Tall, Tall Shadow

I can’t stop listening to this amazing song from Basia Bulat’s new album of the same name. I first heard it last week on Jian Ghomeshi’s show Q while driving home. It came on just as I was pulling into the driveway. I turned the engine off and sat mesmerized, my heart in my throat for the next four minutes. It came at just the right time…I’ve been struggling with the abrupt switch we’ve had here between summer and fall. I’ve been listening to this album every day since, letting the lyrics sink deeply into my bones:

“Take it to heart, you can’t run away when you know that the tall, tall shadow is yours…”

Disclosure: There’s always been something about this shift in the wheel of the year that tugs deep within, sometimes uncomfortably. I know I have a history of seasonal depression. And it’s true that right now I feel tender. Half-way across the country, a beloved elder in my family is journeying closer to the end of her life and I hate that I can’t be there right now to hold her hand.

The rains are coming and the light is fading into the endless gray that characterizes this region of the country during winter.  I try in vain to re-write the script in my head about how I deal with the gray, despite nearly eight years of evidence that this time of year has always been a struggle. If only I could think myself into a more positive attitude, I tell myself…but every cell in my body just wants to embrace the slow, dark melancholy rather than fight it. What I really want to do is channel my inner grizzly bear, find my cave, and go to sleep for the next six months.

Instead, I up my vitamin D and dust off the sun lamp and dive into a term that is based around chronic and end of life care. One of our term-long assignments is to read the blog of someone who is dying. I find myself vacillating between wanting to cry and wanting to scream. Chronic care brings up a whole slew of emotions for me–so much of it involves diseases that to me exemplify all that is wrong with our so called “health care system”.

My clinical instructor (a nurse who I respect and admire deeply), said that if he could sum up the experience of chronic disease in one word, it would be spirituality. More often than not, he sees chronic disease as a journey to find meaning in one’s life. The midwife in me totally understands this and can even see the potential beauty and transformative power of this experience.

But right now, I find no satisfaction or peace in this framing of chronic disease. My fellow students are all so excited to start clinical, for the opportunity to start feeling like a “real nurse,” to “get their hands dirty.” This is what I say, too, because it’s easier than telling the truth.

The truth is that thinking about chronic illness makes me feel angry, and not just angry, but hopeless. In my mind, the devastating prevalence of chronic illness in our country is not just a woo-woo opportunity for spiritual enlightenment on the individual level. That’s a high price to pay for some level of self-growth. In my mind, chronic disease is also the direct failing of a medical system that prizes compartmentalized care rather than holistic well-being. It’s the result of a system that prizes allopathic medicine over naturopathic medicine. It’s the legacy of deeply rooted historical disparities that target people of color in low-income communities. It’s a systemic failing on a grand scale to adequately address the life-long health care needs of an entire country.

I don’t see spiritual awakening in diabetes or emphysema or renal failure. I see a fucked up health care system driven by a senseless greed that prioritizes profit over true health. And because I’m tired and it’s fall and I haven’t found my groove yet this term, I question whether I can actually have a meaningful impact on any of it. This is when I start to question whether I will ever feel truly satisfied as a clinician when the systemic issues stare us in the face. But I think this will always be my struggle, one of my many “tall shadows” that I will continue to run away from until I can learn to make friends with it.

“Take it to heart, you can’t run away when you know that the tall, tall shadow is yours…”

[Friday Wrap Up]: 22

So many interesting items in the news, it’s hard to keep up with it all. Here’s what I’ve been saving:

American Way of Birth, Costliest in the World

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute thesingle biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.

How Long Can You Wait to Have a Baby? I’m sure this is somewhere in the minds of many of the midwifery students out there in the world…

The widely cited statistic that one in three women ages 35 to 39 will not be pregnant after a year of trying, for instance, is based on an article published in 2004 in the journal Human Reproduction. Rarely mentioned is the source of the data: French birth records from 1670 to 1830. The chance of remaining childless—30 percent—was also calculated based on historical populations.

In other words, millions of women are being told when to get pregnant based on statistics from a time before electricity, antibiotics, or fertility treatment. Most people assume these numbers are based on large, well-conducted studies of modern women, but they are not. When I mention this to friends and associates, by far the most common reaction is: “No … No way. Really?

Getting Men to Want to Use Condoms I would love to think that some new creative condom will help increase use of contraception…but honestly…I think it’s gonna take more than condoms, no matter how cool.

Profiting from Pain This is mostly a placeholder for me to remember, once we get to opioids in pharmacology.

Disabled People Say They, Too, Want a Sex Life, and Seek Help Attaining It

But many disabled people, including Ms. Rebord, believe that they have a right to sexual assistance, a psychological and physical means to overcome their inhibitions and empower them to find love.

Marcel Nuss, a severely disabled father of two who breathes with an artificial respirator, is the author of “I Want to Make Love.” The book describes his personal fulfillment through love with his former wife and a sex life with escorts. His experiences, he said, persuaded him to support the use of sexual surrogates.

Institute for Healthcare Improvement’s Open School: as if I need more reading…but still!

Native Generations

I was going to write about this in my [Friday Wrap Up] for the week, but an hour later it became clear to me that this deserved to be its own blog post. So, with a full heart, here it is.

A friend of mine shared this video exploring the Urban Indian Health Institute’s Native Generations project, which aims to increase awareness about disparities in AI/NA infant mortality. The video eloquently argues that there is value in prenatal and postpartum support that is culturally relevant to the needs of the AI/NA community–that in fact, this kind of support is a crucial piece of promoting strong, healthy families. The history of forced removal of AI/NA children from their families has resulted in several generations of the community being disconnected from their cultural heritage and parenting traditions, exacerbating the health disparities that are prevalent in Native communities across the country.

One of the goals of the UIHI’s project is to create safe places where the AI/NA urban community can come together to rebuild those connections. They understand the interconnections between physical and emotional health on both an individual and community level. Again, the power of group care and support is evident throughout this video. These are the spaces where new parents feel supported in their own journeys, where they can acknowledge their whole selves and receive health care that is not just “culturally competent” or “culturally sensitive,” but culturally affirming.

It makes me tear up a little just thinking about it, because as a Korean adoptee, I couldn’t help but be struck by some of the parallels between the practice of removal of AI/NA children and the trans-national/trans-racial adoption. A second generation of Korean adoptees in both the US and Europe are now growing up and becoming parents, trying to figure out how we want to raise our children. We straddle several cultures and also have our own unique adoptee culture…but I know several adult adoptees who have spoken about that deep longing that emerges upon becoming a parent to reconnect to their own roots. It’s very powerful stuff. Jerilyn Church, former ED of the American Indian Health & Family Services, is quoted in the video

Many of our families are second and third generation removed from our homelands…[they] are grandchildren of those who survived boarding schools. I find a real reverence and respect for that history and all also this collective longing to heal that history.

I think there are many adoptees who would recognize that collective longing–it often emerges when we become parents ourselves and are faced with the reality of a huge missing piece of our family history that we can’t pass on to our children.

To be clear: I am not saying that trans-national adoptees face the same systemic oppression and disparities that the AI/NA community does. Adoptees often benefit from white privilege and in fact, adoptees are the unwitting beneficiaries of an immigration system that favors them and their (often white, middle and upper-class) parents over the many thousands of immigrants that struggle to make it in the U.S. But, I do see parallels in the experience of cultural disconnect, and it is from this place that my heart really resonates with the programs that the UIHI are creating to re-establish that community and support new families. This is a video that is going to stick with me for a while…and I think it is going to deeply inform the way I approach my work as a midwife working with families during the childbearing year.