Leaky Ladies

I've just finished up two months of urogynecology. I feel completely stress free. Its amazing how different areas of medicine are. The daily emotional stress I'm used to dealing with went from a hundred to zero. One rotation the bad news you break to people alters their life forever, but the next well... they already know the bad news.

I'm sorry Mrs. Smith, we have some bad news... you're leaking urine when you cough.

Uh yes... I'm aware of that.

The good news is... we can fix it!

That's how it goes. End of story. No broken baby, no cancer, no infertility, just a little fixable leakage. Of course its more interesting than that, there are plenty of ladies with an inside-out vagina after a few vaginal deliveries, or a uterus that fell out and is terribly annoying as it bangs between their legs when they walk. But guess what? We can fix that too! We just pull it back in and tack it to your sacrum...pretty fantastic, don't you think?

Although I really do enjoy the surgical aspects of urogynecology I must admit, there were some perfect quotes from nameless attendings that I am unlikely to miss.

"Some people call us vaginal plastic surgeons, but I prefer to call it origami of the vagina." [I commented to my attending that this should be the title of their next book.]

and

"Now, I supposed gallbladder surgeons think that gall bladders are lovely as well, but although not everyone thinks so, I think vaginas are beautiful, and they should be respected."

Oh dear...

And now I move from the incontinent to the infertile.

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.

90th Birthday Parties

My Auntie Edna turned 90 yesterday, we had a great party. I read her this letter, one that I had sent last year (when I clearly had more hope and more sleep!)

Dear Auntie Edna,

It was so lovely to see you over Thanksgiving and I’ve been meaning to write this since I got back. I just got in from a fantastic bike ride through the Endowment lands. I got home covered in mud, chilled, and completely soaked but blissfully happy. The fresh, bright spring mossiness has now turned to the sweet, musty yellows of fall and each time I go out there I’m amazed at the towering trunks and lush vegetation, comforting in its peacefulness . . . I’m incredibly blessed.

I was a bit worried about you when we chatted in Calgary and I know you’re excited about getting to heaven and all but I was wondering if you were depressed. You voiced the frustration of having to rely on others so much and feeling like a burden with your physical limitations. It made my eyes well-up with tears that you felt this way. I suppose I understand it though, your whole life you have given and given and given, you’ve been self-sufficient and supported dozens and dozens of people spiritually, emotionally, financially and in other innumerable ways. Your whole life has been a gift to all of us and I hope and pray that as you live out your twilight years we who have been blessed by you are able to give back just a little bit of the immeasurable gifts you have lavished upon us with your time and your love. My other thought was that you no longer feel that you can give and contribute in the ways you have done your whole life. Well, here’s the deal, we’re not done with you yet. I get all choked up when I think about all the love, encouragement and support you have given me personally and my whole family, well, you are part of my family. You write us weekly letters when we’re not in Calgary, whether we’re in Tanzania, Peru, or Australia, those letters gave me roots, they held my home for me. You know me better than any biological or missionary aunts I’ve ever had. In this messy world we live in where who we are depends on what we accomplish you love me regardless of anything I do or don’t do. You’ve taught me that my worth doesn’t depend on what I do but on who I am. You loved me when I was a rambunctious, bratty little kid bouncing off the walls when you visited us in Peru, you loved me enough to go into a store and buy my me an Oilers shirt to bring me when you came to Ecuador, you loved me in all my bitterness about Canadian winters, and you need to know that your love still makes a difference to me now, today, on the soggy west coast. Your life is a testament to hope.

You probably want to know how I’m doing out here. Honestly, life is delicious (not gonna lie). God has given me a peace like I’ve never experienced before, about who I am, where I am, and what I’m doing. I have moments of incredible joy, my life is so full and I am blessed and privileged in a way that I am infinitely grateful for. God is so good. Not that things aren’t challenging now and then, but I am held tightly in a blanket of grace. I want to live fully, to do justice and show mercy. When I think of those in my life who have demonstrated this I think of you, you are living a rich legacy for all of us.

Love,

S

I Feel

A single tear rolled down my cheek. I blinked, wiping it quickly away with my hand flippantly, hoping nobody noticed.

The deepest empathy pouring out of my being in response to the heartache before me.

It felt good to feel again.

My Wee Gran

I'm all outta grandparents. My parents are orphans, and I'm a granorphan.

Although she was 90 with worsening dementia I still find myself not believing. The reality of it all is far away over the ocean, across the Firth of Fourth.

Gran was a constant, a deep part of my confused identity, and although the gran I knew changed drastically over the years, her loss is a loss of my foundation, my roots and I find myself shaken and unsteady. Her love for me was unconditional, as grandparents' love tends to be. It did not matter, what I did, where I traveled and what or if I studied, she loved me for no reason other than because I was me.

I don't remember my dad's father, who died when I was very young, running around terrrorizing my closest friends and family in Peru. But Gran was always there, in Balingry with Silva, her little terrier. Memories of the comforting smell of coal fires, endless chocolate biscuits and mince and 'taties for supper spring to mind. I remember curling in front of her fire, the scratchy rug on my cheek and smoky smell tickling my nose. When we lived in Scotland, Sunday afternoons were spent driving to Fife from Edinburgh across the Fourth Road bridge, a sacred time of walks with Silva and eating more Kit-Kats and Caramel bars than mom approved of and Gran insisted on.

After we moved to Ecuador and then Canada, we went back at least every two years to visit, and then it became us going individually as we grew older. I remember a trip with Rhoda after I'd spent a summer in Peru and I took two massive books of photos to tell her all about it. She was then visibly aging and her memory declining. I wondered how much of it she would take in. But she went through the hundreds of photos, asking questions and repeating again and again. "We just don't know how the other half of them lives, do we?"

No matter where we lived, in the vast extent of my families globe-trotting, Gran was immovable, unchanging and obviously the central part of my Scottish identity. She seemed to shrink each time we saw her, and always hugged us fiercely, smiling widely when we came. Her eyes watering when we left. Its heartbreaking to leave bits of your heart in so many places, and Gran was where I left the Scottish chunk of my heart. She held it safely. Now my heart is missing that same chunk with her gone.

My last visit with her was in March of last year. She had been in a nursing home in Cardenden for several years and was different than I had ever seen her before. When the care-giver introduced me, her grand-daughter from Scotland, she beamed from ear to ear, re-arranging all her wrinkles. She touched my face, and said my Gaelic name like only a wee granny from Fife can. Then in clear dulcet tones, she started to sing, I couldn't follow the meaning of the words, and I have no idea if she actually knew who I was, but she sang to me and told me she loved me and I will take it as a gift.

So as my parents bid farewell to Gran and she returned to ashes on Friday morning in Scotland, late at night in Vancouver I cut babies out of taut bellies. Slimy, flailing and crying indignantly at the insults life brings, new grandparents were made that will love these grandbabies for no other reason than that. That they are their grandchild.

Goodbye Gran, I love you.

Ticks and the Meaning of Life

Pedro and Emeterio lead us, winding up and down the narrow path, clearing brush with machetes as we go. Dirt slides under my feet as we wind our way up to the falls through 'virgin' forests (as our hosts describe them). Twice I stop to pick ticks off my arm, tiny, red and leggy. Before embarking on the hike they doused us with cattle-strength tick spray, declining to disclose the ingredients of the white kerosene-smelling liquid. Its humorous to me that the ticks mock this surely cancer-causing chemical I've bathed in. My friend Luis in Vancouver has set my friends and I up with a trip to the ejido or cooperative farm, that his family is part of on the west coast of Mexico.

I had a strange flash back to a summer I spent in northern Peru after my second year of undergrad. I trekked through mud and bugs out to villages and along rivers to my hearts content collecting stool samples for parasite research [insert inapropiate comment here]. One six day trip where I got to tag along to Aguaruna villages has always stuck in my imagination, likely embellished with multiple tellings. It involved being auctioned off for marriage for two monkeys and a wild boar, eating roasted Rana frogs with plumb maggots from the Aguaje tree among other incidents. The first day of our trip the new outboard motor on the boat failed and we drifted slowly towards the shore. Several of the men hopped onto the muddy bank with their machetes to cut us some sugar care to chew on as the engine was tinkered with. In my naivety in all matters pertaining to tributaries to the Amazon I followed them onto shore thinking this was the perfect pit stop for my pea-sized bladder. Tromping through the mud into the jungle I found a spot and bared my hind end to the wild. Immediately a strange sensation, almost numbness, spread over every exposed inch of my tender skin. Turning to look, my bum was completely black with tiny biting black flies. I jumped up with a shriek and started slapping... to the exquisite delight of my traveling companions who instantly appeared out of the bush, machetes ready to rescue me from certain death.

It was a humbling summer... challenging, fun, eyeopening, lonely, profound... but definitely humbling.

Before I arranged the Peru trip that summer I had an emotional conversation with my parents. I hated university, didn't see the point of being there and had approached them with an (obscenely expensive) opportunity of a field school in Africa. I recall my dad's thoughtful words, giving perspective, delving to the root of my feelings. I had lost sight of the reason I was studying, exhausted and defeated. I find myself in a similar place now, not knowing why I drag myself out of bed each morning, work 100 hour weeks and hating how I have come to see people. As diseases and things on my to-do list instead of people. Scared, sick, loved people. It took a lot of mud and bugs to give me a glimpse of an alternate reality that summer in Peru, and maybe it just took some ticks in Mexico this time.

At days end we removed several more ticks from each others' bodies, squirming at the uncomfortable intimacy of having tiny squirming legs attached to our person... some very personal parts of our person no less. Sometimes it just takes a few ticks to regain faith in life. To be reminded of past passions and future hopes. To realize that I may be on a low part of my journey right now, but I still have a capacity for hope and opportunities to share that hope in ways that recently have seemed clouded over and far away. Ticks.

Grasping at Cockroaches*

As the irritatingly perky barista raised an inquisitive eyebrow in my general slovenly direction, I realized I had in fact reached a brand new low.

Yes, I would like three shots of espresso in my extra-large coffee... and don't stinkin' think you can tell me to have a bloody fabulous day as you place it cheerily on the counter chic barista boy!

Other low points last week? I was told my humour makes it appear that I am in fact incompetent. I poked an (uninvited) hole in an (unsuspecting) uterus shortly after squirting my (unsuspecting) attending in the face with saline... to the OR nurses' delight. I actually did grocery shopping at the Shoppers IN the hospital (and felt an instant of normalcy as I strolled down the aisles mid-day). I ate poutine for breakfast, chocolate milk for lunch and an avocado for supper. Someone stole the carrier off my bike while at work after a long post-call day, causing tears to well up in my eyes and a lump of overwhelming emotion clogged my throat.

But truth is, I had felt that lump the day before. As I sat with Nate, a man in his early 70s, as his wife was vomiting into the toilet, a day after the surgery to debulk her advanced ovarian cancer. He wore a John Deere cap and an Abraham Lincoln-style beard. His gentle smile won me over as he told me about driving into town yesterday (from Fort St. Nowhere of course).

Isn't it amazing that at 9 at night those stores are still open? You'd never see that where we're from, everything rolls up at 7! I know Flo loves sausage rolls so I went out and bought two, one for me and one for her last night. We've been together 38 years you know, been through a lot, now its my turn to take care of her and boy does she ever have a will of steel.

The irony of retractable vomiting and the thoughtfulness of a sausage roll gift hit me. Flo came back from the washroom, stooped and thin, her weathered wrinkles gave the sunken post-chemo cheeks and bald head a look of wisdom beyond words. She was full of piss and vinegar alright. So we sat and chatted about nausea, sausage rolls and pick-up trucks.

It put all of my misery into a divine perspective.

So what if Dr. Orange feels I should be more professional and less personal? That's actually not who I aspire to be. I'd rather get to know Flo and Nate, joke about shooting gophers and figure out how we're going to treat her high blood pressure with home made pies and venison.


*Reference to Papillon (1973) ... yes, I'm planning an escape.

Pus and Tubes at the Death Star

The tower looms up into the grey Vancouver winter sky. Fifteen floors of impersonal, cement general hospital. Endearingly known as the Death Star.

We see lots of ectopic pregnancies, miscarriages, and the most common thing I've seen? TOAs. Tubo-ovarian abscess. A big ball of pus wrapping your fallopian tubes in inflammatory angryness and your ovary in cozy adhesions. Causing you infertility and ectopic pregnancies in the future. Why all the pus? There's not enough condoms in the world. Why can't people just use a bleeding condom? Not gonna lie. I get the impression that Chlamydia is overated.

The drizzle falls. The pager beeps. I count up the days I have to go before I get to sleep in for a day... 1,2..... 18, 19.....26..... hmmmm... 26 days in a row. Mild nausea sweeps over me.

Three weekends in a row. On call.

Truth is, pus in the pelvis is fine... but I miss babies and the Happiness Ward.