A Report

“Mommy, what happened to this girl?”

I turn around to see my 7-year-old daughter sitting on the floor with the latest issue of Rolling Stone. In less than 30 seconds, she’s managed to flip from an innocuous cover featuring Dave Grohl’s uncontroversial face to the image of a girl, looking at the ground, her body covered in red handprints.

“Why is she sad?”

Do you remember where you were the first time you read the story about a University of Virginia student named Jackie? I do. I was sitting on the train, heading home from a long but mundane day at work. When the issue first showed up in the mail, I remember seeing something about “sexual assault” and “college” on the cover and thought, well, obviously, I’ll need to read that. I mean, it’s sort of one of my things.

But when I finally opened to the story later that day, I wasn’t expecting what happened next. I mean, besides nearly missing my stop.

Now, I work in a college health clinic. I’m one of the people that sexual assault survivors on a college campus might find themselves talking to, after. The fact that sexual assault is happening on our college campuses is not news to me.

But I don’t work in an emergency room. I don’t even work in the campus urgent care clinic. I’m the clinician you might see in a routine visit days, or weeks, or even months after it happened. When you finally muster up the courage to see a medical provider in the hopes that they can run a few tests and tell you that physically, at least, you’re okay.

What this means is that most of the time, before they even end up in my exam room, my patients have usually decided that they don’t want to file a formal report against their assailant.

When I first started working in college health, honoring this decision was hard for me to accept. Really hard. But prevailing wisdom won me over. We want survivors to feel comfortable coming forward to access all of our carefully planned support services, right? Wouldn’t mandated reporting and the specter of unsolicited disciplinary action serve to silence, to an unknown degree, those survivors who need help, but haven’t yet found the courage – and believe me, it takes serious courage – to enter into the unknown and very scary legal side of their already traumatic experience?

So instead, I would be a sympathetic ear. I would help them give a name to their experience, using the words “sexual assault” or “rape” if they hadn’t yet used it themselves. I would slowly and thoroughly walk them through all their options, from the medical side to the administrative side to the legal side. I would give them lists of phone numbers, or call them myself if they’d let me. I would tell them that, legally, I had to file a report (check out the Clery Act if you’re not already familiar with it), but that if they so chose, the report could remain anonymous.

The day after I read the UVA article for the first time, I found myself waking up in the middle of the night, unable to get back to sleep, unable get the story out of my head.

At first, I wasn’t entirely sure why. I mean, Jackie’s story is, without question, horrifying, and really hard to read. If you don’t find it affecting you in some way, well, no offense, but you’re probably kind of a bad person. Just saying.

But there was something else nagging at me about the story. And then I realized what it was.

That administrator that the author calls out, in no uncertain terms, for her – and by extension, her institution’s – inaction after Jackie came to her for help? The one that you, as a reader, find yourself condemning for being part of the system that fails to protect and seek justice for Jackie and other UVa survivors? The one that, for some reason, is seen by survivors as such an ally on campus?

I saw myself in that administrator.

Well, I mean, to a point. There are pretty strict confidentiality rules that limit what information medical providers are legally able to share with others. Even when it comes to discussing patient information with other university officials outside the clinic’s walls, signed consent on the part of the student is needed. But still. I bought into the spirit of the law here, not just the letter.

And then, a few months ago, I moved to another state. One of the only states in the country that mandates that health care providers make a formal report to local law enforcement (I’m talking the real deal, not the campus PD) every time they’re made aware of a “suspected violent injury”.

At first, I complained. All the native Californians I now work with, who never knew any differently, were a little baffled. Um, hello, it’s a crime, right? Shouldn’t we let the cops know? But this idea, that the best way to honor the survivor was to honor their wishes when it comes to reporting, was lodged in my brain.

And beyond the theoretical, I was afraid of what this would look like in real life. What about the patient who decided that morning that the most she was up for was a quick visit to the campus clinic to get STD testing? What would she say when her profoundly difficult – but clinically relevant and necessary – disclosure was met with the news that a full, non-anonymous report would be filed with the local police, with or without her consent? Would this idea of a mandated report deter survivors from accessing the care and services we might be able to provide?

And then, I started seeing patients. And guess what? So far? Not even remotely an issue, as it turns out. Every patient I’ve had to have this discussion with has completely, 100% understood. Even, almost, as if there’s a sense of relief in the decision being out of their hands. As if it clarifies the fact that it was, in fact, an actual crime that took place.

So that’s the me that read this article. The me that had already started to come full circle on the idea that initial university respondents to reports of sexual assault should be required to, at a minimum, formally report every act of suspected sexual assault to come to our attention to local law enforcement.

And that’s the me that found herself trying to figure out how to answer a first-grader’s simple question about a magazine article.

After giving some half-assed answer, shoving the Dave Grohl issue to the back of a tall dresser, and wrapping up bedtime posthaste (parenting fail, probably), I found myself thinking about the big girl my little girl will someday be, and the world she’ll be living in. Would I want the school staff tasked with keeping her safe and healthy to turn around and dump the decision of whether or not to report a potential crime back in her lap? Hell no. That’s their job.

If we, as university administrative and clinical staff, aren’t doing everything possible to protect the survivors, and ultimately, other students, under our care, then we’re not doing our job.

Advertisements

The beginning of the end/the end of the beginning

20140506-040538.jpg

The same thing happens to me every year.

I’m heading to work in the same sleepy way I start pretty much every day. (I wish I could say I WAKE UP EVERY DAY READY TO TAKE ON THE WORLD! but that would be a dirty lie. Plus, annoying.)

So there I am, riding the train with all the other groggy commuters as we all zone out, staring at the free paper the guy pushes in our hands on our way in, or at our various depersonalizing digital devices, or at nothing at all, eyes unfocused until the conductor calls out our stop.

Eventually, my stop is called. I get up, moving forward slowly with the zombie-walking masses onto the platform and up the escalator.

As I emerge on to the main level of the station – which just so happens to double as a footpath through campus – I remember that it’s not a routine, mundane day at all.

It’s graduation day.

And every year, the sight of those no-longer college students, those-not-so-young-anymore young adults, dressed in their grown-up best with black polyester gown flapping open in the late spring breeze, gets me.

Now sure, I may also have been known to tear up at a really well constructed Coca-Cola commercial, BUT STILL. It’s a pretty amazing sight.

I mean, think about everything this moment – wearing the respectable yet still-uncomfortable heels Mom insisted you’d need for job interviews and carrying the mortarboard hat you stayed up until 2am decorating with scrapbook material from Target – represents.

It doesn’t only represent the end of your childhood. It represents the beginning of the rest of your life – the part where you start down the path you’ve chosen over the past 4-6 years, and continue down that path until…maybe…forever? AND EVER? Let’s hope you made the right choice (nervous laughter). BUT NO PRESSURE. Enjoy your day!

Oh right. That’s where that glint of terror in their eyes comes from. It’s hiding behind the breathless anticipation of all the pomp and circumstance, sure, but it’s there.

There’s an exuberant finality to this Hallmark-approved milestone that makes graduation both really, really exciting and really, really scary, all at once.

When I was a kid, I always thought of adulthood as this time where you’d become A Thing – a doctor, a lawyer, the president, a rock star – and then you did that Thing for the rest of your life.

But speaking as a Certified Grown-Up (GU-C) myself, I think we need to rethink our thinking on this. Mentally committing yourself to one profession for the rest of your life at the age of 22 feels a little like preparing for years to climb Mt. Everest, finally making it to the top, and then pitching a tent (presumably a very small one) and staying there FOREVER.

Yes, graduation day is exciting. But it’s really just the beginning of the rest of your life – just like every day is the beginning of the rest of your life. (Except this one comes with a really good party and thirty years of loan repayment.)

I guess what I’m saying is that if you’re not sure you’ve found your Thing by the time you’re standing there with that heavily decorated cardboard square on your head, don’t let it get you down. Even those of us who thought we’d found our Thing by the time we graduated from college, or grad school, or insert-milestone-here, later realized that the person we’d become wanted to do another Thing altogether.

Because that’s life. Life is evolution. The person we are at 22 might not be the person we are at 30, or 40, or 55. Each of those people has learned some new stuff about themselves and the world, and the super fun thing about all of this is that each of those people gets to decide to change course and start doing a completely different Thing if they feel like it. It might not be easy, or cheap, but it’s your choice to make.

So with that, here’s to all my soon-to-be-former patients: enjoy the party, tell Sallie Mae I said hello when she comes calling, don’t forget to get that repeat Pap in 6 months – and in the meantime, just do the Thing you think you’re meant to be doing, right now. The rest will sort itself out in the end.

Dear too-many colleges: here’s why you’re next in line for a Title IX suit

ivy

Another week, another famous institution of higher learning in the news for mismanaging cases of sexual assault on campus.

This time, it was Harvard. The most common response, from what I can tell, seems to be summarized thusly: “Oh myyyyy – even at Hahvahd?” (eyebrows raised in surprise, mouth forming a delicate “o” of prim concern).

The morning the story broke in the local news, I happened to be having lunch with these two guys who work in administration at a nearby college. Guy #1 says to me, “So, have you heard about Harvard? And the sexual assault case?” Why yes, yes I have. Guy #1 continues, in a voice of genuine concern: “So, what can we do to keep people from drinking so much?”

Guy #2 murmurs in agreement, eyebrows knitted with empathy.

LADIES AND GENTLEMEN. EXHIBIT A. This, right here, is the crux of why colleges keep finding themselves in trouble when it comes to dealing with sexual assault.

I know, I KNOW. It’s not like Guys #1 and #2 are alone in their thinking here. Just read the comments section of any article on the college-sexual-assault topic for a primer on the latest and greatest in victim-blaming. The idea that intoxication negates one’s ability to provide consent seems to be a logical stretch for quite of few of the world’s armchair analysts.

But here’s the thing. I don’t really care if some random dude with a laptop disagrees with whether rape is rape when alcohol is involved. I mean, I don’t like it, but one guy with an opinion just doesn’t matter all that much. The extent of his power ends once his opinion’s been expressed.

However. If you’ve made a career for yourself in college administration or college health, and you continue to think that the epidemic of sexual assault on college campuses is really about excessive drinking and morning-after regret, don’t act shocked when your school is next to hit the news with a Title IX suit and a bunch of unflattering media attention of your own.

Yes, you could be the next Harvard. Or Dartmouth. Or Mizzou. Because sexual assault is happening on college campuses EVERYWHERE. It has, without question, happened on your campus. And if this common-yet-ultimately-wrong-minded perspective frames how you choose to respond to a sexual assault survivor’s case once it’s been brought to your attention, there’s a good chance that survivor will feel justifiably wronged. And, if they’re feeling brave enough, they just might decide to take this dissatisfaction with you and your colleagues public. Very, very public.

Don’t misunderstand me. I’m not denying that there’s a problem with binge drinking on college campuses that we need to address. But it needs to be addressed as an issue that’s separate and distinct from that of sexual assault. After all, just because it might be easier to mug someone who’s walking home late at night after they’ve had few drinks with friends, it’s not like the mugging itself isn’t still a crime.

I mean, someone who’s been attacked and robbed isn’t told by the authorities that their mugger didn’t REALLY commit a crime, because, y’know, you WERE pretty wasted, after all, and maybe sorta kinda asking for it by walking down the street in the middle of the night. I mean, who’s to say you didn’t HAND that aggressive stranger your money when he asked nicely? Who knows? He said, she said. You know what? Let’s just chalk this one up to youthful indiscretion and a lesson learned.

Hell no. Safety bulletins are sent out, city and campus police start patrolling overtime, and no one rests until the assailant’s been caught.

Intoxication may make a predator’s job easier. But it doesn’t make them NOT a predator.

In a perfect world, everyone would GET THIS, and this tortured public debate over what-is-or-isn’t-rape would cease to exist. I’m not naive enough to think that sexual assault wouldn’t still happen – because some people are terrible human beings – but society would deal with it the way it does any other violent crime. Meaning a) those who choose to commit a crime are consistently removed from the community for the safety of others, and b) the threat of criminal charges and incarceration might make some of the would-be assailants of the world think twice before committing assault. Both of which would result in less sexual assault. And I’m pretty sure we can all agree that less sexual assault = GOOD.

Those of us who work on college campuses need to be held to a different standard than Random Laptop Guy. You can’t hold regressive and harmful views on a topic as important – and yes, public – as sexual assault, with those views shaping your institutional response to individual reports of rape, and NOT expect that it might come back to bite you someday.

Unless, of course, you’d been hoping to end up on the front page of the Globe someday. In which case, vaya con Dios, my friends.

When “good” isn’t good enough

insurance pic

Dear parents-of-college-students: before you decline your kid’s college health insurance plan because you have “good insurance”, please check to make sure that “good” will be good enough.

Recently, a patient came to see me with a history of recurrent ovarian cysts. She presented her story like it was old news, since this has been happening to her since she was 14 – or in other words, since well before she left the comfort of her parents’ home for the big wide world of college.

Her issue is that three or four times a year, she experiences what she describes as several weeks of progressively intense unilateral lower abdominal pain, culminating in severe pain (which she assumes is from a cyst rupturing) that eventually resolves on its own, with the help of lots of pain meds and missed class. 

Generally speaking, she manages things on her own, but yesterday, the pain was worse than usual. Her prescription NSAID wasn’t cutting it. She’d missed a midterm. I had a few questions: who does she normally see for this? When was the last time she’d had a pelvic ultrasound or any other imaging? Was there a plan to change her birth control pill, which she was ostensibly taking to keep things like this from happening? Was it time to dig a little deeper, to see if maybe something else was going on?

Well. It turns out that she hasn’t seen a health care provider (besides our college clinic) in years. Why? Because she grew up in New York. Her parents continue to live, and work, in New York. Their insurance allows her to be seen by providers in New York, and to have labs, and imaging, and procedures, and pretty much anything medically-related she might ever need, in New York. I’m sure it’s very “good” insurance – in New York.

If she actually lived in New York, well, that would be just fine, wouldn’t it?

BUT SHE DOESN’T.

I know, I know. Parents have a hard time thinking of their grown-up kids as no longer living with them. Sure, they’re away at school, but that’s just temporary. Their permanent address is still here with us, at home, right?

Hold up. If your college kid wants to keep listing your house as their permanent address while they’re bouncing around between dorms, sublets, and friends’ couches, living the typically transient life of an undergrad, that’s all well and good (after all, those parking tickets have to be sent somewhere).

But they need to have medical coverage in the place where their physical body actually spends the most time. If you live in California, but your daughter goes to school in Arizona, the place she needs coverage is Arizona.

You might be thinking something like this:

“I’m not worried. We just schedule her routine care while she’s home on break.”

Great, but what if she needs care that’s non-routine? What if something happens in the middle of the semester that might not meet criteria for being rushed to the ER, but really warrants being evaluated by a gastroenterologist, or a cardiologist, or whatever-ologist this week or the next, rather than months from now when she happens to have a few days off from school?

And what about that time – that not-too-distant time – when she stops coming home every summer or spring break? When she gets an internship, or a part-time job, or decides to take classes over the summer? How do you expect her to be able to get even routine, preventative health care if her insurance doesn’t allow her to have Pap tests performed in the state where she lives 95% of the time?

“Well, our insurance is pretty good. I’m sure she’ll be covered.”

Really? You might be surprised. One way that insurance companies trim costs is to limit where you can access care, so even if you’ve been pleased as punch with your plan’s low co-pays, and local provider network, and coverage for fun stuff like acupuncture, you can’t assume it covers anything beyond emergency care once you – or your dependents – leave the state.

Back to my patient from New York. Our options were limited to this: ER or no ER, since emergency care is all that her plan covers here in the state of Not-New-York. Beyond bringing her to an ER, my hands were tied – I couldn’t run labs; I couldn’t order an ultrasound.

Even though she was in pain, she didn’t want to miss yet another midterm. So against medical advice, she refused to allow us to transport her to the ER down the road, and instead returned to her dorm room, clutching her lower right side, with strict instructions to call the campus police to bring her to the hospital if things got worse overnight.

Had I been these parents, had this been my daughter, I would NOT be okay with this state of affairs. I would insist that we find a plan somewhere, somehow, that allows my daughter to access medical care where she actually lives. And I would insist a whole lot harder if she had a chronic or recurrent medical condition.

If, despite my best efforts, I couldn’t find a plan for our entire family with decent in-state and out-of-state coverage, I’d look really, really closely at the plan offered by my daughter’s college before checking the little “waive school insurance” box hidden somewhere within all that orientation paperwork.

So. My humble request to the college parents of America is this: if you’re planning on waiving out of the health plan they’re offering through your kid’s school, please, please, PLEASE read the fine print, or pick up the phone and sit through the terrible hold music until you get a human being to talk to, and find out whether your plan covers medical care – specialists, labs, imaging, etc. – in the state your child is about to move to.

Those insurance premiums aren’t cheap. So make sure they’ll pay for the care your family actually needs.

Let’s talk about…

20140220-002212.jpg

Did you know that 1/3 of all routine health maintenance visits with teens don’t include ANY discussion of sex or sexual health? Like, NONE?

And in those visits that do, the conversation lasts an average of 36 seconds?

I’ve been told I’m a fast talker. But if I tried to cram everything sex-related that I wanted to talk about into 36 seconds, I’d sound like an auctioneer on Adderall – and I’d STILL be providing my patients with lousy and inadequate counseling about their sexual health.

So, health care providers, what’s the deal? Don’t pretend it doesn’t occur to you that your teen patients might be having, or at least be thinking (constantly) about having, sex. It hasn’t been THAT long since you were a hormone-fueled adolescent yourself, has it?

Nope. Providers aren’t avoiding The Talk because it doesn’t occur to them. They’re avoiding it because it feels uncomfortable. The sense that you’re asking someone you barely know to discuss the most intimate details of their life feels vaguely icky. Far easier to ask a few general questions about how your patient has been feeling, chat about their plans for the summer, maybe (just maybe) ask about smoking, sign a few forms for school and send them on their way.

It used to make me feel uncomfortable too. But changing the way I thought about taking a sexual history and talking about sexual health with patients made things a little easier.

1) First of all: Get over it. You need to get used to talking sex with your patients. ESPECIALLY if you’re caring for teens and young adults. There’s just no way to do this job well without it. I’m not saying you should feel like you have to talk condoms with every patient who comes to see you about their runny nose… but you and I both know your patients are coming to you with more than runny noses.

2) Create a little script for yourself. Practice it. The less time you spend in the visit fishing around in the dark abyss in your mind for the next question, the less opportunity there is for the awkwardness to expand and grow to fill the void left by your silence. Know that the more you do it, the easier it gets. Pinky swear.

3) You may think that the fact that your patient isn’t bringing it up means they don’t want to talk about it. Unlikely. More likely, they’re feeling just as uncomfortable as you are, yet they also have a million sex-related questions and thoughts and worries, and they’re just waiting for an excuse to pretend to reluctantly be dragged into a conversation about it.

4) From your perspective, you’re asking about morbidity and risk factors: exposure, prophylaxis, pregnancy risk, infection risk, symptoms. But think about it from the patient’s perspective: what you’re really asking about is relationships. The guy who asked them out once and texts every once in awhile just to keep them hanging on. The girl they dated for a whole semester until they broke up, and now she’s dating your best friend…but they might have hooked up again that one time a few weeks ago. Framing the history as a series of stories allows your patient to tell you what’s going on in a familiar language, as well as providing you with context that you just won’t get with a few yes or no answers.

5) The more presumptuous and judgey the questions (“You’re using condoms, right?”), the less likely it is that you’ll get the full story, or that your counseling will make much of an impact. Is actively shutting down an open, honest conversation actually worse than no attempt at all? Well, probably not. But this isn’t a race for the bottom. (No pun intended.) You can do better.

Any other suggestions? Were you as surprised as I was by the results of this study? What do you think we can do as health care providers to improve these numbers?

More than an absence of No

20140213-170629.jpg

The chief complaint varies: “STI testing”, “pregnancy test”, “GYN problem”. It’s not until I enter the exam room and see my patient, eyes downcast and voice in a near-whisper, that the real reason for the visit becomes clear.

Apparently, it continues to be open season on questioning the legitimacy of the sexual assault epidemic. This time, it was the Wall Street Journal that decided the world needed yet another article blaming women for their own rape. So brave, WSJ! It’s about time someone stood up for those poor accused assailants.

I mean, it’s not like assault survivors have had their trauma minimized and dismissed for years – er, decades – wait, no, EONS now or anything. “She was drunk, so she was asking for it” is today’s “she was wearing a short skirt, so she was asking for it”, which is really just another version of “she’s female, so she’s always, somehow, asking for it”.

In case you missed it, the numbers around rape in college are pretty insane: approximately 1 out of every 4 to 5 college women will experience sexual assault at some point while they’re in school. Numbers like this are hard to ignore; a incidence rate of 20-25% must meet epidemic criteria by pretty much anyone’s standards. But rather than saying “holy crap, we need to do something about this”, some people prefer to respond to these numbers by questioning their legitimacy, citing evidence that assaults involving college students often involve alcohol — ergo and therefore = not-rape.

If you’re one of these people, a question: have you, or anyone you know, ever actually been to college? You know, that place where day-that-ends-in-Y is cause for celebratory drinking? Where the next generation’s ingenuity is expressed through the laborious construction of elaborate snow-carved beer pong tables? Where it’s often harder to find an event WITHOUT alcohol involved than with?

In other words, yeah, binge drinking in college is a legit problem. I’ve seen more injured wrists and broken collarbones than I’d care to admit due to the ubiquitousness of college alcohol use. But part of being a young adult living on your own for the first time sometimes means figuring things out the hard way – like how to consume alcohol responsibly, without the puking and blackouts. Today’s monster hangover paves the way for tomorrow’s dignified glass of Malbec (or three) with dinner. We’ve all been there. I know I have.

Which is why I see myself in the eyes of my patients. The ones who come to the clinic after a night where yeah, maybe they had too much to drink, but that didn’t mean they planned, or deserved, to wake up too-early the next morning, dawn not quite ready to breach the horizon, in an unfamiliar room, clothes and hours unaccounted for. In pain.

There is no amount of alcohol, no level of intoxication, that justifies assault.

If you think that the real epidemic is one of morning-after-regret-turned-false-accusations, spend some time with me at work. Look in my patients’ eyes as they struggle to tell their stories. And know that you, and others like you, are part of the reason that most of them will never file a formal report, no matter how many ways I talk to them about their rights, and resources, and recourse. All they can handle, in that moment, is a modicum of damage control: please, just tell me what I can do, what I need to do, to be okay.

Today, all I can offer is damage control – antibiotics, EC, labs, lots of counseling. But tomorrow, I’m hoping for more. I’m hoping I’ll stop waking up to rape apologia in the mainstream news. I’m hoping that the socially accepted definition of consent will shift from an absence of “no” to an enthusiastic “YES!”

Because eventually, I’m hoping that the gradual elimination of rape culture (eternal optimist that I am) will mean that I get to spend more time focusing on the more mundane aspects of a career in college health: strep tests, ankle sprains and contraception.

Fake it till you make it

20140206-143038.jpg

Last weekend, I found myself at my first sample sale.

Apparently, there’s this clothing brand out of the UK called Boden, which, as far as I can tell, makes very nice, very pricey clothes for your most well-dressed aunt. The young, cool aunt – the one with a successful boutique business doing something lucrative enough to afford a fabulous, crave-worthy condo and a closet full of, well, Boden.

I shop the clearance racks at Target and H&M. Maybe Loft, but only if I’m feeling a little spendy. So how did I find myself at the back of a mile-long line waiting to file into a convention center filled with communal dressing rooms, aggressively sharp elbows, and piles of off-season fashion?

I blame obstetrics.

*****

Before I’d even started nursing school, I had the idea bouncing around somewhere in the back of my mind that I might want to teach someday. I like talking, I like people, I like the idea of sharing my deep and vast knowledge about the secrets of nursing with the next generation of nurslings. It’s not like I’d actually acquired this deep and vast knowledge at the time I was telling myself all this, but I was confident it was on its way.

And then before I knew it, there I was, a newly minted health care provider, with a license and prescriptive authority and a raging case of imposter syndrome. I’d put on my white coat and grab my stethoscope and bluster into an exam room with a confident smile, certain that any minute now someone was going to figure out that I didn’t belong.

There was no way in hell I felt ready to teach. I barely felt ready to go to work every day.

Thankfully, spending a few years actually working as an actual nurse practitioner does wonders for treating imposter syndrome, and eventually, I felt legit enough that I agreed to start precepting NP students. Precepting is kind of like dipping your toes in the shallowest wading pool at the water slide park of nursing education. You don’t even really need to be wearing a bathing suit. All you’re really doing is explaining why you’re doing what you’re doing with the patients you’d be seeing whether you had a student with you or not.

Don’t get me wrong, the clinical placement is in many ways the crux of the whole learning experience for the student. It’s super important. Check. But for the preceptor? Your expertise is only expected to encompass the stuff you already do every day. Easy peasy.

So when one of the nursing schools I’ve been working with asked me if I wanted to teach a clinical seminar, I thought, you know what? I’m pretty decent as a preceptor. How much harder could teaching a real, live, in-person class be? Nah, I got this. Let’s go.

But it wasn’t until I started really preparing for this class that I realized one of the problems with for-real teaching: you don’t get to only teach the stuff you know and like the best. My class of women’s health NP students wouldn’t be expecting an entire semester of the kinds of things I see in a college health clinic.

In particular, they’d be expecting to spend at least half their time learning about obstetrics.

I haven’t cracked an OB reference book since grad school. My role in managing my patients’ pregnancies typically begins and ends with a urine hCG, a long talk, and a referral.

The first couple weeks of class we managed to keep things firmly in my wheelhouse: vaginitis, molluscum, herpes, IUDs. HEY LOOK, I KNOW SOME THINGS. A one-off question about first trimester screening was deftly turned back to the students, since those things change constantly and who could possibly be expected to keep them all straight? Please.

But next week, I’ll be forced to lead an in-depth discussion of cervical incompetency and cerclage. And just like that, imposter syndrome comes roaring back.

Solution #1: retail therapy. I can’t wear a white coat to class, but if I start dressing Iike an actual grown-up, maybe my students won’t laugh me down from the front of the classroom, right? Which is how I ended up in line on a Saturday morning with hundreds of other women at this sample sale. Yes, I now have a few nice things that I didn’t have before. And they are quite pretty, even though I’m 100% sure I’ll be trashing these cashmere and silk blends in a hot second with my unsorted, overloaded laundry style.

Yet for some reason, the $125 I spent on blouses (not shirts! BLOUSES) doesn’t seem to make me any more of an authority on cervical cerclage than I already was.

So I suppose I need to deal with my discomfort with not knowing everything about everything the same way I did as a new NP: a confident smile, and a metric ton of reading.

And in the meantime. “Hey, you look like a professor!” was an actual quote from one of my colleagues in the clinic this week. BEHOLD THE POWER OF THE BLOUSE.