't want them, lol.  Who knows.  My point is, I'm not really worried right now. I am actually surprised by how unworried I am.  I have never been one to be too, too worried about finding a job... I always seem to find something.  I have a large skill set and interview well.  But I'm not really looking right now because I have no idea what I want to do in 6 months.  That's so not like me.  Well, the truth is that I know exactly what I want to do (live in a cottage on the beach in the south of France) but since that's not happening, I have no idea what I want to do, lol.  The midwife who precepted me on Monday's shift gave me lots of advice (she is an alum of my school) about marketing myself and about what to do/where to work if I don't want to be a midwife right away (like if I want to be a L&D RN or a GYN only provider, etc) and about how she went about choosing where to live and making it work with her husband, etc.  It was really good to hear a midwife talk so openly about these things.  It was also good to hear a midwife say "you might not want to be a midwife right out of school if the timing isn't right, and the other options are just as good" and not be freaked, thinking OMG she doesn't think I'm ready. (She followed it all up with "You'll be ready, you're going to be great" and some side comments about how the practice likes to hire those they've trained themselves) I'm still trying to convince myself that I want to live in this area for the next few years.  As the economy flounders, I am more and more tempted to move to a place with a much lower cost of living.

The economy is really hitting poor people hard.  Every time I see the news about the bail out and where the money is going I'm infuriated.  In a whole morning of clinic I didn't have one patient with appropriate weight gain.  I had several patients who've lost weight... and they're not in the first trimester with nausea and vomiting, nor are they obese benefitting from better diets.  These are women of a normal BMI without any income or one-earner incomes of 12-16,000/year.  Women who are getting a large portion of their food from WIC. Women in the second and third trimesters, losing weight... total weight gains of 7,8,9,13 pounds over the course of a pregnancy.  Women measuring significantly "size smaller than dates" with accurate dating.  Women we must send for untrasounds they cant afford (and likely wont get) because they aren't eating enough. Women who flat out admit that they aren't eating enough.  And we ran out of our free vitamins, so we have women who have not taken witamins for 6 weeks.  I keep writing prescriptions, telling them that they can fill them for $4 at Target or Walmart.  

newFNP and lesbonurse are seeing it too.

I'm looking forward to a 3-way chat this afternoon with my girls, and for the man to come home saying "I got the job."

Monday Mornings

suck.

It came too fast. No patients on the board in L&D. This can be good or bad

Time

passes by slowly at the hospital and clinic, fast on the weekends, and even faster in blogland. I have been gone a long time from my blog. I'm tired and overwhelmed with integration and my thesis. There's so much I could write if I didn't spend every free moment eating, writing on other people's blogs, logging onto facebook, or simply sleeping. Already Saturday night is here. That means tomorrow is Sunday, and the next day is Monday. Monday. Back to integration. One never really leaves though I guess. The first three weeks of integration were tough, but still I did it. I had every intention on writing about it often, but since I'm living it, I never want to spend any extra minutes talking about it. Honestly, I just want it to end. I'm tired. I don't think it's midwifery. I think I'm just smack dab in the middle of a severe case of senioritis that is compounded by the fact that I've been in school nonstop for the last... six years. OMG. I didn't realize that it's been six (goin on seven now) freakin years straight. No wonder I'm exhausted. Just plain burnt out. This is the explanation for why I have vivid, relentless daydreams about working as a temp answering phones, setting appointments, or typing documents. I just want to sit down. Rest. Work. Get a check. And go the hell home. Preferably before it gets dark. No one quizzing me. No panic at not knowing the answer. No extreme thinking necessary. No studying after work. No taking it home with you, to bed with you, in your dreams. Of course I want to sleep. I've been at this for 6 freaking years. The bureaucracy, the smiling, the bullshit. Ahh. Academia. Fill in this bubble, jump this hoop, pay this fee. No, no, no, leave who you were over... there. See, I'm trying to show you the way... this way, this is what you want, this is what we need.

But I'm sitting here wondering, how in the hell did I get here?

All as time passes me by.

I've been catching babies. It's harder than I ever, ever imagined it would be.  I didn't think it'd be easy, but I definitely didn't think it'd be this hard.  When I read the blogs of homebirthing midwives, there is such calm. It all seems so normal. So very different than what I'm learning. I try to tell myself to stop comparing, homebirth and hospital birth... apples to oranges, really.  Because I'm at a high volume hospital and midwifery practice, I often manage multiple patients at once. For example, on my first day, I caught as many babies as I did my whole first semester of midwifery school... and I caught them in a matter of hours. Yeah. Granted it really isn't that many, but I was shocked and scared and thinking, what the hell kind of midwifery is this? I know this is what it's like in high volume settings with low resources. But I had no idea that this was also the case for midwives here working regular hours at"regular ol' hospitals." I often find myself managing inductions, triage, and births simultaneously, then rounding on all the postpartum patients.  I find myself thinking, I couldn't do this for real, all day, all week. I can see the bright red burnout sign before I even start.  I am 10 times more interested in group prenatal care now then I was before I experienced what a true high volume clinic is like. I have never seen group prenatal care in action, but I know it must be better to get 12 women together in a room for 2 hours than to try to see the same twelve individually in the same amount of time- leaving you 10 whopping minutes per patient. 

Integration Status

I'm tired. Dead on my feet. That's about all.

Winding Down and Orientation

It's really hard to embrace the fact that my vacation is winding down. This morning I had a meeting with the midwifery practice to learn more about my schedule, the practice and what's expected. Early this week, my main preceptor emailed me and said that for Monday (my first day on the L&D floor) I needed to "bring a lab coat and wear comfortable shoes." Today I found out why. Busy + poorly designed. Here are the stats:

L&D rooms: 10
A multiple room triage cluster
PP rooms (unknown, but two floors)
A Birth Center Suite (this is awesome, by the way)

Now, this isn't a very large maternity ward (well PP is kinda large, but still) However, it's a very busy practice... in fact the practice has multiple offices. I would say that at sometimes 100 births a month, they qualify as high volume. So, although there aren't a lot of rooms, there are a lot of patients, and the layout is kinda all over the place (different corridors, part of PP is on a different floor, etc) There are a lot midwives on the schedule for this month, and they provide 24/7 coverage to their patients. My schedule for this month is usually two 12hr call shifts and one and a half clinic days per week. Sometimes I have a 24hr call shift and one clinic day. I have never done a real 24hr call shift before... this will be interesting (I have been on call for 24hrs before, but not required to be in the hospital all that time) I like the fact that to be "on call" is to show up for a full shift. No waiting for the call, no getting up in the middle of the night- just show up at 8am for your shift. Period. Because it is so hard to learn and adjust to different midwives schedules, I am trying to stick with 2, maybe 3, midwives during integration, but of course it may not work out that way. I also think this is important because you want to have stability and someone who can accurately measure your progress every week. I am also going to try to stick to one main clinic because the private office and county clinic have different procedures and honestly it's hard enough learning one set. 

I got a badge this morning and a list of required tasks (HIPPA, etc) to do this weekend. My badge says "Ivy1 Medical Student" which really made me cringe. Now not only will everyone know what school I go to, but they will think I'm a med student. sigh. I have a drug test scheduled in two weeks.

Things I Left Feeling Good About:

• The midwife that oriented me was really nice and wanted to put me on her own schedule for the next few weeks
• I will get plenty of experiences both in clinic and on L&D
• Waterbirth (woohoo!)
• The midwife call room- very cozy and all ours!
• Plenty of hours to choose from when making my schedule

Things That Left Me Hyperventilating:

• The 34hr work week
• The fact that this is it

I guess it's good that the good list is longer than the omg! list.

The plan is to study very casually this weekend... all weekend.

Another Year Another Move Another State

We have finally, finally, moved.

Almost a week later than we planned.

After an unexpected trip to the ER for the man.

After much stress.

We are at our new destination.

And now, now, I'm on vacation.

Starting Over

This is our FIFTH across-states move in the eight years we've been married. That's a lot of starting over. And over. And over. It's one thing to move a lot (which we also do) but to move hundreds of miles away is a beast of a different kind. We moved here by airplane, so you can imagine how very little we came with. I mailed my books before we left, but that was about it. We accumulated an apartment's worth of stuff over the last two years and now I am faced with sitting a small fortune's worth of stuff out near a dumpster. This includes a 27inch tv that the pawn shop wont take because all the TVs are being switched to the digital thing in couple months. A tv, a kitchen full of appliances that I actually like, a table and four chairs, a sofa bed, a sofa chair, and everything else a house takes to function like dishes and lamps and electronics... all outside, in the snow, wasted. Some of the items I think we will try to take to a local good will, but we have so little time and so, so much to do I don't know if it's gonna happen. I should make a commitment to make it happen. sigh.

I'm tired of starting over. I want a house, to sit in, to stay in, to live in for the next decade. No more moving. No more cramped studio apartments. No more packing my life into two suitcases and a box. No more buying furniture and then giving it away or selling it for dirt cheap. When we moved in we said we weren't going to get a lot of stuff because we knew this day would come. But still, there's a lot here. Where did it all come from?

Anyway, back to packing.

Sigh.

It's Happening So Fast, Part 3

Our wonderful friends/neighbors came over on Thursday late afternoon and dropped off dinner they cooked for us. I had spent another few hours at the health center getting two of the million things checked off my list that now reaches the entire length of the Brooklyn bridge. It had also snowed like a million inches and I had to walk home... uphill... because the buses had stopped running to my house because I live on top of the hill. Luckily, I ran into a classmate while leaving the health plan who was also about to tackle said hill, so we did it together. I won't say which of us fell, lol. It was cold, and snowy, and my face burned from the little ice pellets flying by. By the time I got home the man had caught a fire under his azz and had actually gotten a lot done in our basement, which of course put me in a better mood. So, right after my last post things turned around a little. And then, yesterday, a friend came and helped the man move the couches down to the dumpster. Those couches (together forming a sectional) were very heavy because they were also a sleeper sofa. They did this while me and my friends (one of whom is the wife of the man who was helping move the sofa) went to eat sushi for in celebration of the end of the semester. And, yes this couple is also the couple who brought us the dinner on Thursday! (all of that to say, they're wonderful and we're going to miss them)

So me and the girls had sushi last night at a beautiful place with bad service but cheap and good sushi. I'm going to miss them and our pow wows. I just kept thinking "this is happening so fast." Not school... that was really, painfully, slow. But now that the semester is over, and my to do list is getting longer and longer and the countdown to when we leave is getting shorter and shorter, it all feels like it's happening very, very fast. I've been getting messages about integration- what to bring, who to meet with when, and tasks that should be completed before I start. This of course adds to the mega to do list (I feel like I should name my to do list something jazzy at this point, lol) but is also exciting because I remember being stressed about whether or not this was even going to happen. My friends talk about how they didn't want the stress of setting up their own site and moving over break and meeting new people in a new setting as their integration experience. I can understand that because this was definitely more stressful than just letting the school stick me in boston or south dakota or something. But the reality is that we all couldn't stay in the area, there were only a few spots here and some of those were taken by people who had been at the same place the whole time they've been here. So I wasn't going to take any chances getting sent off to some unknown place where I still would have had to meet new people in a new office and sub lease my apartment and be away from the man at one of the most stressful (I'm assuming) times of my midwifery education. Um, no thank you. I'll take responsibility for my experiences, even with the added stress that it has definitely caused. This is certainly not the ideal, doing all of this in a short period of time. But being home with family and not having to pay my own way for a while, that's fabulous. The chance of learning my clinical skills alongside a midwife of color- which both of my friends have had the opportunity to do, but I don't know if they really understand how much of a blessing that is, and how much different it is when you never have that as minority student- is going to be fabulous. Not yelling at an interpreter phone all day, fabulous. Being in the city and building connections where I actually want to work, fabulous. I think I need this in order to see myself as a midwife, and when I'm finally there, and can finally breathe and not worry about all that has to be done before I can get there, the stress will no longer matter. Oh and the bonus: not having to move over graduation or while studying for the certification exam. So, yeah I'm stressed, and I've cried about this whole integration madness, and I'm having to pack up fast so that I'm not stuck here for Christmas, but still... I'm leaving and you know? I'm happy. I mean really happy. Happy that I finished this looong leg of midwifery school. Happy that my friends made it through, too. Happy that the man is still here by my side. Happy that I have so many people rooting for me. Happy that my family is coming up for graduation, but really we could all just as easily go on a cruise with all the money it will take :o)

We also talked about graduation plans, but that's like a whole 'nother post.

The Bliss Before the Breakdown

First, I'm done. I actually finished the semester. I don't know how successfully, but finished nonetheless. There was a moment during the exam, at the second to last page, where I didn't know the answer to one single question. 10 questions. All on one page. I just laughed. And laughed. And laughed, sometimes even out loud, but I don't think every one is in their own mental hell and didn't really pay attention or care. I just had this feeling of... bliss. Like, you know? There aint nuthin I can do about the fact that I forget to study hepatitis in pregnancy. I mean I didn't study one ounce of it. The questions were over hep B and C, comparisons of which is more dangerous, ect, whether you get hep c from contaminated water (yes) etc. I knew none of those answers. The other questions on the page were about asthma. ugh. and bronchitis. random. So, I laughed as I looked at that page full of guesses.

And then I turned the page.

Last night I drank something that tasted like a cross between champagne and white wine... it was a German Riesling and it was great. Over the semesters I have developed a tradition for how I handle the night before a big exam. I study all day, then, I stop at a decent hour, somewhere between 9 and 11. Then I usually take a shower and get something ready to wear for the next day. Then I have a drink. A good one. More than one. And I relaaaaaaaaaaax. Then the next morning I look at my one most important sheet... it's titled "I will not go into this exam not knowing:" And has the things that I feel are most important or that I've been running from/skipping over while studying. It also includes lab values, etc that I feel are basic and should be able to answer off the top of my head. I only allow myself one page, and no tricks like writing really tiny. It give me something to say "ok, if I don't know anything else, I know this." This whole ritual has really helped me keep myself in check in that time the night before and the morning before an exam. Of course not much on my list was actually on the exam this time, lol, but I still felt really calm going into it.

Then I got home... and hit a low.

Isn't it weird how one thing in your life can be going so well... or least be done... big cheesy grin here... but the rest be a big mess? Home is a mess. Everything about it.

We have a million things to do before we roll out of here on Tuesday.

And I feel like I don't have any help to do them.

Let me go back a few months. We had this grand plan. The man would stop working on an agreed upon date, and then collect unemployment and pack us up so that when the time came we wouldn't be stressed. There were also some career-related things he wanted to work on while he was off. Well, unemployment never came. Long story short, in this crazy state that we hate, you aren't owed unemployment simply by virtue of working for a few years. You have to seriously be granted it, like by a trial and hearing. After many weeks of BS, a fake azz "trial" wherein he was denied but told to reapply (no kidding) he was not granted any unemployment. So, ok, whatever. I still work, per usual, and we can live off of what I make. BUT this also means that for anything that is not a budgeted item, we are using savings. Ugh. Ok whatever, that's the way it turned out. That's ok. What's not ok is that we're leaving in a matter of days and my house isn't packed. What's not cool is that there was a very short list of things we decided he would be responsible for... over the last three months... and none of those things got done. (If this were his blog, he would say "yet") So I've been standing back because I hate that 'mama' role thing that happens between us when I keep trying to ask about the progress of things, it's like asking "is your homework done" everyday. I also don't like when women ask their partners to do something and then proceed to do it themselves because they don't like how the other person's doing it, so I tried not to do that either. My point is I was very purposefully standing back to let him do it his way, on his time. But, some of the things were time sensitive.

For example, our car broke down like a month ago. This became one of the things on his list of stuff to take care of. I wiped my hands of it because we decided he, who was home all day and not packing, nor working on his own projects, could handle it. Well, he didn't. I started to nag. I said do something. Get it fixed, or get it towed, or donate it to charity (it's not worth anything) just do something. I don't want the city to tow it. I don't want a ticket on it. I don't want to end up paying some stupid fee for something that can be totally avoided right before Christmas... right before we move. What does he do? Nothing. I am running around like a chicken with my head cut off trying to pass my full time school load, my call shifts, and my clinic days, and do my job, and the other random house stuff that is my responsibility- like making sure all the bills get paid to who they're supposed to, and can not/will not deal with this car. Packing and the car = the man's job. Do you see where this is going? Yeah.

So, about two weeks ago, apparently, someone hit our broke down, parked on a residential street, car so bad that they totaled it... smashing the trunk into the midsection of the car. How did I find this out?

Well, on Monday night I opened my mailbox and had a letter from the state. Before I could read past "state vs..." I panicked and thought, "how can I be sued when I'm still a student?" and was all freaked out... until I read the rest and saw that it was state vs some other girl. Phew. So I call the investigator at the bottom of the page. He tells me this woman has hit my car and do I want to add my damages to the other damages in the case. I say, I dont know, let me talk the man and get back to you. I now start yelling about the situation cause I am pissed because I have been asking him to handle this for weeks. The next day he goes to where the car is and, of course, there's no car because the city police have towed it. He is clueless as to what to do next. And this brings me to an ultimate frustration of mine. Why in the hell can't you figure anything out?!?!? So I'm thinking, ok... he's not going to figure it out how to process through these kinds of things unless you leave it up to him to figure it out.

But he didn't take any initiative to figure things out.

So as moving day nears, I'm getting even more frustrated, and of course am looking at the days ahead, and them impending 4-8 inches of snow forecasted for tomorrow and am thinking, I gotta do this myself. He isn't going to do it. And that's when I break down. Right here in the house.

I think of all the shit I have to put up with on a daily basis. And I'm angry that there were two tasks that he had to do and he did not one of them. I have to call multiple police stations because there are a million little cities in this little azz area and I have to find exactly which one towed the car. I have to figure out how to go about paying for all the days that have accumulated from the car sitting there for soooo long as he sat here on his azz. I'm left trying to add these tasks: go to the police station to get the police report to see if this woman had any insurance, call said insurance company if it exists to file a claim, if not, get some money to pay the tow and storage fees, then go find this place and the car (this is after I've called the guy to set up some kind of deal to sign over the car to him so I can get the plates back), return the plates to the DMV- required in this dumb azz state when you cancel your car insurance policy to prove that you aren't driving an unregistered car and to prove to the tax folks that you don't owe them any money because here you must also pay property taxes on your car! I'm adding these things to a list that is already incredibly long and filled with things like: get that second physical, follow up appointment for shingles that cursed me a few weeks ago, stop by student health and get this SECOND PPD read because when I took the time to go get my immunization record yesterday they realized they had LOST the results of the one I had done in August, so "come back on Friday for an accurate set of records," a three hour meeting with my thesis advisor, a meeting with my academic advisor to check out for the semester, pick up a rental car, and on and on and on. And while you're at it, do it all on public transportation. And pack up the house cause not ONE box is really packed. And do it all in, oh, 5 days or so. And while you're at it:

"Can you make me some pancakes?"
"Are you serious?"
"Is that a no?"

Here's the thing. I'm tired. And he's sleeping... all day... most days. I know he's depressed. I know it sucks to be him, according to him, I get that. I understand how he got to this place. I watched it. I know his history. I know how far he's come. But today, right now, I don't give a shit. I'm tired.

I'm tired.

I'm tired.

And I need help. And I'm disappointed that someone who loves me is watching me, or snoring through, me work my azz off and it doesn't at all compel him to get up off his own azz. I'm teary, but they won't come. I think it will come after the move. I think it won't come because I know I have a lot to do between now and Tuesday. I am not at all confused about the fact that it will all work out. Afterall, I know me. I know I will do what needs to be done. But I'm not supposed to have to do it by myself. I swore I wasn't going to do it by myself. But what else am I going to do? There is not time to

Breakdown

Breakdown

Breakdown.

The Liver is NOT on the Left

Yeah. I've reached a new low. While trying to understand the right upper quadrant pain that is associated with HELLP syndrome, I just could not figure out why this pain would be on the right... is it referred pain? No. Of course not. FYI: your liver is on the right side of your body. Now, of course I knew this at some point. But right now my brain is mussssssssssssh.

To top it off I had a so-called annual this morning with a CNM who did nothing but give me a pap and refer me to a physician for the rest. She refused to give me documentation for a physical (understood, because she didn't give me a physical!) but neither did she listen to my heart, my lungs, or feel my thyroid- all of which I have been taught for the last 2.5 years is part of an annual well woman exam??? Ummm. ok. She then preceeds to ask me who is seeing me for primary care. A midwife!! Hello!! It's in my chart that XYZ, CNM is my "primary care provider," yes she does my routine health management, she does all my screenings, she does all my exams, including the GYN stuff.

Now. If I had known that YOU weren't going to give me a full exam, I would have NEVER made an appointment with you in the first place. I would have begged to put into a slot with my midwife. And I do not think it's fair that you will be billing for a well woman check up when all you did was a pap and half hearted breast exam. But I digress.

Where does this leave me? Having to go to the doctor's office yet AGAIN next week to get the annual exam I was expecting to get today. And I have to wait until 2:20 in the afternoon to get it... I was hoping to leave in the wee hours of the morning on Tuesday so that I didn't have to drive 6 hours in the dark for this move. Ugh.