The Antidote to Burnout

It’s been a hard year. 

It’s been a hard year for EVERYONE. 

But, I can (maybe) only speak for nurses, and say that for us, it’s been really, really hard.

People often talk about burnout in nurses, and how this is a problem, and how to fix it and yadda yadda. But really, how does one fight burnout?

I had an idea one day, and it wasn’t radical, or new, or even particularly innovative. It was just simply: gratitude. It’s the only thing that has ever lifted me from depression, the only thing to combat self-doubt, pity, depression, sadness. So, at the end of this year, I’ve decided to dedicate this last post to gratitude. The thing about gratitude is that, when you look for it, it’s actually in abundance. Once you start being grateful, miraculously, you find more things to be grateful for. It’s this magic that saves us, that pulls us from the darkness, that reminds us to keep going. Gratitude grants us the ability to step back and realize that there is goodness in our lives, and that a portion of that goodness lies outside of us- whether that be nature, other people, experiences, or faith in a higher power or purpose. 

This isn’t the first time that I have leaned on gratitude. During the divorce I started wearing a Fitbit, and at noon each day I had a recurring vibrating alarm. That small reminder was just to myself, each day, to say something that I was thankful for. Some days I couldn’t say more than being thankful for the weather. Eventually, I was able to list a few things. This wasn’t a linear process, but one with peaks and valleys, steps forward and backward. But over time, I came to see that the more good I could pull from my life, the more good started coming back to me. 

Knowing this, I suggested a gratitude practice during a Unit Council meeting at work. I shared that I thought it the most powerful antidote we had to fight the unmeasurable burnout we have felt this year. Burnout breeds more burnout; it’s only natural to commiserate with others about shared challenging experiences at 2am when you’re still documenting your assessments. Yet, we know that gratitude also breeds more gratitude, and for this reason, I proposed that we start weaving gratitude into our practice.

In the spirit of this, and the New Year, I feel compelled to share what I am grateful for this year. Despite everything, there is always goodness.

I’m grateful for technology; Facetime and Zoom have made this year tolerable. Between calls with my family, Zoom workouts, Microsoft Teams meetings...this year was conducted over the internet. This fact isn’t to be overlooked...it has kept us connected to our people across the world, when our physical presence couldn’t. It’s not the same, nor is it trying to be. But in times like this, it does a damn good job, and I’m thankful that I have it available to me. 

I’m grateful for Tom. There is nothing that I do that, frankly, he doesn’t support. I volunteered for Covid back in the spring, and he said Yes. I wanted my brother to live with us, and he said Yes. He wanted to start a new business and I said Yes. To have someone who is your biggest advocate is priceless. I wouldn’t trade it for anything.

I’m grateful for my dog Phoebe. Who would have thought that adopting dogs from the south would be so hard in 2020? We waited so patiently for her, looked at countless photos of dogs on websites, filled out so many applications. Pheebs came to us so quickly...Tuesday we saw her picture and by Friday, she was in our laps. She has been such a joy. I cannot imagine our lives without her. 

I’m grateful for my best friend Robyn. She did some amazingly bold moves this past year, leaving her husband, job, and home in NJ to work for Kamala Harris like the badass bitch that she is. More importantly though, she continues to call me on my shit, right when I need to hear it most. Seeing her only 2 times in an entire year has been absolutely rotten, but somehow our friendship will come out of this pandemic in better form than when we entered.

I’m grateful for my coworkers. What a year we have had. Oncology, Covid, Oncology with Covid. To be in a place with such flux, but with such dependable coworkers, is a gift. The nurses I work alongside want nothing more than to give the very best care. They work so hard for our patients, stopping at nothing to give their all, every day. To learn from them has been a privilege. To stand amongst them in this pandemic has been an honor.

I’m grateful for my family. This year has not been without losses: Uncle Pat, Grandpop, Granny. We are significantly changed by this. Despite these losses, we continue to lean on each other, to remember the years gone by, to smile at the memories. We have been so lucky to have such revered members of our family for so long. Sometimes, it feels like not enough time. Yet, here we are. 

I’m grateful for my brother Jake. This might be the hardest to write about. The pandemic has shifted the goals and aspirations of many, my brother included. This brilliant man was studying in London at the time that shit hit the fan in the US, and eventually he found himself back in NJ. Luckily, we here in Philadelphia had more space than we needed, and Jake came here. For a bit of context, Jake and I are 5.5 years apart. Something about our age difference just put the slightest wedge between us when we were younger, and it wasn’t until the last 5 years or so that we settled into a great friendship. Something changed when he was living abroad; we started to text, call, and connect more while he was gone. Perhaps I was just a small bit of home. Regardless, once he was back in the States for the pandemic, I offered that he come live in our house, 

“Jake, we have plenty of space.” 

And so he did. I’m not sure Tom was ready for a roommate during the first year of marriage, but he got one, and thus a family of 3 was formed, with Phoebe by our sides. I’m not sure I have enough words to articulate the joy that he has brought to my life since being here. In some ways, I saw this pandemic as a “once in a lifetime opportunity” for us.  When again would I have the chance to live with my brother, as adults, without children? When would we be able to have this much time together? Potentially never. We played games, watched movies, drank countless beers in our backyard, went on walks, visited museums, ate our weight in sushi, and read side by side during many evenings. It has been the biggest gift of 2020 for me. It makes me think of my grandparents, and the importance they placed on “making deposits in our emotional banks.” I think they would be proud.

We look back on 2020 with many emotions- frustration, loss, regret, sadness. But, if we choose to see it, there is also gratitude. It is this shift, to see the good and to be grateful, that will help pull us through, it will save us from burning out. Perhaps we connected with nature again, perhaps we caught up on sleep, or started to run again. Perhaps we reached out to distant family members. Perhaps we learned to cook, or perfected French macarons, or learned to speak spanish. Maybe we just binged on Netflix or crushed a reading list.  Regardless of how you spent 2020, there is something to be proud of, something to cherish, and something to be grateful for.

WTF are you grateful for?

One Year

Today marks one year as a nurse. It’s hard to wrap my head around all that has happened, but I’ll try. This year is remembered in moments to me, little bits of feelings and events- small, ordinary, fleeting. Holding the hand of my dying patient, while describing the sunset out her west-facing hospital room. Trying to make a man smile, the doctor now turned patient, with only a few weeks left to live. Walking in Christmas morning to find that my first primary patient had died. Crying...in the bathroom at work, on the floor of my kitchen, in my car after my shift countless times, wrestling with the volume of loss that I’ve seen so soon into my career. Hugging a patient as she cried, urging her to believe me when I told her I cared so much about her. Hearing my patient say to a colleague, “As long as I’m with Adrienne, I’ll be alright.” Or being called an angel by a man who was recently released from prison, forcing me to fight back tears at his bedside as I wondered how a person so wronged could still find such beauty at the end of all things. 

I will never be a first year nurse again, and for many, many reasons I am grateful for this fact. And though this year may have been more difficult than expected, the pandemic has made a powerful impact on me. Accepting limitations, taking leaps of faith, trusting those around me, making real life nursing decisions on my own...Covid propelled me into bigger, messier lessons of caring for humans than I would have expected. No longer were my biggest concerns that of asking how to draw up meds or how to program the IV pump. My concerns shifted, becoming wider as I questioned why the demographics of my Covid patients were so vastly different than my oncology ones, why similar preexisting conditions were being seen time and time again, how systemic racism was so evident in healthcare. For this, I am grateful to have been a nurse during the pandemic, to experience firsthand the problems others only speak of. 

I have learned much in this year, more than I can even try to write down. This is just the beginning, in many ways I suppose, but for now, I find hope for carrying on through the power of teamwork, from the ability of humans to adapt and change, and from the grit of an everyday nurse, like me, willing to step up and do some good for patients. 

Wherever Is Needed

“But you have been chosen and you must therefore use such strength and heart and whits as you have.” -Gandalf, The Fellowship of the Ring

This was the quote I posted on my letter board the night before I started on my newly converted covid floor. I had volunteered to stay behind as my oncology patients were relocated, and within an evening, I was no longer an oncology nurse, but a Covid one.

Before it was an option to volunteer, I knew that I would be doing this work if I had the choice. I told Tom once the pandemic started to pick up, “You know that if I get the choice, I’m going to Covid.” There was never a question for me, and he knew that, acknowledging that if I got sick, then we would both get sick. We were weathering this storm together, just like any other. We called our families, and though I was nervous to tell my mom, she didn’t skip a beat, saying, “I assumed you’d be on the front lines of this eventually.” With their well wishes, I eagerly stepped into a world of infectious diseases, investigational medications, and more PPE than I’ve ever used before.

It was a new challenge at the start, exciting even, to know that we actually we’re taking care of patients affected by the pandemic. I’ve never been in favor of this “front lines” chatter, but I can’t deny that that is what we were doing. I remember shrieking a little while watching the news when the first inklings of Remdesivir started, and I had just administered it that very day. It piqued my curiosity about research, public health, and infection prevention. I felt like we had the inside scoop.

And we did, in ways that weighed on me more than I thought. Reading about the tough stories or seeing the uncomfortable photos is not the same as being there in person. You don’t hear about the 45 year old man declining over a week, ending up in the ICU and on a ventilator. You don’t witness the homeless patient leave AMA because finding Covid friendly housing through the Dept of Health takes too long. You don’t see the married couple, who both being positive can share a room, and watch as one decompensates as the other is in the next bed. You don’t have to be there when your 20 something patient is being tearfully being wheeled off to surgery and you can’t even hug her because she’s Covid positive. You're not the one told to hold up the ICU transfer in case the daughter wants to Facetime her mom one last time, because her mom won’t survive an intubation. 

These gut wrenching moments are part of nursing, and definitely woven into our work as oncology nurses. But what is different now is that there is no break, no rest from this work. Cancer is not usually all over the news. Yet now as a Covid nurse, the world, the news, social media, our communities are constantly buzzing about this pandemic. It’s a never ending reminder of what we’re battling at work. We come home and we hear the same statistics, we continue to wear the same masks, we quarantine, we remain surrounded by covid news, only to return and pick up the fight again. We as nurses, and all healthcare workers, are facing the grim realities of this pandemic 24/7, making it that much harder to hear the hospital-wide calls for Anesthesia STAT, to read our patients names on the deceased list.

I joked at one point that it was apropos for the WHO to name 2020 the Year of the Nurse and Midwife. Naturally, it’s the best year for a pandemic! I said. The world did recognize us, and still does. Thrust into the center of this disaster were doctors and nurses, doctors and nurses, all those brave doctors and nurses. The heroes. 

“Thank you for your service. Thank you for being on the front lines.”

Oh the perks came flying in, the free food, the free water bottles, supplements, socks, and shoes. I’m not complaining, we were well fed. But yet, though the pandemic is not over, our time as America’s sweethearts has already come to a close. Frustrated last week, I vented about the shift towards reopening, towards moving on. Towards getting over it. But yet, nurses are still here, still taking care of these patients, still holding their hands. Will America, and the world, still remember it’s the Year of the Nurse in December? Will they remember when we threw on isolation gowns and goggles as fast as we could to stop our patients from falling? Will they remember the buttons we sewed onto headbands to protect our ears during 12-hour shifts? Will they remember that, despite any virus, we leaned in close to hear your grandmother’s whispery voice as she struggled to breathe? Will they remember when we stepped up, to be a nurse wherever was needed, whether that be a different hospital, state, or country? Or will the allure of “normal life,” of concerts and restaurants and bars, the rush to leave the uncertainty and fill our days again, erase the memory of when the world stood still and watched as normal people carried out extraordinary work? 

We Don't Talk About It

The other day, one of the college kids at the rink asked me about my job. When I told her I worked in oncology, she replied, “Wow, that must be hard. How do you deal with it?” I answered almost immediately:

 “I talk about a lot of death with people.”

And this is true. Though I may not always see a person take their final breaths, I am often caring for people in their final weeks, days, or even hours. It is sad, but that isn’t always what I am focused on. What’s more pressing to me is the family, how they are coping (or not), their level of preparation, their level of understanding what the patient actually wants in their final days, and their willingness to accept that sometimes, there are no more options. The only option left is to love. It is the tension between holding on and letting go that draws me to patients at the end of life. The pull between giving up and fighting, between what the patient needs and what they want, the pull between family members. It’s the realization that, perhaps, they never took the time to figure out what the dying person’s wishes truly were.

Oncology has highlighted for me that most people do not talk about death enough. We just don’t have enough frank conversations about our wishes surrounding death, or the wishes of others. This is not morbid or taboo, this is a fact of life- we will all die. Just like we will celebrate birthdays, marriages, and birth, we can also celebrate the culmination of life. Whether we live for 5 years, 55 years, or 95 years, our lives will be the longest thing we ever do, something my father said to me long ago. I believe that the same vigor we bring to these other milestones in life should be brought to conversations about crafting the ends of lives to reflect our wishes and preserve our dignity. 

After Kobe Bryant died, I saw an outpouring of grief over his and his daughter’s lives cut short from the helicopter crash. People all across social media spread their “thoughts and prayers,” but I had to wonder, what was everyone thinking about? Were they thinking about his wife and remaining daughters, and the horrific new norm that they were completely unprepared for and now had to live with? Were they thinking of themselves, and what their spouses or children might do if they were to meet an untimely fate? Perhaps both. I wondered too, did anyone go and talk with their children about what would happen if a parent died? Would they tell them that they would go live with their uncles in Delaware? Because I always knew that was the plan for us, and while I would have never wished that in a million years, there was a comfort in knowing that my parents had thought about me and Jake, and had planned for us to live our lives with loving and equally wacky relatives. This was never morbid to me, it made me feel safe. 

Did anyone stop and think about what they would want at the end of their life, if given a choice? I recognize that most people don’t walk down the street contemplating intubation or not, but it seems that only once we are reminded of our mortality do we ruminate about these things. What is it that is actually important? Do we want to fight to the very end, despite the side effects? Do we want to prioritize normalcy for as long as possible? Do we want to endure clinical trials for the sake of aiding in the future of research? Do we just want to stay at the beach as long as possible? When we are fighting for days to live, how do we want to live them, and with who?

I don’t ask these questions to make you sad. I ask because perhaps, they could help you to live. Maybe once we prioritize the things that *truly* matter, the people and feelings we want to carry to the end of life, we can have better clarity NOW on what is important. Perhaps, by pondering the ends of lives, we can find more joy and intentionality in the parts we are living right now. When I think about death, and my work in oncology in this light, I find that it’s far happier a place than I could have imagined. 

WTF do you want at the end?

Unraveling

Today I did something that I think is so embarrassing- I cried on the ice. As a coach, I would always shake my head at the dramatics of some of the kids at my rink, crying in frustration at themselves, at their partner, or at their damn double axel. I was far removed from that as a coach; I only skated my prescribed dances with a few of my students and stayed very much within my comfort zone. And surely as a kid I NEVER did that, right?!

Ha! Upon further reflection...I used to call my mom crying to tell her that my partner wasn’t working hard enough. I used to keep a journal where I would write so hard in anger that I would rip the pages during fits about my coach at the time. I remember running to the bathroom to throw up and cry after our second year competing at Novice at Nationals where we ended up in the same place as the year before. These are just the memories that have stuck with me 14 years after my last competition, surely there are many, many more lost in the depths of my mind, clearly illustrating my highly emotional side as a skater.

So this test of mine- we’ve made some concessions about what should be fully leveled and what shouldn’t. For me, the twizzles were going to be hard no matter what, but I decided from the beginning that they were going to be as “real” of a twizzle sequence as they could be. All the revolutions, all the directions, and as many features as feasible. I said I wanted hard right? I’m pretty sure I asked for this. But today I unraveled emotionally as I fell down time and time again, making the same error over and over. I’ve had days like this before. Sometimes I wonder if I have them to keep reminding me not to be afraid of this element. If I can survive the falls, then I can survive the element. These days are also a lesson in skating.

Skating is hard, and this is also rushing back to me each time I skate. I’ve only been back on the ice consistently for about 4 months right now, spending much of that time finding my balance and flow again. I’ve also forgotten the variability of this sport- sometimes the ice is a little different, it’s colder than usual, maybe I didn’t sleep or eat as well, maybe I just came off or am about to go on to night shift. These small nuances were maybe easy to get over when I was a teen, but as an adult dusting off my skating, these are probably playing a greater role than I realize in the progress of this test. I’m not lending myself nearly as much grace as I should. 

The real issue is that I just can’t regulate myself. I put so much pressure on myself, on each practice, and each attempt that I’m constantly disappointed. This is something I just don’t remember when I was a kid. I know I wanted to do well, and I always wanted to please my coaches, but I don’t remember this level of soul crushing expectations. Sometimes I feel like coming back to skating with perspective and more knowledge is a double edged sword. Now I am fully aware of every mistake I make, leading me further down a road of frustration and feelings of inadequacy. I’m thankful for this insight and self-awareness but today it was just too much for me to handle and I unraveled emotionally as I glided around the edge of the rink, failing to hold back my frustration.

When I started this blog back in 2015 I would have told you that I thought I was a bad writer, that I used the passive voice too often and was too wordy. Those things may still be true now, but I have also become a stronger writer by facing this practice week after week. I stumbled through the difficult feelings, and struggled to find the right words to convey my thoughts. But I kept at it, with no time frame in mind or expectation of how I would grow through this blog or the lives that it would touch along the way. I think I need to do the same with my skating- come back to the practice day after day. Release my old labels of being “bad at twizzles”, stumble through the choreography and the awkward spin positions. I entered this project knowing it would be hard, knowing there would be bumps in the road. But I also came back for the joy; though today wasn’t a joyous day it was in fact a real day in the grind of this practice that I know will, ultimately, lead me to something I am proud of in the end.

The Red Door

Quite impulsively the other day, I decided to paint our front door. I had been wanting to paint it since after looking up door prices, I decided I’d rather revamp the older style door than buy another. Red was just the punch that our entryway needed, in my opinion, so Tom and I went off to Sherwin Williams and I bought the first red I saw and proceeded to paint the interior side of the door. While teetering between loving and hating the idea, it got me thinking about how the simple act of painting my door paralleled some of the biggest lessons I have learned in this past year, but more so in the past decade. In lieu of a letter to an Old Adrienne for NYE this year as I have done previously, I have opted for some lessons that this door has reflected back to me:

Paint the door because it feels good to you.

I’m a people pleaser, I will admit. I felt for so long that I needed to do what was expected, what I “should” do. And maybe that works for some, but for me, inevitably I woke up, looked around and realized that I was somewhere that really didn’t sit right with me. At the end of the day, we have to act in accordance to what makes us feel best, what allows us to sleep at night. While not listening to our gut can lead us astray, not all is lost. We can always tune back in, choose what is right over what is easy, and paint the damn door red because we think it’s best for the house.

Paint the door because it’s an expression of your most authentic self

The paint color is called Show Stopper; does this sound like a color that everyone might like? No, and I don’t really care. The color spoke to me and thus I chose it. Now when I walk into my home I am greeted by a door that makes me smile. I’ve learned that this life is so fun and playful when we allow ourselves to let loose, to dress how we want, to overplay the soundtrack from Fame as often as we wish, and to pick the boldest color door paint for the block. There was a time when I felt like I was in a haze, not really being the me that I knew I could be. Now, I get to talk to my patients every day about their poop, and honestly, I’ve never been happier. Paint the damn door red because your soul loves red and that’s all that matters. 

Paint the door with the true support of a partner

Tom maybe didn’t have the same vision as me for this door. But more importantly, he trusted my vision and supported my desire to carry out the project. Though a small example, it’s one that shows me the power of a partnership where trust is at the core. So much of what we have accomplished during this past year, both alone and together, would have been 10x harder without the other’s support. Sometimes it’s overt support, and sometimes it’s just knowing they will back you up, but having that safety net in case you fall makes it much easier to swipe that first coat of paint.

Paint the door red because it’s just out of your comfort zone

I didn’t really need a red door. But it made me just the slightest bit uncomfortable, and that was reason enough for me to try it. Stepping out of our comfort zones is unsettling and anxiety provoking. I still feel this way most days when I work on my free dance. But it's within this uncertainty that I am discovering joy, disappointment, and lessons. Here is where we grow, we stumble, we look back, we look forward and we eventually travel to the other side, marveling at the distance which we have traveled. There’s beauty in this instability, in the rawness of new growth, in the vulnerability of opening yourself up to critique. It’s a reminder that we are human. 

Paint the door knowing you can always change your mind

Sometimes we don’t get it right on the first try. I sure know this lesson. And while that lesson came (time and time again) with pain and challenges, I can now say with ease and self-assurance that nothing lasts forever, both good and bad. Celebrate the highs, and hunker down during the lows for few things are permanent. Success can follow failures; it can follow many, many failures. You are capable of change, furthermore, you are ALLOWED to change. Paint that damn door red knowing that you can just as easily add more coats if you like it, or paint over it- Sherwin Williams does after all, sell primer.

Perspective

On this Eve of my first working holiday as a nurse, I told Tom that I didn’t feel like it was Christmas. I had missed my annual Christmas Adam Dinner that we always have with our friends at my parents’ house, and had just spent the last 3 days at work feeling drained. The presents are wrapped and the tree is decorated, but I think for the first time not celebrating Christmas “normally”, it had me down in the dumps. 

As I mulled this over on my way to the rink, I started to think about the patient who was new to the floor. A 20-something with leukemia. I hadn’t met them, but had received report from the outside hospital in case they arrived during my shift. As I was considering going to say hi tomorrow regardless of whether I was their nurse or not, I started to think about their first Christmas in the hospital. Not being able to wake up in their own bed, not being able to see their family, happiness and joy replaced by uncertainty and fear. Their “normal” Christmas was gone too. Who was I to be complaining about missing Christmas?! Of course, everyone has their own battles, and this is not meant to negate anyone’s feelings, even my own small feelings of sadness. But after my shift on Christmas, I will be able to go home to see my healthy family and husband, a luxury that my patients do not have. I have clear lungs, and a body free of cancer, a luxury my patients do not have. What I also have is the opportunity to make someone’s worst Christmas ever, not so terrible. In this season filled with sales, doorbusters, and material objects, I have discovered the greatest gift I got this season: perspective. 

Oncology is really hard. I think the hardest part is seeing the evolution of one’s disease, their grief, and their subsequent understanding of their own mortality. Relapse after relapse, we see these patients come back, after positive bone marrow biopsies and pushed-back discharge dates. We watch their hair fall out, their strength decline, and their appetite fade away. We listen as they discuss hospice, as they count the weeks they have left, as they reflect on their lives. Sometimes we are the punching bags for their families’ displaced grief, knowing that they are in a crisis we are lucky enough to not understand firsthand (at least some of us are this lucky). I look at my patients and their families and think, “This is more than one should endure.” 

A few months ago when I had first started at Penn, I was taking an Uber to work and the driver commended me for doing God’s work. I thanked him, but quickly brushed his comment aside. I told one of my coworkers later, and he jokingly replied that since I was early on in my orientation, and with only 2 patients, I wasn’t quite there yet. He said, “When you get to 3-4 patients, then you are doing God’s work.” While sometimes we make light of the work we do, I have to wonder sometimes, are we actually? If cancer pushes people to the darkest hours of their lives, and we are there walking beside them, is this God’s work? As we hold space for the dying, comfort the grieving, and tend to the sick, are we doing the work of something bigger than us? I’m a spiritual person, but not really a religious one, yet it makes me wonder if in fact those who are drawn to this field do possess skills like those of guardians. 

By the time I had reached the rink this morning, I had tears in my eyes. It had dawned on me that working Christmas was one of the most important things I would do this year, a very needed shift in perspective than earlier this week. What a gift to be needed somewhere, not just for my skills, but for my ability to connect with people, to hold space for them, to celebrate their lives. What an honor it is to shepherd people through their dying, to bring them comfort, and ease their suffering. What a blessing it is to see the rawness and delicate nature of this human life we have, for we are all just humans caring for other humans, but sometimes, it does feel like more than that. If this isn’t the best gift of Christmas, then what is?

Merry Christmas to you all. May you relish this joyous time with family and friends, continue to move and celebrate your healthy bodies, and remain ever grateful for this complicated and amazing existence we have here on Earth.

Right On The First Try

There finally came a day of skating with Colin that I couldn’t avoid any longer- the first day of lifts. Now there’s nothing radical about this day, but it can be awkward. You grab things you don’t mean to, you make weird noises, it’s just not...cute. And while Colin is of course my friend, as partners on the ice, we are new to each other and I have found to be overly hard on myself to “be a good partner” and have quickly regressed to my old people pleasing ways. So a day trying out new lifts was definitely anxiety-provoking for me.

We were working through some ideas off ice and naturally all of my deeply rooted ideas of body image, weight, etc are flying through my mind while also totally grunting my way through these changes of pose. Like word vomit, I say to him, “Ugh am I being a sack of potatoes? I’m sorry for being so awkward at this!” And without skipping a beat he says back to me, jokingly of course, “God Adrienne why can’t you just get it right on the first try?!” Oh yikes, he’s right, that’s exactly what I was not just hoping for, but expecting of myself. Right on the first try- is that even possible? On anything? Maybe once in a blue moon, but with any kind of consistency? I doubt it. But here I was, being self conscious and disappointed that I wasn’t being perfect. 

Perfect- where did this come from? As I reflect on this ugly inner wish, I can’t help but remember all of the things lately that *haven’t* been right on the first try- a degree and career, a marriage. I definitely didn’t have those right on the first try. Yet, was it my intense drive for something better that pushed me to reach for more? Was it my relentless pursuit, though frustrating to manage on a daily basis, the exact thing that lead me through the phases of wrong? Is the grass really greener on the other side? And if not for some, then why for me? 

So given this history of imperfection, why now? Why now do I feel this need to control and analyze every movement of my skating, and furthermore, of my nursing job? I started at Penn so intent on “getting it all done” and never missing something. And for sure, there are elements of nursing that must be done and should never be missed. But I’ve struggled these first few months with forgiving myself for occasionally not clearing an IV pump, or forgetting to do my signouts at the end of the shift. In the grand scheme of my day, these are minor issues, but these little things were the ones I would ruminate on during my ride home, ignoring perhaps the good catch moment I had, or the emotionally distant patient who started to trust me. Why is it always easier to harp on our errors rather than celebrate our successes? Why am I expecting so much, so soon?

When Colin and I revisited lifts a few weeks later, we were on the ice trying out a new rotational lift. After a few awkward and semi-successful attempts, I suggested that we just go for it with some speed. To be exact, I said, “Let’s just really do it before I overthink it and can’t do it again.” And lo and behold, we totally got it on that next try, and then true to form, I started to overthink it. But isn’t it funny how well we know ourselves? I knew both how to fix the issue, and how it would unravel. But I think the answer is somewhere in there for me. I have to be willing to let some things go, to go full speed, to trust myself and those around me, to trust Colin, to trust Tom, my coworkers, Lizzy, Robyn, and my family, and all of the people who have guided me through the wrongs, through the missteps on that first try. I’m learning so much by being wrong on the first try, if anything I am grateful that I am far from perfect. 

WTF did you get wrong on the first try?

How To Love It Again

I watched a documentary not that long ago called The Iron Cowboy. It’s about a triathlete that decides to do 50 Ironman distances, in 50 days, in 50 states. He calls it the 50/50/50; I call it insanity. The amount of physical and mental fortitude that was required of him was remarkable, and this endeavor pushed his body and emotional drive to the absolute limit. While this may seem like an impossible feat for many of us, he never dwells on the difficulty of this project, but that for him, this was the ultimate level of “hard”. He discusses further that everyone’s idea of hard is different, and is no less challenging for each unique person. It got me thinking, “What could I do that would be hard?” Sure, an Ironman would be really hard, but I would also hate it too (because running sucks). For me, it would have to be a labor of love.

If you know me, you may know that I call skating my first love. I smile as I write this, thinking of boyfriends in the past who couldn’t quite grasp this idea, of how there could be a sport, with associated people and places, that I could have possibly loved before *them.* But alas, I did, and still do. Like all long-term loves, skating and I have gone through our waves of intensity, passion, annoyance, and disappointment. Since I stopped coaching at the end of 2017, my relationship with skating as been nonexistent, outside of being an official. I brought my skates out to California during my internship, just to find myself wandering around aimlessly on the ice, neither secure nor bold enough to push myself to do anything remarkable. I felt completely lost on the ice. Since I turned 18 and stopped competing, I had only been on the ice to serve the wishes of others, my students, and aside from a few scattered tests, had never carved out any time for me to skate for myself. And here I was, with ample time, and no drive.

As soon as I watched that documentary though, I knew what my hard would be- I have never taken my Senior Free Dance test. Over the years this test has warped into a convoluted ball of emotions, with quite a bit of my own personal regret and baggage attached to it. I waxed and waned between “just get it done with before you’re too old” to “you should really do this justice.” It’s hard sometimes for me to remain in a sport that has brought me so much joy, yet I am continually surrounded by people who have competed far longer and more successfully than me, a sharp reminder that I stopped way before so many others. My life has gone on so many twists and turns since competitive skating, I am no longer in a place where I can say, “If only I had kept skating…” It’s been too long for that. Yet oddly enough, when I look back on old videos of myself is when I feel the most regret. The world of ice dancing is so vastly different now that I can’t even watch myself. It’s like when you were in grade school and you thought you drew something great in art class, and then in high school you realize how amateur it was. While I haven’t competed in over 10 years, there is a very real part of me that believes I am a better skater now than I ever was before, but I have no evidence to show that. This test could be the way I could prove it to myself. It’s an opportunity to create something I can be proud of now.

Though previous attempts to find a willing man to take on this challenge had been futile, the timing finally lined up with my dear friend Colin. That first day we skated we lapped around the ice for a while and I just laid out all my emotional crap about this test, skating, regret, all of it. It *may* have been more than what he bargained for. Yet, he just let me have my space and I knew from the start that he was willing to buy into the importance of this project for me and would help me do it justice. Of course as soon as I started skating, I started adding on more months to this journey, because skating is FREAKING HARD. But, I was really happy to get started. I got into the car after those first sessions and I cried. In just 80 minutes, I had been happier on the ice than I had been in probably a decade. It felt so good to just skate, and to skate for my own reasons. 

By no means is this project all rainbows and butterflies. I’ve learned quickly that this will take significant time, patience, and practice. It will force me to come to terms with my own shortcomings, and push me outside my comfort zone. That is in fact, the whole purpose. Poor Colin has already seen my inner psyche, bless his heart, and my insane need for perfectionism (a post for another day). However, he has accepted my insanity wholeheartedly, and I can’t thank him enough. None of this would have started without his unconditional acceptance of my quirks. I hope that he can find satisfaction and happiness through this project too. Each of our relationships with skating, though very different, share deep and complicated emotions which tie to our identities, our sense of worth, and still shape who we are today. It’s been a long journey to allow skating to evolve in my life, and I think we both continue to mindfully navigate this as coaches, officials, and lovers of the sport. 

Despite it all, somehow, I realized that I could love skating again. I’m not sure what changed for me, or where the shift occurred. Maybe I needed time, maybe I needed someone to support me, maybe I needed to talk through all of the crap, regret, and sadness. Maybe I needed to grow up. Or maybe I needed to remember why I had started so many years ago- not to be competitive, or to skate for Team USA, or to win medals. I started because I couldn’t stop thinking about skating, because I begged my mom everyday for a year to take me, and when they did, I just TOOK OFF. I started because I liked to go fast, because I could dance on ice, and because I could just be me out there. At the end of the day, something brought me back to the beginning, to the WHY, to that 8 year-old Adrienne. Sometimes our childhood self really does know best.

So now it’s time- to take off, to fly, to push myself, and to create something I’m proud of. Maybe this isn’t just limited to skating, but to my career, my marriage, and my relationships. Perhaps, this is why these have all timed themselves to start over, together. I’ve started to love skating, but I think, perhaps, I’ve really started to love living.

WTF can you love again?

Rubber Band- a *very* belated birthday reflection

“A rubber band is only effective when it is stretched.”

I can’t recall when I first heard this, or who said it to me. I’m inclined to think that it was a skating coach of mine, and while it was most likely used as a reminder to stretch my free leg on the ice, I think it is more suited to describe this past year. I struggled to label this last year of life- was it hard? Was I challenged? Did I build resilience and learn to cope? And after some thinking, I realized I had been stretched. I was stretched to be uncomfortable, to adjust, and to find new space that I had either not known existed or refused to find before. This stretch enabled me to discover capabilities I didn’t know to exist.

Nursing school stretched me in ways I could never anticipate. I will admit to everyone now- I entered school with the goal of finishing first in my class. About one week into my program, I let go of that goal. I was so intimidated by my peers, their thoughtful questions and advanced degrees, that I decided top 10% would be my new goal, surely surrounded by people far smarter than me who would out rank my work. Ironically, class rank was never discussed or even apparent, so my first stretch came in that I couldn’t compare myself to others. As the highly competitive person I am, this was hard! How did I know if I was good enough? What was my barometer? I came to learn that the barometer was me, that there was only one standard and bar to measure against, and it was the one I set for myself. While I always thought I had been intrinsically motivated, I learned this past year that I never really was, but nursing school forced me to be. I wanted to do well for my own reasons and I generally kept my successes private. 

This led me to my next stretch- I had to learn to “keep my eyes on my own paper.” Being surrounded by my peers each day, with stress running high and the strong type A personalities in my school, it was easy to fall into the ugly spiral of, “Am I working hard enough? Did I start studying too late? Should I get an externship?” This need to compare pushed me into yoga, where I learned to turn inward, a practice I continue every time I step on my mat. One of my teachers said that if you’re in the pose one inch, you’re in the pose. It doesn’t matter how deep into the pose you go, or whether you take the harder variation or not. What matters is that you’re there, and I tried to be content with my place, and not turn my head to see who’s arm balance was better than mine. I was stretched to be at peace with my progress and success, without validation from the outside.

Remaining grounded in what felt right was hard this year too. The pace and uncertainty of last year was at an all-time high; in one year I finished school, got engaged, started planning a wedding, bought a house, moved, and got a new job. While everything all landed where I wanted it to, there was a fair amount of time spent in uncertainty. We took a leap of faith and bought the house first, a huge stretch for me to make this adult milestone in the midst of school and without a job. But it felt right, and that’s what I allowed to guide me through the process. In the midst of the unknown, we needed to anchor ourselves and I’m glad we did. Being a homeowner is exhausting, but there’s a sense of ease now that we didn’t have as renters. It sure is a money pit though.

A fresh rubber band can feel stiff at first. Maybe you have to stretch it a few times before you can use it. Sort of like a balloon that you warm up by stretching out with your fingers before you blow it up. But once it’s ready, that rubber band can stretch and hold things better than it ever could have done while unstretched. I’d guess that if a rubber band could talk, it would tell you the first few stretches might hurt, but then it gets used to it. Are we any different? Maybe those first few times of being pulled beyond our old form may hurt, and we’re quick to return to our original state. But if we allow ourselves to be stretched again, we will adapt, we will settle in to this new state, and we will find that we are capable of growth and adaptation. We can learn to be more effective.

I guess the year isn’t complete without telling you how my goals ended up, and I tell you this not to seek recognition but to complete my story. After finishing the first quarter with a 4.0 GPA, I knew that this was my bar. In some ways I was mad that I had achieved this, for I knew this was what I “had” to maintain. As the program progressed into 2019, I chose the word engage as my Word of the Year, knowing that as school wore me down, I would find it harder and harder to remain engaged in my goal. Wouldn’t you know it, my perfectionist GPA would be determined by my last exam in my last class, and I needed a 96 to hold my A. This wasn’t out of the realm of possibility, but it still wasn’t a walk in the park. Two days after that last exam, I logged in to see my score:

98

I put my hand over my mouth, both shocked and not at the same time, and cried quietly at my desk. Not because I had a 4.0, or that it ended up placing me tied for first in my class, which I would later learn at graduation. I cried because I had shattered the idea that I wasn’t smart, that I couldn’t do it, that it was really hard to start life over. In that moment, I snapped that rubber band. It wasn’t a snap that indicated brokenness, but a snap of growth, of being stretched far beyond what former Adrienne knew, and a readiness to take on dreams and goals that a former self would never have considered. It was an ordinary moment, spent alone at my desk, that will forever change how I view myself.

But now I want to tell you, those who might be reading this at your own time of transition or uncertainty- I see you and I am with you. It’s hard and I feel for you as you wander through the darkness, searching and waiting for the light to shine. I urge you to keep going, to keep asking and wondering, and listening to what feels good. Always follow what feels good to you, even if others don’t understand. It was in those moments where I learned to trust myself and the universe again, and you can too. And perhaps the most important piece to consider is that there is always something to be grateful for, and especially in the times of hardship, it was remembering my gratitude practice that saved me.

It’s been quite a year and I thank the many people who helped me through. It was the culmination of many years of work, frustration, tears, being lost, finding my way again, endless cups of coffee, many margaritas, and lots and lots of stretching.

WTF is stretching you?

The Connected Birth

“Damn, I burned your breakfast.” 

These are never happy words to hear, but especially when you’re in the midst of labor. I was in the kitchen of my client’s home, prepping food for them to take in the car as we made our way to the birth center. We were heading into LA rush hour traffic, and I knew that getting some food into my client was important. So far, my greatest contribution to this birth as their doula was prepping food, calling the midwife, and packing the car. My client was set on having her husband beside her for every contraction, leaving little time for him to do these other tasks. While happy to help, I was lost in their kitchen, and hence, the burnt breakfast.

We arrived surprisingly fast to the birth center, and were happy to learn she was about 6-7 centimeters dilated. We moved into the birthing suite to get ready. She did amazingly well, moving around the room from bed, to tub, to toilet, with her sweet husband right next to her, whispering little reminders in her ear, letting her squeeze him as much as she needed, and barely taking a moment for himself while he supported her. They were so connected to one another, and were so prepared to really labor together. 

Despite the quick jump out of the gate, this birth was bound to follow its own course, as all births do. A few hours later, my client was at 8 cm and unchanged since the previous exam. The midwives told me to go get lunch, but before I dipped out for a bit, I spoke to my client. As she had been managing her contractions for the past few hours, with no cervical change, she kept saying, “I just don’t want to push for hours,” perhaps knowing that allowing herself to get to 10 cm would bring the pushing stage. I carefully explained that perhaps she needed to address her mindset a bit, and that a little mental shift might be needed to get beyond this hurdle. While I’m not sure if it helped or not, I knew that some level of resistance from my client would continue to slow her labor, and eventually affect her confidence in her body.

Ina May Gaskin discusses this mind/body connection in her book Ina May’s Guide to Childbirth (I’m sure she discusses it in Spiritual Midwifery too but I just am currently reading the other!) Ina May shares stories of births where both negative memories and positive affirmations both have a profound effect on the laboring woman and her ability to lose or build momentum in her birth. Furthermore, she even discusses cases where she witnessed labor reversing itself (WHAT?!) when the woman was feeling alarmed, negative, or scared. This phenomenon is not new, with examples from births dating back to the mid 1800’s where labor had stalled and reversed; doctors from this time also make suggestions that they should allow the laboring woman to invite you in to her presence, a practice I can say is not in use at the hospitals I have attended.

The power of positive thinking is not new to many of us. I’m sure we have all had experiences where the negative self-talk we created indeed came true, and this can also happen with positive talk! I wonder sometimes, when it comes to birth, what would happen if we stopped adamantly sharing the negative and scary aspects of our own birth stories, and started to spread the news of joyous, happy births? What could this shift in our mindset do for the greater birthing community, and possibly even birth outcomes? Of course, I recognize that there is always a need for interventions and emergency precautions, yet as one experienced doctor said to me, “We train for the 5% of cases where problems happen, but most women do not need our help.” Why don’t we start highlighting those normal cases instead of spreading fear to our soon-to-be parents?

True to form though, my client DID push for many hours, exactly what did she didn’t want. Looking back, I can’t say I’m too surprised. But I’m also not surprised that the midwives allowed her to go for so long. As always, they were prepared for that 5%, but their deep knowledge of birth allowed them to trust her. When the baby was born, the father started to cry, and Lord knows I cannot handle a crying dad, so I too cried. Through it all, they had been such a team. Even with mom’s faltering confidence, he was there, urging her along as she waited between contractions. They were the definition of a true partnership, and the greatest example of connectedness I have seen in a birth yet.

To the man who was the last to know

I wrote this a long, long time ago when I needed to write about a terrible working relationship I was in, but wasn’t really in a position to broadcast my feelings. While plenty of time has passed, and I’m mostly beyond my anger, I feel that this post deserves its place on my blog and not just saved away with my writing. Many of my feelings were validated by reading the book A Beautiful, Terrible Thing by Jen Waite, though this relationship was not a romantic one.

There was a time where I thought you were great at your job, even respected you for the work you did. I thought I could learn something from you, and that perhaps unlikely combinations of people could create something special. You, however, never respected me. I was not your next partner, I was your next victim. When you looked at me, you saw something young, new, and easily controlled. Or so you thought.

I was naive to your ways in the beginning. I tried hard, I put forth my best effort, and I tried to communicate. I tried to prove my worth, even shooting myself in the foot to prove that I was a team player. I stood by you when I didn’t believe in you, certain that my loyalty would be rewarded in the future. Unknowingly, I had signed a deal with the devil.

It wasn’t all bad though. There was a time when we thought things were moving in a positive direction. We thought we saw little glimmers of hope, of regret for the past, and of knowing better. Maybe you felt it too. But people like you don’t change. They don’t look out for others, they only look out for themselves. They do not see people before them, they see what they can get out of them. I was not a colleague, I was a means to an end.

And then the tides turned. During this time, I had learned that I had been disconnected for many years from my intuition. I had found it though, and when the time came to listen to you or myself, I chose me. I chose to push back. It was easy at first. I just said no, over, and over, and over again. And you, with your inability to read people, to understand them, failed to see my resolve. Instead of respecting me, you insulted me. You threw me under the bus, you slandered my name, you discredited my work and my abilities. More consumed with being right than having support, you took your greatest ally and turned her against you.

Did you think I wouldn’t find out?! Did you think that you could trust the people you trash talked me to? No, because you fail to understand the intricacies of relationships. You don’t know trust, loyalty, compassion, or empathy. You have none of those.

The more that you pushed me to cave, the stronger I had to stand, and the uglier you became. All of your true sides came out. Your accusations got nastier, your finger pointing was constant, and the guilt and blame you laid was thick. Was there ever any truth to what you had said? Was anything from the past few years ever based on fact? Or was everything just a shell, an empty promise, a foundation built on smoke and lies?

Along with some true friends, we started to figure you out. I started to learn how to manipulate our interactions, because a person like you cannot be treated rationally. I put my guard up, everyday, everytime. I stopped being the doormat, I stopped giving you what you wanted, I stopped the manipulation. And although you made the end a fucking. living. hell. I had in the back of my mind my exit plan. And it would be perfect, leaving quietly and calmly with you left in the dark. I knew I would be gone and what would you be left with? As the clients fade away, leaving with bitterness and disappointment, there is just you, with no one in your corner. Who will be happy for you when you succeed? Anyone?

Don’t think for one moment we are friends. Do not think that because I hugged you and said thank you with a tense and forced smile, that you will ever get anything from me. Do not think either, that you are forgiven. But you will not haunt me anymore, because I am free of you, and you were the last to know.

Letter to the 2018 Adrienne

In keeping with a semi-tradition (does 2 times qualify as a tradition?), I’d like to write a letter to my former self for the New Year. I did it some time ago and it was a very cool way to sum up the year. I feel like 2018 is not a year to be missed and though I am late, better now than never. So here you have it…

Dear 2018 Adrienne,

This will be a year unlike all others. First off, you will make no money. You will learn that whatever is in the fridge is for dinner. And you will learn to be happy with that. More importantly though, this will be a year where you really say YES to all the things you wanted to do.

You will say YES to uncertainty, packing up just 2 suitcases and moving out to California to live with one of your oldest friends for one of the best experiences of your life. You will see a baby come into the world for the first time and the thought of that day will always bring a tear to your eye because that was also the day you said YES to your future. You will say YES to midwifery and although it is far off, you are now sure that it will be yours. To cap off the experience, you will convince your mom to say YES to driving across the country with you, a bucket-list item and an experience you both will never forget.

You will say YES to a life without skating, a place that used to be home that has now turned difficult and painful. You won’t even miss it at first, too busy soaking in the warm goodness of California, babies, and midwifery to even notice. But eventually you will learn that it can be your space again one day, when you are ready. You will take it back and make it what you want. This is still a work in progress so be patient.

You will say YES to being a student again, to facing your inner perfectionist and mostly appeasing her. You will feel so very insecure and nervous on that first day, certain that you will be SO MUCH older than everyone else, yet lacking all the clinical skills that everyone else has. And while that’s partly true, you will soon learn that age is an advantage, and anyone can learn how to do a blood pressure reading. Age lends itself to hard work and motivation, and you will never question why you started, just perhaps what took you so long to get here. You will be tremendously grateful for this perspective.

You will say YES to a wonderful man, Tom, who has believed in you all along. From skating, to pre-requisites, to quitting your job, and adding more time apart from each other he has always been in your corner. There is no one better to build a life with, and though wedding planning stirs up #allthefeels, you recognize that this is completely different territory with a true partner by your side.

After so many years of saying, “I don’t know” this year will be the breath of relief you have been waiting for. It may be one of your happiest years because for the first time in awhile, you will know where you are going, and better than just knowing, you will be driving exactly where you *want* to go. You will say YES to being exactly who you were meant to be.

Here’s to 2019...to friendship, love, fulfillment, and to more beautiful YES moments.

The 2018 Adrienne

PS- WTF are you saying YES to??!

The Family Birth

For most of my internship in CA, my phone volume was so high that it scared me. I was terrified of missing a call from a client or a midwife. Even when not on call for the birth center, I was often on call for my clients. I designated certain ringtones to these numbers so from afar, or even while in the shower, I could tell who was calling. Yes, my phone comes to the bathroom with me every time.

I hate being woken up when I don’t need to be up. I had to send quite a few texts and emails to family members while away to remind them about the time change and my strict obligations to my phone volume. So imagine the joy I felt when awoken by surprise on an early Monday morning, to a non-urgent ringtone, “Ugh, who the hell is calling me again so early?!” Shockingly, it was a California number and not my best friend Robyn (who operates before the sun). There were two laboring women at the center, and they needed extra hands.

When I arrived, I was surprised by the number of people connected to one laboring woman. To my recollection there was the husband, the doula, the soon to be grandmother and grandfather, the mother-in-law, and maybe a sister? I’ve lost count; most were not serving a role vital enough for me to remember. The laboring mother was struggling- crying between contractions, murmuring to her mother that she couldn’t do it, and not finding her groove. The midwives were discussing the lack of positive energy and the expectations they were feeling from the family. They even spoke to the family members telling them to not enter the birthing suite with their negative energy.  There were too many questions, too many interruptions, too much worrying that something was wrong, and not enough faith. Ultimately, she ended up transferring to the hospital because she was stalling in her progress and dilation had remained unchanged for many hours. In my eyes, her will to push through the birth had stalled and she seemed more emotionally drained than physically.

Extra participants at a birth is an interesting topic. On one hand, our friends and family know us better than anyone else. They know what you want to hear, they know how you may want to be held or encouraged. Yet most adults are not familiar with birth. They do not know that the timeline of birth can be both long or short, and still be considered normal. They may enter with their own expectations, doubts, and anecdotes. In a world where everyone fears the worst scenario, they may search for things that are “wrong” or “abnormal” as a way to protect their loved one. Their intentions are good, but sometimes they can be counterproductive. The midwives at SCM says that each non-essential person at a birth extends the labor time by one hour. Sometimes the additional energy, whether it be positive or negative, can still impede progress.If the team isn’t committed to creating a positive vibe, they can place unnecessary pressure on the mother to make something happen, not realizing that sometimes the best way to make something happen, is to step back and let it go. (Perhaps this is true in many areas of life…)

On the flip side, I also had a client who's mother was instrumental in the success of the birth. She was just the right amount of involvement and encouragement that the laboring mother needed. She also had that magic touch of being able to get her to daughter to drink a smoothie that neither I or the husband could convince her to do. Most importantly, she was a huge fan of out-of-hospital births and I think brought her own positive experiences with her, and innately trusted the midwives too.

When in labor, the woman has to remain mentally dedicated to the task at hand; she has a job to do, and it doesn’t involve tending to anyone other than herself. Her mind needs to be on doing the work of labor and not being distracted or uncomfortable by someone unwanted in the room. Labor and birth is an intense and intimate time- you’re naked, bodily functions are out of control, fluids of all kinds are being lost, you’re making sounds you’ve never heard before...you’re working!! This is hard, amazing work and it requires rhythm and grit. It also requires everyone there to believe in the awesome power of this soon-to-be mama.

The Induced Birth

My client was 41 weeks when I received a frantic call following her nonstress test earlier that day. Due to some concerning results, she was being transferred out of the midwives’ care to the hospital for an induction under their partner OB/GYN. They had been planning a home birth, so this drastic change to a medicalized induction was far from what they wanted. All of their planning was washed away, and they were now left to navigate very unfamiliar waters. I later learned that once a client is transferred out of care prior to starting labor, the doula intern doesn’t have to accompany them for further labor and delivery as we are employees of the practice. However, in my eyes, they had lost their midwives, their home birth, their entire plan and I felt that something needed to remain constant. I helped them pack up and we all headed to the hospital in the evening to begin the induction.

Over the span of the next 40 hours, I saw the whole spectrum of interventions. Lorri Walker, the CEO and Head Baby Catcher at SCM, calls interventions the snowball effect- they just keep building up. And boy, do they ever. Foley bulb induction, to artificial rupture of the membranes (increased risk of infection now), to non-progressing/ineffective contractions, to Pitocin, to an epidural, to constant fetal monitoring, to antibiotics because now mama had a fever. There were other steps along the way, too numerous to count, and probably most we all wished could be forgotten.

After 2 nights of no sleep (aka 41 weeks + 2), I felt that there was no end in sight. Please, please, I thought to myself, don’t let this end in a c-section. That was all I could hope for by the second afternoon, as I groggily gazed out the window to the gorgeous view of Newport Beach. I felt like we were fighting against that snowball, which now felt like an avalanche. It was my only goal for her, and all I could do was feed her courage and reassurance. Yet, the time came- 10 cm dilated and time to push. Despite having no feeling below the waist, my client found that beautiful, effective push. Forty-four hours after arriving to the hospital, she pushed her baby out. Nobody knew the gender prior to the birth, and during the span of our stay I had changed my mind from predicting it was a boy to a girl:

“Seeing how stubborn this baby is to come out, I’m thinking she must be a girl now!”

Sure enough, a baby girl was born. No less than 15 people were there in the room, armed for every bad scenario possible. However, that little girl cried out all on her own and her mother and I burst into tears. I cried so hard for them, grateful for the long road to have ended so happily.

This was a such a challenging birth for me. I felt stuck between worlds- the doula world with clients who hated the healthcare system and needed an advocate, and my soon-to-be-world of nursing, which recognized the procedures of the hospital, and empathized with the nurses’ normal duties. I toed the line, prompting my clients to ask questions and evaluate their options, while also helping them process the realities of birthing in the hospital, and specifically, as an induction. With the valid medical concerns present, there really wasn’t much room for choice; the interventions were necessary based on the results of the NST. This was a hard reality for them to face, but one they needed to if they were going to let this birth continue joyfully, or be weighed down with stress and conflict. I tried to validate their feelings of disappointment, while helping them release these sentiments and adjust their expectations.

Did the sight of a healthy baby wipe away the disappointment of the birth story? No, I don’t think so. For some people, I’m sure it would have. It didn’t even wipe it away for me, despite my obvious joy and relief. Who knows how it would have turned out if the NST was normal and they labored at home- would she have been slow to progress? Would she have gotten exhausted? Would the comfort of her home and midwives spurred a faster labor? All questions we cannot answer. Yet, the story does matter to me. How she will remember the birth matters- we have only one chance to support the mother in her amazing feat. I hope she will remember this birth the way I do- with fierce determination, courage, and teamwork.

Something Bigger

My official journey to nursing school began in the Summer of 2016. I had hit a major turning point that summer; I had lost a few clients, was about to lose a few more, and was staring at the bleak realization of not making rent. I decided that I never wanted to feel that way again- like one or two clients could take me down, that all my “eggs were in one basket,” and that at anytime it could all drop out from under me. Being self-employed, these were all real possibilities even for those who try to plan ahead. I needed to make a big change.

One evening, my girlfriends and I were having a night at my friend Helen’s house. Helen has the loveliest cat (the only one I’d ever say that about), but I’m terribly allergic. As I struggled to get my allergies under control and take some benadryl, I cried out in anguish, “Damn my histamines!” My friend Liz, who is a nurse like Helen too, asked me, “Are you sure you don’t want to be a nurse?” My reply, completely off the cuff and with no hesitation was:

“Actually, if I was a nurse I would be a Labor & Delivery nurse.”

There, in the midst of sneezing and snot, I stated the answer to the agonizing question of WHAT SHOULD I DO WITH MY LIFE?! Randomly, uninhibited, instinctive. Yet when I said it, and when I later shared it with others, no one was surprised. I had finally uncovered something that had been ignored for quite some time.

Yet this time when considering nursing school, because I had in the past, it was different. I was ready to go back into the classroom, sit amongst kids I didn’t know, and try to take the science classes that had once scared me. Once I started, I never even considered turning back. The more I dove into my prerequisite classes, the hungrier I became. I started researching schools in Philadelphia, and then later I expanded my search. I investigated The University of Maryland, Johns Hopkins, Columbia, and NYU. I thought about accelerated BSN programs versus Direct-Entry MSN programs. I met with alum, spoke to professors, and started as a research assistant to a PhD candidate. It began to energize me. I started to have hope in myself and what I was capable of.

After learning the power of manifestation, I wrote down on post-its all the names of the schools I was applying for admission. I stuck these notes around my apartment and everytime I looked at one, I touched it carefully and paused, thanking the world for getting me into those schools. Mind you, I hadn’t even sent in one application yet, but I knew it was coming. It was going to pay off.

This past fall I finally applied. I'm thankful for my year of exploration because ultimately, I only applied to Philadelphia schools. Sure, it was easier to stay home. Yes, it was smarter in regards to cost of living. Of course, I wanted my friends and family nearby. But frankly, I just wasn’t done with this city yet. It had just become my home and I wasn’t ready to leave. Like all decisions, it had to be for my reasons, whatever they ended up being. I applied to the accelerated BSN programs at Thomas Jefferson University and The University of Pennsylvania, knowing in my head I would most likely go to Jefferson. My gut told me I could get into both, but my head knew that Jeff was the smarter choice. I got into Jefferson in November and was so thrilled! I was finally going to be a nurse.

And then, I was accepted to Penn.

While I had manifested this for over a year, I was still shocked. How could *I* have gotten into an Ivy League school? The girl who had always placed skating first, who took the lighter workload during high school, who picked her college based off of proximity to the rink...how could she have gotten into Penn?? I’ll be honest, I have always felt my strengths lie outside the classroom. My father has always told me I have an old soul, and innately I gravitate towards children, feeling as though I can understand them better than adults sometimes. My empathetic ear has been my greatest asset as a friend, not my ability to recall historical facts or launch into political debates. Even as a teacher, I always emphasized social skills in my classroom. My brother was the brainy child, and I was the emotional one. Just ask my parents.

Yet, I opened that email and started shaking with shock. Pardon my language, but I fucking did it. I accomplished something so much bigger than I had ever thought I could do. Five minutes later though, I started to cry, knowing I would have to say no. Suddenly and irrationally, I wanted the name of Penn on my resume. I wanted to say, “I graduated from Penn.” Everything rational about my process from the last year and a half went down the drain. I knew the reasons not to go: price and duration of the program were the biggest factors. But that was too logical for me; I just couldn’t latch on to those being MY reasons.

Remember, I’m the emotional one. I needed to feel the reason in my heart. And one average day after my acceptance email, I felt it. My journey wasn’t about getting into Penn, it was about finding my calling. It was about finding something I am so. crazy. passionate about. I didn’t actually need to be a Penn student, I needed something bigger. It was about creating something bigger for myself, for women, and ultimately for the world of childbirth. And when I felt that, I knew it didn’t matter if I said no. I knew I was going to get my nursing degree and I was going to accomplish the goals I had set for myself. I am proud to have been accepted to Penn, but maybe even a little more proud to know it wasn’t the place for me.

The First Births

My phone rang (again) while on call, this time around 4:30am:

“Hi, it’s a home birth. I’ll text you the address. They said they can see the head.”

Oye, better get moving. Shockingly (or not), I hit traffic when I got on the highway 15 minutes later and I sped along hoping I could stay awake and make it on time. Was she crowning? Could they just see little tufts of hair? These are big differences when discussing the timeline of birth. I arrived to the home and entered the second floor apartment for the couple and sat down by the midwife. No crying baby, no chatter, nothing was happening. “Guess I made it!” I thought. Luckily, something in me prevented me from asking how the labor was going because a few moments later, the nurse came over to update the midwife about how the baby was doing. Damn! Missed it, and missed it by about 15 minutes. I came to learn later that the midwife arrived not more than 90 seconds before the birth and caught the baby in the tub barehanded. This was the mama’s first birth and quite rapid, to say the least.

In contrast, a few weeks later I received a message while on call that there was a mama at the center who was 8cm dilated. It was around 8:30 at night and we were optimistic about the timing of the birth. Maybe we would have a baby by midnight, we said while sipping tea in the office, rested and ready for the upcoming pushing phase.

Seven.

Hours.

Later.

She started pushing. Two centimeters in seven hours.

Two hours after that, the beautiful baby was born. Everyone was healthy and happy, from both births. Whether rapid or slow to progress, these babies were going to come at their own time. Interestingly, these were both first time mothers, and both of these labors can be considered normal! One just happened to be fast, and the other slow; yet throughout mama and baby were safe and cared for. These two cases are examples of the most common phrase I have heard in regards to childbirth: Variations of normal.

The midwifery model believes that pregnancy and birth are normal life events. As midwives, they are your “lifeguard” during birth, monitoring both baby and mama for any changes, helping when needed, but allowing the laboring women to move at her own pace and give her the space and freedom to do just that. The midwives at SCM treat all clients as healthy until proven otherwise, and minimize risks by eliminating most interventions that would lead to more risks (and more interventions). As always, the midwives are ready for any emergency circumstances that may arise during the birth. Prenatal visits emphasize communication and education, while empowering the soon-to-be mother to make her own decisions about how she would prefer her care to look.

Because this model governs their care, they are well-versed in what is “normal” in birth, and thus know all the ways that birth differs yet still remains normal. They have seen the rapid births, the slow births, prolonged active or second stage labor, back labor from a posterior baby (“sunny side up”), the breech births, the water births, the VBACs. They understand that while a first time mama could push up to 2 hours, a healthy mama and baby can go longer and still result in a successful vaginal delivery; I just had a client push for 4 hours! When you have the experience of supporting so many different paths towards a birth, you have the confidence to know what is and isn’t normal. Most importantly, there is a shared trust between the client and midwife. The midwife trusts the woman’s body, her determination, and her strength; the client trusts the expertise and care surrounding her. When this is present, any variation can be conquered.

Running In The Rain

It hardly rains in Southern California, as evidenced by the muted brown rolling hills behind my friend’s home. When I first arrived here in January, you could see small scorched areas from recent fires. Rain in California is like snow back home yet even more unexpected, and frankly, tolerated poorly. As the native East Coaster, I continually shake my head at the complaints about rain. Don’t even get me started about how they drive in it. It’s not even heavy rain! One notch on the windshield wiper setting at best.

The rain is needed though, and when it rained this past weekend I imagined the hills of Chino Hills exhaling in relief. It was a Saturday afternoon, and I was feeling a little restless. I noticed a lull in the rain and suited up for a run. I started off and felt a light drizzle, but with the warmer temperature and my vest I figured I would be fine. Of course, it got heavier. As someone who has never wanted to run in the rain, this was an easy time to turn back. I contemplated it but eventually, I just gave in. I couldn’t find a good enough excuse to stop, so I pushed on, wiping my face every few paces. I even enjoyed myself.

Naturally, my mind started to wander about my upcoming start date in Jefferson’s one year nursing program. Titers and vaccines to get, my chem class I still need to successfully pass and transfer, scrubs I need to buy, books I need to order. And while I was ticking it all off in my head, I became so unbelievably thankful to even be thinking about it. My desire to be a nurse and help people has always been a part of me, but for so long I was discouraged by the time it would take to reach my goal. It sounded SO long- 2 years of prerequisites and then another year of full-time school. For many, many years I didn’t have the motivation to do it. Would you believe that 9 years ago I wrote a Facebook note about wanting to enter medicine, just around the time I was graduating from TCNJ? I even had old bookmarks on my last computer for Jefferson’s program, along with Drexel and Rutgers. I had buried this idea for a long time.

Sure, could I have started 9 years ago and been well into the nursing field by now? Could have, yes, but I’m glad I didn’t. I really needed the last 9 years. I needed to try things out, make major mistakes, fall flat on my ass, and then rebuild. I needed to grow up and become myself. And eventually, I found that I had run out of excuses to not go to nursing school. The time is now, and the best part is that I am SO READY. I can’t imagine that I would have had the drive and motivation had I started when I was younger. While I realize that I am not “old,” I do know I will be older than most of my classmates and for that, I am again thankful. The value of life experience, as well as truly understanding myself as a student and a person, will definitely be to my advantage this coming year. I was the only person on my interview day to wear something other than black; I wore a pink blazer because that’s just who I am!

Nursing school used to be like running in the rain. I always had a reason not to do it. But just like that run last weekend, giving in and taking the plunge has been the best feeling. I feel invigorated and excited. I feel like there is so much happiness, positivity, and opportunity ahead of me. I used to feel like I had no idea what I was doing with my life. Now, I find myself saying, “So much to do and only one life to do it in.” During my run, I threw my head back and opened my mouth to catch some rain, stretched my arms wide open and just smiled. It’s been a long journey to get to this place, but I made it.

West Coast...Best Coast?

The big question since I’ve temporarily relocated to Southern California has been, “Is it going to be hard for you to go back?” The idea that I could love a place that was colder, wetter, dirtier, and less vegan-friendly is foreign to some of my native California acquaintances, so I thought it would be fun to give you my feelings on the Golden State:

• Everyone kindly asks you if you have dietary needs, in many cases because they themselves do. I’ve had to turn down a lot of avocados out here.

• Traffic is terrible and much worse than the East. There is no other way to say this.

• Rain is scarce (yay!) but needed (boo). Weather is obviously nice 95% of the time here. Downside, I have to hold back an eye roll when someone says 50 degrees is cold.

• At first I wondered if everyone was so sincerely happy, and I’ve come to find that they really are. Perhaps the phony people live in LA, but much of Orange County residents remain pretty down to earth.

• They don’t seem to call it skim milk here, just non-fat. Oftentimes this is not an option, so I go with almond milk.

• Mexican food is way better overall than back home.

• If you were driving on 76 back home, Californians would call it “the 76.” I may have adopted this language for now, but trust me, this is unnatural.

• The stereotypical “surfer guy” exists- I’ve met him.

• I’ll be bringing back some California style- pink sunglasses, Vans slip-ons, and easy everyday clothes.

• Van living is alive and well out here. I’m enthralled and would love to try it one day!

• Many CA residents who I encounter are not native, but people who came and never wanted to leave. Not sure if many Philadelphians fall into this category…

• Californians say hi to each other SO often, even when you are running by with headphones in your ears.

All in all, I definitely like it. But don’t worry Mom, I’m coming home. There’s something about the grunge of the East Coast, the fast-paced nature, and the strong daily hustle that will forever suit my personality.

The Home Birth

The sun crept through the orange trees in the backyard, creating the most radiant magenta and golden sunrise. We gazed out the window from the kitchen, and I thought to myself, “What a beautiful day to give birth.” Next to me, the laboring mother tried to take a picture, but not even a new iPhone camera could catch the beauty of the morning of what would be her daughter’s birthday.

Inside their perfectly decorated mid-century modern home, preparations were underway for the anticipated home birth. The scene was quiet: just the couple, myself (the doula), a nurse, and the certified nurse midwife were present. The husband lovingly filled the birthing tub with hot water while I stayed with the mother in their bedroom, massaging her lower back as she breathed through each contraction. There was an ease to the morning, and a quiet anticipation of the new life about to join us earthside. 

When she was ready, the mama moved into the tub, finding comfort in the warm waters while her diffuser nearby sent the familiar scents of her essential oils into the air. A picture of their wedding party was nearby, as was a letterboard with her breathing mantra. The smell of omelets lingered in the air from their morning breakfast, and down the hall you could find a rogue sock on the tile floor from one of their older children. The midwife sat nearby patiently waiting for her cue; even I wondered for a moment what we were waiting for until suddenly the mama cried out. The midwife sprang to action, pulled on long gloves and within minutes, a beautiful baby was born. It was a gender surprise, and when the mother lifted the baby out of the water and cried out, “It’s a girl!” I broke into tears. It was the first birth I had ever witnessed, and it was a perfect setting. 

I learned quickly why the midwives at South Coast Midwifery enjoy home births. It’s really something special to be in the comforts of someone else’s home as they labor and deliver their child. To be a part of this intimate event is one thing, but the added element of spending time in the couple’s home during labor, delivery, and postpartum adds an extra bit of intimacy to the sacred event that is hard to describe. It’s comfortable, easy, and familiar. The expectant parents are calm within their own environment. They feel safe and ready.

You may be thinking to yourself that this is wildly unsafe. Allow me to stop you right now and explain. First and foremost, midwives care for low-risk pregnant women. Some women are low-risk all the way up to the day they give birth; if things change then the midwives will send a client to an OB/GYN for their birth (a post for another day). They absolutely will not keep you in their care if there is something amidst. At the time the midwives enter your home during your labor, or when you are admitted to the birth center, your risk level is evaluated and the continuation of care is based off this assessment. Midwives are highly-trained licensed medical providers, and are ready for all emergencies. Any equipment, supplies, or medication they have at the birth center are also with them at a home birth. Theoretically, if you are in favor of birth center births, you are in favor of home births. Every emergency that could be handled at the center can be handled at home such as postpartum hemorrhage, neonatal resuscitation, perineal tears and repairs, shoulder dystocia, and complications with the umbilical cord. 

Lorri Walker, the founder and “chief baby catcher” of South Coast, draws a parallel between home vs center births and the dilemma of, “Should we eat out, or cook for ourselves?” Sure, going out is nice because you don’t have to clean up afterwards and there is no preparation; however you do need to get yourself there and sit somewhere you aren’t familiar. At home, you need to prep and handle all of the cleanup, but it's nice to not have to travel and just be content afterwards. It’s the perfect analogy for anyone considering the setting they want for an out of hospital birth. 

It’s not for everyone though, and I recognize that. There are many people who feel safe with a doctor in a hospital. You may think that because I started this internship and am a doula, that I am anti-doctors, anti-pain medication, or judgmental of those who choose interventions or c-sections. Please do not think this for it is not true. The only thing I care most passionately about is that women are given choices about their births. Many, many decisions are not emergencies (though there are plenty that are), and when there is a choice, I hope you are given one. Whether it be a question of home/hospital/birth center, medication free or with an epidural, on your back/your knees/in a tub, with candles burning or Led Zeppelin playing in the background, I hope you know you have a choice. And if you are seeking choices and feeling stuck, perhaps midwifery is the place for you. I know it is the place for me.