Wednesday, October 28, 2009

Listen to Women....a Lesson Learned from a Student Nurse Midwife

October 29, 2008

Today is a day that changed my life in a profound way. I called my preceptor this am at 5:45 as usual, and she told me that no one was in labor and we had 2 PP rounds to make, so I would meet her there at 8:30. We made our rounds and as I went back to the call room she told me that the induction we had scheduled for 12:00 pm had just come from the Oncologist and her biopsy of a lump in her right breast had come back as invasive breast cancer………..

Rewind several weeks….my new friend’s right breast starting “itching” in a strange way. She was unable to palpate any lumps but felt that something was not right. She came to the clinic and still no lump was found on the first visit, but the next ROB a lump was present.

She was referred to a doctor at Baptist Hospital who, after a biopsy this week diagnosed her today with cancer, the day she was scheduled to be induced at 39.1 weeks due to a prior term IUFD in Kenya…..

I said all of this to set up for the life changing day I spent with one of the most amazing, strong, powerful, graceful and determined women I have ever met in my 42 years of life. I was granted the rare opportunity to share my day with this woman who was left alone at the hospital to begin her labor journey only 3 hours after receiving heartbreaking news about her health.

We laughed, cried, shared hair conditioning tips, talked politics, watched the Obama 30 minute commercial, and watched Deal or No Deal during the emotional rollercoaster course of our day. Her husband had to be at home with their 4 year old son and would not be coming to the hospital until tomorrow morning after the baby is born. With no family or friends in Nashville, I quickly became her “sister” as she stated. We were both under the impression that I was to offer her support and company during the day, when in reality, she gave me much more than I could have possibly given her.

My new friends’ story began in Somalia, where she was born into the family of her Somalian father and mother. At the age of 8 she was one of many little girls who lined up to take part in the generations old tradition of Female Genital Mutilation. She told me heartbreaking stories of infection from razor blades used on more than one little girl, stories of family and friends who bled so much on their wedding night they would have to be transfused to save their lives. Stories of nothing but a “pin hole” left from the FGM in some women that they are unable to have penetration with their husbands, stories of women who died from renal failure due to the fact that they have chronic UTI’s after FGM.

As a teenager she was forced to leave her country of Somalia with her family when civil war broke out. She and her family lived in a refugee camp in the country of Kenya for 16 years. She built a good life in a country not her own, all the while knowing that eventually the government would require her to leave Kenya.

Her father was a practicing polygamist who had 3 wives and many children (as is the custom in Africa, one can have up to 4 wives). We laughed and wondered out loud how any woman could share her husband with other wives. She told me how it works for her culture; and that she told her husband before they married, “If you want more than one wife, marry someone else, I don’t share”. She told me that in Africa adulterous affairs are rare….having 4 wives should be plenty for any man!! Her father was an educated man and saw to it that she and her sisters all had college degrees. She told me that the greatest gift we can give our children is a good education. She was an “assistant physician” in Kenya. Similar to physician assistants in our country. She saw anywhere from 30-50 patients a day in the government clinic she worked in. She met her husband (an Ethiopian refugee) while she was working with Doctor’s Without Borders. He is an accountant and owned his own business in Kenya. The heartbreak of 2 professionals in one country, and not being able to find work in another country.

She told me the story of her courtship with her husband, wedding celebration and the traditional customs involved with an African wedding. The heartbreak of delivering their first child in Kenya after he died in the womb during labor. The agony of her breast milk coming in after she went home from the hospital empty handed and heartbroken. The joy of delivering their 4 year old son and breastfeeding him. We cried together as she realized that she won’t be breastfeeding the baby currently in her womb. She has battled TB and hypothyroidism. She had never used a washing machine in Africa, a luxury we take for granted in the US. She told me of the loneliness of living in Kenya with their infant son for over a year while her husband had been moved to Jacksonville, FL first then to their current apartment in Nashville. The heartbreak of her mother and father both dying in 2006 within 7 months of each other while she was waiting to move to Nashville. The feelings of being torn between leaving her family in the refugee camp in the country of Kenya and the anticipation of being reunited with her husband in yet another country not her own. She told me of the 24 hour journey from Africa to the United States to begin life over once again in a country she had never even visited. The struggles of being given one months rent, $200.00, food stamps and no family or friends to communicate with. And now, the long road ahead of her with the diagnosis of breast cancer just hours before.

She asked me about my family and we cried together as we both shared our stories of once having financial security and the heartbreak of standing in line at the DHS and putting your pride aside to ask for food stamps and TennCare to feed and have medical insurance for our children. We laughed together at the realization that it just might be possible that I am one of the few at Vanderbilt on food stamps and Medicaid while attempting to put myself back through school for a second chance at financial security for myself and my children….we are from two different worlds, with two very different stories. She believes as I do that I was sent to Vine Hill Community Clinic for integration this semester for a reason, one I may never know. Even though I can’t even begin to fathom the heartbreak, and loneliness my patients have experienced; I can relate to losing everything and having two choices, to either stay down or begin the long, grueling, hopefully rewarding journey of “starting over” and making a better life for me and the children.

I have never been good at recognizing the signals God puts in front of me to pay attention, be still and listen. My life changed in profound ways today as I “listened to women” (a woman) with an open mind, allowing myself to feel her pain, while embracing the very personal pain of my journey the past 4 years as we shared our life stories with each other. Two strangers, who in ordinary circumstances would have never crossed paths. But this is no ordinary circumstance, and we have chosen no ordinary profession. WE are soon to be nurse midwives in a country that values volume over quality. We speed through life, fast food drive through windows, we are double booked in our clinics with the assumption that someone won’t show up for their appointment; having to mindfully make the attempt to “listen” to our patients when no one “no shows” and we have every room filled with patients wanting to share with us their fears, concerns, joys etc. of their pregnancy. Had I not been a student this week, I wouldn't have been able to spend and entire day with this amazing woman who made a lifelong impression on this single mother of two. We had two patients in labor, and I was fortunate enough to be able to dedicate my day to this woman while my preceptor took over the other patient. A gift I am grateful for, one that I hope I can return to another student someday.

My day was long, and my heart broken when at 9:30 pm she was only 5 cm and I had to make a decision to relieve the babysitter at my house, who was keeping my children that I had not seen in over 24 hours; or stay with this woman that had no one with her to welcome her baby boy into this world. We hugged, cried and said goodbye as I left the hospital with a heavy heart; torn between the needs of my family and my patient….

October 30, 2008

She delivered 2 hours after I left her bedside. As I made post-partum rounds today she relived the birth experience with me. I met her husband who for the first time got to hold his newborn son. I took pictures with my camera so that they could send them to family in Kenya. Last night my daughter and I took the pictures and a card to her room. She was sleeping peacefully. As I was putting her gifts on her table, I noticed that beside her was a book on “Surviving Breast Cancer”. A stark reminder of the journey this woman has in front of her. And a true testament to the WILL of this woman to live. A true survivor in every sense of the word. She told me that she knew October was breast cancer awareness month; she just wasn't prepared to be “joining the numbers”!

My phone rang at 10:00 PM last night (the first patient I have ever given my number to) and it was her in tears over the pictures I had left for her and her husband. She talked about the book on her table, and how exhausted it made her to read it and contemplate her options. She is considering a double mastectomy, radiation, chemotherapy and whatever else she must to do survive and raise her sons. Her appointment is November 10 with the oncologist. She asked me to pray for her and her family. I am asking you to do the same. She shared with me that in her religion they believe that God gives you trials to test your faith, and even though it isn’t easy ~we must believe that everything is for a reason. I know that whatever the reason, God put a Southern Baptist girl from Gilbertsville, KY (a town still to this day without one single African American living in it) in the path of a Somalian refugee with a lifetime of tragedy in her 33 years of life. And together we will face the challenges of our very diverse life. I have a new “sister” whom I will forever be grateful to for giving me a wake up call in this whirlwind of a life I have been living the past 2 ½ years of my CNM/FNP education.

I have shared only a portion of all that we have discussed over the past two days (for those of you that know me, know I have never been short on words, so the time I spent with my new friend has been filled with many more stories than I can ever begin to put onto paper). When I walk into Vine Hill on Monday, I will be a changed person. I will still be overbooked, still too little time allotted for translators, there will still be angry patients that somehow had their appointments mixed up, triage patients to sort through~but this future CNM/FNP will be radically aware of and in tune with the needs of my extremely diverse population of patients I am blessed to serve every day I am there. And when I catch myself frustrated, wanting to just ask only the necessary questions to fill in the flow sheet~I will breathe, relax and attempt to refocus on why I am on this journey that encourages us today, tomorrow and for a lifetime to “listen to women".


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