I worked Monday and Tuesday, and had two great deliveries, one each shift. I am slowly getting the hang of my delivery tasks on EPIC, although I don't know how I will admit the baby, get the orders up and signed, get stickers, get the cord blood drawn (and gases, if necessary), hang pitocin after releasing orders and scanning armband (and after closing the chart, because one cannot scan for meds while the chart is open, no, that would make sense) and med--that is, if the pharmacy has released it: all that, alone, in five minutes? Mmmm. Probably no time soon. I was still fortunate enough to have help at each delivery. And while I screwed up one of the cord blood orders (hold, not workup, for non O-type Rh+ mothers, geeze), I did okay. And my recovery on Monday only took, umm, four hours instead of the regular two and half, plus the extra hour of strip charting afterwards. Shit. So. Much. Charting. I was fortunate that my patients were not on pitocin or diabetic, or I'd have been even farther behind. I know that sometimes I am not the most efficient charter; I focus on tasks and my patient, and there's always something urgent to be done, not written about (although the rule is, that if it's not charted, there's no proof that you ever did it), so I end up charting later, when I catch my breath. But there's never time with EPIC. NEVER. I know this will change, when it becomes second nature, but it will take a while. All of us are struggling.
I haven't even been to the OR yet. That will be a nightmare of snail, and I will be in a pot of boiling water.
One delivery was a gorgeous midwife-attended, natural birth: beautiful, lovely, uncomplicated. I had graduated from high school long before this patient was born. I feel so old these days. The mother of the patient said to me, "Oh, I was a school teacher. It only gets worse." LOL But I loved working with the midwife, who is so kind and easy and nonplussed, and I am energized by seeing mothers do their thing without interventions (when possible). Birth is a natural act, not a pathological one. My patient was strong, and rocked it. Plus, she got a beautiful little girl, and seeing the joy in her and her husband's eyes healed my soul. Those are the days that make me happiest at work: births without complications, without maternal disease, without everyone rushing to the room to have to fix fetal heart rates or other things gone awry. My mentors say that 15 years ago, most births were like this, but now, maternal disease (primarily the trifecta of obesity, diabetes, and hypertension, sometimes maternal age) has made things far more stressful. I have seen a change in the acuity in the majority of our patients even in my five years. Sad.
Wednesday and Thursday I went with Nalini, my film friend and soul twin, to the San Francisco International Film Festival. On Wednesday, we attended a Q&A with Richard Linklater and Julie Delpy, who were in town to discuss their film, Before Midnight (and the previous two films in the trilogy, charting the relationship of Jesse, an American man, and Celine, a French woman, over 18 years). The moderator was awful, sadly, and as a screenwriter himself focused only on the workshop aspect of three people writing a screenplay. I was amazed at how many times he could ask the same question in different form, while the director and actor maintained their cool. Yes, it was workshopped. Yes, each of the three writers wrote for each character, and each had veto power over lines. But then, let it go! Talk about other things. Oy vey. I have been in university environments much of my life and am used to having better quality questions. One person asked, after all this, if there were ideas for the ending or other scenes that were discarded. Linklater and Delpy both smiled, raised eyebrows, and said, "Yes." I wanted to say, "Where are your critical listening skills, person? Have you not heard a word of what they said for the past hour? Is your degree from UC Berkeley?" Ugh.
Linklater discussed having an idea for an interaction, but not necessarily the lines, and having placeholders in the writing process; for example, the characters would hash out some topic, but they had to decide when and where and how that would happen. I liked the idea of placeholders. It's simple, and I do it myself when roughly outlining. "Oh, this should go here, perhaps," and I insert brackets with a few words to remind myself of what I might wish to say. It's also hard to know where to start, and who characters are, and what parts should be foregrounded. Fascinating stuff.
I fell in love with Before Sunrise back when it came out in 1995; yes, it's one of those Gen X cultural markers, and fuck, Linklater gets us. I saw it when I was 25, not quite yet 26, and remembered that feeling of traveling and being open to new experiences and people and getting to know them rather quickly (or not), and moving on. I didn't exactly have that kind of experience, of meeting for only one day, but I fell in love quickly and hard and still treasure the memories and words of one particular man I've mentioned before, whom I met when I was living in England when I was 22. He wrote me the most beautiful, articulate, self-lacerating, willing-to-be-vulnerable love letters I've ever received. On my worst days, I can read them and remember what it felt like to be loved right down to my bones, if only briefly. I watched Before Sunrise again when I got home last night, and that scene as he leaves her on the train at the end was something I lived. Oh, it was bittersweet and amazing. Even when I saw the film in 1995, it transported me to that place. Magic.
I saw Before Sunset in 2004, eager for the next installment, and it was jarring and fabulous. The exchanges, the anger, the guilt, the missed meetings, the desire to find something in that space between people: what a tight, nearly perfect screenplay! There's that great line of Celine's, where Jesse wants to know if she thought about him in the nine years after they parted in Vienna, and she says, "No, I didn't [forget about you], and it pisses me off."
I had been wondering how things might play out in the new film, Before Midnight. It was thrilling to see it in SF, in the majestic 91-year-old Castro Theater, filled to the rafters with cinephiles and people wanting to know about how love changes, grows, is challenged. I watched the dance of the middle-aged characters, bickering in ways so familiar to me from my own life. Knowing where to put the knife in your partner; knowing how they're manipulating you; hating that they know you so well that they have access to your buttons and know where you're going before you get there. It was raw and real. Some of Jesse's comments about Celine could have been made about me, such as "You're the Mayor of Crazytown." Precise, hurtful, pointed. I was impressed by the analysis of how love and expectations change over time, and how as we age, we come to accept imperfections because life is a mess. There is no perfect match, there is no perfect anything. We have those who love us, or who don't, and we love those we do for who they are, warts and all. Sometimes it's difficult to love, but the offer of unconditional love is rare. And how often do we set people up to fail? All the time.
Then speaking of unconditional love and commitment, Nalini and I saw a powerful, well made documentary, After Tiller, about four providers in the United States who do third-trimester abortions. What does it mean to work with women who choose this? How do you help them? How do they arrive at that place? One of the physicians in the film said that it was an enormous burden to have women tell their stories, and then to have to say yes or no to them.
One potential client called, wanting an abortion at 35 weeks. Not for fetal anomaly, or for maternal illness or hardship, but because of bad timing, it seemed. The physician ended up declining to perform the procedure. As an RN who regularly attends deliveries of 35-weekers who do just fine, it seemed hard to imagine choosing to terminate at 35 weeks. But then, it's not my body or my life. As Mark and I discussed afterwards, why do I think it's okay to abort up to 20 weeks, or even the edge of viability, and then get squeamish? What is my invisible moral line? As another physician in the film said, when you're delivering a patient at 28 weeks, what comes out is clearly not tissue; it's a baby. But what comes first in thinking about it has to be the mother's concerns. I get that. I also didn't know that they euthanized the fetus with digoxin, stopping the heart, before performing what's basically an induction and delivery. I wonder why they use digoxin and don't also use some fentanyl, or painkiller. I know that there's this idea that fetuses don't feel pain, but believe me, when 28-weekers are born and are in the NICU, we do pain assessments on them, IMMEDIATELY. There is no imaginary line inside and out of the uterus. The idea that newborns don't feel pain is outdated and disproved to all but the black box people. I need to research this.
During the film, I sat crunched up, regularly squeezing Nalini's hand. I know I wasn't wanted. I was told more than once by my mother that wished she had aborted me. I could have been terminated. I accept that. It's her body, her life that were messed up by a pregnancy she didn't want. But now that I am in a better place in my own life, I do see that my potential would have been gone, and that can hurt sometimes. Nalini said to me, "You were meant to be here. You have to know that." But I also know the truth, and that's the hardest thing to live with sometimes. As Jesse said in Beyond Sunrise, I am crashing a party, the party of life. I was talking about being an unwanted, mistake baby one day, and Tobey, my younger son, got very, very angry. "MOMMY! You were NOT a mistake. You were meant to be here." I told him that the truth is hard, but you have to face it. I am here, and he cannot be erased now, either. But that the circumstances of my arrival were not the sunny ones of his, and that's the way of the world. I understand how his whole existence is shaken by the contingency of so many cards, balanced tenuously on one another, and yet they held, and he is here, and loved. I am touched that he is unerringly loyal and hates to think of me as being unwanted and inconvenient in 1969. Another Coeur de Leon, chivalrous and eager for battle.
I was also thrumming with anxiety to see how adoption might play out in the film, or in the discussion afterwards, as adoption is often put forward as the opposite side of the coin to abortion. I believe strongly that they're not related: adoption is the decision to parent or not; abortion is the decision to carry a pregnancy to term or not. And the film actually didn't push adoption as a good alternative to these late-term abortions. Certainly, in counseling, the women were asked what brought them, and what other options they had considered: keeping the child; having the child raised by family; placing the child for adoption. But really, none of the women there considered adoption. They all said that if they carried to term, they would keep the child. It was refreshing. One young woman, very religious and plagued by regret, said that she didn't want to keep the child or have the child raised by her or her boyfriend's family, so this was the best option for her, out of three shitty options. And yes, I support her in doing what was right for her, and by corollary, for her child. At the same time, it sucks to be the child whose mother faces three shitty options, none of which include being happy about the pregnancy. 44 years into that life, yeah, it's not awesome to know this, but we all have our crosses to bear and must find our way.
As one of the characters said in Beyond Midnight, to paraphrase, "You stop looking for someone to complete you, and learn to enjoy life, to live."
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