Chasing A Child

Babies, grandparents, and moms of a certain age

Squeaker is sleeping better. Not significantly, but enough that we aren't completely crazed. We haven't really changed the bedtime routine. I suspect the fact that he's cut 3 teeth in the last 2 weeks (we're at 5 total, and more on the way) might have something to do with it -- teething screws with his sleep big-time. The Mister's folks were in town last week and thoroughly wore Squeaker out with grandparent excitement, which was good for all of them. But I think he's also just getting the hang of the sleep thing a bit (knock wood). The only change we made was to add music to the mix, playing a semi-new-age-meditation-music CD while we do the story-reading, bottle-feeding, rocking, pacing, etc. It seems to make Squeaker less manic, and has the added bonus of lowering the adult's blood pressure a few notches, which probably contributes to the decreased child mania.

He still does this thing where just when you think he's groggy enough to pass out and you've lowered him into his crib, he grabs onto your neck like a boa constrictor, making it impossible to actually put him down without unleashing the howling banshee. He does the boa thing in the middle of the night, too. But instead of waking 6-8 times during the night, he's back to 2-3. The Mister tells me Squeaker only woke once the other night, but I was away at a friend's wedding, so wasn't here to experience the bliss.

The more sleep thing is particularly important because we've started going to counseling and need all the clear-headedness we can get during that process. I think it's important to mention this -- to pretend that people can plow through the stress we've had during the past few years without experiencing some kind of serious rough patch would be to promulgate belief in a flowery fantasy world where everyone gets to live happily ever after, no matter what nastiness they go through. Those of you who know how I feel about the helping professions will recognize that things must indeed be rough if I'm willing to pull in the talk-therapy folks.

Unfortunately, I can't blog about the experience (although I would really really like to, because the process of peeling the onion is turning out to be a much weirder thing than I expected) ... but too many of our relatives have access to this blog, and being that honest with them would create more trouble than it's worth. I might do some password-protected musing at a later date.

That wedding I mentioned earlier? It was the daughter of one of my high school friends. The bride was 24, a lovely young woman, who clearly found a great guy. They're incredibly lucky, and we were all so proud to wish them well as they started their journey. Of course, I can't imagine getting married at 24. I could barely feed myself at that point! But she's 4 years older than her mother and I were when she was born, and thinking about that actually made me realize how lucky she was that we didn't just drop her on her head or let her wander out in the street. Twenty-year-olds caring for infants ... yikes. And yet, it happens all the time.

And who's to say that young moms do a worse job than, say, a 44-year-old first-time mom? My friend, for instance, raised a well-educated, grounded young woman, kind and beautiful, with a good head on her shoulders. She went through some extremely hard times, but she survived, and she loved that child with everything she had in her. She did great! It was just so funny knowing that the baby who taught me everything I know about babies was walking down the aisle, while my 10-month-old was home tormenting the Mister ... And of course, my mother-of-the-bride friend is so completely over having babies, and our other friend who came to the wedding has decided not to have kids at all, and here I am, late bloomer, just getting started. We all live in different universes, but our friendship is stronger now than ever. I got so much strength from spending less than 48 hours with these women. The timing couldn't have been better.

On the plane home, there was a 10-month-old baby sitting across the aisle with his mom and grandma. When I told them I had a 10-month-old at home, they were both clearly surprised. Age-wise, I'm probably closer to the grandma than to the mom, and the readjustment they both had to do was really interesting to watch. I felt ... weird. Judged, somehow. The baby's mother should be my peer, because our babies are only weeks apart, but she was clearly uncomfortable seeing me that way, because I was at least 15 years her elder, and the grandma was clearly uncomfortable that someone so close to her age could be in the same situation as her daughter. Internet, I ask you: where are my peers, and how do I find them???

Why doctors are bad for my health

I went to the lady-bits doctor last week. It was the first time I've been since my post-D&C appointment in which I was declared physically healthy and sent on my un-merry way. I was due for a mammogram and, since it's been almost a year since my last OB appointment, I scheduled an annual exam while I was at it. Figured I'd get all the ugly stuff done at once. (Have I mentioned how much I hate doctors?)

It was difficult being back at the OB's office -- I won't lie. This is a particularly wonderful office (for an HMO), in a clinic that is associated with a hospital where they love midwives. Love. Them. Therefore, the staff is as nice as they can be, and the focus of the office, understandably, is on You And Your Baby. Which means, as any IF vet will testify, that there are (oh, the horror!) posters all over the walls of Your Uterus, and Your Baby In Your Uterus and, if you've already been lucky enough to have your baby, helpful suggestions about How To Take Care of Your Body Now That You've Had Your Baby. And if you happen to have miscarried a baby at home, you look at the posters that show a fetus developing over the 9-month cycle and you find the appropriate month and you think to yourself "yes, that's about the right size. That's what it looked like."

You can see where this is headed.

Wonder Doctor, who saw me through the aftermath of my miscarriage (after Doctor From Hell botched the handling of the actual miscarriage itself), was not available. Doc Wonder is, after all, the head of the department, and is apparently booked up solid until, oh, a year from now. Sigh.

I saw another doctor -- or perhaps she was a CPM. Regardless, she was in her 50s, cheerful as she could be, and a bit bemused as to why I was there. Had she met me before? No, this is the first time. Have I seen someone else in the office? Yes, I saw Wonder Doctor last time.

Pause.

"Oh." Looks through my file on the computer. "I see she did a post-op visit with you."

Yes, I had a miscarriage and a D&C and ... <sniff, sob, sniff> Goddamn it. I hate crying in doctors' offices. <sniff>

"I'm sorry." Pause. You can see her doing the math ... ("let's see, if she's 44 now, and she had the miscarriage last summer, she was 42 when she got pregnant, 43 when she miscarried -- damn, that's old ... there must have been IF involved.")

"You'd been trying for a long time?"

Yes. <sob sniff> But it's okay because we adopted and ... I tell her about Squeaker. Really, we're okay. (Hold on a second. Why do I use "we"? This is my medical appointment ... but IF is such a "we" event that now even a regular OB appointment somehow becomes about "us" ... and why do I feel the need to reassure her about our relationship anyway? oh lord, she's giving me the sideways eyeball ... she really thinks I'm nuts.)

And sure enough, at this point, you can see her readjusting her whole approach to the visit. Up until now, I had been a normal patient, here for an annual exam. Now I was Fragile Patient To Be Handled With Care. (By the way, I hate hate hate being Fragile in any context. It's annoying. I hate how people treat you when they see you that way. I want to be Tough Bitch Who Can Handle Anything and Doesn't Need to Be "Handled". So here I am in nothing but a hospital gown, explaining myself again to yet another New Doctor when really I'd rather be anywhere else doing anything else, and I'm mad about being sad, and sad about being sad, which makes me madder...)

She decides that it might be good to skip over the obvious IF portion of my health history, since it is clearly not something that will induce a Smiling Relaxed Patient. She jumps straight to the obvious alternative: "Any cancer in your family history?"

Yes, a cousin had breast cancer in her 30s.

Doctor gives me a Look. "Anyone else?" Grandmother liver cancer, grandfather adult leukemia ... Again, she gives me the Look.

"Any heart disease?" Not that I know of. "High blood pressure?" Yes. I list the names. "Osteoporosis?" Yes, my mother and her mother. Again, Doctor gives me a Look. "And how is your father's health?"

I burst out laughing. By now, Doctor is looking at me like I'm not only quite likely to die any minute, but I might be crazy as well. Which very well could be. Dad, you see, is off his meds, and is currently taking a bit of a forced vacation in a facility where folks who go off their meds go for a rest and re-medication (whether they like it or not). He's been in and out of places like this for the past 20 years. In between, he seems relatively healthy, all things considered. I explain this to the doctor.

"And what do you do for a living?" Lawyer. Again with the Look. "Are you working full-time?" Basically, yes.

"So what do you do for fun?" I can tell this is a loaded question. Um ... Truth be told, there hasn't been a lot of purposeful "fun" lately ... birthday parties and dinners I barely remember because I was so tired while I was there, jogging or walking that is more because I need to blow off steam than because I have time to exercise. I even gave away some of my favorite yoga videos to another new mom, because I knew she'd use them long before I ever got back to them. I begin to lie like a rug ... Yoga, hiking, jogging ...

"Good, you need to be doing weight-bearing exercises to stave off the osteoporosis. And you'll notice as you head towards menopause that your periods will get heavier ..."

At which point I practically begin wailing. <SOB SOB SOB SOB sniff ... sniff>

"Oh, I'm sorry ... but I usually try to tell moms about this before they get there ... should I stop?" Oh no, I tell her. By all means, keep on going. Do your worst.

And so she does. Then we chit-chatted about very silly stuff for several more minutes, she did the exam, and off I went. And yes, I bawled all the way home.

============

The first time I stepped foot in the offices of this particular HMO, the Doctor From Hell had used the words "donor eggs" almost immediately. The last time I was in this office, I was mourning the death of what I knew would be my only biological child. And this week, I spent more time than I ever cared to discussing menopause.

See, the problem is, I'm not ready for that yet. I still know exactly when I ovulate, and I still think about "if we did the deed tonight, it would be 5 days before, and well, it worked once so it could work again ..." Except that I'm forty-fucking-four now, and if I so much as mention the possibility of another miracle pregnancy, every scientist in the world is going to look at me with pity and suggest that I get some counseling or get back on my meds. The realistic part of me knows it ain't gonna happen. But that doesn't mean I shouldn't be allowed to have my fantasies. I really didn't need the cold hard voice of Reality, masquerading as a Perfectly Nice But Clueless Doctor shoving what I already know to be the truth down my throat. It's enough to make a girl just skip the whole medical establishment experience for the next few years, ya know?

My point is, people, you never get over IF. You may decide to remain without children, you may adopt, you may be lucky enough to give birth to one, two, perhaps three babies in a scary wondrous litter. But no matter which road is yours, this shit stays with you forever, and comes back to bite you when you least expect it. And medical folks who don't know your history will look at you like you're nuts when your PTSD kicks in. And your relatives will never really understand. And if you're lucky, you've got an online posse to tell the tale to. Because you know they get it, and you know they've got your back.

You can't make this shit up

It's open enrollment time at work -- that time of year where the human resource people trot out their cheesiest smiles and tell you how much your health insurance will cost you this year, which of your benefits are changing or going away, and what the limit is on your pre-tax contribution plan.

This year, they're changing our dental insurance again and they've replaced our PPO provider. They're keeping my old HMO and, amazingly enough, the amount I'll pay for coverage has actually decreased.

"So what?" you ask. "Why do we care?"

Well, I spent the last 2-1/2 years at this company paying a lot for a no-frills HMO policy that didn't do me much good. It covered 1/2 of the cost of IUIs, but not if my RE did the procedure. I could get Clomid for $20, but the policy didn't cover monitoring. And those IVFs? Fuhggedaboutit. We bought those completely out-of-pocket. And they weren't cheap.

So back to open enrollment where, lo and behold, the new PPO -- and the newest version of my current HMO plan -- now cover 50% of fertility treatments!!

Fucking wonderful.

I'm almost 44 years old. I've fucking missed that fucking boat. And they fucking have to rub it in by covering this shit now when it will do me no fucking good whatsoever?!

Let's add this up. Between the IUIs, acupuncture, IVFs, drugs, monitoring, etc., that's about $15K we could have saved. Which would have meant that we wouldn't have had to to pay PMI on our new house, so our monthly mortgage payments would now be hundreds less.

Not to mention that the decreased financial stress might have made a difference in the overall outcome. If they had covered those treatments 3 years ago, we might have had a chance. A slim one, of course, but a chance.

I'd just about made my peace with all of this. I'm totally in love with Squeaker and absolutely delighted to be his mama. We've paid off the doctors and closed the door on further treatments. No more drugs, no more swollen ovaries, no more vicious mood swings and crushing disappointment. This is no longer a process or an expense we need to worry about. We're finished. It's over.

And of course, the change in coverage is wonderful news for my younger co-workers who may be battling the IF monster. I'm sorry that they're facing that battle, and delighted that it will be a less expensive battle to wage.

But I'm not going to lie -- when I saw that "50%" in the "amount covered" column of the insurance summary, it was all I could do not to burst into tears right there in front of everyone. And I've cried every time I've retold the story.

FUCKETY-FUCK-FUCK-FUCK.

Making lemonade

I'll say it again -- my new OB is fabulous. Turns out she's head of the department for this region of my HMO, which could explain some things.

I went for a follow-up appointment today. She said the D&C went really well but that she was glad she had had ultrasound techs in the operating room so that they could check to make sure she got everything. They did and she did. I'm officially over my m/c. And I do feel much better, by the way. In fact, I felt much better almost immediately after the procedure, except for the annoying bleeding, which has actually stopped for good. There was one last surge of clots weekend before last -- my body's final hurrah, I suppose. People, my people -- I basically bled from July 2 straight through August. That's a lot of winged pads.

My actual gyn appointment was over in about 5 minutes. We spent the next half hour going over miscarriage information documents that we had both brought to the "meeting." Yes, indeed, the Brochure Project lives! She is completely into it. I gave her my scribbled comments to the HMO's "standard" materials that Old Doc gave me. Her reaction to some of them was "What is this? Where did this come from? I didn't know we had this!" with much grumbling under her breath about the dysfunctionality of big organizations. My scribbled comments were mostly "Confusing. Not applicable to m/c after 6 weeks or so. Need more details."

Essentially, the problem with their standard documents (none of which I received before my m/c of course) is that (1) they're written by doctors so they're packed full of medical jargon or (2) they only hint at what happens when you miscarry or take an inducing medication like misoprostol or have a D&C, which means that (3) they do not give women enough information to make an informed decision. "You may bleed heavily" is not very helpful in a situation such as mine, when it looked and felt as though my body was vomiting blood. "You may experience nausea" doesn't include "and you'd damn well better have some anti-nausea medication in your house before you start miscarrying or you'll be very sorry." And nowhere -- absolutely nowhere -- do they give any practical advice like: "You may wish to sit on the toilet or squat in the tub while this is happening because it will be messier than your wildest dreams" or "You may wish to have another adult in the house in case you need to make a phone call or you pass out" or "You should plan ahead for child care if it is possible to plan ahead because you will be completely out of commission for several hours ..." 

They expect that women will ask their doctors for the details, but if you don't know what could happen or what your options are, it's very hard to ask questions that will give you the information you need. We also talked about the differences between early first trimester miscarriages and later ones like mine, and the additional information that women experiencing the latter type will need. I tried to raise her consciousness about women over 35 who have experienced infertility and their legitimate need to be given more information and have more information available about genetic testing options after a m/c because time is so precious. I'm not sure that I clearly made my point on that one, but I'll keep trying. I also mentioned the need to give patients plenty of time to make their decision, unless there is a medical need to hurry. She was 100% on board with that.

So we're working on it. She's going to draft up a document and send it to me for review. The document will be used by doctors whose patients are going through miscarriages and as a training document for the advice nurses. I may contact a few of you to lend another eye to the document when I get it. I'm not sure how many doctors and nurses will be receiving this document, but my sense is that it could change the way that miscarriages are handled at my HMO -- at least when they happen in this city or perhaps this region. And that is a powerful thing.

"At least some good is going to come from your horrible experience," she said. My thoughts exactly.

*** If I end this post here, I'm going to get a lot of comments saying "good for you," which is not why I wrote today. I'm going to end instead with a challenge to each of you. This may have started out as my experience, but it's become much more than that -- it's now about making sure that other women have a better experience than I did. New Doc talked with me about women whose (very understandable) response to loss is to withdraw and turn inwards. I had that choice and I could have taken that road, but it would have been a horrible waste of my time and a waste of a once-in-a-lifetime opportunity to make a difference. I'm not saying that everyone should respond to loss by becoming an activist. Not at all. But if any of you in the course of your everyday lives have the opportunity to challenge the status quo in your doctor's office, your community, or even your workplace, please think about doing so. One person can make a difference. And you don't have to be tough as nails or trained as a lawyer. Sometimes just one quiet shaky voice speaking up and saying "this isn't right" can be the catalyst for important change.

Finis

My D&C went quite well, all things considered. I haven't even needed my new supply of pain meds. New Doc said there was "quite a bit" of placenta left, so it was good that I had the procedure done. The hospital was pleasant enough and the nurses couldn't have been nicer. My sense was that they had been clued in to my story -- in fact, the nurse who wheeled me out of the building told me that she too waited to get married and have kids until after her career was established, then she and her husband had trouble conceiving but finally had a little boy. And then she got breast cancer. Ouch.

New Doc had prescribed an anti-nausea patch for me to use before the procedure so that I wouldn't have to deal with my usual post-anesthesia pukiness. It worked great. I was starving because they make you fast before the procedure, and I was able to eat an entire Su*bway sandwich when I got home without any problem. I also asked New Doc about antibiotics. She apparently had them put some in my IV, which seemed like a clever idea.

The Mister particularly liked the pager they gave him, which resembled a very large purple cookie and flashed like a disco ball when the nurses sent him text messages. The pre-op area was a holding pen divided by curtains that were all open to the nurse's station. At one point they closed my curtain while the guy across from me had something horrible done to his feet. Ew. And the woman in the cell next to me, who was there for a hysterectomy, was telling anyone who came near her that her daughter in Kentucky was at that very instant in labor and howling for an epidural. Between all of this entertainment and the photo in Star magazine of a very fat Matt Damon, the waiting time just flew. (Oh yes, and Angelina and Brad are supposedly going to adopt kids from Myanmar and Zimbabwe. I'm not sure whether to be impressed or roll my eyes!)

Before they took me in for the procedure, New Doc talked with me about my pamphlet idea. She had clearly been talking to Old Doc and had done some research on her own. She agreed that the materials they currently use tend to vary by doctor and do not address the kind of situation I had. She asked me a lot of questions about what I would like to see in a pamphlet, what kind of information would be helpful, what confusion exists about the various options, etc. She told me that this is not the first request of this sort that they have had. She is going to draft something up and use me as her patient advisor on the project, if that would be okay? Of course! We shook on the deal.

"If you knew then what you know now, would you do it the same way?" she asked. Yes, I would. Except for the part about turning Sammy over to the clueless lab folks. That I would have done differently. And if I knew then what I know now, I would have had the pain and anti-nausea meds up front so that the Mister wouldn't have been at the pharmacy when I started bleeding. But miscarrying at home, while messy and unpleasant, was the right thing for me to do.

The Mister suspects, and I agree, that the pamphlet idea is getting attention now primarily because the patient currently kicking up a fuss and dropping oh-so-subtle hints about malpractice is a lawyer. My mom says it's also probably because I remain quite articulate in my arguments even while raging through tears. Whatever it is, I'm glad that is going to get done. I'll keep you posted as things progress.

For now, I'm going to enjoy my doctor-imposed 4-day weekend and go back to napping on the couch. I'm on the 5th Harry Potter book -- he's really gotten me through the bad times this summer. I mean, I'm dealing with some nasty stuff, but if I had to choose between this stuff and battling Voldemort ... well, it would be a tough call.

Just when you think it's over ...

Yesterday was a step forward. Today was a step back.

But first, the comic relief.

I went for an ultrasound to make sure that there was nothing left over from my m/c. The perky ultrasound tech seemed pleasant enough until she asked, "So how far along in your pregnancy do you think you are?" (Oh. Yes. She. Did.) After we got that minor bit of misinformation cleared up, her trainee/assistant then proceeded to tell me about a story she either witnessed or learned in ultrasound class the night before. It goes like this: A woman pregnant with twins was complaining of horrible abdominal pain. The ultrasound showed that she had also had an ectopic pregnancy and her fallopian tube had burst. Amazingly enough, this didn't kill her or the twins, and the embryo from the burst tube attached to the uterine wall and developed normally. Everyone lived happily ever after.

Now I don't know whether or not this story is true -- it seems a little far-fetched to me, just a wee tiny bit -- but that's not the point. What I really wanted to know but was so shocked that I completely failed to ask was: Ladies, is this really the kind of story that is appropriate to tell when you're doing an ultrasound on someone who has recently miscarried?!  "Pregnant Woman Survives Infertile Women's Worst Nightmare and Ends Up With Triplets"??!!  I think not. Seriously.

This was followed by a visit to my new OB, who is completely great -- love her! She asked all the questions I would expect a competent OB to ask, listened carefully, made notes in the computer file while I was talking, and had just the right bedside manner. And the new clinic doesn't smell like puke-inducing P*ine-So*l, which is really an extra-special bonus. New Doc was pretty horrified at the story I told her, and I didn't even tell her the whole thing. She didn't actually say it, but I got the strong impression that she would have handled my m/c in a completely different way than Old Doc. No big surprise there. We all would have.

The bad news is that the ultrasound showed a blobby object of some sort attached to my uterus, complete with its own blood flow. Which means it's growing, or at least trying to. New Doc is pretty sure it's a piece of placenta that decided to hang on and, oh, I dunno, grow a baby out of stem cells or something. This explains my continued bleeding and could also explain my tiredness. So I'm scheduled for a D&C with New Doc tomorrow afternoon. Whee.

I picked up my post-op meds today, completely forgetting that I still have pain meds leftover from my m/c, so now I've got way more Vi*cod*in than any one person should be allowed to have. New Doc jokingly suggested that I sell the extra on the black market. It's a tempting thought ...

Beware my vorpal sword!

Today has been one long clash with the medical community.

It started out with a dentist appointment. I haven't been to a dentist in a long time, partly because the last time I had a cleaning, I had a panic attack in the chair (two reasons -- 1. I was certain that the hygienist was going to snap my fragile front teeth in half, and 2. holding my mouth open for too long plays havoc with my TMJ with great anxiety ensuing). But also last winter my job canceled their dental contract with my evil HMO, forcing us to buy more expensive insurance and find new dentists. A week or so ago, one of my fillings began crumbling and I knew it was time. I had asked around at work for a dentist who could handle problem patients, and the referral turned out to be great. I trusted this dentist the instant I saw him. His office staff was very professional and I felt that he immediately understood me, my teeth and my freakish attitude about dentists.

Which is a good thing, since he has prescribed an immediate root canal, then a cleaning, then fillings for 4 cavities, and once we're done with all that, he wants to discuss orthodontia to correct my bite so that my constant tooth grinding doesn't kill all the nerves in my poor fragile front teeth. Whee!

As if that wasn't fun enough, I spent an hour this afternoon with my OB. Yes, that OB. She had scheduled me for a post-m/c follow-up appointment, so why not take advantage of the opportunity to express myself face-to-face? Amazingly enough, it went quite well, except for the fact that I cried the whole time (out of anger mostly).

We spent a few minutes on m/c stuff. Bleeding has been a continuous dribble until yesterday when it finally stopped. Had one last blob of tissue emerge weekend before last but nothing since then. Yes, I'm probably anemic, so let's test my blood. No, I don't think the depression and crying has reached the medication and therapy stage. Etc.

Then I began to speak my mind. She listened carefully to everything that I said and didn't do much in the way of making excuses. She admitted that she had failed me and handled the whole situation badly. She said that my bad experience with her and her staff was unusual, and that it was mostly her fault. She apologized several times. I explained that I wanted a new OB with more experience dealing with patients who have been through IF, and she promised to call several doctors for me this week -- doctors at a facility across town that apparently handles a lot of IF cases (diagnosis and IUIs only; the HMO doesn't have specialists). She said that she would tell them she had failed me and would ask them to provide me special treatment.

I then explained my brochure project and she voluntarily offered to gather all of the standard information that the HMO has prepared about m/c's (none of which she had given me previously), together with the HMO's nursing protocols about counseling m/c patients and send it to me for review. She said that if I have suggestions for improvements in the documents and protocols, she will help me express them to the people who manage such things. I asked her to put me directly in contact with the patient communications folks and she agreed.

We talked some about the conflicting information I received from her and the nurses in her office. This took some time, as she kept insisting that the information they gave me was the standard protocol. I had to keep reminding her that it was only standard for women having m/c's at 6 weeks or so, and that at 11 weeks, the information should have been very different in a variety of ways. She finally agreed.

Another point on which we disagreed was the genetic testing question. She insisted that their standard protocol is to not test unless someone has been through multiple m/c's. I replied, if that is the case, then why the hell had the nurse told me to bring in the "products of conception"? This got her thinking. Apparently it's their standard protocol to do that to make sure that it is not an ectopic pregnancy. Which makes no f-ing sense when the non-ectopic pregnancy has been seen on several occasions by ultrasound! She agreed that they needed to work on that particular issue. I also explained to her that people like me who had not had multiple m/c's might still be interested in genetic testing for other reasons. She said she saw my point, but mumbled something about the HMO not wanting them to do genetic testing on every single m/c because it is expensive and often doesn't tell them anything helpful.

Then -- and this was the funny part -- she asked me if I was sure I wanted to change doctors. Apparently, she likes me, thinks I'm proactive and sensible, really has taken an interest in our struggle to conceive (despite all appearances to the contrary) and, because of her personal respect for me, she assumed that I had more knowledge about what would happen during the m/c than I did and/or thought that I didn't need her to be as doctor-y as she might be for other patients. Weird logic, but I kind of get it. Nevertheless, this means that she put her professionalism aside and treated me differently than she would treat other patients. I told her that she was dead wrong to do so -- that she should always assume patients need all the information up front unless they tell her otherwise, and that if she'd really cared about my struggle, she wouldn't have made it worse by not returning my email or phone calls and by failing to advise me about what to expect during the m/c. She said she understood and she was sorry.

I thanked her for her time (she was incredibly late for her next appointment - ha!). Then I drove to We*ndy's and got a large chocolate milkshake. With whipped cream. And a cherry.

When I got home tonight, the Mister called me a doctor slayer. I suppose that's a compliment? And I guess I feel better having gotten all that off my chest, but that tooth that needs the root canal is causing my TMJ to flare up, which is getting in the way of my righteous triumphant feeling ...

There oughta be a law ... or at least a pamphlet

Thanks for all of your supportive comments. I am going to change doctors -- in fact, I've already emailed my doc asking her to refer me to the OB in the HMO's local system who has the most experience dealing with high risk pregnancies and patients with infertility issues (which is my not-so-subtle way of firing her). I like the email approach because then it becomes part of my medical record. We lawyers like us a good paper trail, mm-hm!

I don't want to be over-medicalized or treated like a fragile flower, but I do want my doctor to have a clue about ... well ... treating patients, for starters. Preferably also a doctor who won't throw tired cliches at me when my IF issues come up. My own private theory is that even the HMO's top doctor won't be much help because the HMO is an HMO and not a hotbed of highly-paid experts, but perhaps I'll be proven wrong.

The other project that I'm going to work on is convincing my HMO that they need to develop a "What to Expect When You're Miscarrying" pamphlet that their OBs can distribute to patients like me. It would set out the basic options, include information about what will happen if you choose the various options and describe what will happen afterwards. I'm expecting an uphill battle on this, but honestly, it's only fair!  My HMO drowns you in glossy folders, info sheets and pamphlets when you find out you're pregnant. Then suddenly, when you find out you're miscarrying, no one will speak full sentences to you anymore (probably because they're afraid you'll melt into a puddle), and the information they do give you is not helpful.  Not that you can get past the screaming grief banshees in your head to hear what the medical folks are saying to you anyway.

If I'd had a nice simple pamphlet to read on my own time when I was in a space where I could deal with it, it would have made all the difference. It was so damn stressful having to have make phone calls and have personal interactions with these people so I could get information, when all I wanted to do was crawl under a log somewhere. Anyway, this won't be simple, but I know how to bully my way through corporate structures, and I figure that exposing this gaping hole in their patient communication system will have a bigger effect than filing a formal complaint against my doctor -- if I'm successful, then other women might not have to go through what I did.

I don't want to show up empty-handed for this project. My plan is to give them a list of information that women who have experienced miscarriage have identified as valuable information. I found a wonderfully honest, incredibly sad thread on motherhood.com with stories by women who have had miscarriages -- 4 years worth of detailed stories, wow -- so I have a ton of information to work from with regard to the variety of ways women experience miscarriage. But I'll need help with my main question, which is "Why the hell didn't my doctor tell me XYZ?"

Here's where I go out on a very fragile, emotionally-fraught limb and humbly ask for your help. Do you have relevant experiences that you're comfortable sharing? If so, what did your doctor tell you that was helpful? What did they NOT tell you that you really wish you had known?  If you aren't comfortable leaving your answer in a public comment, you can drop an email to cranberryesq at gmail dot com. I know that this is not easy to talk about and I definitely know that these are excruciating memories to re-live. I'm just trying to figure out a way to make it easier for others so that some positive energy can come from this awful experience ... I'll try to post the final information too, once I pull it all together. Fully anonymous, with identifying details removed, of course.

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Meanwhile, in the latest adoption news, we passed our FBI background check, much to our amazement! (Seriously, the Mister is always getting packages and emails from Iran, and you should see the emails we send around about the president ...) Our intake interview with the agency is scheduled for next Friday. And then the fun really begins.

Apparently, professionalism is too much to ask for

I've been putting off posting about this because I thought I should cool down first. I realized last week that I'm definitely in need of a new Ob/Gyn. My doc is a very nice albeit spacey lady who is probably just fine if you are a normal fertile person experiencing normal pregnancy, but OMFG ... it has become incredibly clear that I need to be dealing with someone who has some, er, experience in dealing with infertiles -- particularly older educated ain't-got-time-to-mess-around infertiles.

On the day of my miscarriage, the nurse assured me on the phone that the doctor would call me the next evening. Of course, that evening came and went without a phone call. And then 4 more days passed. Finally, the doc calls me at home during the workday. The Mister tells her I'm at work. She calls me there and, getting my voice mail, proceeds to leave a long rambling message. So sorry she hadn't called me, hopes I'm feeling better, so sorry for my loss, gosh it's nice that I feel well enough to go to work, and oh by the way, to answer the question I posed in the email almost three weeks ago which she has not yet answered, no, she doesn't think we should do any genetic testing on the miscarriage material.

Now, keep in mind that, per the nurse's instructions, I had taken my containers with poor little Sammy and god knows what else to the doctor's office the day after my miscarriage -- 4 days before this phone call. One would expect that if they were going to do any testing, they'd do it right away, yes? But the doc waits 4 days to leave me a message saying they're not going to do tests?!

Through tears of rage, I put on my pissed-off lawyer writing gear and sent her an absolutely scathing email demanding an explanation of this unconscionably bad behavior and an immediate report on what the fuck they made me bring everything in for if not for testing, and oh, by the way, they'd better do some more training on their nurses because I got a different story from every single one of them that I talked to as to what to do with the, um, stuff that came out of my body. And not one of them offered any advice about what I could expect afterwards, how long I might bleed, what activities I should abstain from, whether I should only use pads, etc., and since the doc didn't call when she was supposed to, this means I did not receive timely medical advice from anyone in her office, which is simply appalling. Of course, I already knew most of the "what happens afterwards" stuff thanks to Dr. Google, but fergodssake, shouldn't one's doctor's office provide this information voluntarily without you having to ask?! Or perhaps a pamphlet entitled "Sorry you're miscarrying -- here's what to expect"??

She called me back an hour or so later. Oh, as it turns out, they actually did try to do genetic testing (despite the fact that she told me in her voice mail that they weren't going to do any testing, which means she didn't even check on the status before she called me the first time!!!), but due to the necrotic state of the materials, they were unable to get any DNA to grow. Sorry. They did a visual check of the embryo and were able to rule out a few specific genetic disorders, but not all genetic disorders would show up in a visual check at this early stage. Sorry again.

I was so angry I couldn't see straight, which of course meant that I was busting a lung trying not to cry. "Now let's go back a few steps ... you used the word 'necrotic.' Please explain." 

She was caught. The Mister thinks, and I agree, that she used that word hoping I wouldn't know what it meant and that I'd just ignore it as medical gobbledygook. But I got really high scores in my verbal SATs, and I know a synonym for "dead" when I hear one. And I had just read the first several chapters of this book, so I knew what should happen when they're performing genetic testing, and I know that there are more expensive testing methods (that this doctor's lab doesn't perform) that can improve the chances of determining if there were genetic problems, even if the genetic material won't respond to normal testing.

What she was trying to tell me without actually saying the words was that Sammy was too dead for her lab to determine why s/he died. (And of course they couldn't tell me what the gender was, not that I would have wanted to know anyway, but I guaran-damn-tee you she didn't know.)

"So if I'd brought it in the day of my miscarriage instead of the day after, would that have made a difference?" I asked. "Not necessarily," she said. "Once the heartbeat stops, things start to, um, decay. That's why we don't usually do testing unless there's been a D&C."  In other words, if you want to know why your baby died, you have to let them immediately pry apart your cervix and scrape it out of your uterus (which, according to some things I've read, actually can mix up the baby's DNA with yours, thereby confusing the results, so no option is perfect). But at my doc's office, if you don't get a D&C, you'll never know. And because the nurses are all used to people having D&Cs and not used to people waiting to miscarry, when they get a phone call from someone saying they're miscarrying, they give the advice that they would give to someone who was spontaneously miscarrying, which is "bring in the materials." What they didn't consider was that poor little Sammy had been getting processed by my body in preparation for his/her eviction, and that "bringing in the materials" wouldn't do any of us any damn good.

I want a doctor who tells me shit like this in advance and whose nurses think things through before dispensing advice. And I want a doctor who doesn't wait 5 days after I've miscarried before checking in on me. And you know what?  Because of my weird medical plan (Kaiser, ugh), in order for me to get these things, I may have to change my insurance carrier, which will mean paying a whole lot more out of pocket every month for my policy. And the icing on this miserable cake is that I can't do that for a year because my employer's open enrollment period just ended. So if I want a competent doctor, I'm going to have to pay full price out of pocket for them. Doesn't that just fracking figure?!

Raging and aging

So it's 2 whole weeks until my next doctor's appointment, and I'm not sure that I can stand the suspense.  Yes, of course I have to assume that I'm pregnant until proven otherwise, but the range of symptoms I've been having are so familiar at this point that I keep thinking they've disappeared.  Until the cat walks on my chest (ouch!) or I realize I honestly don't have the energy to do ... well, anything. Or when I realize that most of my pants don't fit.  That kind of thing. Other than that, and the very faint sense of not nausea but just kind of "blech" that hovers faintly in the background so constantly that I'm completely used to it, I feel perfectly normal.  My kingdom for an ultrasound.

My new symptom last week was rage.  Not crankiness, not anger, but red-hot blazing out-of-control rage.  I'm pretty sure it was primarily hormonal, but there were some legitimate causes as well.  For instance, the denial by my employer of my very reasonable and obsessively well-documented request for more staff. It's a long complicated story that I won't bore you with.  Suffice it to say that they made a bad business decision and supported it with incredibly weak and transparent excuses. I can't wait to see the look on their faces when I tell them that their only attorney is going to take maternity leave and yes, it would have been much simpler and less expensive to have already hired and trained someone to hold down the fort, rather than having to scramble to fill the position at the last second, now wouldn't it?  I love my job and the people are very nice, but oy! sometimes I miss the east coast business folks and their hard-nosed practicality.

The other thing I was raging about was my research about older mothers and c-sections.  According to the NIH, "older mothers with normal, full-term pregnancies—particularly first-time older mothers—were more likely to undergo Caesarean delivery than were younger women with similarly low-risk pregnancies."  Not only that but, "regardless of their age, women giving birth for the first time were much more likely to deliver by Caesarean. First-time mothers were six times more likely to have a Caesarean delivery than were women who had given birth before, and even when their pregnancies were low risk (full-term, infants without birth defects, with a normal, head-down presentation, and in the absence of any bleeding complications)."  One of the doctors who conducted the study "theorized, first, that physicians' concerns of potential malpractice could be one cause of the increased number of Caesareans for older and first-time mothers. She added that the mother's weight could also be a factor. Women tend to get heavier as they age and with each subsequent pregnancy. Obesity and overweight are known to complicate pregnancy and labor. Moreover, some of the Caesarean deliveries among older women may be elective procedures, with women opting for the procedure over conventional labor." (emphasis mine)

Okay, so I'm an older first-time mother with no known risk factors, no problem with my weight, and no desire for an elective c-section.  If I understand the gist of this article, my physician's concern for potential malpractice will therefore be the primary factor in determining whether or not I deliver by c-section. How comforting.

Now, couple that article with this one, revealing that in many states, insurers providing individual health plans (as opposed to employer-provided group health plans) may charge women who have had c-sections higher premiums or refuse to provide them coverage at all. So if you or your partner don't work for a company that provides group insurance and you buy your own health insurance, your ability to be insured may rest upon whether you have had a c-section, which itself may have been caused by your doctor's concern for potential malpractice!

Indeed, the U.S. national cesarean rate in 2006 was 31.1%, up from 4.5% in 1965.  Surely, the birth process has not become over 25% more complicated since then?  Some factors that can explain this increase are the rise in multiple births and women electing c-sections.  But according to the studies cited in this article, those factors only begin to account for the increased rate; rather, "there is a change in practice standards that reflects an increasing willingness on the part of professionals to follow the cesarean path under all conditions." (emphasis mine)

Is it any wonder that a site like this caught my attention?  I wish I could get to some of the studies that are cited in it, or the journal editorial that stated "Where there are no tangible medical complications of pregnancy, the risks of childbirth in older women are no greater than in younger women.  There are many other examples in obstetric practice where a survey suggests that an outcome, rare in itself, may be more common in women with a certain characteristic, which results in many women receiving unnecessary and often unpleasant treatment." (again, emphasis mine)

Don't misunderstand me -- I know that the goal is to have a healthy baby, no matter how s/he gets into the world.  But people, I cannot and will not abide with a fear-based medical professional performing major abdominal surgery on me unless it is absolutely and medically necessary!  Particularly not if their decision to perform that surgery is based primarily on my birth date.

On a lighter note, this article suggests that having children at an older age may actually reset one's biological clock.  It cites a study showing that "women who delay having children until their 30s and 40s, and then have only one or two, are more likely to live into their 80s, 90s and beyond. Female longevity, they say, is linked to the number of children a woman has and her age at the birth of her first child."  Moreover, "centenarians are four times more likely than the general population to have had their first child in their 40s."

Now that's more like it.