Only early afternoon, yet I was instantly exhausted by the couple that sat in front of us. She cried quietly into a tissue. He put his arm around her, looking slightly bored and detached as he looked at us accusingly. They had gone through three miscarriages and were now pregnant again, being followed closely at the recurrent pregnancy loss clinic after being fully investigated. An ultrasound had just shown a normal fetal heart rate at 10 weeks, but also found a subchorionic hematoma, a blood clot next to the developing embryo. Although things were fine at this point, it gives her about a 25% chance of losing this pregnancy as well.
There was a strange dynamic in the room. Deep pain and defensiveness. This is a place they had been before, and with all the medical technology in the world we could not give them a child of their own. I had seen the same look in the eyes of couples who have spent thousand of dollars on fertility treatments and IVF (in-vitro fertilization) to face failed pregnancies, or none at all.
A woman I saw at one of the fertility clinics had separated from her husband last year and was now dating someone else. Someone who would have a child with her. “He’s good enough and my eggs aren’t getting any younger.”
It amazes me. The desire we have to bring a child into the world. Is it desperate signals from rotting ovaries that do it? Maybe its the evolutionary drive to have our genetic material continued in the world? Or perhaps an equally altruistic and selfish desire to have someone else to love, to care for, and to bring us laughter. Is there a divine calling of love that creates this desperate need within us?
I don’t know what it is, but the desire for a child drives people mad. It breaks their hearts, destroys their marriages and makes them feel like they have failed at this business of life.
That same morning, prior to going to the recurrent pregnancy loss clinic they schedule residents at the Comprehensive Abortion and Reproductive Education clinic. Where the other side of human desire comes in. Seemingly the polar opposite, yet on some levels the same. The desperate need not to be pregnant. Not to have a child. Not to let anyone know. A 15 year old in foster care. A mother of four. Some heartbroken and scared, others logically facing the facts of life.
The incongruity in my mind and heart at the end of the day is a feeling I am slowly getting used to. The stories I have the privilege to witness in this messiness of life are not always easy to digest. We so much want what we cannot have and desperately don’t want what we have. The folly of human desire.
Tuesday, January 12, 2010
Sunday, December 13, 2009
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.
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.
Friday, October 9, 2009
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.
[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.
Wednesday, September 30, 2009
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.
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.
Wednesday, August 5, 2009
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.
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.
Saturday, July 25, 2009
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.
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.
Wednesday, July 15, 2009
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.
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.
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