Climate Change

My work schedule is pretty great-- I work Tuesdays, Thursdays, and Fridays.  So Monday off helps to ease into the week, and Wednesday off helps to break up the "work week."  It's pretty awesome.  Can't complain.  More about the actual work in a bit.  But this morning, seeing the second snowfall in the past week coming down and highs expected only in the teens, I decided I probably wouldn't be going out for the day.  Over a hot cocoa and toast breakfast, I settled in to read some local news on-line.

I grew up reading the Omaha World Herald-- it's the biggest paper in Nebraska, and we got it daily for most of my childhood.  Claire and I were usually most interested in the "Living" section, particularly the comics.  But as we matured we read other sections, too.

Aside from leafing through the paper at my grandparents when visiting, I haven't read the World Herald in years.  This morning I was most struck by the stark contrast in tone from the manner the news is presented, but even the content of the news! from what we are used to.  As if I didn't already know it, this just reaffirmed the dramatically different, conservative climate we now live in.  It's surprising how different two areas of the country really can be.  Here's two articles as prime examples:

http://www.omaha.com/news/nebraska/promote-meatless-monday-not-here-unl-says/article_ca6a4bb8-e044-5ad4-8c5b-57efeed8ac82.html

--(apparently, because "livelihoods are at stake," we cannot talk about the environment or our health here…)

http://www.omaha.com/news/legislature/i-think-we-just-recognized-gay-marriage-lawmaker-says-after/article_ec438da2-9d0f-54ff-a8cc-9491e4564730.html

--(as several commenters noted, how interesting that NE lawmakers find it more comfortable to acknowledge same-sex rights through gun possession rather than marriage)

And speaking of the climate… because that's what everyone's talking about here, the Midwest has been dumped on with snow.  Saturday through Sunday we got about 8 inches of snow.  It was a very pretty, wet, heavy snow which caused several school closings.  Jon and Estrella both were fascinated with the snowfall, as it was the most significant snow they'd ever seen.  Jon  also got in on his first snow shoveling experience!  Later, doing the boy-playing-in-snow thing driving/ sliding around the neighborhood in 4WD, he observed, "Now I see why most people are out with their snow blowers!"  I'm not that used to driving in snow in my little car, either, so I was grateful to head to work on a day when most roads were plowed.  Today again many schools are closed due to the new snowfall, and again conveniently and cozily, I get to sit inside and watch.

View from our front door on Sunday-- you can barely see my car in the driveway!

These daffodils I dug up from our garden in Petaluma, as they were just starting to put forth sprouts in December.  I brought them in a pot, anticipating they might bring needed brightness to our home in wintertime Nebraska.  The first bloomed the day it started snowing!  View from our kitchen window to the backyard (see the trellis from our wedding?)

Estrella watching the snow, fascinated

And speaking of work!  So I've now been orienting for about 2 weeks.  It's been a nice, slow orientation process-- as in, yesterday was the first day I saw patients on my own.  And I'll still be shadowing patients at the other location at the end of this week!  Tuesdays and Thursdays I am at Community Alliance, a wonderful organization which provides mostly social services for adults with mental illness.  They have departments for homeless services, acute needs clients (those who have required significant inpatient stabilization), their own residential apartment units, and most significantly day programs.  Every day during the week they serve breakfast and lunch, with an extensive schedule for groups (which of course warms my heart, as groups are where it's at!!  no matter what the population, from "Group" in Residency to shared medical visits in clinic, the sharing of mutual experience is where we gain our sense of community and shed social isolation).  Every hour there are 4-5 group offerings, with such diverse themes as "Understanding Your Diagnosis," "Art & Poetry," "Trust 101," "Science," "What's Up, Doc?" and, one of my favorites, "In Your Dreams."  I sat in on "Schizophrenia & Schizoaffective Disorder," where they were finishing up on discussing delusions and moving on to hallucinations, and the next day "Attitudes of Hope," where the topic of the day was "using humor in times of darkness."  The last half of that group was everyone sharing jokes which was, as you can imagine, in itself darkly humorous.  It was great.  I loved it.

Community Alliance:  http://www.community-alliance.org

So Community Alliance (CA) is full of amazing people who have been drawn to do amazing work.  And tucked to the right, just past the front door, is our little clinic.  Two years ago CA received a grant to fund a primary care clinic for their client population.  While all of their clients have a psychiatrist (it's a requirement for the program), few had regular primary care.  Recognizing the need to help with out of control hypertension, diabetes, and so much more, the clinic was born.  They approached One World, the community health center which is my actual employer, to fill this need.  I've been brought in as an MD, as prior it was only staffed by an NP.  When I am there I am the only primary care provider, surrounded by support staff:  an MA, RN, 3 health navigators, a wellness coordinator, the program director AND a full time psychiatrist.  Six patients per half day is the max scheduled.  While granted there are more complexities in helping with this population, with such an army of support, it feels amazing.  The patients aren't so different from those we all have seen in community health centers.

One World:  http://www.oneworldomaha.org

I work at One World on Fridays.  I'll start out prior to maternity leave with a full day of regular clinic, and on my return do half a day regular clinic and half a day of acupuncture.  I'm anticipating this may expand to a full day-- if demand/ referrals are what they should be.  One World is indeed impressive in their mission and what they offer.  Fully dedicated to improving health in their community, the largely Latino South Omaha, they operate three low-cost housing units (one for adults, two for seniors) and, my favorite, own the Community Learning Center, which among other programs provides low-cost ESL classes with free childcare.  They've expanded to several new sites in the past decade in West Omaha, 4 schools, and are now discussing rural sites.

The clinic environment is… well, it seems a lot like any community health center.  Fortunately or unfortunately.  Chaotic, rushed, but with friendly staff all around to help.  Instead of Vocera they use Walkie Talkies (a bit humorous) between patients to communicate their patient's needs prior to moving to the next.  The EMR here is NextGen which has left me really missing ECW and all of the work Danielle Oryn did to make it user friendly and streamlined (e.g. there is nowhere to free text PMHx or Social Hx.  I can't see meds on the main screen, but must go to a different module to order meds, then enter again if I want that to show up in my note.  No templates!  No stored physical exam findings!  And the screen is all black, white, and blue).

And, having shadowed 3 physicians there with very different styles, there is a consistent use of medication for this, that, and everything.  Which is not that different from the entire country's health system mode of operation, but… it only takes a few times to see someone on adderall, valium, risperidone, and morphine to get an idea of what is (and is not) happening here.  I'm sure I'll get used to things.  And make my own way.  Already I've had different staff members voice some sort of excitement that I do acupuncture and "holistic medicine."  I had a patient yesterday at Community Alliance who'd gotten herself off all psych meds and was doing great (seeing on her own that the depression diagnosis and meds that started at 15yo were more the result of the trauma she'd experienced than a chemical imbalance) who said, very hesitantly when I asked about her diet, "Um… I do paleo?"  As if I wouldn't recognize it or would ridicule it.

And then I have to laugh at myself a bit, comparing these experiences to my friend Nicki's experiences in Rwanda as she works to establish an ER residency program there (she has a blog, too, where I partially got the idea!).  These cultural differences are minute compared to those she sees everyday.

And then… a little baby talk.  Baby boy is kicking and growing.  I had been freaking out or… we'll say "hyper focusing" on his position, as our first midwife appointment two weeks ago he was transverse.  Reading online, especially the very detailed information on the website spinning babies.com, I started to get nervous about him not being head down by 32 weeks.  So every night I was trying to check his position (w/ an anterior placenta, a little harder… and it's hard to be objective when it's your own belly and baby), and doing all these inversions and pelvic balancing exercises.  Last night was our second midwife appointment, and I was happy to be reassured his head's in the right place.  So.  Yay.  :)  There's still apparently a lot of exercises I can do to help him not be OP, but maybe I can relax a little…

Estrella is such a sweet cat, cuddling up w/ my belly.  (Don't fret, that IS a bio-dot mat you can sort-of see under my shirt, protecting baby from the computer's electromagnetic frequencies!!  :)  

Now I'm going to go bundle up like I used to on wintry days on the farm, head outside, enjoy the crisp weather, and try my own hand at snow shoveling… it's been awhile for me, too!

We've Arrived!

Good morning!  We finally got internet set up yesterday (with smart phones, these days it doesn't feel as urgent), so I thought today might be a good opportunity to write my first post.  Tomorrow is my first day of my new job, too.  So perhaps a good time to reflect.

We've now been in Nebraska for nearly two weeks, having pulled out of our beloved west Petaluma home Monday, January 5th.  The preceding weeks were really crazy.  The weekend immediately prior to the move was particularly emotionally messy.  Basically a peak of weeks of tension and stress that Jon and I had been experiencing both individually and also in our relationship with each other.  Both my mom and his dad were there, adding elements of family patterns.  All the deep fears came out in the way they do in the eye of the storm, especially as I've found during pregnancy.

But, as always, a new day broke with healing and promise.

Our last Dillon Beach sunset… for awhile

Everything was cleaned (even the 2 year old meat juice leak in the fridge I never cleaned, thanks Mom!) and packed, and even, thanks to our dear friends and neighbors, our herb/ flower garden was completely cleared out.  I was more relieved than sad about the latter, as the grouchy owner of the house had, to me unbelievably, requested we remove all plants!  The landlord modified this by telling us to "do our best," but in the end I was happy to ensure that at least my beloved plants would find homes with caring hands.  Some of you have a few of these plants-- thank you for loving them!!

Our cross country drive went relatively without incident, other than creeping along at times:  Jon and his dad drove the giant 26 foot Penske truck pulling my car behind, while Mom and I followed in Jon's SUV.  The truck would fall to 30-40 MPH going up any significant incline, but that was okay.  It was probably just what we needed, to have some quiet, contemplative time to rest and have an isolated mother-daughter space.  We also had Estrella in the car with us, with a nice little nest for her litter box and several comfy perch spots.  I dosed her with Bach's Rescue Remedy for pets, which I'm a totally believer in-- she was a little trembly the first day, sitting on my lap mostly while I was driving.  After that, she seemed to adjust and be as comfortable as she could be given the circumstances.  Particularly because we were staying in "pet friendly" hotels, and I imagine the multiple other pet smells there were also grating her nerves.  Most hotel clerks said, "A cat?!  Mostly we have dogs."  Of course, because most people don't find it compelling to road trip with their cat.

One of Estrella's comfy spots in the car, with Mom driving

Neither she nor I are sure about the concept of cat walking...

We arrived in Omaha late afternoon on Thursday the 8th, as dusk was falling and the temperatures were dropping from 15 degrees on down.  While waiting for the guys in the truck to arrive (we'd gone ahead), Mom found a broom and swept the snow from the sidewalks and driveway (at least 2 inches)!  And then Mom's cousin Rusty and his 4 very able-bodied sons, all with various shades of red hair, a veritable "Army of Rustys" arrived, along with a handful of other family, and our truck was unloaded in record time-- despite the dark and frosty weather.  We were officially welcomed with open hearts, hearty constitutions, and strong arms.

Since, Jon and I have slowly been unpacking and "recalibrating," as I've been calling it.  Settling and testing out the new soil our roots have found here.  Our hearts have found their way back to each other's.  As the stress hormones fall, I've had days of complete exhaustion-- one day where I barely did anything, just sat on the couch and read and drank tea.  It's hard for me not to do things, particularly when it's clear there is so much to do.  But I appreciate the lessons of pregnancy, the leniency it's allowed me to give myself (because, of course, right?  we're hardest on ourselves with our expectations and judgement, etc. etc.).  It's still a challenge at times to overcome the hardwiring, though.

The kitchen, shortly after arrival.  Super fancy appliances and cabinets!

After the snow has thawed… our new home!  1819 N. 49th St, Omaha, NE 68104

Our living room, looking towards the backyard and peeking through to the kitchen.  Everything still in transition.

I also feel grateful the enormous task of moving across the country that loomed large for my pregnancy to this point is generally past.  The move made both a physical and emotional separation between the "here now" in Petaluma, and the "future there" in Omaha.  I now feel like I can more completely focus on the birth as the most exciting thing to occupy my thoughts and preparations.  And the baby is moving more than ever, so he's reminding me of his presence quite actively these days.

I didn't feel much of a connection to my prenatal provider in Santa Rosa, and felt mostly like I was being my own guide through my first 7 months of pregnancy.  I highly anticipated my first appointment here at the only free-standing birth center in Nebraska, which was last Friday.  It already feels dramatically different to see the location where I will give birth, to begin relationships with the people who will help with my birth.  There's a few things I'd still like to work out with how I feel about the place, but more about that later.

Tomorrow is my first day of work!  They'll start me out with a fairly slow orientation process it seems, just 3 days a week which I'll stick with even after returning from maternity leave.  My "sabbatical" time now draws to a close.  It wasn't completely without work, as some weeks I worked a fair amount, but it was removed from the feeling of much responsibility toward my employer.  A lot more freedom of time.  Although I had many busy plans for activities, conferences, classes, courses to fill this time, I completed few of them.  Instead I started my pregnancy.  Thought about things a lot.  Rested abundantly.  Joyfully spent last days in my first real garden of my own.  Harvested herbs and seeds to carry through the winter and to future seasons in our new home.  Preserved the fruits of the trees.  Read books both silly and informative.  Talked with cherished friends.  Opened my heart further to my husband in our first months of the discovery of marriage.

In other words, just the work that needed to be done.

30 weeks and 4 days