Anger; Understanding.

I have found myself angry at the women I serve this week. I thought I was disguising this well, and successfully brought nothing but a caring and supportive demeanor into the room. I work so hard to hide the anger I am feeling. But, regardless, I feel it.I am angry that it has been six weeks since you last came in for prenatal care.I am angry that it has been seven weeks since you last came in for prenatal care.I am angry that it has been four months since you last came in for prenatal care.I am angry that despite all counseling about chlamydia and chronic consequences, you had sex within the week of taking the medication, and your partner didn't take the refill I sent.I am angry that you want to stop taking your urinary tract infection medication, despite being symptomatic and my concerns for it progressing further.I am angry that despite my taking extra time with you this morning, I could tell you still felt I did not spend enough time.I am angry that regardless of my counseling about needing to control your blood sugars in order to better regulate both your menses and your fertility, you made an appointment with my collaborating doctor for "irregular menses/infertility."I am angry that you are late, again, for your Depo.I am angry that I am seeing you for the third week in a row, after all of your herpes testing came back negative, and you continue to be dishonest about your level of risk, after your best friend revealed to me during the first visit, while you were in the bathroom, why you were actually in the clinic.I am angry that I sent an 'abnormal ultrasound' result to my medical assistant, she did not make a separate appointment because you were already scheduled to see me that week, and then you did not show for your appointment, and rescheduled two weeks later, and then were angry at all of us because it turns out it was a big deal.I am angry that you did not attend the appointment with the high risk obstetrician, despite my making the appointment after you revealed something that was likely difficult to admit to someone you had met for the first time.I am angry. I am mad. I am frustrated. I am spent. And I understand.I have found myself angry at understanding why it is that things are different than you and I planned.I understand that you know your body better than anyone else, and if you came in when you thought you needed to, that is rational and appropriate.I understand that you had only met me once, and coming in again seemed daunting.I understand how complicated it must be to plan to terminate a pregnancy, then decide not to, and figure out how to re-enter into prenatal care with me, when our last visit was entirely about not moving forward.I understand that sex feels good, infection risk is hard to grasp, a treatable infection seems less problematic, and that medication is expensive when you are without insurance.I understand that your unmanaged mental health is affecting your every interaction and judgement, and even a urinary tract infection and medication side effects can make you want to control what you do and how you do it, to feel in control when perhaps you do not otherwise.I understand that the system does not give us enough time to work everything through.I understand how important it is for you to become pregnant in the next year, and that diabetes perhaps feels completely different from fertility.I understand that purchasing the Depo, and then paying the sliding scale fee, is nearly impossible, and so one happens one week and another happens the next.I understand that herpes is scary, and cheating on your spouse is scary, and wanting to be sure that nothing permanent is going on that could be passed on to your loved one mandates a weekly follow-up until the risk seems less.I understand that follow-up of abnormal results, and your availability for appointments, are not always in line, and communication breakdown is infuriating.I understand that sometimes it is easier to be scared of something than confront it head on.I am angry, and I understand. I support you, and I am with you. I care for you, and want the best for you. I know that I know you, and I know nothing about you. I am your midwife, and I am here to do all that I can. And sometimes I am angry that even that is not enough for either of us.