Live Everything

The crisp fall air bit my face as I made my way to my car this morning at the end of a very full call shift. As I drove down the hill from the hospital towards home, the morning sunlight danced with red and gold leaves and I burst into grateful tears. I got to meet five tiny (or not so tiny!) new humans in the past 24 hours. I had the honor of standing with people at the edge of a series of moments that would change their lives forever, and of safely guarding their baby’s passage into the world. The way the light mingled with the leaves took my breath away, and with the full harvest moon sitting on the horizon as a round, silent witness, I felt myself fall in love with my life again.

This year has been one of major transitions for me, and words have been hard to come by. I keep reflecting on what this blog means to me now, nearly six and a half years after I started writing it. I am no longer the eager young prospective midwife who moved alone to a big city on a grand adventure.

I live here now, both in the city I call home, as well as in the career I have chosen and the calling that has chosen me. I am an experienced midwife. I’ve caught hundreds of babies, spent untold thousands of hours in clinic and at the bedside in labor, screened countless cervixes for cancer, helped thousands of families with breastfeeding, and supported lot (LOTS!) of people in whatever their sexual and reproductive health needs might be. I teach students now, take baby midwives by the hand and guide them as they catch their first babies and insert their first IUDs.

For most of my twenties, I had this burning goal at the forefront of my mind: become a midwife. All of my effort moved me in that direction. It worked. I did it. Then I got my first job, and then my second. I’ve settled into my role. I feel comfortable and confident in my work more often than not, which takes much of the first few years of being in practice to cultivate. (Hang in there, new grads. You will not always look over your shoulder wondering where your preceptor is!)

Now I’m finding myself in a liminal place where I don’t exactly know what’s next. My work is internal: cultivate a life (and a home, and a body, and a community) I am in love with, a world I can stay alive in. It means finding my voice in new ways, and claiming my wholeness when much exists that tries to deny me that. It means taking my word for the year, belonging, and following it wherever it has taken me.

I will admit, it is disorienting not having a major life goal to move towards. Being in-between is a rich, fertile space, not unlike how it feels to sit in my garden at night and feel the plants growing by the light of the moon. Sometimes I find myself longing for certainty and an ease in being defined and definable. But who I am called to be in the world is bigger than any boxes could readily contain. Often I distract myself to avoid the discomfort of not having answers. But then sometimes, like this morning, slivers of magic will break through the noise and offer me a split second of utter certainty that I belong precisely here, doing precisely this, precisely now.

I feel this way when I’m out in nature. I camped and hiked a lot this summer, and something about standing at the top of something so much bigger than me made me feel exceptionally small and insignificant and also deeply needed as part of the bigger whole. The summer sun shining on my face welcomes me to inhabit each day as fully as I can.

But the seasons are turning now; the chill in the air and the darkness coming earlier is inviting me inward. There are inner landscapes to explore, and dreams to dream, and new projects to undertake and goals to set, eventually. As we move towards the darkest part of the year, the shadows in me are asking once again for my attention. I don’t know where these explorations will lead me, but I’ve learned to trust that when my inner voice is calling, something vital will offer itself to me when I show up and do the work of being alive in the world as my whole self.

I don’t know what that means for this blog. For now, it will continue to be a space I return to, a touchpoint. It allows me to look back over the miles I’ve already covered. My work, now as always, is to show up and, in the words of Mary Oliver, “Pay attention. Be astonished. Tell about it.”

I wanted to write a letter to myself, but I am finding that in this moment, suspended between two call shifts at the end of a very busy week, and running on insufficient sleep, I don’t have the bandwidth to drop that deeply into connection with myself. So I will borrow from Rainer Maria Rilke’s Letter to a Young Poet:

I beg you, to have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don’t search for the answers, which could not be given to you now, because you would not be able to live them. And the point is to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer.

The contrast of the two photos of myself I posted bring up a lot of feelings. There is a lot I would say to the eager student kneeling beside their nursing school’s sign.

I would tell them to go for it, knowing how hard it would be.

I would tell them the sleepless nights are tough and worth it.

I would tell them they would make it. And they would make it. And they would make it again.

I would tell them that their heart breaking wouldn’t break them.

I would tell them that a brand-new baby screaming will always be one of the best sounds in the world.

I would tell them that the weight of stillborn babies in their hands would be far more than they could imagine. Then again, maybe I would hold that detail back. Maybe the heaviness of death mixed into this work is something they have to discover on their own.

I would tell them that bad news doesn’t get easier to tell, but they’ll get better at delivering it.

I would tell them that so much love is waiting for them. So, so much.

I would tell them that they will be lost and found and unlost and unfound over and over again.

I would tell them that they are better at surviving than they realize. Which is saying something, because they already realize that quite a bit.

I would tell them that home and family and belonging and wholeness are things they will get to experience in this lifetime.

I would tell them, again, that it’s worth it. Darkness and light, pain and joy, grief and celebration, laughter and tears, and all of the supposed binaries mixed up together.

I would tell them to live everything. Answers may come. But for now, love the questions.

Born of Dust and Silence

Several months of silence have elapsed since I last showed up to pour my thoughts into this space. Much has been unfolding that is more personal than I am able to explore in this format at this time, and I trust that as stories arise that want to be shared, words will accompany them. For now, know that much is shifting beneath the surface, and perhaps the surface itself is shifting, the landscape of my life changing shape a little, taking on new elements of beauty and fascination and curiosity to marvel at.

I have wondered on and off if it is time to retire from blogging for now. It seems I have less to say here than when I was a student, and it is at least as much personal as it is about midwifery. And then, at the ACNM Annual Convention last week, I spoke with no less than a dozen people (many current midwifery students, or new midwives) who told me that my blog was instrumental to them choosing this profession, or helped them through the rough waters of school, or reminded them that they were not alone. And I realized that I could still do that, even though I am in a very different place now than six years ago when I first sat down to write about my excitement about becoming a midwife and explore my journey towards this career, this calling of mine. Six-years-ago me could not have imagined that I would be sitting down during a lull on a call shift (I didn’t say the “q-word…” I learned never to say the “q-word!”) after a busy day in clinic to blog about being a midwife and becoming myself. Or, perhaps, could have imagined it, but not what it would be like from here.

But six-years-ago me isn’t the part of myself I’ve recently been most strongly connecting with. Ten years ago this summer, I was ill to the point of bordering on death. I look back at the photos of my emaciated body, hollow eyes staring at me through a decade of time, and I have so much I want to tell the person I was then. Last week, I went back to my childhood home (one of them) to visit my parents and my sister, and I spent some time connecting with myself. It felt like a deep healing sort of magic, to be able to send love back through time to myself when I desperately needed it.

Brene Brown put it this way:

A deep sense of love and belonging is an irreducible need of all people. We are biologically, cognitively, physically, and spiritually wired to love, to be loved, and to belong. When those needs are not met, we don’t function as we were meant to. We break. We fall apart. We numb. We ache. We hurt others. We get sick.

A number of those things happened to me a decade ago. I was newly out as queer, and newly in love with the person who would become my wife. I was living in a place where I did not get to express my queerness with a sense of safety or acceptance of who I was, and I managed to internalize the unspoken message that I needed to be small and take up less space. Combined with some undiagnosed physical health issues that spiraled together with anxiety and systemic oppression and not feeling a sense of belonging or knowing where home was, I made myself small. I lost 70 pounds in a year, dropping from an average weight to one that I still cannot believe I could survive at. I broke. I fell apart. I got sick.

I didn’t know if I would get better, or if I could, or even if I wanted to. I could not conceive of a life where I got to be my whole self and was loved exactly as I was and where delight was a theme woven through my days alongside the complexities of sadness and beauty and loss and heartbreaking joy.

I remember a singular moment that felt like a tipping point, where I sat alone in my room, my stomach raging in pain and nausea, gnawingly empty. I watched the pulsations of my aorta through my gaunt belly as I sat staring at a banana and trying to decide if I could eat it. I sat with that banana for hours, feeling like choosing to eat it despite how ill I knew I would feel was an affirmation of my intent to stay alive in the world, and uncertain if I had it in me to say yes. I journaled about this inner chaos. On July 1, 2007, I wrote of how “frighteningly low” my weight was (below 100 pounds), and described all the medical interventions that were on the horizon if I couldn’t force myself to eat, and what my choices were there. And then three small words at the very bottom of the page: “I choose life.”

I ate the banana. I somehow pushed through walls of pain and mountains of fear and kept eating. I left home and built a little family and fell in love with my life again. I didn’t die. I dreamed big dreams and from the depths of myself found the courage to follow them. I moved again, by myself, went to school, got divorced, became a nurse, became a midwife. And here I am on my couch at 11 p.m., pager clipped to the waistband of my shorts, hundreds of babies later, blogging about it.

In my grand tradition of writing letters to my past selves, here’s one specifically to me in that moment when I was sitting there with that banana:

Dear Rob (yep, that’s your name now; hang on),

I see you. Where you are at right now SUCKS. You feel sick constantly. Your body is wracked with pain and your mind with terror. You can’t imagine ever feeling alive again. You are eating your own flesh to stave off death for a bit longer, uncertain how much more you have to give. You are possibly the loneliest you’ve ever been, there in the solitude of your descent into illness.

I know, trust me I know, how much you don’t want to do this. You know how sick you will feel if you eat. You know what it will cost you. But just for a minute, I want to plant the seed of the idea that you not eating will cost me everything I now have. I need you to survive. I need you to do whatever it takes to keep your body alive. I can go back and repair anything else, can return with new perspectives and skills and coping strategies and will happily clean up any messes left behind. I just need you to feed yourself.

If I could, I would give you a glimpse into what lies in store for you on the other side of not dying. In the way that time is not as linear as we think it is and magic is weird and knowing that I went back last week with the intention of reconnecting with you, I’ll give it a shot. If you eat that banana, and keep eating, and keep doing whatever you need to do to stay in the land of the living, I promise you on everything you know to be holy and good that you will come alive again. This is not where your story ends. Far from it. You will keep writing.

In a couple of months, you will move to California, and you will meet people who won’t bat an eye at your queerness. A year from now, you will be married. You will put on a dress (sorry, next time it can be pants) on International Women’s Day and say “for today, and for the days to come” to a woman you love, and you will mean every word of it. You will explore together to the end of your exploring, and your paths will diverge, and you will be sad, and you will feel broken, and you will crochet and write and cry and study your way to feeling whole again.

During this time you will have moved again, to Seattle, on to one of the biggest challenges you’ve ever given yourself. You will dream a seemingly impossible dream, and you will have no idea until you’ve actually done it whether you can. From where your emaciated body sits, banana in hand, you can’t fathom being able to take on the role of caring for anyone but yourself, but you will do it. You will kick ass at one of the most accelerated intensive nurse-midwifery programs in the country. You will rise to the challenge of the dream your grandmother offered you. You will sit in a session at a midwifery conference ten years from now and hear her whisper, from somewhere, that you are her wildest dream, and you’ll realize that she gave you yours as well.

You will get a job that will stretch you and teach you a lot about how to be and how not to be a midwife. You will stay there until you need to leave it, and then you will go to a new place. You will bring your whole self to your work. You will receive babies into your hands and stories into your heart. Your presence with your patients is being cultivated by the quality of the ways in which you are showing up for yourself right now. So keep showing up. Keep doing the hard work of staying alive in the world.

Know that you are not alone. I promise that I will come back for you. Ten years from now, I will return. I will sit in the bedroom you spent your adolescence in, and I will bring all of my accumulated love and wisdom and magic with me. I will sit in the living room eating an apple (because I can’t stand bananas anymore), and I will feel the weight of your frail body sitting there with me, and I will reach out a hand to you from across the decade and lend you all of the strength I have built in the 80 extra pounds of muscle and fat and blood and bone and life I hold in this body you now occupy, and through our collective tears I will call you home again. I must leave home to stay alive, and I promise I will come back for you and through some time-warp magic I will reach back through the past and whisper courage to your palpitating heart, the courage you need to stay alive so you can grow into me and I can go back for you.

Your (my? our?) pager will go off while you write this, and you will go catch a baby and not come back to finish blogging for another week. What will remind you is a sunset that is so astonishing in its simple brilliance that it will move you to tears. You will stand in a spot a block away from where you now live, the fading light of day dropping down over the Olympics before you, and the way the sky makes a perfect silhouette of a sprig of Queen Anne’s Lace will flood your cheeks with saltwater because you are alive to see it.

You will be listening to “Turning Wake” by Ayla Nereo right then, and you will stand still with the cool evening breeze caressing your face as she croons,

I’ll be dancing’ with the ones who remind me
we are born of dust and silence
we are made of ancient songs
and there are ones who’ll keep us sleeping
and there are ones who bring the dawn
put your back to the birch and your mind to the matter of a
listening kind of way
we are born of dust and silence
we are made of ancient songs…

I will stare into the lens of my camera in that moment as if I could look through ten years of history and catch your eye.

I will gaze unblinkingly at the memory of your dying body as tears pour down my cheeks, and I will smile because (spoiler alert!) I know you made it out alive. You can’t know that now, and that is terrifying. Your body will indeed die one day, love, and you will return to the dust and silence you were born of. But not yet. This is not where your story ends.


I will stare back across a decade and hold you with limitless compassion, borne out of all of the precious life I’ve lived in the 3644 days between these two photographs. I will grieve with the embodied memory of what happens when I try to take up as little space as possible. You have no idea what you are capable of, how you will proceed to gleefully and unapologetically refuse to fit into anyone’s boxes, how in claiming your authentic wholeness and all the space that is yours to occupy you will create for yourself a life that you can thrive in.

I imagine myself with you in my lap. I would kiss the top of your head and stroke your bony cheek and tell you stories of the life you will live if you eat that banana. I would whisper in your ear the names of every single baby your hands will catch. I would sing you songs you have yet to learn and recite to you some of the poems you will write. You have to stay alive, love, because the world’s best cat has yet to be born, and yours are going to be his favorite shoulders to sit on.

Oh, my love, the tales I have to tell you of who you are becoming! You have so much life left to live. I wish I could tuck you in at night with stories of how brave you are, how resilient, how you will create a home and a life and a chosen family for yourself. It will be a long, tough rode; I won’t lie and tell you otherwise. Dozens of healthcare providers, well over a hundred appointments, several surgeries, and countless medications and treatments of a variety of kinds will be required to keep your body alive. You will do so much inner work, filling journal after journal with your thoughts and reflections. You will come face to face with your own shadow and welcome it. The journey of a lifetime is to integrate all that you have seen and done and experienced and been in the world, and I promise you that you have within you a seemingly endless well of courage that you will draw from again and again to show up and do the work.

Your beautiful queer self belongs in this world, Rob. Despite what you grew up hearing and what you still hear: there is a place for you at this table. You will discover, as you do the work of staying alive, just how much the world is in love with you. Oh, I wish you could take just a tiny glimpse into my bank of memories from the past decade! You have no idea what a ridiculous life I’ve built for you to come home to. I need you not to give up on living just yet, because there are full moons to admire and queer humans to kiss and mountains to hike up and songs to dance to and heart-shaped rocks to discover in all of the places you go. There are books to read and baths to take and poems to take your breath away. There is love to give and receive and make and fall into and fall out of and do it all over again. There is so much delicious food to eat (I promise that nourishing yourself won’t always be as hard and painful and scary as it is now). There is this incredible body that you get to inhabit, and as you put in one of your poems, “to live in this skin and come alive here.”

And so you will, dear one. You were born of dust and silence, and one day you will return to the same. But not yet. I came back for you. I came to bring you home with me, to carry you to a life you’ve made for yourself to thrive in. I left a heart-shaped stone behind so that you can find your way back to me. I’ll take care of you; I’ve learned how.

Come home with me.

All my love and magic,

Rob (roughly 5,247,360 minutes later)

Between Earth and Sky

It’s been over a month since I last sat down to pour my thoughts into this container, and what a deeply moving month it has been. Each day has set before me an ever-changing landscape, and I have made it my intention to be present and deeply listen to what my life is asking of me. So far, what has been coming up is a request from myself to show up as my whole self wherever I am, and to take up all of the space that is mine.

It is the nature of my work to hold a lot of things. I accumulate so many stories during my clinic days and the nights I spend wiping sweaty brows and supporting perineums and welcoming new little lives onto the planet. I hold with my clients the intensity of pregnancy loss, the discomfort of aching backs and swollen ankles, the sweet relief of that first newborn cry. My hands guide babies safely into the world and their parents through the process of birth, mostly without excessive effort (aside from careful watching) on my part, though occasionally swift intervention to save a stuck baby from birth injury or a hemorrhaging person from complications is needed. I show up and occupy that space between life and death, and I feel it deeply when I do. I am learning that my education in science and the skill and training I received can coexist with my intuition and more subtle ways of knowing, and I am working at trusting them both.

I find myself in an endless process of becoming. I am in transition, now and always. I will never not be changing. Nothing feels solid to me right now, because I exist in the dynamic tension between beginnings and endings. There is a certain sweetness in just being in the discomfort of transition without having to know how the story ends, without having any idea if the paths I am walking will take me where I want to go, or even if where I think I’m headed is where I actually want to be.

I stand here in this singular moment in time, occupying this particular space between earth and sky, gravity holding me fast, feeling deeply into the strong force that unites the particles of matter that have come together to form this thing I call myself. I hold gently to my heart the groundlessness inherent in being human. I sit in the questions without having or needing the answers just now. I can breathe into the restlessness in my heart that wants to know what is going to happen, or if I made the right choice, or if it is all okay in the end.

Several times before in my life, I have felt a sense of being invited to do something by something larger than me, and of that being something I just couldn’t not do. I didn’t have answers, or even certainty that I would be able to do it. I felt this when I decided to come out of the closet 13 years ago. I felt it when I was deciding if I should go on the Equality Ride in 2006. I felt it as I was trying to figure out if I would be able to survive midwifery school. And I feel it now.

Mia Hollow put it this way:

every now and again,
you will feel a dull ache in your soul.
a gentle humming around your heart.
a longing for something without a name.
if i ever told you to obey anything,
this would be it.

listen to the call of your authentic self.
that part of you that lives just outside of your own skin.
let it have its way with you.

i have died a hundred times trying to ignore it.

I have learned to deeply trust this voice, because every time I have followed it, the subsequent journey it has invited me on has become a vital part of my becoming myself. It is a call to my deepest courage and most audacious visioning. It is, as Mia Hollow said, “the call of [my] authentic self.” And I have made a commitment to myself that I get to show up whole and take up space, which means claiming all of the parts of myself as mine and not making myself small to make other people comfortable.

Standing at the edge of this unknown, I feel a pull from what feels like a future iteration of myself whispering, “Yes, take this next step. You don’t have to see the whole path now. But take this step.” I also feel an immense surge of gratitude to my past selves for all of the times that I’ve shown up for these invitations with an open, curious heart, and how each of the steps I’ve taken so far have led me right here. There is a sense of continuity here throughout my evolution thus far, and as I sit with my own liminality, it is becoming clear to me that while the destination is uncertain, I know that I am coming home to myself.

This word that I’ve chosen for 2017, belonging, is already challenging me to show up for my life in brave ways. This afternoon, during a meditation on grounding, I felt a fierce sense of belonging as I sensed myself occupying the space where earth and sky came together. There was a wholeness, a continuum between the farthest reaches of space and the solid core at the center of the earth, and I existed in that expanse, taking up a miniscule fraction of it, but nevertheless belonging here.

So much is happening under the surface, and I keep coming back to a question posed by poet William Stafford: “Ask me whether what I have done is my life.”

Some time when the river is ice ask me
mistakes I have made. Ask me whether
what I have done is my life. Others
have come in their slow way into
my thought, and some have tried to help
or to hurt: ask me what difference
their strongest love or hate has made.

I will listen to what you say.
You and I can turn and look
at the silent river and wait. We know
the current is there, hidden; and there
are comings and goings from miles away
that hold the stillness exactly before us.
What the river says, that is what I say.

I’m sitting here at the edge of the river, trusting the current, asking myself whether what I have done is my life, taking up space between earth and sky.

Tell About It

pay attention.
be astonished.
tell about it.
-mary oliver

Words have been hard to come by lately. This year has been a transformative one for me in so many ways, and I have found it challenging to find ways to describe my experience in language. I’ve spent this year doing countless things I’ve never done before, and I am doing my best to listen to Mary Oliver’s wise words. I have indeed been paying attention, and I am astonished over and over again. So here I am to tell about it.

This January is when I started dancing, which was the first time I ever really intentionally began moving my body. After a couple of decades of my muscles existing in a trauma-induced state of permafrost, I remember the exact moment (in the middle of dancing) when I felt them melt. At first, learning to dance was an endeavor of being in deep solitude in the middle of a crowd of people I didn’t know, but over the coming months, I developed a community of beautiful humans who have become family to me in ways I cannot begin to define in words. These people have gone on so many journeys with me, both in the container of an evening’s set list, as well as journeying with me into the wilderness of my humanity and vulnerability while exploring deep connection and belonging. I am unendingly grateful that this year brought dance to my world, and the people that have come with it.

February brought me to the end of one job–my first position as a midwife after graduation–and the beginning of another. That transition was an important one that afforded me much more time for self-care, as I am currently working much less than I was previously. My quality of life has drastically improved in this new role, and I view my decision to accept this new position as one of my most important life decisions thus far. I am grateful for the environment in which I work, the delightful midwives and nurses and other staff who make my workdays something I look forward to, and the precious individuals and families I have the privilege of serving. This month, I also met for the first time someone who became a member of my chosen family and one of the dearest humans in my world. The end of February was also when I learned that my mother had cancer, which would prove to be a thread woven throughout the remainder of the year.

March was full of cherry blossoms and poetry. This month ushered in my thirty-second year of life, and with it, the first labor I ever attended where the baby shared my birthday with me. That is a special moment I will not soon forget, and a hard birth that compelled me to dig deep into my reserves and hold exquisite space for what was unfolding. I went home to vegan cake with a small handful of special friends, and I felt loved. I also stood on a stage on the tenth anniversary of the start of the Equality Ride and told a deeply personal and hilarious story about my journey of self-discovery of my sexuality, which felt like an embrace of my choice of the word “storytelling” as my word of the year.

April involved a road trip that took me to a workshop that proved life-changing for me in several important ways. I met some people who made a big impression on me, and formed new connections that would push me to the edges of discovery and increased self-knowledge. I continued to become more comfortable in my new job, and kept building relationships as I met more people in the dance community I joined at the beginning of the year. April took me away from home to help me find home within myself in new ways.

May brought me love, and exploration, and curiosity, and growth. So many stories unfolded this month, stories I can’t begin to unpack just now. May was about mindful embodiment, witnessing my formerly trauma-frozen body continuing to melt and heal and open to movement and wonder and delight. I kept dancing, and catching babies, and writing poems, and falling in love with the world in new ways.

June took me out into the woods and brought me home again. The magic I created during my five days there left indelible imprints on my life. This month kept teaching me about relationship-building, and boundaries, and attachment, and family. June also contained some new trauma that shook me to my core for a while, and ultimately it showed me the importance of healing in community. I claimed very openly my whole self, and I lost some people I loved because of it. I saw how resilient I have become, and how even painful wounds can be tended to in ways that strengthen my wholeness.

July was about coming undone. The trauma from June seeped into my spirit, and I could not keep holding it all. I went into the woods again, and I fell apart. I set some clear boundaries in relationships that were not serving my wholeness. I grieved hard for what I lost. I felt everything deeply. July was messy and important.

August, again, took me out into the wilderness in search of something inside myself. I went to the coast alone for a week, and felt so very lost. I wrote my way back to myself there, and I came back home with thousands of pictures and hundreds of heart-shaped stones and dozens of ways I had reclaimed lost parts of myself. I went to dance camp this month, and explored movement in community. I allowed myself to be witnessed and held in extraordinary grief, and through this found the strength to go all the way through it to the end of my sorrow. Relationship creation and nurturing continued to be an important theme throughout the end of the summer, as did showing up in my solitude in the natural world and finding myself belonging to it.

September taught me more about healing and letting myself be held and loved by my chosen family. This month found me unearthing the courage to be vulnerable in my storytelling, to choose to unload shame that was not mine to carry, and to see myself through the eyes of the ones who love me the most. This month, I traveled to Oregon for the second of five times this year, and I saw my mother and her family and connected with them in the beauty of nature. I made memories of collecting heart-shaped stones from the beach together with my mother, which I will always cherish.

October taught me again about loss and grief. In the span of two weeks, I lost a dear mentor (a mother figure I have loved since college, when her presence in my life was instrumental in keeping me alive in the world) to cancer and two queer friends to suicide. I grieved their loss in my bones as I continued doing my work of baby-catching and community-building and working for justice. A bright spot in this month was getting the chemical structure of oxytocin, my favorite hormone, tattooed onto my forearm, reminding me to generate love and connection and relaxation wherever I go.

November was a hard month. Anxiety building up to the election, exponentially worse afterwards, gave way to an odd mix of paralyzing despair and dedicated action towards resistance. Two more weekend trips to Portland, and a third to Bainbridge Island, made this month full of travel. I stayed on friends’ couches and in guest bedrooms and in a gorgeous cabin in the woods, connecting with chosen family and my ancestors and finding belonging in the world I inhabit while continuing to work for justice in as many ways as my limited energy would allow.

And now it’s December. 2016 is close to over. This year of exploring storytelling has taken me into both my past stories, as well as giving me many new ones to write. Indeed, I think I am realizing that I write in ways that go much deeper than words. My presence in the world is writing epic poetry to the time I inhabit. My body is composing a love story to the land. My feet are dancing stories into sand, snow, dirt, grass, and on hardwood floors throughout the Pacific Northwest. The birth stories I witness unfolding and help to write with the families I serve may go untold, but they are writing themselves into my memory, not to be forgotten.

I may not have been writing as much this year, definitely not blogging as prolifically as I used to, which has required much gentleness and self-compassion on my part. But silence here does not equate to a lack of stories being lived or being told. I think I am just learning new ways of storytelling. I am seeing that the way I eat a ripe satsuma tangerine is a story. How I trace my fingers down the cheek of someone I care deeply for. The ways my body has learned to move to music and to rest in stillness. The quality of space I hold in my clinic and hospital rooms when important things are unfolding. The presence I give to the feeling of fall air on my face. The tenderness with which I welcome new people onto the planet. All of these are evidence of the ways I am becoming a more prolific storyteller and stepping into my greater wholeness as a member of the human family.

I have been paying attention. I am astonished. And I am doing my best to tell about it.


Burying Sadness

But if you bury your sadness under your skin instead of letting it out, what else can it do but grow in your veins, to your heart?

–Nikita Gill

My life is full of joy. I have spent delightful hours over the past couple of weeks at my new job, getting to know a new population of clients, most of whom are expecting to welcome babies into their families in the near future. I have had the immense honor of catching their babies in my hands and whispering a blessing of welcome into this big world. Witnessing contractions opening bodies so new members of growing families can come through never ceases to amaze me. I have no doubt that I am doing my work in the world. I am lucky that my job is also my vocation and my calling.

Mixed in with that joy is now and always a fair bit of sorrow. Sometimes my experienced hands cannot guide the Doppler to a heartbeat. Sometimes a scan shows worrisome findings. Sometimes the lying bastard known as depression tries to steal away the happiness of welcoming a new little love into one’s home. Sometimes a partner unexpectedly turns violent, or cheats, or leaves, and my client is left with a mess on their hands. Always, always, there is fallout, and often this bubbles up in my clinic room.

And my life, too, has its measure of sadness. It is not easy to be a healthcare provider and simultaneously the adult child of a mother with cancer. It intense to live in a body that so regularly reminds me that I am made of flesh that aches and bleeds and can sometimes break open. I have not hidden the fact that my mind has myriad reasons for big feelings to arise from time to time, and when I am in periods of transition, everything in my history tends to ask for my loving attention again, which I am willing to give, and which offers me insights into deep and beautiful things when I slow down and show up for myself.

It takes its toll being queer in a world that doesn’t have a box to check that easily defines me, always being “other.” No part of me easily fits into a box, and while I would not trade in my queerness if I could (though I did spend the bulk of my teens trying, without success and with plenty of damage to my wellbeing), the idea of being understandable and understood by more than just other misfits and weirdos has its appeal every once in a while. Coming home to an empty house after a long call shift spent helping other folks create their families doesn’t always touch that place in my heart that aches, but today it did. Being a wounded healer is a privilege with a heavy price tag attached.

So on nights like tonight, I feel my sadness instead of letting it settle in my flesh unexamined. I notice the ache in my sternum where my awareness of mortality lies. I feel my ovaries begging me to use their eggs. I feel my belly (always), chugging along, painfully digesting my life as it so diligently tries to do. I sense the vast empty places in my bed that for now will be filled with feline companions. Sinking into my body, I remember that sadness is a universal experience, one which links me to the whole world. Catching my breath, I feel the ice around my heart melting. Tendrils of compassion wrap themselves around me and extend outwards to hold the shared sadness of others. I feel all the feelings at once. It is not possible to feel so alone when I remember that I am a part of everything.

So much is shifting for me, and so quickly, that it is easy to get lost in what is different. And also, in the groundlessness, there is space to rest as well.

We are always in transition. If you can relax with that, you’ll have no problem.

–Chogyam Trungpa Rinpoche

Transition is hard. In labor, it’s when many people hit a wall and feel like they can’t do it anymore. In life, it’s when the maps that used to prescribe where I should go next no longer show me the road ahead, and I must wander through and trust that the way will open before me.

Choosing “storytelling” as my word of the year is kicking my butt. I didn’t realize that such a word would call me to more deeply question and explore who I am as a storyteller. This year is not even a quarter over, and already I am not the same as when it began. My life is dynamic just now, and while all that is changing leaves me feeling like I have no solid ground on which to rest my feet, relaxing into that reality is bringing me comfort. Not long ago, I felt very stuck, and while I had solid plans for what direction I would be going, I wasn’t happy. Now, I am most definitely not stuck, and I have no idea where I will be in six months or a year, but I feel free in a way that I didn’t before. Free not only to tell stories that have been holding me back, but also to release their power over me.

For me, I have found that in my vulnerability and acceptance and willingness to face the things I haven’t wanted to write down or speak aloud, they lose their power over me. As I claim all of my life experiences and actions as mine, I become free from them. Integrating every last bit of my life into one complicated whole has been some of the hardest and most rewarding work I’ve ever done, and there is certainly plenty left to do.

Sometimes, when I remember to pause in the midst of chaos, I ask myself, “What is the work of this moment?” And then I do that. Tonight, my work has involved rearranging furniture, answering pages from clients, remembering to feed myself, having a good cry, reaching out to friends to break my isolation, and writing a blog post under the warmth of a snuggly purring cat-friend. And now, the work of this moment is to rest (until morning or the pager goes off again, whichever comes first!). Much love to anyone and everyone who has ever felt sadness, and may the willingness to feel it deeply open you to greater joy as well.

Jealous of Trees

When people ask me where I am from, I am never quite sure what to say. The short answer I give is “everywhere,” but the long answer is ever-evolving. Do I say I am from Colombia, where I took my first breath in a cold operating room (illuminated only by flashlights in the middle of a power outage) and spent the majority of the first decade of my life? That makes sense, as it is the only physical place in the world that I have ever truly, truly felt I could call home. But my home there is a place that does not exist anymore. I can never return and have it be the same.

Home is not Minnesota, where I spent one very cold, dark winter of my childhood.

I also refuse to say I am from Texas, even though I spent more time there than any other place. The house in which I grew up is not home, though it is mostly familiar when I return for brief visits.

Do I say I am from southern California? That is where moved here from, but I never really belonged there. I loved the four years I split between Santa Monica, Santa Barbara, and Pasadena, and still find myself craving satsuma tangerines grown in endless sunshine. I came back to life in that place and will be forever grateful for it, but I don’t think I could truthfully say I am from there.

Between leaving Texas after college graduation and moving into the house where I currently live, I have had ten different addresses in six different cities in three different states. I have spent much time packing and unpacking and packing and unpacking again. I have settled and unsettled and resettled quite a lot.

I have spent much time jealous of trees because they have roots. I have leaned my back against their solid trunks and gazed up into branches than have been home to many birds, and I have wondered when or whether I would ever feel truly at home in the world.

During panic attacks as a teenager, the most common sentiment that would arise from the depths of my anxiety was, “I want to go home!” I didn’t know where home was, or what it even meant. I kept looking for a literal place that felt like all of the things that I thought home should mean, and I kept not finding it.

When I was in Haiti this summer, during my relatively terrifying 24-hour stay as a patient in a hospital in Port au Prince, listening to the agonal breathing of people mere feet from me who died before my eyes, feeling dreadfully sick myself and attempting to coordinate travel back to the States and doing my best to advocate for my wellbeing in a healthcare system I didn’t understand, communicating in a jumbled mix of college French and self-taught Creole through my feverish haze after not having consumed solid food in five days, I had a moment. It was a moment so striking in its clarity that I doubt I will ever forget it.

I wanted to go home more than anything. I wanted to be off that sweaty stretcher, away from the fierce heat and the flies and mosquitoes I had to keep swatting away (the same ones that got me into that dengue fever-induced stupor in the first place!). I wanted to be able to sleep in my own bed. I wanted not to have a poorly-taped-on IV in my arm. I wanted not to be surrounded by the sickest people in Port au Prince, who were vomiting and seizing and gasping their last rattly gasps. I wanted to be in my own hospital with healthcare providers whose language and medical culture I understood and tests I could research and friends I could call on for support. I, without apology (at the time), wanted access to all my various forms of privilege, which was getting me much farther than the people laying in the beds beside me but was not getting me home. I wanted to go home.

In that piercing moment, I realized that if I could climb into my sick body and be at home there, I could be at home anywhere. I wanted nothing more than to escape the whole situation, but I chose to be exquisitely present, one breath at a time. I counted them slowly, breathing six deep belly breaths per minute as I was trained in meditation. I calculated how many breaths to get through an hour at that rate, and rationed them out. Breathing deep into my sick body, I felt as if I was sending love into the body of the earth, pouring out whatever medicine I could conjure into every wound she showed me. I reached my energetic love towards the dying man in the corner and, from my cot, felt the same ferocious love that helps me welcome new people onto the planet gently help him leave his body. I dug deep when the keening howls of his grieving widow threatened to undo me. I looked at every person in that intensive care room with me–the skinny elderly woman two feet to my right, the young man carried in by a friend during a seizure that would not stop, the woman propped up in a wheelchair sucking on an oxygen mask as if it were her only hope at survival, the plump woman vomiting right in front of me into a metal bucket held by her young daughter, the woman beside her moaning in agony, the man in the other corner coughing violently, and a few other folks that I could hear but not see–and held the intensity of their suffering, and then blew it out the open front door with the force of my carefully-measured exhales.

I felt myself settle into my body, this body that has during my 31 years in it been my friend, my enemy, my lover, my muse, my agony, my inspiration, my limitation, and my delight. I came home to myself in that moment, something I have spent the better part of at least two decades trying to do. This is my body. I am here now.

I still wanted out of that place. I still wanted my own bed and my own country and my own language and my own food and my own kitties to keep me company as I healed, and in the space of the next couple of days, these all reappeared in my life. But when I walked through my front door again, I was not the same person who had left, nor did I live in the same body.

For the past couple of years, I have chosen a word at the beginning of the year that I want to spend that year exploring. In 2014, I chose “delight,” and found it around every corner. This year, these past 365 days, I have been exploring the deepest meaning of the word “home,” and I could not have picked a better word to explore. Looking back now over the past year, my journey with this word did not take me where I expected it would. I had been planning to build a home and a life with a person, and that did not go as I had anticipated. But home took me to even deeper places. Home brought me to myself.

In the last fifteen minutes of this year, I am committing to my word for 2016. I had a hard time deciding on this one (there were several strong contenders!). I know what this word will ask of me, and I am not quite sure if I have the courage to show up for it. But I want to go to the places it will take me and stuff my pockets with anything worth bringing back.


That’s my word. That’s my goal. Now that I’ve journeyed back home to my body, I need to explore all of the stories I carry. I need to remember where I came from and who I am and what my life wants from me.

I need to rest my palms on my sturdy trunk and feel that I, too, have roots. I belong in this world, and this world belongs in me.


Thanks to the trees and this gorgeous sunset at the end of the year for providing me with the angst to realize that I am jealous of their rootedness, and thanks to my amazing massage therapist/friend/fellow magician Nekole Shapiro for finding that jealousy in my right ankle (her way with finding stories in my body is phenomenal).


Here’s to a year of storytelling!


You Burn

“You burn because you carry fire.”

–Rune Lazuli

I know that I am not alone in this sensation of burning from the inside out, this intensity that has called my name since I was a child and has compelled me to follow a tough path with many opportunities to give up and choose something easier. I know that I take up more space than is “ladylike” or comfortable or easy to witness. I speak openly about some very difficult topics and don’t hesitate to move in the direction of big feelings. My dinner table conversations are likely to make some people squeamish. If I take a liking to you, I will probably ask to see your soul and show you mine in return. I believe in and practice radical vulnerability. As Brené Brown says:

“Owning our story can be hard but not nearly as difficult as spending our lives running from it. Embracing our vulnerabilities is risky but not nearly as dangerous as giving up on love and belonging and joy—the experiences that make us the most vulnerable. Only when we are brave enough to explore the darkness will we discover the infinite power of our light.”

Sometimes this is scary. Not everyone can hold this much fire, at least not without practice. I have felt lately in certain relationships like I might be too much, too big, too intense, and have contemplated how to go about being just a little bit smaller. I would fit so much better in the world as it is now, in my family of origin, in polite company, if I could contain some of this potent energy, if I asked less of the people I love and showed them less of the harder-to-love parts of myself. But the thought of making my magic smaller hurts me. I feel like I would be less whole, less authentically me, if I worked to fashion myself into something more acceptable. I feel that burning, and lately, I’ve been struggling with what to do with it.

“You burn because you carry fire.” What a simple and potent statement! The ardent heat in my chest that put me on the path that has led me to becoming an ever-closer approximation of myself is not an anomaly. It is not a symptom to be treated, a burning to be extinguished. I burn because I have spent my life chasing down my demons and reclaiming their power over me, and this has made me brave, if not exactly fearless. I have gone to many dark places, some with company and some alone. I have made space in my chest for the enormity of grief, the agony of loss, the ugliness of shame, deep waves of sadness, isolating loneliness, and the bitterness of rejection, and in turn this has carved more room inside me for deeper joy than I could have ever imagined. I live in a body that I have only really known in a semi-broken form, and I invest much time and energy working to understand what level of wholeness is possible for me. I am a broken healer, burning because the fire I carry is not something I can put out.

I do not exist to make anyone comfortable, not even (especially not) myself. I am here to invite you to go to the scary places where you will meet yourself. If I extend a hand to you, it is inviting you to come with me to the edges and peer over to see what lies beyond them, to discover what wholeness you might claim from going to the places that scare you. I am here to hold up a mirror to show you the most beautiful things about you that you’ve never let yourself love. I am happy to love them with you.

This will likely be unpleasant. Big feelings will come up, and along with them all of the things we do to avoid feeling those big feelings. But if you can breathe, and stay at that edge, and not run away, I promise you that something valuable will be there to explore, something that will deepen your understanding of yourself and your life and your purpose.

I am at that edge now. I am breathing. I am wanting to run away, wanting to quiet the feelings with chocolate or mindless chatter or anything but actually feeling my way into them. So much in my life is shifting, and with these transitions come both the finality of closed doors and the invitation of open ones. In this period of liminality, I invite my whole self to show up and remind me who I am and what my life wants me to be. “Let your life speak,” the Quakers say, and I am working to create the stillness necessary for the quiet voice to come forward and beckon me into deeper wholeness.

Paying attention to the voice of the whole self is dangerous, because often it asks for what it needs, and these requests require action. I have been offered invitations to make some big changes in my life this year that are pointing me in the direction, ultimately I believe, of greater authenticity and wellbeing, but for the time being, I also feel a certain degree of chaos surrounding them. I am making changes in my personal life, in my most important relationships, in my work life, and in my home, and I anticipate that while I feel destabilized temporarily, I will settle into a place of greater stability in the long run. All of these choices presented themselves to me initially as a sense of unease, whether in my mind or body, and only as I explored them was I able to mine their deeper messages.

2015 has been a big year for me. I have had several major health issues to deal with (including needing surgery and having a couple of procedures under general anesthesia), an important relationship that grew as much as it could but ultimately was not sustainable, my first international midwifery volunteer experience, many dozens of babies caught and hundreds of encounters with pregnant folks as well as those seeking general reproductive health care or contraception, some lovely new friendships and relationships built, and the beginnings of transition from one place of employment as a midwife to another (which will officially happen in February 2016).

I am making choices that will stoke this fire that I carry, that will help me guard it and use it well and help it keep burning strongly for as long as I live in a body to carry fire in. It is not easy to stand up and say, “I need this to change for me to be my best self,” especially when claiming one’s wholeness risks disappointing others. But self-care is the least selfish act I know of, especially for those whose job it is to care for others. It took guts for me to recognize that the work situation I was in was not sustainable if I wanted to remain healthy and balanced, and to take steps to orchestrate the changes necessary to create that balance. The same goes for relationships, and for my interactions with family. Ultimately, I am only responsible for myself, and if I do not love myself fiercely and protect this spark inside of me, I risk it going out.

Robin Williams said, “You’re only given a little spark of madness. You mustn’t lose it.” He’s right. We just have that one spark. But if we care for it, that one spark is enough.

You burn. You burn because you carry fire. So carry that fire. Merge it with other flames, dance on dry twigs, and stoke smoldering embers. Let the fire inside you burn whatever does not make you your most whole self. Let it remind you who you are in the world to be, and then go be that.

The Love of Thousands

Yesterday, these hands of mine had the honor of welcoming three new people into the world, and last week, I caught my 200th baby. It felt like a terribly ordinary moment but one with an extra measure of delight added in. Counting c-sections I’ve assisted in, homebirths I’ve attended, births I’ve attended but not as midwife, and all of my doula babies, I figure that I’ve seen at least 350 births. This is probably already more than my grandmother witnessed in her whole career as a nurse and a midwife, which is hard for me to grasp.

I went to Seward Park this afternoon, just as the afternoon sun was beginning to sink low into the sky. The fall leaves were rustling in the tree branches above my head. A gaggle of geese huddled together in the water. Red, orange, yellow, and brown leaves littered the grass. I saw my breath in the crisp air as I exhaled.


Just bringing myself back into nature, I felt my energy quicken. As I began my walk around the circumference of the park, capturing the sights through the lens of my camera, I noticed tears running down my cheeks. I paused, trying to make space in my mind and body for the immense beauty that surrounded me. A stiff breeze kicked up, causing the leaves to whisper their secrets to me. I felt the incredible aliveness of the world around me. As I stood still, I recalled the time I felt the trees breathing me in the redwood forest in northern California. I felt these trees breathing too, and reaching up to touch a branch, a gentle, “Hello,” escaped my lips, a greeting, a recognition of our kinship.


I walked through the damp grass, my breath catching in my chest as if anticipating a lover’s kiss. I fell terribly in love with the world again, a sensation which surprised me given the various transitions that are occurring in my life at the moment. I expected maybe to be sad that I was walking in the park alone, when the last time I was there I was with a partner. This time, the whole park was my partner, and was showing me its beauty in ways I might not have seen had I been holding someone’s hand.


Tears again came as I felt love coursing through my veins, and they come now as I find words to describe the immense gratitude I feel to have found myself again in the magic of the world. I think back to all of the people I have been throughout my life, all of the various iterations of me, and I am just so delighted that each one of them made the choices they did that brought me here. I am thankful to them for not giving up, for finding a way through some very difficult times and places, for continuing to believe in the idea of home.

The cold wind kissed my cheeks as I sat on a damp log on the shoreline, looking at rocks on the beach. Anytime I am around rocks, I look for any that are remotely heart-shaped; these make their way into my pockets and come home with me. Sometimes it is a stretch to see a heart in a rock, but if you look closely enough, you can find love everywhere. I look closely.


I took my time wandering, and the sun quickly faded beneath the horizon. I found myself on a path in the dark, and was momentarily struck with the various and sundry fears that arise in the dark. But then my breath came back to me, and I stood still, watching leaves tumble from their branches down to the forest floor. I must have witnessed this for five or ten minutes, just soaking up the wisdom that allows the trees to release without fear what they no longer need to hold onto and trust in the cycles of life. These giants towered above me, and they’ve stood in this park for far longer than I’ve stood on this planet. They have seen countless seasons come and go. Millions, billions of leaves have been shed onto this ground.


I thought of the following quote as I walked back to my car:

“Walking, I can almost hear the redwoods beating. And the oceans are above me here, rolling clouds, heavy and dark. It is winter and there is smoke from the fires. It is a world of elemental attention, of all things working together, listening to what speaks in the blood. Whichever road I follow, I walk in the land of many gods, and they love and eat one another. Suddenly all my ancestors are behind me. Be still, they say. Watch and listen. You are the result of the love of thousands.”

–Linda Hogan, from Dwellings: A Spiritual History of the Living World

I am the result of the love of thousands. The babies that I have welcomed are the result of the love of thousands. You, you my dear, are the result of the love of thousands. Watch and listen.

That Long Journey

“And you?

When will you begin

That long journey

Into yourself?”


I am aware of the silence that has permeated my blog lately. I have been very mindfully (sometimes) sitting with the intensity of the words I can’t find to describe where exactly I am.

I know my posts in Haiti ended abruptly. So did our trip there. I got sick (likely with dengue fever), and we had to come home a few days early. That is the short story, the one I can put words on.

What I have been having trouble describing is the day and night I spent as a patient in a Haitian hospital while I waited for transportation back to the States. I was pretty sick, and feeling pretty darn awful, and pretty good and dehydrated. I had no idea whether to expect to get better or suddenly worse (dengue can go either way), and I knew that if I got worse, I was in a place where there was no medical care that could help stabilize me to the level that I might require. To say I was nervous is an understatement.

I watched two people die in front of me in the hospital ward I was in that night, and listened to the agonal breathing of a third all night long. I watched no one rushing to save them. I watched a soon-to-be-widow swat flies away from her dying husband and bring the sheet further and further up towards his face, ready to cover him once he gave his last gasping breath. I heard the keening of a family member at the bedside of another patient who died during the night. I sat up from my restless attempts at sleep dozens of times when there were gaps in the gasping sounds, wondering if this poor man’s suffering was finally over. I watched exhausted family members hold buckets for their sick loved ones to vomit or poop or pee into, right in the middle of everyone, without any privacy.

I laid there on my bed which was covered by a sheet someone scrounged up, without a pillow (as I hadn’t known I was supposed to bring my own pillow and linens), sweating in the heat even at midnight, swatting away flies and those damned mosquitoes that got me into this predicament in the first place. The front door to the hospital (and the “intensive care unit” I was in, as it was the only inpatient unit at the hospital) was kept open all night due to the immense heat, and at one point I saw the rain pouring down, which provided a small amount of relief from the heat.

There was a bucket under my bed, but I refused to use it. I was so dehydrated, I barely had to pee after the liter of fluid they gave me before my poorly-placed IV fell out, and I chose instead to use the filthy bathroom where family members dumped out the contents of the buckets.

That night that I was alone in that bed, trying to advocate for my well-being in French and Creole–that night changed me. Watching people die while I was trying very hard to stay alive changed me. Seeing how hard it is to be a patient in a foreign healthcare system that you do not understand changed me.

I had a moment there, when I was alone in a sea of other sick people, when I remember having a choice. I wanted desperately to allow myself to go into full-blown panic mode, but I felt like I had to hold it all together. So I stayed with my breaths, one at a time, purposely slowing down my inhalations, as the phrase, “I want to go home,” settled in my mind.

I want to go home.

I didn’t just want to be in my own bed, in proximity to my own healthcare system, not surrounded by dying people, and speaking a language I could better understand, though all of those things were certainly true.

I wanted to come home to myself. I wanted to feel like I belonged in my body again.

I made a choice on that hospital bed to feel everything. I decided that I had the courage to climb into my own skin and find myself at home there. “If I can feel at home here,” I remember thinking as I looked around the crowded ward, “I can be at home anywhere.”

And, for fleeting moments in between waves of panic, I felt myself fully alive in the present moment, in my body, in the space I was inhabiting. I felt the raging headache and the brutal bone and muscle aches and the gripping pain in my belly. I felt the flies settling on my sweaty skin. I felt the shifting sheet barely covering the plastic-covered gurney beneath me. I heard the sounds of caregivers soothing sick family members in Creole. I watched people leave their bodies forever, and I realized how desperately I want to be alive in mine for the time I have left in it.

That night moved me more than the rest of the trip combined, though I have other stories of midwifery care to tell at some point, and I will tell them as I wade through the layers of what that trip meant to me. Being a patient changed me more than being a healthcare provider.

Last December, I chose the word “home” to meditate on for 2015. I thought I had a pretty good idea in mind of what home would mean to me and where that process would take me. I am discovering that I might not have left enough room for my life to surprise me, as it is wont to do.

A good friend reminded me last night that my whole experience with my fistula earlier this year asked of me, “Let this open you.” And indeed it did. And, once opened, and shaken, and with eyes wide open to how harsh and fragile and gorgeous life can be, I am finding myself with a renewed sense of urgency to really live the hell out of my days, to strive for more balance in my life, to take better care of myself (noting that the majority of my energy goes towards taking care of others), and to really explore what my soul is calling me to do.

I feel like that has the potential to disrupt my status quo, which is unnerving to me. But transition is rarely easy.

Home is calling me. That long journey into myself continues.

And you…when will you begin?

Packing It All In

Yesterday (Monday) was Teresa’s and my first day to go out on the mobile clinic. We went to an area called Ceramon and set up our clinic in a building established on a concrete slab with corrugated metal roofing. It was quite an adventure to get there and back in the Land Rover! Due to several days of recent heavy rainfall, the roads were even less accessible than usual. Getting out of the town of Hinche was also an issue, as police were diverting traffic due to some sort of parade of schoolchildren through the streets. We ended up going down a back road that was barely wide enough for our “machine” (Creole for vehicle) and the crowds of people and their animals and motorcycles that were arriving for market. Driving is an art form in Haiti, and the horn is a well-utilized form of communication. Drivers use it to express anger or frustration at other drivers, as we do in the States, but it is also used whenever going around a corner or over a hill when the people/animals/vehicles that might be ahead would not be able to see you coming. People often drive in the middle of the road, including right down the middle of the “do not cross” line (when it happens to be painted on the road). Our driver quipped that if he didn’t have a horn, he would kill people every day! The horn is also used to claim the right of way (which seems to follow the same rules as I saw in Colombia, where the largest of the vehicles arriving gets the right of way, regardless of who arrived first; a Jeep will always claim the right to go before a motorcycle, for example).

So the roads were sloppy with mud, and the rains had carved deep channels and ruts in parts of the road out to our remote destination. It was a very bumpy drive, and I found myself turning a little green by the end. We had to snuggle up really close to some nearby trees to avoid the most treacherous spots on the road, and our driver would quickly warn us to close our windows so the tree branches wouldn’t reach inside and slap us in the face! (I still ended up with bits of leaves all over my backpack and clothing!) But we made it without getting stuck in a rut or a deep mud puddle.

It took a bit to set up the clinic from the suitcases of supplies we brought along. First was a song and a prayer in Creole, followed by an educational session led by one of the midwives. She asked everyone who had been there before to name the warning signs of pregnancy problems, and they remembered everything except decreased fetal movement. She then used a poster to teach them about nutrition. After that, charts were handed out to the 20 women who had been there before, and the 5 people who were there for their OB intake and physical exam got new charts established.

Teresa and I helped with vital signs at first, all of which took place on the outside porch, with the women sitting on benches. Vitals included temperature, respirations, BP, pulse, weight (which happened on an analog scale which we had a bit of trouble finding a level part of the concrete porch to place it on so we could get accurate readings), and one that is not part of my vitals in the States but is important here: upper arm circumference in centimeters, which is a good approximation of nutritional status. I helped mostly with taking weights, climbing down on the ground in front of the woman on the scale to read the number upside down and translate the reading from the red needle into a French number which I called out to my translator who wrote it in the patient’s chart. Our translators were a lot more involved in the clinic than they would be in the States–I even saw one of them (a young mom herself, with a 6-month-old son at home) helping a mother of a newborn position her baby to breastfeed.

After vitals, it was time for the prenatal exams, which happened inside the building. The exam table for speculum exams was a massage table covered in a sheet and a piece of plastic shower curtain (more for the muddy feet that would be planted on the corners of the table, because there were no stirrups, and less for an impermeable barrier underneath the women, because they all had their skirts underneath them; the sheet was not changed between exams). The midwife performing pelvic exams had a wonderful system of not contaminating the specula: She brought them in a plastic tub, all wrapped in a clean towel. She had a pair of ring forceps that she kept on the lid of the tub, and whenever she needed a speculum, she used the ring forceps to push back the towel and grab a clean speculum and cover up the others still in the bin. She collected the used specs (most of which were the pediatric size today, as we had a lot of teenage primips) on the lid of a bucket to be transferred later into a container to be taken home and sterilized.

The exams happened behind a curtain that separated the exam table from the outside, but there was no other curtain dividing the exam table from the side room where two other Haitian midwives plus Teresa took histories, gave out medications (folic acid, a prenatal vitamin, and iron tablets to every woman; anemia is endemic here), and Teresa did belly checks (Leopold’s for fetal position, fundal height, and fetal heart tones). So, the women getting speculum exams (covered with a lavender sheet as a drape) were having conversations with the women waiting in line to hear their baby’s heartbeat and to get their medications for the next month. Nobody seemed fazed by this, and indeed, for several of the girls this was their first pelvic exam and the others in the room helped to talk them through it, encouraging them to relax their legs, or laughing with them at what a strange feeling it was.

Somehow, squatting on my haunches in this small, dark cement building for over an hour, lit only by a headlamp and whatever sun streamed in through the windows, helping a midwife perform gonorrhea and chlamydia tests (with only a massage table and a rickety chair as exam furniture) was a better leg workout than I’ve had in recent memory. (My quads are speaking their mind this morning.) Far more rewarding, too! I learned how to perform the rapid GC/CT tests, which required separate swabs, tubes, test media, number of drops, number of times of swirling the swab in the test media, number of minutes to wait (if any) prior to adding the media to the cassette (which looked like the pregnancy tests we use at my office), and number of minutes to wait to read the results. I counted out the drops of test media and swirls of the swab in Creole (thank goodness I paid attention in French class over a decade ago–I still remember how to count!). It was interesting that the packets said “not for use in the United States”–I’m not sure why that is, except that we have a system of labs that can perform the tests for us, and that infrastructure does not exist in Haiti.

After all of the pregnant women and the three postpartum clients and their babies had been evaluated, we packed up our supplies back into their suitcases, tied them back onto the top of the Land Cruiser along with the benches the clients sat on while waiting, and started the bumpy journey back to our home base.

Today, bright and early, we got up to prepare for our separate morning and early afternoon projects. I was in the classroom with the 30 new midwifery students, and Teresa went to the hospital with a translator where she worked with a few people in labor, including people who were being induced preterm with pre-eclampsia.

My role in the class was to teach GTPAL, which is a system of categorizing pregnancy numbers and outcomes. The acronym in Creole is a little different, GPTPAV, standing for gravida (total number of pregnancies), para (number of births after 20 weeks), term (births at or after 37 weeks), preterm (births from 20-37 weeks), abortions/miscarriages (prior to 20 weeks), and number of living children (enfants vivants in French). The students, for the most part, listened carefully and one asked 95% of the questions in class. She tried to stump me with a great hypothetical question: if a woman was pregnant with twins, and she delivered the first twin at 11:59 p.m. on week 36+6, and then had the second twin 10 minutes later, at 37 weeks exactly, and a twin birth only counts as one in the “para” category (because it is one single pregnancy that is ending, and we are not counting the number of babies until the last category), then which slot do you put it into? Term or preterm? I heard this question explained to me through my fabulous interpreter, and I loved the question and its asker dearly. (The long answer I gave her is, it depends, and you get to use your clinical judgment, and thankfully situations like this don’t happen super often, and when you are interviewing a woman about her pregnancy and birth history, she might not know the exact number of weeks she was when she gave birth, and logically we know that ten minutes’ difference doesn’t make much of a difference in terms of whether a baby is term or preterm, so use your clinical judgment in whether the babies seem term or preterm if you have to decide.)

I also taught how to determine due date based on factors other than last menstrual period. I told them the story of my own birth, where my mom was breastfeeding my 6-month-old sister when she got pregnant with me, and had not had a period yet so had no LMP to go off of. Ultrasound dating was similarly not available, especially in rural Colombia. She had a scheduled repeat c-section (I told the students how I was born via surgery during a power outage in Bogota, and the surgeon continued by flashlight–blackouts are quite common here, and they all looked at each other in surprise that this white midwife would have a birth story that they could relate to!), and when the doctor pulled me out, he noted in my birth record that I looked to be about 36 weeks’ gestation. I weighed just a little over 2.5 kilos at birth (I was a tiny little peanut!). They loved this story and I think it helped to underscore how you need to use all of the available data to make the best estimate of due date possible, because otherwise you might cause problems further down the line.

Teresa has her own stories from her time in the hospital today (her close Doppler monitoring of a mom who was being induced for pre-eclampsia at 35+ weeks, and noticing that the baby was having late decels down to the 60s-80s after every contraction, and her insistence that the baby was not doing well, likely encouraged the staff to move towards a cesarean birth sooner than they otherwise would have, and may well have saved this baby’s life, if indeed the baby survived its birth–I will check on them tomorrow), and I will let her tell those in as much details as she desires to share.

After returning from the hospital, and after my class was over, we ate a quick lunch of rice and beans and vegetables, and then hopped onto a moto-taxi to spend a few hours at Azil, a feeding center for starving children and a hospice center run by the Sisters of Charity (Mother Teresa’s order). The nuns there wear the traditional white robe and head cover with blue stripes. Teresa and I found our way upstairs to a series of connected rooms on the second floor of the compound. About thirty or forty toddlers and young children sat in small plastic chairs against the walls in the hallway, having just eaten their 3:00 meal (likely protein porridge). There was a mixture of emaciated-appearing children and those who were extremely bloated with huge, round, firm bellies (indications of kwashiorkor, or protein calorie malnutrition). Some were so edematous that their eyes were almost swollen shut. The children were all sitting quietly and patiently in their chairs in the hallway, which is atypical behavior for children this age but common in institutionalized children. Most of these kids had families who had brought them here for care and feeding for a temporary period of time, and once they were well again, they would return home. The families are allowed to visit once per week on Mondays, and the children who are well enough return home on those days. This being Tuesday, new children were being brought in, and they were all lined up in chairs waiting for an examination by the doctor. Some of them had wild looks of confusion in their huge eyes.

We moved on into the room with the youngest babies and sickest children. About twenty old wire cribs filled the room in rows. Each crib was lined with a plastic square covered in a cloth the size of a pillowcase, for easy changing throughout the day when the babies wet through the cloth diapers most of them wore without plastic covers (though a few tiny babies were in huge disposable diapers many sizes too big), or when they had diarrhea and got their clothes and sheets dirty. Several of the babies had thick, chesty coughs. The nuns invited us to sit down in short chairs they pulled aside for us, and pointed towards the cribs encouraging us to pick up a baby to cuddle. We each scooped up a little one and sat down. The first baby Teresa held was somewhere between nine and 18 months old (difficult to guess because of the malnutrition), and she kept trying to nurse at Teresa’s breasts. She appeared blind with some cognitive and motor delays, and she was covered in burn scars. It was heartbreaking. I held several babies, and when one fell asleep, I would put her down and pick up another. I held a four-year-old girl named Marielil the longest. She was the size of a young toddler, and she reached up her rail-thin arms to me from her chair and begged to be held. When I cuddled her, she kept calling me “Mama, Papa,” and when it came time to put her down, she would not stop crying. Walking away from her in her crib, reaching out for me with tears running down her cheeks, nearly ripped my heart out of my chest. Teresa and I also both held a young infant who seemed to be less than a month old.

There was minimal stimulation in the room, and some serious attachment issues. A lot of the babies didn’t want to be touched or picked up when I offered, though one enjoyed playing games with me (copying facial expressions, and giggling hysterically when I told her my name in Creole–I guess she didn’t expect the blan to speak her language!) but refused to let me pick her up, and I didn’t push it.

There were no toys in the cribs, but there were a random assortment of toys and religious artifacts on the walls, including a shelf with a statue of the Virgin Mary beside one of those giant plastic baby bottles used to give baby shower favors in. Curious.

I am not sure how I will go to sleep tonight thinking of that little girl in her crib begging me to come back for her. I have so many feelings about the experience. Those babies are there because of poverty, malnutrition, disease, because of political corruption and historical occupation of their country, because of war and greed, because of everything that is at the root of all of the problems in the country. I know there are such babies in Seattle, as well. This is not an isolated problem. But to see about 80 babies and young children separated from their families for weeks to months at a time during critical periods in their development is just heartbreaking. And the problem is so much bigger than anything I could possibly to do fix it. So I go, and I bear witness, and I get dirty, and I snuggle the hell out of those babies, and I leave when I must, but I leave changed at a molecular level. I cannot unsee what I saw there. Some of those babies will die, and some will survive and return home to families who cannot feed them food that helps their minds and bodies grow, and the cycle may repeat itself.

I had such a strong sense of being in a place when Teresa and I were on the motorcycle on our way to Azil. I saw the beautiful landscape in front of me, felt the breeze on my face, held tightly to the waist of the moto driver and felt Teresa holding tightly to me, saw the people and the goats and pigs and chickens wandering the streets, felt every bump as we drove over it, and noticed the warmth of the sun causing hot beads of sweat to trickle down my back. I was so very present, so very HERE. It is a moment captured in my memory that I plan to return to again and again.

So much of what is here is not up to me to change. I had another profound moment in the classroom this morning, sweating bullets in front of the class. I realized in a deep way that I was here for them, for the students who will become midwives and will scatter throughout their country and do more good here than I could ever hope to do. I am here to support this program, whose mission is to make more midwives for Haiti. I will go back home in 12 days, and I will continue this mission long after I return to my own practice with my own patients in my own hospital where I do not have to bring whatever equipment I need for that day.

Tomorrow, though, I will spend my first day at the hospital. Anything I plan to want to use, I need to bring. I packed a backpack and a fanny pack full of supplies. I am impressed with how much I could fit into a medium-sized fanny pack! From memory, I know I had the following in there:

  • A doppler
  • Doppler gel
  • Several pairs of sterile gloves
  • Sterile lube in packets
  • A blood pressure cuff
  • A stethoscope
  • A full-sized bottle of Purell (as water for handwashing is unpredictable)
  • Misoprostol tablets in a ziplock baggie in case of hemorrhage
  • A bottle of lidocaine
  • Suture packets
  • Gauze
  • A couple of needles and syringes
  • Tubes of erythromycin eye ointment
  • A cord clamp
  • A watch
  • Alcohol swabs
  • Three drapes to go under women for deliveries (cut from unused delivery gowns)
  • A gestational wheel
  • A tape measure
  • Some cash (a $5 and a few $1s)

All of this fit into my fanny pack! In addition, in my backpack, I have some blankets, a breast pump I assembled yesterday from random pieces of donated pump parts (to take to the woman who delivered preterm by cesarean section today), a box of gloves, and a number of other supplies.

I am nervous, because I don’t know what I will face or if I will know what to do. But I believe in myself, in my skills, in my knowledge, in my ability to stay present in intense situations. I know that much of what I will encounter will be outside of my control. But what I can offer, I will give wholeheartedly.

I feel like that list of items in a small bag is a metaphor for how this trip is “packing it all in.” I am cramming so many different experiences into such a short period of time, wedging them down, to be lived now and accessed later as memories that will serve me for a lifetime.

I have no photos to share today; it seemed most respectful to the children and the nuns not to document our presence there, and photos are not allowed in the hospital compound. But my heart is full of images that it will never forget, and hopefully I have transmitted some of them to you. They say a picture is worth a thousand words, so hopefully these 3500 or so words will give you a few pictures’ worth. 

If not, you might just have to come here and see it for yourself.