Old Mamas and Sister Surrogates

56 yo G13 P1 T0 A11 L0 at 26 weeks gestation with severe IUGR.

[Translation: 56 year old woman who has had 13 pregnancies, one pre-term birth, no term births, 11 miscarriages and has no living children now 26 weeks pregnant with a fetus showing severe growing problems.]

I stopped short, going back to re-check the birth date. Yup. 56 years old. With a story that would break even a stone heart. Loss after loss, desperate for a child. She had had multiple failed cycles of IVF overseas. In Canada there are 'gentleman's agreements' that for the most part limit this from happening. You don't implant embryos in a women past her 44th birthday, unless its a donor egg and then not past her 50th birthday. This doesn't apply in India, South Africa, the US...

I'm not a mother, but I'd like to be someday and regardless, I have no concept of what this women has gone through and the importance of her having a child, that biologically speaking, she will never have. I can't help but think there are other options, as judgmental as it sounds. I have several single 'aunts', the kind any self-respecting missionary kid has growing up. Aunts of no blood relation, yet closer and more connected than any of my parents siblings were to me growing up in Peru. No, they didn't have biological children, but they were mothers to many children who yearned for love and acceptance.

My lady's baby was born by classical C-section a day after I met her. We couldn't communicate, even through a translator we spoke different languages, inherently clashing world views. Her baby's death in the NICU two days later, saddened me deeply, but more than that seeing his mother devoid of hope stabbed at my conscience. Who gave her the false hope that this would work? Who was it that took her money so freely and put her and a child in such desperate straights?

A few days later I experience a very different birth. The birth mother was from south India, this was her fourth pregnancy. I met her along with nine of her closest family members as she was labouring in the delivery suite. Flipping through the chart I saw form signed stating that this would be an open adoption. Confused, I read further...this sweet young Indian woman was giving birth to a child for her sister-in-law. I asked who wanted to catch the baby and cut the cord when it came out, directing my question to the sister-in-law.

"I can do that?" Her eyes wide with joy, brimming with tears, slightly incredulous. And I must say, I got a bit gooey-eyed myself as I lifted that squirming, slimy, pink, hairy baby into her arms. There was no question that she was that child's mother.

The two experiences clashed together in my head, perhaps it was just their temporal association and the similar cultures the two families were from. Such great joy following deep deep sadness. A sadness I can't help but think medical technology made much worse.

God Talk

God gave you that tumour, and I'm going to take it away. - A reconstructive orthopedic surgeon to his patient.

Thankyou Jesus. - A pregnant woman undergoing laser ablation of the vessels connecting her twins after hearing that things were going well.

Actually, you can call me Alan. - The obstetrician performing the laser ablation on the patient.

Jesus Christ, Sheona! - My attending to me as I topple off my standing stool in the middle of a challenging surgery and sprawl backwards onto the floor.

If God didn't want you to masturbate he would have put your genitals splat in the middle of your back! - Overheard conversation of two psychiatric patients having a cigarette outside.

And then there was the five year old, wailing in his mothers arms after his grandma passed away in the hospital bed - Why...would...God...let that happen...why mom? Why?

God seems to be all over the place.

Danny-Walker, Tetralogy and TRAP

There's this clinic called FDS, the Fetal Diagnostic Service. Here's how it works: you're thrilled that you're pregnant, things have been going fine and then you get your routine detailed ultrasound at about 20 weeks in. The ultrasound tech is evasive, won't tell you what they're really seeing, perhaps a radiologist comes in during the scan and mumbles. You figure out somethings isn't quite right. They say you need at special scan at the Center for Excellence Across the River.

A phone call the next day, you have an appointment in Vancouver tomorrow... book the whole day off.

You show up and wait. Then a medical genetics counselor sits down with you and your partner where they extract every ounce of family history you have. Did you have any maternal aunts with crooked teeth? Any distant uncles who died suddenly? Perhaps a sibling who was a little slow on the uptake?

More waiting.

Then an hour long ultrasound. A dim, cool room. Gooey gel, prodding, poking, sliding.

And you wait some more. Then an appointment with the medical geneticist followed by the perinatologist. You sit before them nauseated with anxiety.

There's part of you baby's brain that isn't developing properly, we call it hypoplasia of the cerebellar vermis also known as a Danny-Walker malformation. Prognosis is variable......

I imagine the rest fades into nothingness. Or maybe we say:

Your baby's heart doesn't seem to be forming properly. You see, its missing half the pump, the hoses at the top are backwards and there no pipe going to the lungs.

You're telling me my baby had a broken heart?

Today we had a TRAP sequence... it looks like you had triplets initially but it turns out that one of them is a 'pump twin' with no heart which is parasitising the other two babies. We could insert a radio-frequency do-ma-hickie into the pump twin's umbilical cord under radiological guidance to stop it pumping. We can experiment on you here, or you can always go to Toronto.

My twins are really triplets and one is a parasite?

I have no concept of what they go through, hearing that their dear, beloved child is broken. We often don't know the extent of it before birth or how drastically or minimally it will effect the life of their baby. Maternal fetal medicine is a tough rotation for me. It breaks my heart and blows my mind. We buzz placentas of twin pregnancies if they are growing unequally, when otherwise there would be a stillbirth. We try plugging up holes if your water breaks too early, give you Viagra to help your tiny tiny baby not growing well, give transfusions INSIDE the uterus to babies with Rh disease. Amazing things that give these babies a shot at life when nature would otherwise take it from them. It baffles me, fascinates me and fills me with questions I will never know the answer to.

R3 and Hope

I have survived my second year of residency! The toughest most exhausting most soul destroying year there is. Part of me feels numb in disbelief, the other part nervous about the new expectations of me, but mostly, I feel hopeful. There's less call, more sleep, more awareness of the substance of life. I write after a sleepless night at The Baby Mill, but despite eyeball-stinging tiredness, I had fun. I had a blast catching wrinkly pink babies, sloshing out twins at that STAT stat C-section, popping a bloodvessel and my wrist bones in the exertion it took to pull up that low low head from the pelvis. Joking with the nurses, rolling my eyes with the attendings, reassuring patients... it felt like something I could do in the future.

Over the past year I've wondered how I've changed, how the 'system' has shaped me, dehumanized me, desensitized me and overall discouraged me. At times I lost sight of people. I stopped treating them as I would my best friend, my mom or my quirky cousin and started seeing them as illnesses and things on my 'to do' list. Now something has somehow reverted back to the Sheona I used to be. With feelings, goals and passion. Its refreshing. Hopeful even.

I miss my epidermis

Three friends. 330km. One lost tent. One set of car keys missing. Three flat tires. One freshly torn ACL graft. Several thousand mg of ibuprofen. Three square inches of epidermis gone. So far, so good.

When it comes to your epidermis, it really is true that you don't know what you've got 'til its gone.

I'm missing mine. Right over my ischial tuberosities (i.e. bum).

Last weekend I took part in the Seattle to Portland bike ride. It was pretty incredible, we biked just under 330km in two days. About 10,000 people participate and its fully supported so you have food stops along the way, and you meet the most amazing people of all shapes, sizes, ages and walks of life. The first day was beautiful sunshine all day. Day two however involved plenty of rain, wind and three flats in our group. At moments I knew without a shadow of a doubt that it was not physically or mentally possible for me to finish the race. I had no idea I could bike that far! Unfortunately, I assumed that pain was normal when biking these distances...of course this is true, but there's pain and then there's bleeding.

I found it philosophically fascinating, that I have been trained so well. Manicured and groomed not to listen to my body. To ignore feelings of exhaustion and push to 36 hours with no sleep. To pretend that feeling rotten is just part of the race (or the job). To completely disconnect from the signals my body gives me. Fascinating.

Don't get me wrong, the race was awesome, and I'd do it again... but next time I'd listen. Walking around like a wounded cowboy just isn't worth it.

You Took a Strip Off my Soul

Dear Midwife,

Just a friendly note to let you know you skillfully stripped the skin off my soul last night leaving me raw and sore. In general I tend to gel with your colleagues. I deeply respect the compassionate continuity of care you are able to provide. In fact, I personally would chose to be followed by midwifery if immaculate conception befalls me in the near future.

You say you're an open-minded, women-empowering, body and soul restoring wellness worker but all you saw were my greens. I have never felt so judged and marginalized in my life than when you confronted me as you 'advocated for your client'.

Do you know my name? My history? Do you know my passion for marginalized women? Do you care that I'm a person? Your blinders against Western medicine destroyed me. Your hate for all I represent was the focus, not the women you were to advocate for. The harsh words of an angry Obstetrician criticizing my decision-making is droplets off my skin compared to the soft hostility of your words.

Sincerely,

Wounded OB Resident

"No crying!"

He was the cutest three year old I had met since the days of Samuel Houston and his insistent 'excuse me... excuse me.' Toby hopped up and down on the twirling stool, crawled onto his mom's bed constantly squirming out of this father's arms. He wasn't three actually, closer to two and three quarters.

His mom on the other hand was wearing fantastic penguin pajama pants with tiny flower petals dotted on her toe nails. She was exactly 24 weeks and 1 day pregnant, not just pregnant, pregnant with twins... not just twins, twins with a cramping uterus and a short cervix. Twenty-four weeks is viability, the age at which if a baby is born it will be resuscitated. The implication of pre-term birth this early are huge, really really little babies just aren't supposed to see the world that early.

We chatted, I got the history, all the annoying questions. Then as she lifted up her t-shirt so I could examine her belly, the dad asked Toby:

What do we say to the babies?

No crying!

And what else do we say?

Dohn come out! Throwing his arms up in the air as only a two and three quarter year old can do.

It was refreshing. Did I mention he was nearly as cute as Samuel Houston? There is enough human tragedy to fill the ocean, but this kid, he was hope.