Opening

That last post? It was the darkening before the dawn... the cold, bitter rains of March right before springs first tentative blooms poke through the thawing ground... the tensing of every last muscle, stressed, fearful, fatigued -- and then a loved one's arms are there to encircle and release it all to the universe itself.

Do I need to step back a mile or three? Maybe that would help...

From a career/baby-catching standpoint - you could say that the last post was somewhat colored by the sludginess I've felt in my job search. (Which, in itself --- seems somewhat silly... I didn't expect to come out of school with a job in hand, as nice as it would have been. But still - now that it's been five months, I'm getting a little antsy...) Every day that I go without that delightful weight sliding into my hands, without gifting mothers with the words "here's your beautiful child" ... it weighs on me. Sure - I can still go to work as an L&D nurse; I can still whisper forbidden encouragement into the ears of hardworking mama's ("go ahead... eat some crackers... nibble on that granola bar..." ), but it's not the same. The mothers, the fathers - they know I am the nurse; they have only just met me, and even if we have "clicked" and even if they can sense that I am there for them and their babe --- I am still, just, the nurse.

I've sent resumes, CV's, emails of inquiry. I've had an ongoing email chain, complete with an powerpoint proposal, to the physician group that I've worked with for the past five and a half years - a handful of great family doctors who practice this close to the midwifery model of care. Throughout my clinical rotation with Dee, there was the shadow of a promise of her practice adding a second CNM. Nothing. Zipzilchzerozuess. "My" doctors decided that while they felt there would be interest in a CNM in our area, they feared "there would not be enough demand for a full-time position". A few attempts to get in touch with Dee (after a promising email before the holidays that her administrator was going to start the process to try to get the wheels going...) weren't returned. A promising position - complete with loan forgiveness via the HRSA program - seemed very likely and suddenly... *poof*! Que sera, sera.

But. On top of this, I live in the Midwest. In winter. A gray, long, cold Midwestern winter. The task of looking for a job - refreshing the same search engines, day after day (many times multiple times daily) - combined with more and more student loan payments being auto-debited as the days stayed devoid of sunshine ... you get the picture. Little by little, negativity begins to replace the fresh enthusiasm of graduation; did I really just sacrifice three arduous years and an incredible sum of blood/sweat/tears/trees/memories/etc (not to mention indebtness to the good old Department of Education/Loan Repayment Program), only to continue to work very part-time as a labor and delivery nurse?! Am I undesirable as a CNM?? Is there something that screams "don't hire this girl, for pete's sake!!" on my resume? Do I need to eat more chocolate - will that help??

So - anyway. It was a long couple of weeks, and maybe that post reflected some of that. In the end, I resigned myself -- or liberated myself -- to the old "letting go, and letting God" (or the Creating, or the Universe, or destiny, or karma, or what have you... I'm not entirely sure, myself) take over.

And - it worked.

Not long afterwards, I heard back from the site that seemed like it could be the "perfect" fit (we'll call that site "North" for the sake of, well, easy-ness). It turned out the midwife's mother had been ill and unfortunately passed away; that had prolonged the interview process, but ultimately within the next week or so I spoke with the midwife and HR folks, and set up a time to go up and meet them all in person and tour the site. I also sent a CV to a second site - this one a private midwife practice out west (we'll call this one "West" for those of you following along), and had some nice back-and-forth communications with them via email. After my first Skype interview (interesting enough), I was invited to fly out there and meet them in person as well. Both visits/meetings went great, and now I sit with one likely offer (from "North", pending the approval of one final committee) and a call back next week from "West", where there were still 2-3 other applicants to be interviewed.

My dilemma may or may not be solved by next week's call by "West" ... but that's another post!

The Abyss

I waver between two different realities. One, I stand on the edge of a total, all-encompassing darkness. My bare skin is chilled - goosebumped - but invigorated. Behind me is all I know, everything familiar, the things that have always been. In front of me is... what? Nothing? The steep, sudden chasm at my toes should frighten me, yet I feel nothing but an overwhelming sense of calm now; that fear - fear that should envelope my entire self - has vanished along with the light from this space. I know that to step off could end everything - but it could also be the beginning of everything. With the slightest step into the unknown I will open my wings and fly to the place of my dreams, or simply land where I'm meant to be: a pillow of soft clouds, the waiting arms of a One who created me, or the place of my family's future. A soft wind's push, a strong legged-leap, a quick stumble... any of these things would move me on, and yet - I pause at the edge of the question marks beyond.

Then there's the second place; the place where the Fear lurks. Down a constricted, narrow earthen tube - barely wide enough to descend, long enough to make the late afternoon light little more than a tarnished penny above - lies the insignificant yet crucial room. Constructed of thick steel, lined in double layers of thick and splintering wood, barely larger than a bathroom stall (and certainly less than five feet tall)... it smothers, it suffocates, it shrieks. Time stands still at the same moments that it races by; in the silence of the box, the deafening darkness threatens me with insanity. I stand at this fissure, knowing the only way to complete this journey - to pass this test - is to descend the long ladder downward, to endure my time inside with my Fear, and fight my way back up and through the long, tight passage back... and I struggle, I fight. I know I can do it, and I know I should do it - go down, do my time, and emerge victoriously, proud of my dirt and raw, rubbed skin; I know the struggle is the true origin of my Fear.

~*~*~*~*~*~

And yet - I still stand here, at the edges. Aquiver.

The Most Wonderful Time of the Year... ~ Or ~ When Things Look Bleak (But Aren't Really That Bad, Right?)

A happy and blessed Christmahanukwanzakah and New Year to all! Pardon my hacking as I make it through the six weeks of dust being knocked off the blog as I start typing through this post *blush* ... (I guess it's been a while. Oops.)

Where've I been? Bouncing between the new-found freedom that comes with ((drumroll please)) no more schooling, the excitement of two Mini's and impending snowflakes and thoughts of Christmas time, and the gnawing concern that my baby-catching days are becoming further distant with each day that passes with no job opportunity at hand.

(Now, this post isn't meant to be a mopey, woe-is-me sort of thing... what fun is that?? As you may have gathered from previous ramblings, it may just lazily wander around this topic and - hopefully - come to some sort of resolution by the end. Over the past week or two, these thoughts have built into a strong mental blizzard, worrying at me like a six-year-old wiggling a loose tooth. It's amazing, though, how cathartic putting such thoughts out into the universe can be... I'm looking forward to that sense of peace that I know I'll find after hitting "publish" and sharing this with the world, even if no one actually reads this blog any more.)

Anyway - back on track. No time for anxiety or worrying too much about the job situation in the first weeks of December; our family celebrates Christmas, so between the holiday preparations themselves (taking the Mini's out to my dad's to find the 'perfect' tree, then trimming the tree and decorating the house, etc) as well as holiday concerts for both girls, cookie baking, the traditional trips to see the big red man, and all the other festivities, I was content to wait. (As of the first of December, I had contact with both Dee and the physicians I work with considering adding a CNM; I also had an interview lined up for a part-time CNM position at a family planning clinic...) It was only after all of the "fun" ended - including the last-minute shopping runs, an unexpected slippery couple of inches of snow (pretty to give us at least a bit of a white Christmas, festivily enough --- but oh-how-slick!), and a surprise attack of fevers, aches, and slug-mimicking for the Mini-est - that everything caught me. And by everything, I mean everything. I realized that just about ALL of my student loans were suddenly coming into repayment (which, considering I have not only my graduate school loans to repay, but also those for my ADN-to-BSN bridge program, and my ADN program, and the assortment of loans I had as I was waiting to get into a program... it sucks. Did I ever tell you the story of how it took me six years to get my 2-year associate degree, by the way? Good times, good times....). My student loans, and the Christmas bills (which, of course we tried to go low, we ALWAYS do... but isn't this how it is every year?! Suddenly *someone's* favorite team is selling 'stock' - which by the way is non-transferable and pays no dividends, but does look good on the wall... and who else owns a piece of America's team, right? - and this other thing is on the best, most SPECTACULAR, *AwEsOmEsT* SALE EVER!!! so it needs to be bought now... but if s/he gets that, then of course this one needs this, and yadda yadda.... Oh hey, isn't this Brazil?! How'd we get so far off track here, and can I even use these sweet new snowshoes south of the equator? Where's that map?!) are coming in, and no one was as excited with the gifts that I worked so hard to get *just right* for them, and I was exhausted, and my schedule at work wasn't right and I ended up bawling like a baby because I was exhausted when I saw it to begin with (and I HATE crying, especially when I'm upset/angry/trying to discuss something...) and why was I on a night shift to begin with on Christmas Eve night - my holiday is Christmas Eve, evening, arrrgh?!? and it was just the longest week ever.... and so on, and so on.

And it just kept going. And the family planning job, that I thought I had interviewed fabulously for, apparently was a big bomb. Was it exactly the perfect job I wanted, and was I a wonderful candidate who interviewed like a rockstar? Uh, not so much probably - but on the other hand, I thought I was pretty good and would (all in all) fit in well and enjoy the job. The biggest downside, of course, was the no-baby-catching. My biggest downside - I thought - was that in my typical fashion (ha, ha, pun ahead!) I neglected to actually try on an outfit for the interview until 11:30 p.m. the night before, and the outfit I planned to wear - a sweet little black and teensy, thin blue pin-striped suit... - had somehow gotten a couple of sizes too big (!%@^*), leaving me flustered in the wee a.m. hours trying to decide if I would try to pull it off with some sort of cinching (sans belt loops, of course) or go a little more casual. Anyway, it's starting to look like we're in the tropics again here, so I'm going to leave the interview territory and my fashion deficiencies (for proof of my fashion sense, see right), and go back to my other worries now.

I was assured that I would hear back in about a week about the position, and truly did expect to; the clinic had been short-staffed for awhile, they needed help, all the signals I picked up were a 'go'. I waited... and waited... and waited... (and sent a 'thank you' email...) and waited some more... and nothing. No "thanks, but no thanks" call, no polite "we've gone another way" rejection letter, nada.

I've also just been hanging with both of the nearby clinics; I emailed Dee a few days ago, gently hinting that I'd love any updates if she had any from her clinic administrator (who had started the process of checking into adding another CNM around the end of November, and had thought she would know more one way or the other in three weeks...). Checking my email neurotically - the one where messages from either Dee or my current physician group would contact me - doesn't seem to be doing much more than giving me little blisters, so I'm at a loss. It seems to be a fine line between being pushy, persistent, and the perfect amount of persuasive... it's just so difficult to read where things are at.

At this point, honestly, I'd just love to not be in this no-man's land. If all three (really, just the clinic groups - I've more or less written off the family planning clinic, although I may call the director just to touch base) facilities would just give me an answer, one way or the other --- I'd be happy, even if it's not the answer I really want to hear.

Even working as an RN in L&D is getting to be a struggle now. It's difficult to not step on toes, and to remember my scope of practice... and I miss being the midwife, making the calls, being able to do (and not do - or to be able to say, "we're not going to do this - we don't have to do this, everything is fine.") ... or if a baby is coming too quickly for the physician to make it, having to try to stay back and have another nurse 'catch', or have a mama try to not push --- one of the worst feelings in the world, and not good for mama or baby --- to provide the assurance needed to everyone that I wasn't trying to "take matters into my own hands" on some level. Awkward, awkward....

Soooooo, about the IHS.... 23 pages of application for *possible* loan reimbursement, if funds are ever available? Oh heck, why not. What else do I have to do???

Just Pickin' Em Up & Puttin' Em Down...

Yep, I think that's what I'll do. Every day, if that's what I need to reduce my focus to, I can do it - one step at at time. Simple, easy, as little stress as can be. Starting with lifting each foot, and then putting it down again a little bit further ahead than it started. I have a keychain that is engraved "Learn in Baby Steps" --- one of my new mottos, I believe.

Sounds easy enough, right?! I can do this - and I know I will. Patience is a virtue... but it's sooooo hard! The end of this road still seems far off, though I can tell it is getting closer. This week has been challenging; Dee has been out of the office for a much-needed vacation - although you can't really call it that since she is still functioning in a nurse-practitioner role, only volunteering her time (though she is at least enjoying herself I think) - and so I am working with some of her backup doc's and *trying* to make a good impression on them so they will agree that expanding her practice and adding a second CNM --- that is, moi --- is a splendid idea.

From my perspective, it's been great; I've been enjoying seeing things from the MD point of view and also observing visits that aren't typical nurse-midwife cases. However, on Tuesday I was hit by the WORST migraine I've had in a long, long time; the timing could not have been worse. How do you make a good impression, when you go from meeting someone and being eager to soak up all their knowledge to begging to go home with an "invisible" affliction in a matter of minutes-to-hours? It was awful; the worst part was, one of Dee's patients (who I've met several times in the office, as well as in the L&D setting) ended up presenting to L&D that day in labor, and the MD I was meeting that afternoon had offered to let me work with her during her labor. Prior to the onset of my killer headache, I was pumped to be able to follow her through, especially since Dee wouldn't be able to... until, that is, the hot flashes, nausea, and vomiting started while I was still seeing patients in the clinic. By the time I made it home that evening (after pitifully and ashamedly declining to accompany the doctor to see this particular laboring mama), I was miserable; the migraine didn't pass until later the next day, after 14.5 hours of solid sleep in my dark, window-less bedroom, with constant ice packs/hot rice bags, multiple doses of vicodin, and several doses of maxalt. Two words: it SUCKED. And, I was not impressed with myself.

(I've had migraines since I was five. They are something that are just there, and for the most part, I recognize that I have to live with them. A year or two ago, I started taking topamax and was thrilled at how well it seemed to 'calm' them; I also found that maxalt was actually reliable for knocking them out if I could take it when I first started getting an aura... these were the first meds that actually worked for me, after 20+ years of trying to find something. Now, in the past few months, they are steadily creeping back. To have two in the past two weeks, however, to the point that they disrupted my functioning - at clinicals no less - is NOT acceptable for me.... so I guess I will be in touch with my care provider.... *sigh*)

On a happier note --- things have been interesting with the MD preceptors. Again, I've seen several types of client cases that I might not normally see as a CNM: complex chronic health problems, many, many well child visits, and ---- wait for it... --- MEN! I haven't dealt with penises longer than a pinky-joint since I was a nursing student. Crazy, huh?

Tomorrow finishes off my week with the docs... fingers crossed that if nothing else, they think having an extra pair of hands could be good for something or other...

~*~*~*~*~

This can be a glass half-empty/half-full kind of pondering.... I think I posted last week that I had sent out an email to the doctors that I work with - as an OB nurse - just to sort of "feel them out"regarding how they might feel about hiring a CNM into their practice (as there are no nurse-midwives other than Dee delivering within 60-75 miles of our area). I received this response from the 'head' of this OB group today, and took it to be a good sign; it's of course impossible to read, but the gist of it is that most of the MD's in the group think that nurse-midwifery care may be a plausible option, but there are questions that would need to be discussed; it does not give any indication that they are not supportive of CNM care, and that they are willing to entertain the idea... the logistics of it may need to be explored, but it "could be interesting". (Again --- this email certainly could be read with optimism or pessimism, since it doesn't go strongly either way... but tiny seeds, no?)

And what goes around... (on depression and stress, too)

As they say.

Ebb and flow, yin and yang, yadda yadda. After my little meltdown Friday, things eventually lightened up. (If you've followed the blog at all, or know me, I'm sure you know this is nothing new... or maybe this isn't just me personally, but something that is a natural phenomenon of this thing called life. Maybe it's not unique to mothers, or women, or grad school, or th

ose of us who deal with depression. Maybe it is. Does it matter? Not really.)

Anyway. I posted a similar cry for help, bemoaning my situation on Facebook; basically, that the Warm One was at work, I was at the end of my rope with the girls and had no idea what happened to my patience, and the end of the weekend (the Warm One works a weekend program - Fri/Sat/Sun only, therefore leaving the girls and I to our own devices all weekend) seemed ages away. I was desperate.

And out of nowhere, a good friend came to my rescue. She invited the girls and I over, to visit, to play, to stay. It took us hours and hours to get moving and get packed, but eventually, we got there. She opened her home to us, the girls played (she has a daughter the same age as the Mini-est), and we were able to catch up. We spent Saturday together, just hanging out. Was I the most fun and exciting person to be around? No - but I hope I was a better mother and friend than I felt like I had been earlier that week. Little by little, I am crawling out of this miserable, stress-filled hole.

Before the girls and I left, I managed to pull myself up out of my funk enough to send a copy of my resume/cover letter to the physicians I work with as a labor/delivery nurse, simply to introduce the idea of adding a nurse-midwife to their practice (I've been hoping to have the 'right' moment to talk to some of them about this over the past year or so, but it just hasn't happened); I also emailed my nurse-manager to touch base. My fingers are crossed - even though my breath is far from held - that good things could grow from this tiny seed being planted.

The Warm One also came home last night and shared that another doctor, an incredibly sweet family physician working for a nearby tribal clinic, had asked where I was at with my job hunt; she mentioned that the tribal clinic had been trying to fill an open physician spot for the past year, and she was willing to bring up my name at the next physician's meeting to see what the interest there would be. Again, fingers crossed... I've worked at another nearby tribal health organization in the past, and love working with Native populations. The culture and history, combined with the deep relationships between families, make it a community I would be honored to be invited to work within. (I've requested information from the IHS about their loan repayment program, but have yet to complete the application process; it's on my radar as yet another thought...)

*And, if nothing else - this again cements to me the fact that I cannot - at least at this point in my life - function without antidepressants. I know that there are many different viewpoints on this and whether or not medication is something that is "right" or "necessary" but until I have one or two fewer things going on ... I can't let myself - and my family - go down this road. It never fails that when I manage to go without taking the pills for a short period of time - whether because I fail to get a refill in a timely manner, or because I miss one or two, and then tell myself I still feel "great!" - I find myself in a similar murky fog within a matter of days or a week. Someday, I will be able to truly dedicate the time to find other positive

lifestyle changes to experiment against this headgame, but as for now... I'm gonna take the easy way. I need to be able to accept sweet love notes from the Mini and appreciate them; I need to be able to have patience with my girls when they are being kids, instead of being over-anxious and stressed... I can't see the confusion and hurt in their eyes when they look to me for comfort, and don't get it; this parenting thing is hard. I feel like I hardly see the Mini's lately... and when I do, they're not my sweet little girls anymore! They don't listen... they're sassy... they fight. I don't know if it's a stage, or if it's related to not seeing me, or if it's how it's always been (and I'm just seeing things differently because I'm stressed), or if their actions are feeding off of me, or ...?!

Mama Needs a Time-Out

Seriously.

Whatever happened to TGIF?! So much for Friday, I guess... whatever optimism and good vibes I had going into the earlier part of this week somehow dissipated as the week rolled on. In the wee hours of Wednesday morning, while I was gearing up for the clinical week - I usually do clinicals with Dee Weds/Thurs/Fri - I woke up with a killer migraine. (I've had migraines since I was four or five ... nothing new there. They've probably been in the best control of my life for the past year or two, actually; I've found a daily preventative med that seems to help, and for the first time ever, I've found an abortive that seems to actually knock them down when they do kick in. Score. But - that being said - I do still get the occasional nasty f*@!er, but never, or rarely, has one ever woken me in the middle of the night before... so this one sucked!) I did my best to get through the day Wednesday with Dee, but even after taking my abortive, and all my usual knocker-outers, I had nothing and had to leave early ---- which I hated doing. After a few hours of solid rest and a combination of narcotic, another abortive, heat/ice, and some topical cream to my neck/shoulders/etc (which by the way was not a good idea - more on that later), I was somewhat coherent again.

Unfortunately, the arthritis cream that I picked up to rub onto my neck/shoulders/temple (similar to what I usually use, but a different brand... I can't even think of what I picked up that day) was awful. Whether it was the intended effect or not, it caused my skin to feel as though it was on fire - my palms, my shoulders, and my neck raged at me the entire afternoon, evening, and next day, even after scrubbing in an attempt to relieve the sensation. And, of course, smart cookie that I am, I slipped my contacts out (and then tried to replace them the next morning) with residue apparently still remaining. Good gracious golly. Not only was I living in the migraine hangover, I was also fairly certain I was close to blind...

Then, when I got out to my car --- I found it egged. What. The. ... Seriously. Of course, as usual, I didn't have any spare time (why would I?! Any of you who know me, know that I don't generally run with spare time...) to rinse the gook off, much less for a real car wash. Okay, so it was only one egg (or maybe two) on the driver's side door and window, but for the love of mud --- why?! I really, really was NOT in the mood and, as I'm sure you can imagine, would have had some not-so-pleasant things to say to whoever thought sharing their breakfast fare with my vehicle was a good idea.

The rest of the week has pretty much continued as such. Though I am sooooo close to the end of my necessary clinical hours - T-minus 66 and counting - I've hardly knocked any off this week, thanks to the lovely migraine and having to cut out of clinicals early yesterday (Thursday) as I was scheduled to work in Babyland.

So it's been a non-productive, miserable-feeling, blah kind of week. Oh, and that "other" position that I was excited about? I had a phone interview Wednesday evening, post-migraine... I thought it went all right, even though it didn't sound like my "dream" position by any means; while I didn't expect to get hired as they disclosed on the phone that they were doing a second interview for a previous applicant the next day, it still stung today when I received an email telling me that my "career goals didn't appear to be a fit" for the position, and thanking me anyway. Ouch. I guess it just is a downer, all around, even though I had more or less decided that I wasn't all that interested... *sigh*

To top it off, I'm finally home, getting to spend some time with my family --- and my lovely young ladies are not listening to me, I'm incredibly crabby and cranky with them, and I just don't have any patience for them, for myself, or for anything. I don't like how I feel, how I'm reacting to them, or anything at all. In desperation, after too much hollering after too much whining, I sent them to separate rooms for extended time-outs --- but really, deep down, I'm the one who needs the time-out.

Our Strength

I've been thinking about strength today. Mainly, because I am feeling wiped out - emotionally, physically, mentally, financially... you name it. And yet - a part of me truly believes that I just need to give in and accept that this is truly part of the process. I'm all right with this; it's just kind of, well, a drag.

Plus side: I started at my new site, officially, today. LOVE it. Everyone, so far, is amazing. Very welcoming. My new preceptor, "Dee", is introducing me to everyone (docs, nursing staff, random folks walking through the hallway...) as "the student midwife who we're trying to convince to stay here with us as a second midwife with our doctors & I". I so want to be that midwife, and am trying not to get my hopes up, but if there was a wishing well in front of me right now, and I had a penny to toss in, do you think you could guess what my wish would be?? (I won't tell, of course... but if you guessed, well, anyway...)

Not so plus side: I'm exhausted. I think I already alluded to that above. I started trying to type this post almost an hour ago, and keep getting distracted. Like, for example, I wanted a cute little pic to post with this (because honestly, doesn't a sweet picture make everything easier to read??) -- that took forever. Stupid picnik.com and it's stupidness. Also, we stayed overnight at this hunting cabin my grandparents have (I actually love it - it's very remote, quiet, and peaceful --- and a *tad* closer to my new clinical site as well --- but, there's always a but, right?) I got NO sleep. Like, very, very little sleep. A combination of woodtick paranoia (if you live anywhere that ticks are prevalent, you know what I'm talking about - nasty little creepy crawly vampire things - I had the heebie-jeebies ALL NIGHT LONG thinking they were stuck on me), not having the migraine-preventative med that I usually take at bedtime (which has a convenient side effect of zonking me out nicely), a less-than comfy air mattress, and first-day jitters (will my alarm go off? will I make it in on time? etc), all added up for a loooong night and weird dreams. I dreamt that I was living in a strange apartment building --- I think it was early 20th century, yet there was an odd open-air elevator to get up to the upper floors; very odd, in fact, in that you wrapped yourself around what was basically a fireman's pole and held on for dear life as you shot up it. If you let go ---- not good. I was doing okay until, all of a sudden, I was almost at the top and realized my arms were very tired, slippery, and I just didn't think I could hold on; plus, I realized I also had another "tier" to go (apparently, somehow, to get to my "level" I had to switch poles?! Very ... odd...). So that was one unsettling dream. Another involved the cottage we were at; we were apparently taking turns sleeping (in the dream) and someone - my older brother, I think, looked out the door all of a sudden and someone had jumped in one of our vehicles and taken off out of the blue. (There was much more to this dream, when I woke up --- at the time, it was very vivid and I meant to share it with the Warm One... but being that it was 0530, I decided to let him sleep, and know the details have faded. Anyway, it was another disturbingly vivid dream, I guess.)

I think, what this all boils down to, is that I need a good night's sleep. But,instead of going to bed at a reasonable hour (10 p.m. or so) as I had planned, it's almost midnight and I'm just deciding to call this blog post a night. It's nowhere near what I had planned to write (is there anything about nurse-midwifery, really?? Not much!!), but it's good enough. Suffice it to say - I feel stressed; I need to work more so that I can pay my bills, yet I need to get through clinicals so I can graduate. I also need to study more so I feel less anxiety about upcoming boards, comps, etc. I also need to work on family stuff - or maybe let it go; a close family member is dealing with heavy stuff (addiction) and I don't know how to help him. And yet.... I think it's all going to be okay....

(and, big cheers to my CKC'ers --- one just got married, one just passed comps, and one is on her way to CB!! Jaeger all around!!)

Unfinished Business

"A peacefulness follows any decision, even the wrong one." ~Rita Mae Brown

~*~*~*~*~*~*~*~

As the days roll on and my birth experiences seem further distant, I realize there are quite a few loose ends that I need to wrap up. I have yet to hear from the 'new' midwife... I wonder, sometimes, if things will fall into place when I take care of the leftover details from my last rotation.

So, on my to-do list today, I plan to pen thank you notes for both the Midwife and her wonderful nurse; I'm going to run these to the clinic and drop them off, as well as small gifts of appreciation for both of them. (I hope this doesn't come off as suck-upish --- does it? Oh, well... it just seems to be the polite thing to do... maybe I'll pick up cookies for the rest of the MA's, etc, too.) I still regret that I never said goodbye to the Midwife's MA, but needless to say, as I walked by her on my way out of the office on that last day - it wasn't the time... she was in conversation with a few other nurses, and I was red-eyed and a mess.

I also have another small package to send off, but that one will have to wait until I find the address I need; this one, too, goes to someone who I feel badly that I didn't follow up with, and who I thought really was wonderful.

Finally, I need to decide if I'm going to give up on the 'new' midwife and desperately hunt for another site. After six weeks of no-baby, no-mama --- I just don't know. I don't like this feeling at all. I feel unemployed, lazy, useless, rejected. The old feelings of paranoia are starting to creep in. Is the 'new' midwife trying to tell me something? Maybe she changed her mind about working with me... but is trying to drop hints by ignoring me long enough that I just go away...

*sob*

(right before I posted, my advisor/faculty "RCC" called me back and we came up with a plan --- I emailed another potential midwife, and she is going to try to call the 'new' midwife to touch base... *sigh*. stay tuned...)

Drinking, Resting, and Breathing.

That's all I'm going to do for a while, on the advice of someone I consider to be a friend and a kind of spiritual advisor (she's a pastor, but for some reason, that title seems awkward to me...?). Anyway, her wise words: "Drink lots of water, get lots of rest, and just breathe."

It seems like a good strategy, and the kind words - said at the perfect time, by someone whom I have only had a handful of actual face-to-face conversations with - touched me. Like all of the supportive comments to my blog posts, all of the "likes" and thoughts (both heartfelt and sassy) on my Facebook statuses, all of the texts, emails, and walls posts from friends reaching out to me - it was enough to bring tears to my eyes and warm fuzzies through the rest of me. I'm not someone who has ever had a lot of close friends; usually, I have one or two very close friends that I confide everything to, and then a handful of acquaintances. To have so many people that I feel like are there for me, is an overwhelmingly touching feeling.

Today was officially my last day with the Midwife. As expected, it was bittersweet; now that I am home, starting to unwind and draw closer to my bed, I am becoming more at ease and even relieved. It was time. The Midwife and I finally had a good - not great, but at least a better - talk as I was saying goodbye. We did not, by far, clear up many of our miscommunications - but I think maybe, just maybe, things were at least left on a fair note.

As a student nurse-midwife, I feel like it was a good time to leave this site. The last birth that I attended was beautiful; the couple was strong, dedicated, and so in tune to the birth process and their baby, through the many curve-balls that labor and birth through their way. They were "my" type of client: they chose the Midwife because they wanted a Midwife-attended, natural, low-intervention birth. It was a joy to be with them as they became a family of three and welcomed their sweet daughter into the world, exhausted yet exhilarated. They gifted me with another blessing as I said goodbye, with kind words towards me as a SNM as well as words from another past client.

I wish the Midwife the best; I know that she is dealing with stresses in her life, and I hope that peace and calm descends to her.

For me - it's going to be a lot of just drinking, resting, and breathing.

And ... the Paper.

So This Is It... (Or, "The Medwife")

This is my last week with the Midwife. This is bittersweet; of course, there is some relief - the last few weeks have been incredibly stressful and long. But, I will also miss the many beautiful clients I have grown relationships with, as well as several of the nurses and other staff members I have met along the way.

In the end, there is no way around it. The Midwife and I are just too different. You could say she's more XBOX and I'm more Atari... In some ways, I hope that some day I gain some of the Midwife's qualities - she is prompt, she can answer any patient questions without a stumble, and she is assertive. On the other hand, I need to be true to myself and the true heart of midwifery. I will never be an "aggressive" person, nor an aggressive midwife; I will continue to look tired for a few years yet, at least through I adjust to this midwifery gig and my kids catch on to letting me sleep at night (seriously, Mini's --- you're 2.5 and 4.5... get it?!). I will never be someone who appears at events, and the office, an hour before I need to be there. I try to do too much with my time, end up misjudging the clock and how fast I can get to point A from point B, and wind up running a few minutes behind. These are things I have accepted and will continue to work on - but can't change overnight.

The Midwife is, in essence, a "Medwife". She practices with a group of OB-GYN's, she has never practiced outside of a high-risk setting, and she views birth as an occurrence that is one step away from disaster. While I recognize and respect that even in the most normal, low-key labor and birth, something can always go wrong; (I think) I have a healthy dose of the "what if's", especially for those labors that are going smoothly... I am afraid to be lulled. I don't think either perspective is right or wrong, just different.

Will I offer elective induction to my patients at 39 weeks? Probably not. Do I see where the Midwife is coming from, when she gives that option to her patients? Sure. Does it work for her, and for the majority of her patients? Yes, it seems to. Do I agree with her statements after some of these births, that "It's a good thing we induced now rather than waiting because..."? Not always, but that's not my place to argue. If mom and baby are happy and healthy, and were given the choice to make the decision - with full informed consent - I can't, as a student, jump in and point out potential flaws to that logic. As a "green" CNM, fresh-eyed and optimistic - with my views on birth and outcomes unblemished by malpractice insurance, peer reviews, and "bad" babies (or a history in high-risk OB), I still lean more towards the hopes that by giving good care, thorough information and honest explanation of risks and benefits - rather than practicing "defensive medwifery" - the relationships I cultivate with my clients will be close and trusting. (Do I think some of these perspectives will change - probably within the very first year or even months that I am practicing? You bet. The Midwife does what she does, for a reason. But... maybe not. Another good reason that another site, a different site, seeing a different population - might be helpful.)

Because with labor and birth, honestly --- who knows? The most wonderful looking baby on the EFM can come out floppy and blue, needing a full resuscitation, while the baby who looked miserable for the longest time, with a short and scrawny cord comes out wailing and pink. The 9-pound chunker of a primip delivers easily, without a scratch - while the G2P1's barely-seven-pounder gets hung up on the shoulders (unlike the larger older sibling a few years before). A common disclaimer in obstetrics: "We just don't know": a simple way to explain that so often babies are doing their own things, and our bodies - which are made to carry and nurture those babies - will instinctively protect those babies... but also a smooth segueway into a conversation encouraging (with different levels of "encouragement") various interventions that may or may not be truly necessary.

The mystery, and beauty, of birth is that every baby writes his or her own story; as midwives (and nurses, and doctors, and doulas, and mamas and daddies), we are just along for the ride, wild as it may be.

OK...

... now I'm just getting pissed.

When my 2 yr old is looking at me, telling me "I don't want you to be sad!" and running out of the room because she's upset that I'm upset... and I'm sitting here (again) blubbering like an idiot, with no one to talk to... I just get mad.

The Midwife just emailed me back. I fully accept that part of this whole thing is my issue; I am not a perfect person, and certainly not a perfect student. But. But. I feel like I have been trying very, very hard to reach out and figure out what she wants from me, to make this clinical experience work. When we were early in the experience, "daily evals" were necessary; I begged her for constructive criticism, and rarely got anything from her that I could work on besides "you're learning, you're doing fine." She told me often that if I needed to change my schedule because of work or family obligations, it was "fine", just to let her know - which I did, if it happened.

I don't know when any of this changed.

The Midwife has "worked with many students in the past and something just does not feel right". Ouch. Does it matter that I have worked with many, many instructors and preceptors in the past? I have never been told that I was "not right" before... no one has ever "fired" me as a student or preceptee.

First impressions are important... the Midwife, in her reply, seems to be saying that something has been "off" all along, and its noticeable not just to her, but the entire staff. She doesn't feel she's unapproachable or distant... so it must be me.

Well, doesn't this all suck.

My own dystocia...

Dys *to * cia : noun

DYSTOCIA: slow or difficult labor or delivery. (From Greek dystokia)

I'm stuck. Like a wayward fetus or a uterus that doesn't quite have it going on yet --- something just ain't right. At times, I feel like I get in my groove and things start moving along; my rhythm is a-rockin'. And then... something happens to knock me right back down.

This makes me wonder, right from the start, how far back I'm going to have to go to "fix" things. Midwifery is supposed to - and I love this - "high touch, low tech". Me, on the other hand... I'm more of a "high tech, low touch" kind of girl... I've never been a hugger, and I'd much rather text or email than talk directly to someone. (Is it just me, or is it a generational thing?) With all of this stuff--- I can't think of a better term for it --- going on with the Midwife in the past couple of weeks, so many friends have been in touch, saying "Call me", "give me a call", "let's talk!", etc, etc... And it sounds sooo good, and promising... but I can't. I just can't. Instead, I send out a pathetic little email or text, promising to call later, or assuring them that everything is "better" now, or that it's figured out...

(If you are one of those who's been in touch --- I love you, you're awesome... please, please don't take it personally. It's definitely one of my flaws, and - like so many other things I have going on - I don't know how to fix it. Keep reading for more on this...)

The Midwife is picking up on this, at least somewhat. "I don't know how to communicate with you." She says. "I don't know if you're coming or going; you have to tell me." My RCC may have noticed; we have only talked on the phone once or twice, very, very briefly. As much as that one phone call reassured me (she called me after catching on from one of my self-evals that I needed to talk) - I still can't bring myself to call her. I know that I need to be the one reaching out, and yet... I can't. It's difficult to explain.

I know that it is holding up my labor, though; after all I have gone through this far, it is stalling my progress.

This week was, again, tumultuous. The Midwife and I just are not in sync. I can't figure out what she wants from me; we are both getting frustrated. I am trying, so hard, to be there early and to try to do what she expects from me, before she asks or prompts me - but instead, I do the "wrong" thing. My self-confidence is crumbling, and my exhaustion and sense of being overwhelmed is growing by the day. As with Murphy's (or is it Murray's?) Law, the three births that we had this week were all "abnormal" - a shoulder dystocia, a cord that abruptly broke from the placenta (which subsequently required a manual removal), and a postpartum hemorrhage following an OP babe. How much of these outcomes had to do with my management (Too much traction on the cord? Did I let the placenta sit a moment too long at the introitus, letting clots build in the lower segment?), and how much was sheer dumb coincidence, is of course impossible to say. (I know the traction was, if anything, light... and the placenta was *just* at the introitus... but I also believe in the whole positive/negative vibes kind of stuff --- and I have not been riding a positive wave lately, believe me!).

So this is where we are at. As we were leaving yesterday - literally, over the course of about five minutes - the Midwife just barely started to talk to me. She asked if I had any questions, and then said she would "email me" again; then started to sigh a bit. It was good, to the point that at least we had some honest, face-to-face communication. It was not so good, of course, for the reasons above; face-to-face communication is not my strong suit. Between the exhaustion, the migraine that was kicking in, and just everything finally catching up - I started tearing up and was soon blubbering like an idiot --- very embarrassing but, on the other hand, I think a very honest reaction. It, unfortunately, made it hard to communicate any of my thoughts/concerns back to the Midwife, and ultimately made it a very one-sided (short) discussion.

Her concerns (think of them as a bit of Pitocin, if you will - hopefully, they will stimulate me to get moving and back on track): I need to keep her updated with what I'm doing, and I need to be more prompt. (I know these things... somehow, the one-hour commute has gotten worse and worse; staying somewhere during the week and only doing clinicals - and then driving home for the weekend - is starting to sound much, much better... As I described in a response email to the Midwife, my children are like sweet little eels, and they hang on me literally as I'm walking out the door most mornings.) I don't seem interested, and I just seem tired. (I don't even know where to go with this. I am exhausted, and I'm overwhelmed. This ain't gonna change, any time soon...) I'm going backwards. (Again, I feel like I'm going backwards in some areas...?!?!)

So, here we are. I've emailed her back; I need to be in touch with my RCC, but at this moment in time, I just can't bring myself to do it. The Mini-est and I are just vegging for now (I'm thinking a late lunch - delivery?), and that's how I want to keep it for a few hours anyway. I've se

nt out a couple "feelers" to try to find another clinical site for another perspective. I've also sent out a couple of resumes for CNM openings around the state - although I'm not especially hopeful about them (my being "ready" by June came up in the brief conversation the Midwife & I had as well...), it did give me something to do - and managed to shower and get myself and the Mini dressed.

I'll keep you posted. One way or the other, things do keep moving forward... I don't think there's an option of a cesarean in this situation (although, maybe being "taken out" of this site and heading to

a different one could being symbolically viewed that way.... I'm not even going to go there...) If you are the kind of person that does anything like this, I could use some kind of confidence/stress-busting/calming vibes... I know that this is the kind of thing that I make ten times worse myself, and I need to knock that crap off and get back on track.

Speaking of, I need to bring the Bears back out... http://onedeliciousdelivery.blogspot.com/2011/

01/im-scared-to-death.html

Self-doubt

Today, as I was driving home from clinicals, I cried on and off. It sucked. This is the email that I was composing in my head, trying to sound appreciative, and not needy but ---- what's the word?? (Not desperate, but close...)

"thanks for your patience this week (and in general), this week in particular just was not impressive and i'm not sure why. the areas that i'm not 'getting' are frustrating to me - as an OB nurse not to mention as a SNM - and it is getting to that point that i feel like i'm losing ground. i know i need more confidence and to be more assertive, etc - but am not sure how to get there from here, if that makes sense. not being able to palpate fetal body parts/find FHT's, determine what a cervical exam is/isn't, how to tell if the anterior shoulder has delivered or not (is that just feel or is there another obvious sign -- does the anterior shoulder become slightly visible before you switch to the posterior?), etc.

i know that these are women and families that you have been working with for a long time and i appreciate that you are giving me the opportunity to learn with them; i also recognize that your reputation and license are ultimately on the line as well and i am grateful to you for that reason and for the advice/criticism/info that you share, because i need whatever i can get to keep going forward.

also, just as an FYI - i know we talked a little about it when A was here - i have been trying to work out another site to get another perspective for at least part of my remaining hours... if/when that happens, i will let you know (i don't know if it would be just for a month or so, or longer/shorter term, etc... do you have an opinion on that?)

thanks again, have a great weekend... ~m"

(Maybe I'll jump in here and say that all of this may be exaggerated by the fact that (a) I'm probably a bit hormonal... I think AF is going to rear her lovely head *any* day now... and/or (b) I've been outta my little happy pills for days and days - so hopefully for us all, the Warm One has picked some up for me and life can cheer up soon...)

Anyway. Back to the post.

And I've been tearing up randomly ever since getting home. I've blogged before about self-doubt and having low self-confidence, I think. I don't think this is a great thing, but may not be that uncommon, either, for a student going into this sort of field... in fact, part of me thinks that being less-than-100% confident may be a good thing. (Isn't some bit of humility, some sort of willingness to admit that one might not know everything, probably good for everyone?) Anyway, I keep getting off-track here.

Earlier this week, I had a rough night with The Midwife. (My own fault) We had an induction, and another labor patient had come in as well; at around 12:30 a.m. the Midwife called me to let me know that the induction was going to be AROM'ed due to some concerns with the baby's heart rate (rather than "slept" and induced in the morning, as was the original plan...). I unfortunately was out like a light when the Midwife called and talked a lot of mumbo-jumbo, making little to no sense about needing a floor to sleep in if I came in and some sort of lighthouse or something --- totally looneyness, until my brain caught up with my mouth. Eventually, I made it in --- I live about an hour from the hospital --- checked in on both moms and caught up on their labors, and then laid down. Suddenly, it was four hours later when the nurses called to let me know that Mom A was about to deliver. Fast forward a bit, Mom A delivers, all ends up well, blah blah blah.... but it just wasn't my best delivery. At all. Mom A froze during pushing, head delivered, and I froze as well; baby was of course delivered and did wonderfully, but Mom A did get a tear and needed stitches, and the question comes up as to how much of her tear might have been avoided. Mom B delivers later, all is well... yadda yadda...

But, the crux of that night/morning was the Midwife's comment (at the nurse's station) that I need "a lot" of work in L&D. That stung... "a lot". Like many things, of course, that sting, it was important and necessary to hear. I do need a lot of work in L&D.

Of course, now, as the week has progressed, those words have been eating at me more and more. I've been walking on eggshells, slightly anxious about doing or saying the wrong thing... and a teensy bit scared to death about going back to L&D with the Midwife. (The irony is that what I was afraid of happened at work - away from clinicals - and went perfectly, without a hitch, in the meantime...) Not so, though, at clinicals... Our next go-round with L&D was tense again; my cervical checks seemed to be off (I don't get how I'm feeling a rim of cervix all around, and the Midwife can only feel an anterior lip when she checks right after me... I swear I have been checking cervices for years. I can, I can!) The delivery - same thing. Head delivers - mom tenses, fights pushing; I have a hard time "catching" when the anterior shoulder delivers... has it? Hasn't it? Time to go for the posterior shoulder now, or keep with the down and out pressure? I can tell the Midwife is not happy with my indecision (easily) but I JUST DON'T KNOW.

Again, baby delivers, all is well in the end... but the vibe, again, is not so hot. I want to talk with the Midwife before leaving, but it's 5 p.m., Friday, my babysitters at home wanted to leave by 5 (and I still have an hour drive...), and the Midwife is at the desk yet. I change, stop to say something on my way out, and she mentions that she will email me with "a few things"...

Can my preceptor dump me via email?!

Hurts

"Never ruin an apology with an excuse." ~Kimberly Johnson

~ * ~ * ~ * ~ * ~

My heart hurts. My brain hurts. My ego hurts. My body hurts. My checkbook hurts. From my eyeballs down to my left big toe (specifically) I hurt. This nurse-midwifery thing is trying - but I have so much faith that it will b

e worth it.

Where to start?! I'll try going from the top and go down... on a light note (looking back now), I had the embarrassment of walking in on the husband of one of my mama's as he was, um, using the bathroom facilities. I had peeked in her bathroom to see if there were pads and lovely mesh undies set out for her, and - seeing that there were none - headed to her closet to grab some. This apparently took a few minutes longer than I expected, because in the very brief time that I thought it took me to turn around and head back to the bathroom... he snuck in. Surprise!!

(Well, that's what she gets for coming in at 4:00 a.m... right? These people should know I'm no good before 10 a.m.!! Ha, let's see how far that excuse ever gets me!)

So, that was the first bruising of my ego in recent memory. I'm sure there has been others, and there will be many more. Patients who do not like me, or prefer not to have a student working with them; personality conflicts, and, of course, staff/physician/etc conflicts.

Moving on. My checkbook. Oh. My. Heavens. I'm not going to go into details here, since I think my very last post spent a little time talking about this --- but it's not pretty. Thoughts of LAC ("life after clinicals") are really becoming time-consuming, including some pretty in-depth fantasies of where I can find or create a CNM position in the local area. More on that topic soon, I think.

My brain. Oh, yes, the brain... or what's left of it. There are days when it is just a-reelin', if you will. Between the ego-beating and financial stressing just mentioned, and then the mind-trips about future career possibilities, I feel like I'm stretching myself pretty thin when it comes time to actually focus on life and clinical critical thinking. While I know I need to push all of that nonsense to the side and get down to business - that knowledge certainly fits in the "easier said than done" category. Distraction has always been a strong suit of mine, and continues to be so...

Where was I??? Oooh, how about my body next? It is sore as heck, many days. I'm loving what I'm doing, don't get me wrong. L-O-V-E. But, as they say (I think I'm hitting every cliche in the book here) --- love hurts. In this case, it's some of the twisting and maneuvering that I do - usually during births - that gives me some aches and pains. Nothing that I think is going to cause any lingering damage (it's already much better than the first few weeks of clinical, and usually is just a little bit of muscle pain for a bit after a looooong second stage); enough to mention in this somewhat-related post, but not worth changing the way I deliver. (The Midwife doesn't break down the bed; she drapes the foot of the bed, and takes her place sitting on the side of it... this is how I catch, as well, and don't think I would have it any other way... sore back be damned). But, there is al

so my bum toe - my left great toe, to be exact. I broke the S.O.B. four years or so ago tripping on my grandparent's step in my trusty flip-flops, and it's given me a fair amount of grief ever since. I'm still looking for the "right" pair of shoes for clinical/L&D; so far, everything I've been wearing (and maybe it's partially due to the nasty, cold winter weather we've been having --- and the fact that I'm getting to be one of those old fogies that blames the weather for everything) seems to aggravate this darn toe. But, cute shoes are worth the pain, right?

And here we are, at the heart of this post. Pain. My pain, really, is not an issue. I can deal with that. I like to think that I can handle pain, as much as I need to. When "my" mama's are in pain, I help them through it as best as I am able and as best to the plan that they had wanted to follow - whether than means using medications, a shower, or screaming obscenities at passersby. (Well, maybe less-violent forms of vocalization are encouraged, depending on the situation... anyway...)

What kills me, though, is pain that I can't "fix". A mama who has desperately lost sight of what's going on, or feels as though her birth experience is being taken away from her. A baby, who may have suffered an injury during a birth. I have felt these types of aching moments as a nurse, and am beginning to see them now as a student nurse-midwife; fellow students are also sharing their experiences in the same way. A rapid second stage; quick birth of a head with massive cheeks - and then apparent progression of the shoulders. Mama's legs repositioned to open the pelvis further, strong encouragment to PUSH! along with gentle traction as the anterior shoulder finally delivers... and a soft but clear pop is heard/felt. The rest of the baby delivers easily, stunned for a moment, then recovers beautifully and transitions to life on mama's chest.

As a student, this kind of scenario fills me with so many questions and so much guilt (just as a laceration has in the past) - Did I cause this? Could I have prevented it? How could this baby - not "big" by any means, and delivered over an intact perineum - be an innocent victim of trauma?

The sinking pit in my stomach, of course, is only stirred up a bit further by the babe, consistently irritable and refusing to eat; moving both arms but certainly favoring one. Though the Midwife - whose hands guided mine, whose hands guided the baby's head into this world - is reassuring that the injury was not "mine" (but rather a part of the delivery) and the prognosis of a fractured clavicle is excellent... my heart aches at the pain that little soul (and the mother) will bear. However this happened, there are no excuses and no reasons why. Little one... I'm sorry.

Withdrawal

Six days. That's how long it's been since I've had one. To some of you, it might not seem like that long, but god, it sucks! I almost, almost had one yesterday - but I didn't.

I don't know if it's good or bad that I kept my hands off it yesterday. It was SO close - but I held myself back.

I'm dreaming of them; driving to work and clinical, I fantasize about how to get one. How to excuse myself out of the office, for that very reason... In the office, I do anything I can (within reason, of course!) to "help" make it more likely...

(Is this bad?)

All right, all right... the good news is, if nothing else - we have two inductions scheduled Friday morning so I WILL get my hands on one of those long-sought guilty pleasures then. If the multip - who has been so desperately waiting for labor for the past three weeks, and whose membranes I "stripped" a few days ago, hoping it might nudge labor on - hasn't naturally kicked in by then, I think hers will be the first lustily-crying babe I'll get my hands on. I think he'll (we don't know if it's a boy or girl, but I'm banking on boy parts) be a pretty good size kiddo, but she'll do well: her heart will fill with a new love for her child that she allows my hands to catch - such an awesome feeling!

Otherwise, besides the dreams and intense desire to catch one --- no jitters or other symptoms, so I guess my withdrawal isn't as severe as it initially seems. But - just in case... send some baby-vibes this way, please!

~*~*~*~*~*~

The Cost of CNEP Clinicals

So, I finally decided to pop out a calculator and figure out just how much in lost wages this whole clinical thing is costing me. Between clinging, sad kiddos and a dwindling checkbook, I finally admitted to myself that I was having some pretty severe withdrawal from my life as well as the slippery babes. I was shocked, though, to realize just how much we've 'lost' since I cut waaaay back on working to try to plow through clinicals... see below (I won't tell you exactly how much I make, I'm just going to toss out $25/hr as an "average" rate for a newer RN working in a hospital setting in a low cost-of-living area... sound fair?) . So - CNEP program length is 675 hours total...

675 x $25 = $16,875

Holy Bejesus Batman! I knew it would be a lot... but I wasn't expecting that much (I really, really suck at math). Yikes!

And, of course, this nice chunk of change doesn't include mileage/gas costs - I am commuting right around an hour each way to my clinical site, usually 4 days a week, so averaging probably $80-90/wk in gas - or tuition/schooling costs (I want to say this is about $2800 each term, or around $8400 total, give or take, for the three terms of clinical that I will have). Last - and definitely not least - there is the time away from my family and "life"... there is no way to put a price on this, but hopefully, will be a small sacrifice that will be forgiven once time passes.