Grief: Actual and Anticipatory

As I sit from my newly fashioned work from home station this morning I am overcome with grief. I watched a video from my littlest children's teachers on YouTube. While the video was upbeat and loving, it made me sad for my children. Sad that when they said goodbye to them before Spring Break, they did not know it would be the last time they would see them in person this school year. That it would be the last time they would be their teachers. I am saddened for my children. They love and need their teachers and school friends. They thrive on the structure and their brains hunger for what in person school provides. I have taught college students for almost 3 years now and I must admit that I am scared to death of homeschooling my kindergartner, 3rd grader, and high school junior.

I feel grief for us all, for the normalcy we have lost and the connections that kept us feeling love from all of those around us. While we still have that love and connection, there is something lost through a virtual hug and a computer screen.

I teach undergraduate nursing students. We faculty have been tasked with the unenviable task of transitioning the remainder of the semester online while still meeting the necessary requirements for our accreditation and board of nursing. While we have done this, and done it well I might add, it makes me sad. One of my clinical groups had taken to calling me "clinical mom" because they said I was kind and looked out for them mind, body, and spirit as they navigated learning to care for patients, but that I wasn't afraid to call them out if they were out of line. One of them, H., said "You're like our mom, you want us to succeed, but you'll ground us if we mess up!" I loved that because they could see that I had their best interest at heart in all that I did. While I still have their best interest at heart, I wish I could give them a hug and tell them everything is going to be okay on the other side of this. I don't know that. I was jarred yesterday when I watched a Facebook video about a 44 year old New Yorker that is a marathon runner and in excellent health who had to be placed on a ventilator. I am 44 and not a marathoner. Like my own family, I wish I could hug my nursing students and tell them it was going to be okay. We are training them and sending them out into a new version of the healthcare world that none of us have ever seen. Given the projections of the path of this disease, and what I know of epidemiology, I think the worst is in front of us. I pray every day for industry to magically accelerate the production of ventilators and PPE to keep up and catch up. I pray that they do.

This morning I was supposed to have a meeting with my PhD Dissertation committee chair and co-chair. Due to a technical error on my part I deleted the meeting and it didn't happen. It's been rescheduled. But, I have grief for what my dissertation proposal and research process is going to look like. I have lost momentum in the overwhelm of transitioning everything online and having my kids at home with me full time. I don't know what is going to happen with my PhD. I'm not giving up but it isn't high priority for me right now. Quelling the fears of my students and my children is. But I am sad for all that has been and will be lost.

I was present and remember clearly the morning of April 19, 1995 when a coward committed the Oklahoma City Bombing. I remember watching the news and seeing the nurses from St. Anthony's running towards the building to help. I watched the second plane hit the second tower as the realization that America was under attack washed over me. I remember seeing the first responders and healthcare workers going in when others were running out. I was a member of the Oklahoma Army National Guard and helped in the search and rescue/recovery efforts after the EF5 tornado that devastated a large portion of the state in May of 1999. I was part of a medical field unit that helped. We ran in when others ran out. I am honored now to be a nurse and be part of the efforts to help. As all the collective memories of tragedy have taught me, this will be okay. We will persist, we will see the best in people and the worst in people, and in the end, those of us that are still standing will be battered but we will thank God for our unconquerable souls.

But, there is grief. There is grief because I know that for my all my kids, my biological kids as well as my students, there will be innocence lost and it will be replaced with the unfiltered reality of tragedy. It will change them, it will change us all. Tragedy and heartache changes us all. It toughens us. It forces us to add another layer of steel to the armor we wear into our day to day lives. And so, I grieve. Because I want them to do what is needed so that they can carry on, but I don't want it to harden their hearts. I grieve for what could have been. For what was lost and will be lost.

Ingrid

Invictus

Out of the night that covers me, black as the pit from pole to pole, I thank whatever Gods may be for my unconquerable soul. 

In the fell clutch of circumstance I have not winced or cried aloud. Under the bludgeonings of chance my head is bloody, but unbowed. 

Beyond this place of wrath and tears looms the horror of the shade, and yet the menace of the years finds, and shall find, me unafraid. 

It matters not how straight the gate, how charged with punishments the scroll. I am the master of my fate. I am the captain of my soul. 

-William Earnest Henley

This is where you find yourself

Be the change...this is how I try to bring myself back into focus. When life is getting me down, when things are wrong, first...I lose it a little bit. Then I calm down and say

"This is where you find yourself. That's not changing. This sucks. What you do about it from here can make it better or make it worse."

Sometimes, in spite of all the positive self talk, I make it worse. I gripe at my kids, my husband, myself, and I make it worse. I get angry at the world.

But on a good day, on a good day, my positive self talk is downright helpful! On a good day I don't miss the forest for the trees and I deal with it well. And then a few minutes or a few hours later I look back and say
"Good job there Ingrid, well done!"

Then, there are days when I look at the enormity of the change I wish to be for the world, and I feel hopeless, overwhelmed and that there is no way I can make a difference. It is on days like that that I think of where I will be when I die and that my efforts, that I will have worked so hard for something that winds up being just a drop in the bucket. Most of the time I feel sad, overwhelmed and disconnected. Then I get my big girl panties on and go try and "be the change" and I come home feeling defeated.

So...how do you find purpose, how do you find the fuel to keep going? You change your focus. Most of us are not greatly impacted by the 'biggies" as I like to call them. Albert Einstein, Oprah, Mahatma Ghandi. Those people are famous. They have said or done some things that people like. They have contributed to humanity as a whole. But those roles, and the NEED FOR THEM, are few and far between. Ghandi said one of my favorite quotes, but Ghandi is not impacting my life. It's the view of the world that I feel kindred with for some reason that resonates with me. We venerate and mourn the famous, not because we knew them, but because they helped us to know ourselves. Oprah Winfrey has not been a profound influence on my life, some of the things she has said and done have resonated with me or lead me to seek out information about something that helped me grow. But lets be clear, that was me and GOD, not Oprah. God may have used Oprah to help me grow, but don't get stuck thinking it's Oprah, because it isn't. I think she'd agree with me.

But the Einstein, Ghandi, Oprah effect is what leads most of us to be unhappy. We think that making a difference for a huge number of people is the only way to matter. This is why so many people feel like they don't matter. If you focus on all the things that you are not, you'll never grow into the things that you are good at. Instagram, Facebook, Twitter, you are not helping. People are posting the awesomeness and not the crap. And comparison is the thief of joy! I was super excited and pleased about my week in Colorado with my family until I saw someone else taking their 4 kids on a month long European summer vacation. All of a sudden I was the worst parent who didn't have that kind of money and somehow because of this my kids were missing out. FOMO! Fear of missing out!

But, here is the thing, YOU. ARE. NOT. MISSING. OUT! You have all the things you need. If you are reading this, you are pretty well off. You have electricity and a computer, you know how to read, etc.

YOU ALSO MAKE A DIFFERENCE! Most of us will never be Einstein or Oprah, but we can be us. We will never be Jesus, but we can be his messengers. Oprah doesn't do all the things she does alone, but she gets all the credit. Jesus gets all the credit, HE SHOULD.  But here is the thing. You can be the change you wish to see in the world. But do it the way Jesus did it. He didn't ask for glory, he didn't have any glossy magazine covers, TV shows, 1.5 million followers on Instagram, he simply went about doing the work and BEING the change. That is SUPER, Mega, ultimately hard. That's why it took GOD to do it. But you can work on being Christ like. When people were like "are you the son of God? Oh yeah, you're so special??? You're the messiah??? Show us?" But he didn't perform on command, he didn't need to. He was GOD.

That is the thing that is amazing. He could have shown them all, been all like "look at me, Yaweh in the HOUSE!" but he didn't. He was humble. He ate with the prostitutes, the lepers, the tax collectors. The undesirables of society. Why? Because looking good in public and being nice to people that are like you is easy. Being the change you wish to see in the world when it is hard??? Now that's the challenge.

This is why a Christian walk, or just a walk of self improvement or being an altruistic person is HARD. One, because the people who need the love, the people who need the compassion, look a lot like jerks and suck a lot of the joy from you. Hurting people hurt others. Seeing through all of that is the challenge. Seeing the person who is screaming and yelling and telling you how you suck, looking beyond that and seeing their pain and deciding to help them, that is where the real challenge lies. Being kind to those that are kind to you is easy, no growth there. Being Christ like, loving them in spite of their imperfections, not because of them, is where you grow.

Here is the kicker. You don't do it for THEM. You do it for you. You do it for GOD, because that is your purpose. You do it so that they will see the light of Christ through you, but you also do it for yourself so that the light of Christ shines brighter in you so that you can break through more darkness in the next person. You do it for yourself so that the light of Christ will chase away the darkness in you. You need that love of Christ too.

But, when you get bogged down in the fact that you aren't making a difference and you might as well give up, that is when you need to tell yourself to buckle up. Maybe you make a difference for that one situation or that one person, maybe you don't. But it's what you do with that experience that matters. Do you spend hours or days ruminating about how you screwed up and how awful you are, or do you look at it and decide you're going to grow from it. The lessons that you aren't learning are the ones that will continue to be placed before you. Until you get it. How long will you keep repeating the same lessons? Until you get them.

So, when you look at the Utopian version of the change you want to be, of the life you want to create for yourself, make sure you aren't standing in your own way. Once you get those obstacles out of the way things open up. Be the change you wish to see in the world, not only for others, but for yourself.

The future of lactation credentials

I wrote a good portion of this back in July. Although the email survey from IBLCE has expired, the points still remain. I see people in person tell me this, I see this almost WEEKLY on Facebook how people believe that every lactation designation is equal. They are debating in the comments section about "I'm just as qualified as you are" or "the system doesn't allow equitable entry into the profession" or "they keep changing the standards."The point is, you can rage against the machine all you like, the machine is not going anywhere. 

Let's say you decide you want to become a nurse. LPN, start at the entry level. If someone who is lower on the socio-economic scale, or have challenging life circumstances that make working, caring for kids, and going to school exceptionally difficult, is the standard of entry into a school of nursing going to change? Are the pre-requisites going to change? Are the items you are expected to complete to pass a course or pass your boards going to change? Absolutely NOT. So, why do so many people say that our STANDARDS are the barrier to becoming an IBCLC? I don't think it's the standard that is the barrier. We must have a standard if we expect professional respect by other healthcare professions, as well as among lactation service providers. I think it is the ability to meet the standard that is the barrier. So what must we do then? Increase access to the things that are the pre-requisites to meet the standard. 

Are people challenged more severely by socio-economic status, those on the lower end are more underserved than those in the middle or on the upper end? Absolutely. But the thing is, standards cannot be changed. If they are, then you have no standard upon which to measure. You get this person getting special treatment, and this one not. Even more can cry foul. 

It took me 4 years to complete my college classes, 90 hours of lactation and 1000 clock hours of in person experience before I would even qualify to sit for my board examination. Then, at that time, they were only giving the exam once a year. So, after my 4 years of preparing, paying my $500ish dollars (I forget the exact amount, but it was no small some for our single income family), my examination opportunity (only once a year at that time) evaporated. 

I sat crying, seeing my dream die as the minutes ticked past on my cars dashboard. I lived in Houston and was stuck on an elevated section of the 610 loop, no on or off ramp for miles, and we sat there, at a complete standstill, for two hours. I later learned that a bus driver had a heart attack, rolled his bus, and thus blocked 3 lanes of traffic. Access was only given for emergency vehicles, the rest of us could just wait. This was before the era of smart phones, so I sat trapped in traffic, unable to move forward or back. I bawled my eyes out as I missed my exam window. 

When I arrived at the designated testing site, they turned me away. The snarky proctor made a point of saying "perhaps you should have planned better." Her caring supervisor advised that this contract was important to their institution and they couldn't jeopardize that to make an exception for me. I had to wait another 12 months and pay my $500ish dollars again. Where's the equity there? 

The thing is, as uncomfortable as that was, that was fair. Those were the rules, that was the system. No allowances were made. Whether I was late because of some MAJOR unforeseen circumstances, or whether I was late because I just overslept. They applied the rule of the law equally. I most certainly wanted those standards changed. Didn't happen. So, after 5 years, I sat for my exam and EARNED the right to put the credentials IBCLC after my name. 

When I received an email from The International Board of Lactation Consultant Examiners (IBLCE®) advising that they’d “like my opinion as they are exploring the possibility of creating additional credentials which reflect different levels of support for skilled lactation care.” My first reaction was “NO!” The world of lactation support professionals is already confusing enough. Then, I took a step back and thought for a few minutes. IBLCE is considering a way of UNIFYING all lactation service providers under one certifying body. And having two or three lactation credentials, instead of 52.

We are already struggling against so many obstacles to breastfeeding success for moms and babies.  Greater access to quality lactation care comes when we unite our strength. Yet we spend an enormous amount of energy fighting each other.

Isn't helping mamas and babies our real objective?

I am an RN, IBCLC. But I did not start there. I was a CNA(Certified Nurse’s Aide), then a La Leche League Leader, then a Licensed Practical/Vocational Nurse, then a Certified Breastfeeding Advisor, then an IBCLC, then an RN. I am now working on my MSN. If ever there were someone who has been stopped at every rung on the professional ladder, it’s me.

For much of the time I have seen that as a detriment. But in this case, it gives me an enormous amount of wisdom because I have actually BEEN that person in many of those roles. I know how it looks and feels from both sides of the fence.

I have been “just” the CNA, just a La Leche League Leader, just the Certified Breastfeeding Advisor. I have been given the title “Lactation Assistant” even though I was an IBCLC because I was an LVN and being a “Lactation Consultant” was an RN only job.

I have been told in many professional circles that I was not enough because I didn’t have the right letters behind my name. Many of us fear that we are not enough. Being told one credential is better than another taps deep into our core feelings of the need for acceptance. I have been there. I have been discounted and understand deeply the discord and resentment that can bring. That resentment of feeling “less than” and also the pride of “I finally got there, now I’m the best” can blind us to the journey of others, and at times, progress as well.

We all have a role to play, each one extremely valuable. Each one appropriate and accessible in their context. I am an RN. I look at the hierarchy in nursing and see so many parallels in lactation service providers. I have had most every job in nursing, I have had every role in lactation care. With each there is a scope, a value, and also, a limit. My role and scope as a CNA is needed and necessary.  However essential it was, the scope was not the same as that of an RN.

Having had all of these roles, I know how to stay in my lane. In my role as a La Leche League leader, I was given a clear scope of practice and a clear line not to cross. As a Certified Breastfeeding Advisor, I was not. In many of the lactation care provider roles, that line is blurred and sometimes, was never clear to begin with. This is largely attributed to the fact that every different title, designation, and certification each have their own scope, as outlined by their own certifying body, as interpreted by each person that holds said credential. When they go to their “higher ups” for clarification, that too is met with inconsistency. My role and scope as a La Leche League Leader was needed and necessary.  However essential it was, the scope was not the same as that of my role as an IBCLC.

I don't know what kind of reaction IBLCE got, but my guess is they got a lot of firm “NO's” from IBCLC’s. 

What are we to do, how are the blurred lines ever going to become straight? Giving IBLCE a firm “NO” and continuing to fight each other could be the biggest loss to the profession of lactation as a health care field. 

Just as there is ONE board of nursing. They certify CNA’s, LPN/LVN’s, RN’s, Nurse Midwives, and Nurse Practitioners. All of them are “nursing service providers” with different scopes of practice. We are being given the opportunity to have ONE certifying body, ONE board of directors, ONE vision for leadership, ONE certification source for lactation designations that will acknowledge the hard work, and valuable contribution of peer support, certified support, and professional support, all under one roof. Nursing professionals have ONE certifying board. ONE place to go for clear roles, rules, and expectations.

Just like there are national boards of nursing, all those standards are the same. But, where you go to school is up to you. Where you get your lactation education is up to you, and what standard that education meets will be clear, and will also serve as a pathway to IBCLC designation, if that is what you are going for. 

We have that opportunity here. IBLCE is making that an option. If you previously said NO, email IBLCE and say YES to IBLCE and UNITE the Lactation Service Providers!

Ingrid Dixon, BSN, RN, IBCLC