April 26, 2015

I have never resigned from a job before.  My jobs all had natural endings. Two years here, three years there, some one-year gigs like DRC. So this is new territory for me. When we moved here in 1992 it was not because we had jobs.  It was supposed to be my year off.  I’d never had a year off, even when my children were born.  That was always a little sticking point in the marriage, not that I minded being the bread-winner until his career was solidified, but I’d worked since my fourth grade paper route, and really wanted a whole year off.  I just wanted to be a full time mom.  Sleep all night. Be there in the morning and evening.  Stop being a tired cranky bitch.

We had enough money to live for awhile while he found a job.  We lived in a tent and built the little cabin together.  The kids helped by handing me shingles, cleaning up debris, and collecting dropped nails. It was a great experience, at least in my memory; there may be some psychological trauma for the kids they’ve left off the list.  We’d read all the Little House on the Prairie books and this was an adventure they could relate to.

The Women’s Center was an idea back then that was burgeoning into reality.  The job fell in my lap.  I had planned to start my own practice in a little house that I’d rent or buy, but this was already the plan for the center. It was a fantasy come true, except that I wouldn’t be the boss. For many years that made it quite a bit easier.  I never got the year off because who could really pass that up? It was a sweet little shingled house next to the hospital. The five of us who started the place all had the same commitment  to women and success of the place. The conflicts that arose with insurers or administration were handled together as a team and we were quickly more successful than anyone predicted we would be.

We outgrew the building after the first few years, but we compensated. We staggered our hours so we weren’t all working at the same time, we gave up our meeting room to accommodate charts and office staff, we begged for small improvements like windows that didn’t let in frigid air in the winter and stayed open in the summer. (We had sticks holding open the windows when the weights broke.)  We had fundraisers that brought in paltry amounts to offer some education sessions we thought were needed. We worked really, really hard, much of it on our own time. We believed in that place. The feedback we’d get from grateful women made up for the meager compensation.

The administration was a balance of male/female energy for a long time.  That started shifting and as it tilted more toward the male side, the Women’s Center had to argue harder and harder for a safer environment (needed repairs to the building never got done; OSHA would have closed it years before), equal benefits, and a fair allocation of resources. After threatening a gender discrimination suit, we finally got a new building. We were willing to take anything that would give us 1. a furnace that worked, and 2. enough space to work together on the same days.  Our requests were not outrageous.

It’s been a busy week.  Having been away for two weeks, and having a partner who had a family emergency and was away for all that and more, there was a lot to do.  Several babies also chose this week to make their appearance in the world. It feels good to do what we are good at. Our new center has so much potential. Our labor and delivery unit is the most perfect hybrid of birth center and hospital.  Yet, the future is uncertain. Obstetrics is an expensive service to offer, and despite the fact that is the one service that will be eternally necessary, there is always talk of closure.  People are starting to ask what is going to happen when I leave. I have to tell them I don’t know yet. The powers-that-be haven’t shared a plan with me.  It seems to be a secret. I’ve got a good plan, but no one has asked for it.

I had to google “How to resign from a job.” (So weird to use “google” as a verb.) I have had so many moments in the past few years when I wanted to quit because of how we’ve been treated. But, I didn’t, and wanted to do this in the most professional way that would ensure a smooth transition. I do now regret that I didn’t stay in independent practice. That I gave up the control for a regular paycheck and health insurance.  I didn’t want the burden of the business side of it. And with giving up that control I might have to watch all I’ve worked for and strived to maintain, go swirling down the drain.

I wonder what will happen to our feudal medical system. It feels one card away from collapse some days.

April 19, 2015

We arrived in plenty of time, which, is unusual for us. The deliberate attempt to reduce travel anxiety and road rage that seems to exist in that valley of the laid-back, paid off. We’d even have time for coffee before I went my way and she went hers.  So when the message board said the train was late, a tinge of the avoided stress crept back into the soft morning air. I love trains. I actually love any mode of transportation whisking me away to adventure, but there is something romantic about trains.

The station reminded me of a bygone era. I blocked out the surrounding buildings that didn’t suit my retro fantasy. The electronic message board was a bit of an intrusion but the platform had seen some corsets on it’s benches. The red digital lettering was so this century, and I wished there was an officially be-capped suited man walking through explaining the delay; someone with authority who spoke with reassurance that we’d arrive in plenty of time. Instead I turned to a fellow passenger who arrived by bike and looked for reassurance there.

My heart-on-sleeve characteristic hasn’t changed since birth and the longer the train was delayed the more my anxiety about arrival time was evident. I asked if he took the train often? Does it ever cancel completely? What would happen if it didn’t come? I eyed the area for a rental car place.  Suddenly the reality of olden-day inconveniences seemed a little less romantic.

Our conversation distracted me, but as the delay grew longer, he formulated a plan which involved way more effort on his part than was necessary for his day but would save mine. A very kind stranger. As I thought about this offer of kindness and how it would change our existence if practiced by everyone, the train arrived. It’s silver doors opened and as he loaded his bike he turned and said, “Save me a seat.”

Our hour-long relationship was very important to me and I figured it’s duration would only be the length of the journey. He was already late for his meeting.  I’d be there in plenty of time for mine. He didn’t complain or fidget or harp on his tardiness.  He was so zen. I barely noticed the two hours passing.

Delay due to mechanical problems. How different would that have been if the train were on time? Would we even have spoken? I had planned to review my slides during the two-hour ride.  I was going to weed out a few and tighten up the presentation. I thought I’d look like one of those professional commuters who are looking intently at their laptop, apparently doing something very important.  I thought I’d be one of them without the black pumps. But the conversation set in and I never took the laptop out. I didn’t even think of it until I started my presentation a few hours later, then looked up and saw him enter the room and sit in the back.

I’m so glad that train was late.

April 12, 2015

I look out this window at a small, charming chimney, wide at the bottom, tapered at the top, the brick lines curvy, as if a child built it. The house is small and tucked into the earth and I can’t take my eyes away from it. I imagine elves or hobbits living there. The morning air is cool and clear.  Hummingbirds flit in and out among the bougainvillea, then pause for refreshment at the feeder outside the kitchen window.

It’s a residential neighborhood in Oakland. It’s quiet, eerily so, I think, and I don’t see people outside these cute little houses. I wonder who lives in them, what the inside of that fireplace looks like, what they do for a living, what they have for supper, how long they’ve lived here.

I’m making some major life changes and am looking for where I belong.

After pushing my stances uphill for too many years, I am leaving my job.  It’s a biggie. I’ve thought long and hard about it. I’ve considered how much of my persona is caught up in my role as small-town midwife, how much I love the women I care for, how I have no other home, and I am very clear I am making the right decision.

I’m tired. I’m tired of having to be available all the time. I’m tired of having to beg administrators to provide care for the women who need it. I’m tired of having my life revolve around other doctors’ families. I’m tired of missing out on my own family’s events. I’m tired of having to fund-raise for essentials and educational offerings. I’m tired of having to apologize to women for how expensive our services are. I’m tired of watching our resources utilized in a way I don’t support. I’m tired of having people with no leadership skills facilitate meetings that go nowhere.

The average time-span before burnout for midwives is seven years.  I made it thirty.

Our medical system is ridiculous. We have more administrators than patients. We are required to sit through meeting after meeting where nothing gets decided and more meetings are spawned. We are trying to run a humanitarian service with a corporate model and we are failing miserably. Greed prevails. Women suffer.

With the midwifery profession there is the difficulty of the job itself.  There is much joy and satisfaction in this calling, but it is physically difficult to be up at all hours, contorted in ways that hurt our backs and knees for hours on end.  My friend told me recently that she knew the day she had to retire was when she had to have a nurse help her up off the floor after doing a delivery on a birthing stool.  She said, “I did this beautiful delivery, delivered the placenta, got her all set, then couldn’t stand up!”  Ok, so there’s that. Then, we have to continually fight to be able to practice despite all the data and evidence showing we give safe, quality care.  Our outcomes are better than physicians’ outcomes, even in high risk populations (they always throw that defense in there), the cost of the care we deliver is lower, women have higher satisfaction rates, breastfeeding rates are higher, it goes on and on. Even with all this, we are continually fighting for fair compensation and working conditions. And though we have come a long, long way, it just seems like same shit, different century. We no longer get burned at the stake for witchcraft, we just get burned out from the witch hunt.

So after five years of begging for another midwife to practice with, I’ve decided to stop enabling, whining, complaining, and being resentful and put my considerable energy elsewhere.  Now to decide where elsewhere will be.

I’m on a twelve day book tour. I am so blown away by the response I get from the story of Shamwana.  The audiences are people in all walks of life, from cardiac surgeons to elementary school students. I tell this story and watch the faces of the listeners and am very clear that this is part of what I am supposed to be doing. I don’t want to over-think it, but Beatrice and Gerardine are a catalyst. The medical students I spoke to this week were riveted. They wanted to know how to shape their careers to make a difference. I told them that our system works hard to discourage them. They may graduate with tons of debt and make career decisions based on that debt.  I told them to keep these women in their minds when making those decisions. Work to change things.

The ripples are small right now, but I feel the circle widening.

April 5, 2015

It’s been a year since that terrible Friday when Jane got the call that Hannah was dead. I’ve been anxious about the anniversary.  I mentioned that to her.  I told her if I was anxious how on earth must she feel?  She told me she can’t miss her more than she already does.  Another day doesn’t mean anything.

But anniversaries affect me. I don’t know if they affect me more than other people, but I am sensitive to them. Even ones I’m not conscious of. The gold walls of my kitchen have Hannah in them.  I was painting when it happened. For a long time I couldn’t finish it. I thought maybe I’d change the color. But eventually Jane came by and said to keep it.  She liked it. So I did.

So how to honor her? A planted tree? A card? A word or thought?

It falls on Easter this year. We made the cakes. We went to church and had our meal. The guests are gone. The dishes done. The lamb bone simmering.  I’m packing for a trip of book talks. I worry about what to bring, the weather in California, the weight of the bag, the traffic.

Why did I not know that no one likes the lemon cake? Why do I make it year after year?

I told Jane I believe that Hannah is at peace. She looked at me and said, “Do you? Good.  I like to hear that.”