1. Fitzgerald, Laura MSN, RN, CNM

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A windowless hut and the smells of rotting mango and urine. An emaciated woman outstretched on a reed mat, her chin and cheekbones sharply defined. Untouched bowls of cornmeal porridge resting by her thighs, spoons cemented upright. Me, sitting next to her cloth-wrapped head, holding her hand, listening to her brother's slow, precise English. "It's her bowels. She can't keep anything in. She's stopped eating." Me, wanting to run, knowing I have nothing to offer her.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Kirsten Ullrich

Often while in nursing school I asked myself why I'd settled on this profession. In response, I'd conjure this scene, which took place a full two years before I decided on an intensive one-year nursing program and subsequent nurse-midwifery program. The memory grew clearer with time, more vivid, providing an underlying sense of purpose to my daily regimen of medical ignorance and clinical clumsiness.


At the time this event took place I saw myself as an inexperienced and unskilled white American immersed in an Africa I did not understand. I felt painfully unable to support this woman dying of AIDS. Nursing school seemed a simple enough solution. Plug an eager 20-something into a nursing program, convey her through the required classes and rotations, and watch an able professional pop out the other side.


But replacing life in an HIV-ravaged village with graduate school's more cerebral routine proved unexpectedly difficult. After two unsteady and grueling years as a health educator with the Peace Corps in sub-Saharan Africa, I had greedily anticipated a return to safe, structured studenthood. What bliss, to trade in my tin-roofed quarters for ivy-covered walls. I should have known better. The acquisition of nursing skills requires practice and frequent ego-deflating mistakes. Real learning occurs with human beings, not books. During my first semester of nursing school, I found few havens of familiarity or comfort. A simple chore, like taking blood pressure, paralyzed me when I had to do it in the presence of anyone but my assigned patient. Donning blue scrubs in order to play nurse required great effort. I was reduced to tears by an indecipherable urine dip, regularly defeated by the most prosaic clinical chore. Impatient, hoping to spare myself the agony of incompetence, I willed the slow, imperceptible transformation from nonnurse to nurse to occur instantaneously.


Meanwhile, I passed exams. Preceptors were generally kind and patient. But that nagging feeling of inadequacy persisted. I hoped that spending some time working in international health care would quell my growing anxiety that I'd chosen the wrong career. And so, last summer, with an official-looking RN following my name, I returned to Africa to work as a student nurse-midwife.


I palpated bellies, checked fetal heart rates, gave injections, and started IVs. Sewing skills dormant since childhood resurfaced with surprising deftness. After two weeks, I managed to get a handle on suturing ragged perineums. A woman frightened by the amount of blood draining from her groin could actually count on me to assist her. Maybe, I thought, I could do this. At other times it was too much. After a particularly stressful delivery-the cord wrapped twice around an emerging infant's neck, his mama squatting above the gurney-I stepped outside, desperate for sky and air. In a split-second maneuver I had clamped and cut the umbilical cord as the baby's head hovered at the perineum. He was born healthy, but now my hands trembled. Sweat dripped down my neck. Maybe I wasn't cut out for this nursing business.


My boyfriend called once during that month, a voice from across the ocean. I was in the middle of a labor exam. Leaning over an enormous belly, stretching a measuring tape from pubis to sternum, I heard the phone's ring from the pack at my waist. I raised my finger to let the woman know I'd be right back. (She had at least a few more hours of hard work before she transitioned into active labor.)


Removed from the maternity ward, I described a newborn who had emerged with a hand cupping her cheek in an expression of bemused wisdom. I talked of suturing and intubation. For those few minutes, I let go of my patient, sweating and squirming with contractions, awaiting my comforting touch. But I sensed a brand new itchiness as I spoke, an anxiety that hurried my speech. My Zulu patient, enclosed in an inner world of concentration and pain, could not be left for long. When I was back at her side, my internal gauges imperceptibly recalibrated. Time was now measured in fetal heartbeats, and the subtle in and out of my breath took its cues from the body before me.