Crazy Week!

I have been putting in 11-13 hours days this week. To say the office has been crazy is an understatement. Weeks like this and I am ready to quit and be a housewife again. I know this is only temporary. I am off again next week to help my son and family move across country to finish up his last years at medical school. I just have to survive one more day at the office....

While I am gone, here is one of my favorite photographers and a great fundraiser for a little girl who is battling cancer. Check it out here

Girl's camp adventures

I just spent the last week up in the mountains volunteering as the “camp nurse” for a church girl’s camp. I went up with the girl’s I am responsible for at church. All total there was about 200 young women and leaders at camp. It was a crazy busy week but I really enjoyed it.

I had all sorts of medical and not-so-medical problems to take care of up at camp. Lots of girls with nausea and vomiting (some who stayed overnight in my tent so I could watch over them all night). Dehydration, altitude sickness, muscle strains, menstrual cramps, headaches, stomach aches and the like. I did send a few girls off the mountain due to medical problems. I even got to stitch up a knife wound….note to mom’s out there. Don’t pack steak knives in girl’s luggage. They just might kneel on the luggage and get stabbed.

It was lots of work. I didn’t get a lot of sleep. I got just as dirty as the girls did. We were only allowed one shower all week. Baby wipes were my best friend since I could do a “spit bath” with them every morning. I ran up and down that mountain multiple times a day carrying my first aid pack with about 25 pounds of equipment and supplies. I slept in a tent all week. I lost a few pounds.

There are a couple memories I will always cherish and that still warm my heart. I think they mean so much because they meld my experience as a mother with my experience as a midwife and nurse practitioner.

One of the girls began vomiting the first night at camp. This was her first year at camp and she was scared. I loved being able to stroke her forehead and calm her down. She spent the night in my tent. She was fine by morning. Every time she would see me in camp after that she would run up and give me a big hug and a smile. She was my “tent buddy” and had a great experience at camp.

The other moment that is burned in my memory is being able to hold a girl who had seizures. She has epilepsy but none of her friends at camp knew that. She had a seizure in front of all the girls. I held her after her seizure while she cried because she was embarrassed that now everyone knew her condition and she just wanted to fit in and be “normal”. I held her and rocked her after her seizures hit again and during the post seizure state when she was not totally coherent. And I gave her a final hug when we loaded her into the vehicle to evacuate her off the mountain. She is a teenager, but still needed someone to hold her and rock her and let her cry.

There is something so wonderful about being able to give COMFORT. Yes, my medical skills were needed. But what I will cherish the most was the chance to offer comfort to these girls. Some of them just needed a mom to give them a hug or to tell them that it was going to be OK.

Once again I am amazed at the strength of women. These young women are amazing. They were courageous, kind, willing to try new things, faced their fears and overcame them. They learned to shoot a bow and shoot guns. They went down zip lines and climbed up rock walls. They hiked further than they thought possible. And they were reminded that they are special women who are loved and cared about. They learned that God loves them and that they have tremendous potential.

I am going back next year.

girl's camp

I am off to voluteer as the camp nurse at a church girl's camp for the next week. I will see you next week!

Midlife Midwife

Snow in June

Remember when you used to make snowmen when you were a kid? You started out with a small ball of snow and you rolled it around on the snow. With each turn of the ball, it would get bigger and bigger.

That’s how my days have gone at work this week. I started off OK but as the day rolled on, I get further and further behind. My work load just seems to get bigger and bigger. Here’s how my afternoon went today:

I started off with 13 patients, 10 annual exams, one new OB physical and two return OB’s. Busy but certainly do-able. The first exam she also complains of a vaginal infection so it took just a few extra minutes to get an extra culture swab and to order medications. The second one wanted to talk about birth control because she doesn’t remember her pills. So an extra 5-7 minutes talking to her about alternatives and scheduling for an IUD. The third one also had irregular bleeding, the fourth had pelvic pain, the fifth had a vaginal infection and a bladder infection. Halfway through my afternoon those extra minutes are adding up.

And just like the snow ball gets bigger faster, my days have gone downhill even faster as the day wears on. Every annual exam was also a problem visit….pelvic pain, low libido, heavy bleeding with severe anemia, osteoporosis with a fracture, dyspareunia and the list kept getting longer. That new OB has an ugly OB history and requires referrals to the specialist, extra lab work, EKG and eye exam referrals. One of my return OB’s had never gotten her pap smear. So instead of a quick exam, I did a whole physical exam as well. And the last OB I can’t find heart tones and then have to tell her she lost her baby.

In and of themselves, each extra little problem wasn’t a problem at all. But added all together, by the end of the afternoon I was running an hour behind. I stayed after work 1½ hours to finish up all the charting, lab work, signing off charts, returning patient’s phone calls and reviewing ultrasounds.

Too bad that snowball doesn’t help me feel any cooler in the summer heat.

“We walk quietly. ….We sing a prayer song”. I was three years old and that was my first memorized talk I gave to a church congregation during our children’s program. That was the first of an uncounted number of times I have spoken in front of groups.

One of the nice (albeit scary!) parts of being a member of my church is we have lots of opportunities to speak in front of groups. I’ve had multiple opportunities to teach classes and give talks.

Between school and church, I was taught how to outline a talk, how to speak slowly and clearly, how to interject some humor, and how to smile and interact with an audience. Years of being in the theater taught me how to “act” as if I am calm and collected in front of an audience.

All that training paid off in a big way this week. I was asked to teach the breastfeeding class at work. Someone else was supposed to do it but couldn’t at the last moment. I was reassured that they had a video to play and I would just need to answer any questions afterwards. I spent six years doing breast feeding support in the postpartum units and nursed all three of my children so I felt comfortable in doing that.

I got to the class and right before the class I asked if we could check the audio visual equipment. Well guess what, the laptop’s DVD player had been disabled. NO VIDEO. Panic was a mild word for what I felt.

That’s when all those years of practicing, making mistakes, learning to act calm, giving speeches and teaching lessons came into play. I was able to stand up and teach for one hour. No notes, no outline, no props, no audio visuals, only me. And I did it! The pregnant couples seemed to enjoy it and they learned.

So to all those teachers, my parents, my friends, my acting coaches, my church leaders and all those students I taught: Thanks for teaching me how to do this. Thanks for all those hard experiences and scary times that made it so I could teach a class like this.

Sky diving

I had a cute octogenarian (that's a fancy way of saying she was over 80 years old) see me. When I reviewed her medical record, I saw that she had broken both her ankles at the same time in the last year. Here's how the conversation went....

MM: I see you broke both your ankles. How did you do that?

Cute Lady: I broke them when I went sky diving.

MM: Really?!!

Cute Lady: No, not really. But it sounds so much better than saying that I got up in the middle of the night and tripped in my bathroom.

I couldn't stop giggling about that one.

Problems with teens and birth control

Teen:  I am here to get on birth control

MM: how long have you been having sex?

Teen:  For about three months, but I have been careful. Can you do a pregnancy test?

MM:  Yes, we can do a test before you leave today. Have you used condoms every time you had sex?

Teen: No.  We don't like them. They make me itch.

MM:  You do realize that condoms are the best way to prevent sexually transmitted diseases right? If you have a reaction to latex condoms you can use non-latex ones.

Teen: yes, but I won't get any diseases.  I've only had sex with one person.

MM:  How many other girls has your boyfriend had sex with before you?

Teen:  Only five.  But he didn't stay with them.  He says I am his one and only.  He was tested for HIV and he was negative.

MM:  Was he tested for Chlamydia, gonorrhea, trichomonas, herpes, Hep B, syphilis? 

Teen:  I don't know. Why should he?  He doesn't have anything, he said so. Besides, I've only had sex with him.

MM:   But he had sex with five other girls...and who knows how many other sex partners those girls had.  Essentially, when you had sex with him, you exposed yourself to whatever diseases those other people had. I would suggest that you get tested today for STD's. STD's are caused by germs that are too small to see so you can't tell you have them unless you are tested. You don't have to have a pelvic exam.  We can do the testing by blood and urine tests.

Teen: I am not trampy.  Aren't you proud of me for only having one partner? (getting angry) You should be telling me what a good girl I am.  Not lecturing me.  All my other girlfriends have had sex with ten or so guys.

MM:  Yes, you are a lower risk because you have only had one partner, but even one can give you a disease.  You still need tested.

Teen:    I know he doesn't have anything.    I don't need tested and so I won't do them.

MM:  OK, so you don't want to do the testing.  So lets talk about birth control.

Teen:  I don't want to do the shots, they make you fat.  All my girl friends are fat.  I don't like pills. Besides I am too busy to take them.  

MM:  So what about the patch or a ring?  You don't have to remember them every day. 

Teen:   I can't wear a patch, people would see it and think I was having sex. 

MM: But you are having sex.  You can put it where people can't see it. 

Teen:  Not with my bikini's I can't 

MM:  How about the ring?

Teen: gross, I can't put something in myself. 

MM:  Let me show you the IUD or the Implanon device.

Teen:  Will they hurt? 

MM:  You might have a little discomfort when they are inserted but I use medicine to numb you up. 

Teen:  I won't do anything that hurts!

MM:  Having a baby hurts more. 

Teen:  That's why I am here.  I don't want any babies.  I want something that is 100 % accurate. 

MM:  Oh, that's easy.  Don't have sex.  That's the only 100 % accurate form of birth control 

Teen:  I didn't come her for a religious lecture. 

MM:  It has nothing to do with religion. It has to do with the most effective birth control.  You asked for 100% effective. 

Teen:  (angry) you can stop lecturing me!

MM:  OK, so what birth control would you like to try? 

Teen:  I don't like any you said.  I want something else.  

MM:   Well, I've outlined all of your options.   

Teen: Gross.  I don't like any of them.  So find me something.

MM:  I've given you all  your options. 

Teen:  But I don't like them.  You are supposed to get me on birth control.

MM:  I don't have anything else to offer.

Teen:  (very angry)  So you are saying that I wasted my entire time her today? I can't believe you are refusing to give me anything.  Do I get my money back?

MM:  I am not refusing.  I gave you your choices and you have to choose one of them.

Teen:  If I get pregnant it is all your fault then.

MM:  No, it is not my fault.  You are the one having sex.  You do the adult behaviors, you have to take the adult responsibilities. 

Teen: I am responsible.  I am careful.  I am going to report you to my insurance company because you are refusing to give me birth control.  Get out of here!

MM: OK, here are your checkout papers.  If you decide you want to start on a birth control come back and see me and I will get you started.  I would still recommend you use condoms to help prevent pregnancy and STD's.  Stop off at the lab and we can do your pregnancy test.

Teen:  Forget it!  I am never coming back.  You are just stupid.  

 

Sigh, I just don't know what to say sometimes.  I just find these visits so sad.  Because the next patient the same age came in because she was pregnant and just can't figure out "how it happened".  Thank goodness I do have some responsible and amazing teenage patients.