Stress Not

9:00am Thursday July 16, 2009
Listening to Aretha Franklin, waking up slowly this morning. I finally slept well last night after three consecutive nights of relative sleeplessness due mostly, I think, to an extra body in my bed. Austin came to Bali to surprise me on Sunday, which is pretty amazing any way you slice it (even if it does raise the temperature of the mosquito netted bed to an uncomfortable level).

For those of you who don’t know about Austin, my relationship with my previous boyfriend ended just before my birthday in May. Two weeks later, I went camping with some homies and Austin came along too. It isn’t much of an exaggeration to say that we haven’t really been apart since. So that happened. I’ve been missing Austin pretty intensely since getting here and when he got here Sunday, I’d been having a pretty miserable day. He couldn’t have picked a better time to show up and I’m really, REALLY, glad he’s here.

So what’s happened since the kittens made their bed my home, you ask? Well, the mama cat crept back in not long after I fell asleep and was shocked and amazed to find me sleeping with her babies. I tried not to scare her, but she hissed and growled and ran away anyway, and spent the next hour outside my bedroom window yoweling for her babies. I tried sitting on the floor away from the bed and encouraging her to come in. She didn’t go for it. I tried gathering my comforter around me and going to sleep on my porch, but it was uncomfortable and she didn’t go for that either. So I finally went back to bed and slept curled as far away from the kittens as I could. I woke up to her creeping out of my bed with a kitten in her mouth a few hours later. When she had safely left the room, I checked under the pillow and the kittens were gone.

I caught another baby on Sunday afternoon, a first timer who dilated quickly and pushed her baby out like a champ but tore badly and dumped some blood. I’d estimate her total blood loss at 600 ccs which is a bleed for sure, but a relatively small one. However, because she was small and thin and undernourished, it has taken a bit more of a toll on her than it would on a woman I might serve at home. I sutured the tear with the help of the Indonesian midwives, but didn’t feel good about my repair job. The Indonesian midwives eventually took over and I felt awful, wondering if I would ever get the practice and experience I need to suture competently, wondering what business I have trying to sit my license exam if I can’t confidently suture a second degree tear by myself at home. Once the mama was resting and nursing her baby and everyone left her alone, I spent the next few hours checking her vitals and monitoring her blood loss with the Australian midwife and doctor who were both supportive and reassuring to me that I hadn’t botched the birth. And she fainted while trying to use the toilet afterwards, which isn’t fun when it happens in English I can can communicate with the mother before she goes down, and with the father or other support people after she’s gone down, and can now attest that its even less fun when they do it in a language you don’t speak. Nevertheless, I was feeling low, my leg was still bothering me and I was wondering why I am here.

My phone rang with a blocked number. A familiar voice on the other end of the line, but he sounded strange. Austin made small talk with me while I cried with relief that he’d called me when he did, needing to hear a friendly voice so badly. It was the first time I’d talked on the phone to someone from home. He was asking me weird questions, like what I was doing, where I was, etc. “What’s going on? You sound weird. Are you okay?” I asked him. “Yeah, I’m fine. Just really excited to be talking to you.” He told me. Then it dawned on me. “Are you HERE?” I asked him. “No…” he began, “Well, maybe.” 20 minutes later he was at the clinic. Totally unprecedented and totally amazing.

So having Austin here has been interesting. We rented a motorbike, and he’s been riding me around Ubud on it since Monday. We got him a handphone so I can get hold of him when I need to be at the clinic. We’ve been eating A LOT. And it has been just all around pretty magical to have him here. I’ve only attended two births in the 4 days he’s been here, which is a little challenging for me since I’m here to attend births, not traipse around paradise with a handsome man on the back of his motorbike. But the two births I’ve attended have been lovely and a nice counterpoint to the confidence shaking of Sunday’s birth. The day before yesterday, I came down to the clinic to support Tessa, who was catching, and saw her do a nice waterbirth for a first timer, with a gorgeous third stage –I’ve never so clearly watched a placenta just creep down and come out unassisted—and then observed Tessa while she sutured. That night, as I was falling asleep, I had an Ah-HA! moment regarding suturing that I’d been needing, and felt much better prepared for the next tear I see. Yesterday, I was having lunch with Austin and got a text that there was a first timer at 3cm at the clinic if I wanted to come do the birth so I had Austin drop me off on the way home. Another lovely birth. She labored stoically, almost silently, and I saw no difference in her behavior or body language between 4 centimeters and 10 centimeters. Even when her water broke while she pushed, it was silent, undramatic, barely registering on anyone’s radar. I joked that she was just going to have her baby under her sarong and we wouldn’t know until it cried. As she began to bring the baby down more, I noticed that part of her labia looked odd, like raw meat and I wondered if she had some kind of STD or other infection that was causing her skin to look so…yucky. As the baby’s head began to crown, the labia parted further and I saw that it wasn’t her labia that was raw but that there was a long strip of it that was not attached to the rest of her vagina, and had a hole in it, through which I had been seeing her urethral sponge (sorry, to the squeamish amongst you). I’ve never seen anything like it before. I showed the other midwives in the room and everyone sort of shrugged their shoulders and said, lets hold it back and see what happens. So we did. Gorgeous, squalling baby was born with a nuchal hand, crossed over his chest and up near his opposite ear (little stinker), over an intact peri --no need for suturing, though the strip did detach on one side, leaving a very long skin tag that one of the Indonesian midwives cut off. I was THRILLED to have such a lovely birth with so many people in attendance, to help wipe away any negative perceptions that may have been formed after Sunday’s birth.

In other rockstar news, I may have correctly diagnosed a congenital defect in a newborn born at the clinic yesterday morning. No one knew what to make of the baby, but talking about what she was presenting with, I immediately offered up hypothyroidsim of the newborn, based on a case I saw a few years ago. The baby was transported to Denpasar to a hospital in the early afternoon and we are waiting to hear what the pediatricians think, but it was gratifying to learn that, after a bunch of research, everyone agreed my diagnosis was the best fit. Go me. Maybe.

My leg continues its slow road toward what I am hoping is healing. It was better over the weekend, and then worsened substantially Monday, Tuesday and Wednesday. On Monday afternoon, we ran into the clinic acupuncturist, Dr. B, on the street and, seeing my leg, she asked that I come down to the clinic that evening for treatment because it was looking infected. Austin and I showed up at the end of clinic and Danielle and Dr. B conferred over my leg and then took me over to the table to “ring the dragon” which involved having acupuncture needles inserted all around the perimeter of the injury. It hurt like hell. Dr. B also looked at my tongue and declared I needed my liver and my stomach bled. What now? This meant they took lancets to my big and second toes on each foot. I bled like a stuck pig and started to regret my decision to let them treat me at all. In truth, it was great fun. Everyone from the clinic was there, including the mom of the baby I had caught Sunday night, and everyone laughed while I cried out in pain, and everyone took pictures of me being miserable on the bed. It was hilarious and painful and good times. After I thought all the torture was over, I showed someone how the bruise of my leg hadn’t ever materialized around the actual injury, but had pooled in my foot, below my ankle where there was now a huge purple spot. Dr. B scolded me for not pointing this out to her before and promptly stuck six more needles in the tender part of my foot. Me and my big mouth.

I began to get worried yesterday when the swelling was getting obviously worse. Tessa and I had a laugh on Tuesday night when she was examining it and we realized how bad the edema was and were poking our fingers into my tender leg and laughing at how deep the finger imprints left on my leg were. She warned me that she doesn’t like how close to the bone the infection is and that, in Australia, the treatment if my infection got worse would be maybe 4-6 weeks of IV antibiotics. Yeah, lets not go there. So I’ve been being extra diligent with the antibiotic cream everyone swears by and trying to elevate it whenever possible but it was undeniable yesterday that my leg hurt worse and looked bad again. I finally agreed to take antibiotics, if we could find the appropriate ones for me. Danielle overheard these plans and asked if I’d taken the Chinese herbs that Dr. B had suggested I mix in with the antibiotic cream for my leg. Of course I hadn’t. I’m lazy. Take them orally, she said. Seriously. So I took two doses yesterday and, this morning, my leg is 80% better. That stuff is NO JOKE. So I’ve got 8 more doses of the herb, and I’ll continue taking it over the next day or so and if my leg isn’t substantially better, then I’ll take the antibiotics. Who knew being injured in Indonesia would prove to be such a debacle?

Other magical things that have happened:
Austin and I walked through the monkey forest at dusk the other night and followed a path that I hadn’t gone down before. It led to a staircase/bridge over a deep ravine, surrounded on all sides by tall trees with roots plunging down from their branches. We followed the bridge down and walked past an old stone reflecting pool and along the river with the night falling quickly around us and could see bats flying nearby and the monkeys overhead. It was so lovely and amazing –like something out of a movie, like someone made it all up. It is still hard to fathom that someplace as beautiful as this exists.

Dr. B is associated with a school of spiritual teaching related to zen meditation I guess. Every Wednesday, she shows a movie related to these teachings and then gives a kind of blessing she was “ordained” (my word not hers) with on a pilgrimage to India. So, after my birth yesterday, someone mentioned she was going to see the movie and I remembered what day it was and quickly asked Austin if he wanted to go get blessed by Dr. B. “Duh” he said and we hopped on the motorbike and ran off. The movie was good –it was a taped interview with a teacher of the spiritual practice Dr. B is involved with but it was closely related to the tenets of Buddhism that I have been interested in for the past year, so it spoke to me anyway. Austin was pretty into the movie too and leaned over to me at one point and said “this is so much like The Process!” which I could totally relate it. I found myself renewing my promise to continue on the spiritual journey which I’ve been actively cultivating for the past year and feeling grateful to be building a relationship with someone who has parallel experience to me (via The Process) and is interested in doing that exploration with me. After the movie, Dr. B explained how the blessing works, what it’s purpose is, and how to receive it and then they turned down the lights, turned on some om shanti music and got to business. I don’t know if the blessing worked, but I can say if feels really good to get blessed by Dr. B –like she was massaging my brain. Whatever it was, Austin and I left feeling great, had a nice meal together, and then konked out like we hadn’t slept in days.

So, its now been a few hours since I began this entry, and Austin and I have packed our bags and are headed to spend a few days at the beach. We were planning to go one place on the island, knew where we would stay and everything, but then at the last minute had our minds changed by my landlord, who called his brother, who picked us up, and now we are being whisked off to a more remote part of the island where we have been promised quiet, both black and white sand beaches, coral reefs, diving if we want it, and generally “a honeymoon.” I realize this is totally counter to my purpose here but I’ve realized a few things over the last week. First, I’m here to observe and gain extra experience. No finite number of births is going to make or break me as a midwife –if I miss 3 births because I was gone 3 days, its not actually going to make a difference. Second, what I’m observing at the clinic isn’t how I practice at home or how I’m going to practice at home. If anything, many things I’ve observed have been educational primarily in how they reinforce how I’m NOT going to do it. This isn’t to say that what happens at the clinic isn’t appropriate –I think it is, for this clinic and this culture and level of poverty, etc. It is not homebirth in northern california. Not that I came here expecting homebirth, but it’s a good reality check that you alter your practice based on many circumstances, some of them not so obvious or even clinically based. In short, this clinic is not going to dramatically alter how I practice back home. Third, the clinic is crowded right now and tensions have been running high. I can remove myself from that for a few days, recharge, and make one less body at the clinic trying to “get” a birth. Fine with me. Even better that I’m going to spend those days on the beach with my man. So I feel less anxious to be at the clinic all the time. Probably the most valuable learning I’ve gotten here so far has been just sitting and talking with the Australian homebirth midwife, learning how she practices, listening to her 30 years worth of amazing stories. I have half a mind to invite myself to Eastern Australia where she lives and pick her brain and watch her births for 6 months. Anyway, I’m on vacation on my vacation and I’m stoked about it. I don’t feel in the least bit guilty. I’ve got 4 more weeks here. I would love 5 more primary births, but I don’t even need them. I’ve decided to just enjoy the time I have here, and stress not.

That’s the key to being here happily: Stress not.