It's a boy...um-m-m, make that two!

Well, I didn't have to wait much longer for the blessed event! After seeing a few patients in the Indianapolis office last Monday morning, picking up my primary preceptor from the airport, and having an absolutely scrumptious Italian lunch, I went to my home away from home in Muncie. Just as I was falling into a pasta coma...I got a phone call from my preceptor, saying that we needed to meet a couple at 5:30 PM back in Indianapolis. So after gathering everything I might need if we had to stay overnight, I took off for the Indy birth center, a little over an hour away.

I met this really sweet couple there just before 6PM and found out she had really progressed to the latter phase of first stage of labor, yet she didn't even look like she was in labor. She was so calm and peaceful, and they worked so beautifully together. I thoroughly enjoyed watching them. I just did what I needed to do and stayed out of their way as much as possible. They had mentioned that it would be really neat if their first baby came on the 27th, because both of them had birthdays on the 27th (in January and February). Just before midnight, they got into the tub (since they wanted a waterbirth), and my preceptor and I followed them into the tub room. Just three pushes later, a precious baby boy was born in the water. I quickly picked him up out of the water and laid him gently in his parents' arms. He was so precious and there was so much joy in that room! And yes, he was born on the 27th, at 11:59PM!

This precious little one had complications and had to be transferred to the NICU, though, and he was found to have several abnormalities that will require surgery. None of these were evident upon newborn exam, but were found with testing once he arrived in the NICU.

By the time all the care and paperwork was taken care of, I went to sleep at about 5AM Tuesday and slept about 4 hours until it was time to wake up and get ready to see patients in the office again. I can't say I actually felt very well, but I think I managed to disguise it until after I was able to see 3 patients...my preceptor saw the other three patients scheduled. Just about to the home stretch...and then it happened. We got another phone call from a patient who was in labor; I called and asked her to come over for a labor check.

You guessed it...active labor...so I knew I wasn't going anywhere! So, Tuesday night brought more watching and waiting, but it was exciting! At least for me, it's quite freeing to see these women and their partners be so in tune with themselves and their labors. They are central to their own labor process, and I, though I am carrying out the procedures I need to do, try to remain on the periphery... ever observant, though, because I have a responsibility to recognize potential problems and intervene when necessary. That's where I'm finding out that 29 years of experience as a nurse is helping me; it has trained my senses to know that something needs attention, even if I can't pinpoint what the exact problem is.

Anyway... back to the story. Tuesday's laboring mom worked hard for many hours, and finally, at 4:43AM on Wednesday, her little boy was born (this one on dry land)! Before he was born, between pushes, the mom and the other four of us in attendance tooks turns yawning. It was a long night, but such a wonderful experience!

About 3 hours later, once things had settled down a bit, I was sitting at the kitchen table near the birthing suite trying to stay awake and chart while the family held and cuddled the baby, when I heard the unmistakable sounds of a baby having respiratory distress. Everything had been fine when I examined him at about 2 hours of age. And, as I've heard from other family members over the years, the comment was made that those sounds were "cute baby noises". In my mind I was thinking, "No, not cute baby noises...sick baby noises!" I re-examined him, and many of the distress signs disappeared when the baby got warmed up again. However, there was just a faint hint of bluish-gray color on the baby's face and an oxygen level in the mid-80s (for non-nurses, normal is mid-to-high 90s). With oxygen, the level would come up to the mid-90s, but when the extra oxygen was taken away, back into the 80s he went. After talking to my preceptor, I ended up calling the hospital NICU and talking to the neonatologist on call; the baby ended up being transported to NICU for further evaluation about 5 hours after birth.

Two sweet little boys...both transported to NICU. My inner NICU nurse wouldn't shut up and sit down, but I hope both babies will be the better for it. Gotta shake that black cloud from over my head! So...next on my list of hopes and prayers (besides complete health for these two babies) is a great normal birth and healthy baby that goes home with his/her parents, and not to the NICU!

My preceptor insisted I stay at the birth center for a nap before making the drive back to Muncie, because she didn't want me to be in a wreck. I'd had 10 hours of sleep in about 3 days and used muscles I didn't know I had, but what wonderful experiences I had along the way! Once I got back to Muncie, I had a late supper and fell into the bed, where I don't remember anything that happened for the next 11 hours! This, my friends, is going to be a very rewarding way to invest my days on this earth, and I am thankful!

Step by Step...

At long last, it's time to tell what's been going on the past six months as I've been traveling the road toward my dream! Here's just a sampling of what's been going on the last six months....

May 2008:

• I attended the final required on campus session (Clinical Bound) at my school, Frontier School of Midwifery and Family Nursing in Hyden, Kentucky, for a week. And what a week it was! We (student nurse-midwives and student family nurse practitioners) practiced all kinds of skills we would need in our clinical settings on mannikins and on each other. (Eek!!) I made new friends of people I had only seen on our student forums and we still keep in touch by e-mail and phone...Ah, bonding in the trenches! School tradition has each student ring the bell at the chapel when we pass a milestone. Below, in the foreground, I'm ringing the bell for the second time (Initially, I rang it at the first session in May, 2005, at the end of Frontier Bound.)

• Since I had lost my preceptor in Greensboro, NC, just weeks before I was to go to clinicals, I had found one preceptor in the NC mountains who had been a family nurse practitioner for 15 years, but who had become a nurse-midwife only this year. She said she could offer me lots of primary care, family planning, and gynecology visits, but she could not supervise my baby-catching yet (until she had been a nurse-midwife for at least a year). I made arrangements to start with her; the catch was that I had to finish a huge community assessment paper before I could start clinicals. I started working on that course, and she graciously consented to wait for me.


• I had already planned to attend the annual convention of the American College of Nurse-Midwives in Boston at the end of May, hoping to make contact with someone who could supervise my intrapartum (labor and birth) clinicals. I wasn't beyond posting a notice on the bulletin board that said, "Desperate student needs preceptor!" But it didn't have to go that far. My plane was (hours) late leaving Charlotte for Boston due to "mechanical difficulties" (turned out to be a malfunctioning air conditioner... important, yes, but don't scare me like that!). Anyway, on the shuttle ride from the Boston airport to our hotel, I met a nurse-midwife from Indiana who owns two of that state's birth centers. She had come looking for someone to hire for one of them. When I told her I wasn't that far along yet, that I just needed to find someone to supervise my intrapartum clinicals, she said, "Come on over!" I've had a love for birth centers since the early 80's when I worked as an outreach follow-up nurse for a birth center in High Point, NC, so after several chats during the course of the conference, she agreed to be my second preceptor and said she would start with me when I finished at the site in the NC mountains! To me, that just shows how God knows what I really like and arranges things to fit...even if it takes a late departure on an airplane to make it happen!

June 2008

• Milestone birthday on the 5th...the big 5-0! Other than being bogged down with studies, I'm feeling younger by the day!
• Despite lots of frustrations and hard work, I finished the required community assessment paper at the end of the month...92 pages later!! (May I hear another Eeeeek??) This is the middle chapter of my thesis...one more chapter left to go...early next year! I made a 97 on it and learned so-o-o-o much about the city I grew up in and thought I knew all about.
• At the end of the month, I played harp (along with another harpist) for the patriotic musical, Celebrate America, at Hickory Grove Baptist Church in Charlotte. I LOVE playing with a church orchestra!

July-September, 2008

• I started clinicals at one of the health departments in the NC High Country on July 8th. I didn't quite know what to expect...the answer to that is...the unexpected, of course! My preceptor didn't know this about me, but most of the time I do better if I am told what I'm going to do with little or no warning. (That way, I don't have time to figure out a reason that I can't!) I learned that when I was taught how to swim in my 20's -- my instructor took us to the deep end of the pool and told us we were going to jump in...and I believed her! On my first day, my preceptor was explaining to me how we were going to do a speculum exam on our patient and I thought she was going to do it and let me watch...somewhere along the way, it became obvious she meant I was going to do the exam and she was going to watch! (For those of you who aren't OB/GYN nurses, but are women, you know this as the friendly (?!) little instrument that you encounter when you have an annual Pap smear done...'nuff said.) Of course, I knew how to do it...we had practiced back in May...but I was hoping for a longer time before I had to do that. Survived it, though...both the patient and I, and the preceptor was pleased with my first "real" exam. After about 2-3 weeks of doing the exams several times a day with my preceptor, I told her I would go in alone and if I needed her, I'd call her. It was quite a confidence-builder when I didn't need to call her in to help.


• I liked working with the health department clients far more than I ever dreamed. Some of them had so many problems of various kinds, and since the daily pace wasn't very fast most of the time, I had time to offer them and listened to them. For some, I got the feeling that it was the first time that a medical person had ever seemed interested in hearing their stories. They seemed so appreciative, and they were so patient with me while I learned. In fact, I think the only impatient one was me. It's quite humbling on one hand to be a student of any sort, but to be in an area that isn't necessarily your forte (primary care, family planning, and gynecology) is downright scary after 29 years of being in areas related to labor and birth. I felt more than once a heavy weight of responsibility like never before, because I thought, "If I miss something, I could really mess up someone's life". I daily had to "get over myself".


• You've probably seen the sticker in cars, "No fear"... on some cars, it reads, "Ain't skeered"! Not on your life, buckaroos!! I noticed something...until I got fairly comfortable with seeing the patients, I was quieter than a church mouse...focusing so intently on what to examine for which problem...oh, and don't forget this...or that....sometimes I gathered as much information as I could think of about someone my preceptor sent me in to see, only to come to her office and she would ask me something I hadn't thought about. On one patient, I did that 3 times before I finally got all the data I needed. (It was something neurological, in case you wonder...not my forte.) Also, we had a fairly large Latina population (thank God for a wonderful trilingual interpreter), and I wanted to try my Spanish, but it took all the courage I could muster to make an attempt. For some reason, it was easier to try my Spanish with the patients' children then with the patients themselves. (Maybe that's the level I was ready to communicate on.) I learned so much about Latin culture, and even did a couple of assignments that had my Latina clients as the subjects. I was awestruck with the knowledge base my preceptor had about almost anything she was seeing in her patients...and yet, she was so very patient with me. I'll never forget her for that.


• I learned a huge lesson about health care economics there...couldn't just assume that because I said some test needed to be done or whatever, that the patient could afford to have it done. For lab tests, I went around to the inhouse lab and found out the prices of the tests, told the patient what I thought she needed and had to give her the option of how many of the tests (if any) she could have done. I got very familiar with the health department formulary, a list of medications that the health department stocked at CVS Pharmacy (next door) that wouldn't cost the patient anything, and the $4 list at Walmart. Many of my patients weren't even eligible for Medicaid (never mind health insurance) and would have to work out a payment plan with us. It made me very aware of the fact that we have to gauge what we order on what won't make the patient have to decide between our treatments and tests and their rent or their next meal. Hard lesson...but a good one for someone starting into practice.


• I've always loved the NC mountains...and this summer was no exception! I drove up on Mondays and back home on Fridays. At first, I stayed with my preceptor's sister-in-law who allowed me to stay at her house at no charge (3 weeks!); I almost snagged a beautiful kitty to have as a pet, but with all my traveling, there was no way. The whole area was covered in Christmas tree farms...amazingly beautiful! I know I had the most lovely ride to my clinical site. I also got to be a tourist a couple of times: I toured Linville Caverns and hiked on Grandfather Mountain and crossed the swinging bridge, too!

• In August and early September, I stayed at a church retreat center and lived next door to the church's youth pastor and his family. It was something special to come home in the evening to hear the kids wanting to tell "Miss Kathy" what they did at school that day! The retreat center was a converted school building with bunk style quarters. I had one 6-bunk room all to myself. One bunk was the closet, one was the pantry, one was a study place, and of course, one was for sleeping! They only charged me $10/night, and I had full kitchen and bath facilities. I loved getting to know that family...they're really special!

September/October, 2008 --

• Since leaving the mountains, I've traveled many miles. I stayed home about a week packing for who knows how long in Indiana. Then I started off on yet another adventure. I took parts of two days to drive to Indianapolis and stayed in the birth center there while I attended a training session and conference on Centering Pregnancy. It's group prenatal care and it's catching on all over the country. After learning about this type of care, I think it's a great model. It allows women at a similar point in pregnancy to build relationships and learn to care about each other, while giving providers a chance to share pertinent information within the group setting and facilitate group discussion about pregnancy-related topics that the group is interested in. It's like a childbirth education series and the education part of office visits all in one!
• After that, I traveled on to Muncie, IN and started clinicals here about 3 weeks ago. There's a catch, though. I thought I had until I reached 500 clinical hours to finish all my coursework...oh no...not true...the real number is 400 hours, and I already have about 315 hours in with 2 full classes and 1 more test in another class to go. So...I'm only in the office 1 or 2 days a week, trying not to go over the limit. I'm using the other days of the week to study, do assignments, read, etc. The patients here have seemed very accepting of me and my preceptor says she hasn't gotten any complaints about having a student take care of them, and she says that's amazing. She asks every now and then when I'm graduating; she has two open positions at the birth centers. So we shall see....
• I did lots of traveling in October. Sadly, I lost a dear friend (86 years old) who was like a second dad to me since the time I lived in Tulsa, OK. He fell down his basement stairs, hit his head, and went into a coma, from which he never awakened (on this earth, anyway). I took off driving from Muncie to Tulsa October 7-8 to be with my second family, and was astonished to see how I really missed Tulsa and its people. It was my first time back there since moving back to Charlotte 4 years ago. I was able to take my harp and play for the memorial service and for church the next day, then left the following Monday afternoon to return to Muncie. Though tired, I repacked on Wednesday and flew home to Charlotte on Thursday to celebrate my mom's 80th birthday and get winter clothes. I flew back to Indy on the following Monday...and my body proceeded to let me know that was "quite enough, young lady"... had a raging case of hay fever last week...should have bought stock in the Kleenex company! I've rested a lot this week, and in a few hours, it will be time to start my clinical sessions again.
• I've watched the births of two babies so far one in the hospital and one in the birth center, but haven't yet "caught" any myself...my preceptor thinks that could possibly happen this week! Stay tuned....