Friday, April 27, 2012

Week 33: My "Garden of Gethsemane" Moment

Just  yesterday, my sister-in-law, who is also pregnant and due about three weeks before me, confessed that she couldn't believe she was about to have another baby. She said compared to all of the preparation she did the first time, she hadn't hardly done anything to prepare this time, and she was starting to think about it a lot. I joked to her, "I did that on Tuesday." She laughed, but it's true. I did it on Tuesday. Here's what I meant:

Oh, dear. It probably looks bad to begin a post comparing myself to Jesus. Please understand, it's not how it looks.

This week, I was pondering my situation. I'm two months from my due date of June 15, and this baby still probably won't be born for a few days after that. My husband is spending long days and nights at school, trying to finish his last semester of classes. My children want to be picked up and coddled, continually lose their favorite toys underneath furniture where I can't reach, and they want to slam things down into and climb all over my ever-widening abdomen. It hurts. I can barely put on my shoes in the morning. I can barely get my children into their car seats without having a hernia. I'm already down to the last 5 maternity outfits that actually keep me covered up. Every time my blood sugar goes slightly low or high, I torture myself, thinking, "maybe I shouldn't have skipped my last three visits to the endocrinologist."

So, whether it was owing to the fact of the time of night (11:30p), the events of the day, failure of self-control, collapse into self-pity, all of the above, or something else entirely, I found myself sobbing before the Blessed Sacrament late on Tuesday evening. It's a good thing I was by myself in the adoration chapel. And thank God I was praying the rosary, for the insight and blessing I describe here.

It was Tuesday, so the sorrowful mysteries of the rosary were on tap. Since I can't seem to keep myself from being distracted during prayer, I tend to bring all the things that would ordinarily draw my attention away from the task at hand, and I do my best to conform my thoughts about them to Christ and occasionally think about the eternal things to which the mysteries are intended to lift me. This constant struggle against distraction results in fruitful but strange combinations sometimes, such as: meditation on the Baptism of the Lord and how long it will be before Braveheart can actually pay attention at mass (because isn't his baptism supposed to confer graces on him to make him behave or something?), contemplation of the Visitation mingled with a really irritating Facebook interaction I had recently (did Elizabeth resent having a house guest when she was eight months pregnant?), thinking about the Crucifixion and my twitchy need to get a casserole into the oven but you really need to just. finish. first. "...pray for us sinners, now and at the hour of our death."

I brought all my pregnancy anxiety and pain to this moment of prayer on Tuesday, over which Our Lord presided, and I quickly became overwhelmed by it. Not only the present pain of that moment, but the anticipation of all the pain that I would experience over the next two months: blood sugar swings, putting the ex utero children to bed by myself for several more nights in a row, lifting said (heavy) ex utero children into and out of the car, will I have to go through another crazy migraine episode?, doctor's appointments with a woman whose approach to this pregnancy I just can't wrap my mind around, a probable pitocin induction like I had last time which was not horrible but not my favorite thing either, the pains of labor, that dreadful third stage that always seems to last too long, making everyone anxious, and the days, weeks and months of weakness and fatigue following childbirth.

As the tears streamed down my face, I thought to myself, "I'm not sure how I can do this again. I'm not strong enough for this. It's going to hurt so bad, and I'm already so tired and in so much pain. I don't think I can handle it." 

Being in the presence of the Blessed Sacrament is a sure trigger for strong emotions, because otherwise I numb it up, move on, and eventually dinner makes its way to the table. It's not a bad coping mechanism, actually, because constant emotional navelgazing will get you into trouble. But being in the presence of Our Lord is also a great place to be when you are wrestling through strong emotions. So because I was there, and no one else but Our Lord was, I cried and cried some more. As I prayed through the sorrowful mysteries, I began to think, not just about my bodily pain, but about where his sacred body, upon which I gazed, went first. Thinking about my pain lifted me to his pain (not such a strange combination I struck upon this time!). During this season of Easter, he is the risen Christ, but the body of the risen Christ still bears the scars of his suffering. The same body which rose from the dead on Easter morning also suffered, died, and was buried on Good Friday. It will always be just one body which suffered, died, was buried, and rose again.

In this process of conforming my thoughts to Christ, I related my pain to his. I realized that I was now at a moment like one that Christ also experienced. I was staring my impending pain in the face just as Christ did in the Garden of Gethsemane. And agony is a good word for it. Futility, helplessness, self-doubting, no-way-out-now-except-a-miracle. I tasted a little of what it was like to sweat blood, and he was there, with me, having gone there first.

Not only in the Garden of Gethsemane, but in my own small, pregnant way, I will follow where Christ went on that night and all the next day. I will go alone, be mocked by doctors and "friends" (you know, the Facebook variety) who think the solution to my problem is as simple as popping a pill, I will receive scars, grit my teeth against the pain to keep walking, probably fall down with fatigue a few times, and eventually it will be finished. I will almost certainly not die physically, and for that I am thankful to the same doctors that may in another moment despise me. But whatever ill comes, it will be in service to the fruit of new life, just as Christ's suffering gave life to the whole world. It is a unique pain (oh, Eve, how it still stings!), but a privilege and a responsibility to participate in bringing forth the new life of a brand new child.

So with this, I affirm: "no" is still beautiful, even when it means saying "yes" more often than you thought you would, pregnancy is hard but babies are good for a host of serious reasons, and a few frivolous ones to boot, I really did see this coming, and although it may be a perfectly good way for some women to have babies, an epidural is not a sufficient answer to the pain of childbearing, not least of all because it will never be the necessary balm to the crucible that is the whole of parenthood from conception forward. Life is not a process of running from pain, but rather choosing what is good. Sometimes that means following Christ into pain, to and beyond the cross. But I know he went first, and I meekly, humbly, dutifully, and trustingly follow him now.

Friday, April 20, 2012

Big Chuckle

One of my friends posted this on Facebook, and I couldn't even finish reading it aloud to my dad because I was laughing to hard. Enjoy!

Week 32: What I've Done This Week

Here is a photo essay describing my week.

When I learned that the Statesman was breech, I decided to try out some techniques that I've heard a lot about (from www.spinningbabies.net).

I start out my exercise session with:

The forward-leaning inversion for 30 seconds. Sadly, I do not have any rockin' tattoos.

Then, I proceed to the relatively safe, always-recommended-for-pregnant-women,

ANGRY CAT
This looks alarmingly like my cat, except that my cat never gets mad. Ever. Even when I catch my children throwing sticks at him.

Also known as

The pelvic tilt, 20-40 times. Which makes me feel the opposite of how I imagine an angry cat might feel.
In other words, it feels awesome and you should try it

Then, I proceed to

I didn't do this one on the stairs, because I think I read something about falling down the stairs being bad for your baby.
No judgment here.

 The breech tilt, which I did lying on an ironing board with one end propped up on the couch. Except I didn't smile like the Cheshire Cat, and instead I had something like the following expression on my face:

That's a pretty rockin' grimace, eh?

In truth, I only did the breech tilt once, and getting up from it by myself was mightily difficult, so I decided to forego it and see if I could get the Statesman flipped around without it. I substituted this exercise

The psoas release, for 5 minutes.
Dang, it's a good thing I looked this one up again, because I was totally doing it wrong.

 After my exercises, I make sure I'm going to be up and moving on my feet for about 15 minutes.

After about three days, by the time Tuesday night rolled around, the exercises had been so effective that I not only knew his head was down, owing to the fact that his hiccups were really, really low. But his head also seemed almost fully engaged! Towards the end of the day, I had a whole bunch of weak, irregular Braxton-Hicks from the pressure of the baby's head, and

I found myself needing to empty my bladder about as frequently as a toddler (a serious increase in frequency from before). Not that I would know how frequently a toddler needs to empty his bladder, because the Pious One won't tell me when he needs to...

In any case, I'm going to keep these exercises in my repertoire even though they've already done their job. They are so good, so good you see (Green Eggs and Ham reference, anyone? I read a lot of kids' books these day).


Sunday, April 15, 2012

At Least One Problem With Healthcare In Our Country

As I mentioned last week, I decided to call and cancel the appointment with my endocrinologist, for the following reasons. I'm confident that my OB can detect any major problems with my health, including check my A1C and other recommended blood work. My blood sugars are under as good control as they possibly can be and I don't have any questions about how to tweak things. Finally, I was going to have to pay out-of-pocket to see someone that was, more likely than not, going to tell me that I really shouldn't have gotten pregnant in the first place and shouldn't do it again. Besides, I have been sending my blood sugars twice weekly. So, in one of the twice-weekly e-mails I sent with my blood sugar readings, I explained my reasons for cancelling the appointment on the same day.

The response I received from the PA, who reviews the blood sugars, was: "The doctor would still like to see you."

My question: Why?

The response: "Because you are pregnant and diabetic and haven't been seen since January."

My next question: I have ready access to that information. What's the problem we need to address with an office visit right now?

"Diabetes" is, as far as I can tell, a buzz word in the medical community. Doing a Google search on "diabetes" is mind-boggling. Sometimes it feels like a new epidemiological study on diabetes comes out every other week with serious public health implications. For people who have it, for people who want to avoid it, for people who are at an elevated risk for it. Pretty much everyone is affected by diabetes in some way or another, so everyone pays attention when the conversation turns to diabetes, and they set to work trying to figure out its secrets.

On the other side of the fence is a person like me. I've got the dread disease, with all its associated risks and inconveniences. I've spent long hours thinking about what it means for me to have diabetes, to live with it responsibly, to care for myself and my children at the same time, while doing the dishes, going for walks, folding the laundry, and lying awake at night with a baby using the inside of my abdomen as a trampoline. To be sure, the intensity of my contemplation has increased from the moment I first found out I was pregnant with the Pious One in September of 2008, but the reality is that I have lived with diabetes, and done so to the best of my ability, for a whopping 18 years. I have not figured out all the secrets of diabetes, but I've figured out enough of them to run my life pretty well. I don't throw myself a pity party every week, and I just do my best to manage it - with the understanding that my best is all I can do.

I am one of the lucky ones. In 18 years, I have not displayed any symptoms of kidney damage, nerve damage, or eye damage. And it's not because I've always been a perfect diabetic! I remember a few A1Cs in the 9.0s, definitely in the 8.0s, and I think I only had one A1C below 6.0 up until the time that I got pregnant the first time. In fact, my first A1C reading of my first pregnancy was 8.something. Yikes! Fortunately, I haven't had a reading over 7.0 in the 3 1/2 years since then, and scarcely one over 6.5. So I have the disease, with its risks and complications, and my blood sugar control has not ever been perfect (especially if you're going to compare it to a non-diabetic), but no other health problems to speak of.

I am grateful for the proliferation of opinions, statistics, technologies, and money being poured into the treatment of and research behind diabetes, which has, in recent years, been styled a national epidemic (not denying the veracity of the claim, only speaking tentatively because I don't know how to formally define "national epidemic"). As a result, I know way more about my disease than someone with a rare syndrome may ever know. And, technologies associated with insulin pumps are truly amazing, and truly life-changing for diabetics.

From the perspective of the healthcare community, however, I think all this attention makes every diabetic that walks into the office look, at first glance, like an uncontrollable basket case full of problems just waiting to pop up during a routine office visit. There may be an element of curiosity that doctors bring to exam room: "What do we see if we run this test? Is that result normal?" "How about this new diet?" "Hey, that pump looks cool, let's try it out." "I've heard that diabetics may suffer x, y, z problems, so let's rule those out, even though you don't have symptoms." "I had a patient one time who came in with this HORRIBLE complication, so we should look for that every 3 months, too." Furthermore, with the public health push to reduce the costs of and prevent diabetes, there is this sense that if we just twist the tourniquet a little tighter, we might be able to stop the bleeding and control the problem.

Enter, once more, the individual with diabetes. With all this research, public health initiatives, and money being thrown around, such a person seems to have become just one more calculation in the equation, so as to maximize the happiness of the greatest number of people. And the equation is being worked out by the doctors, their professional organizations, and the government, based on research that does not account for individual patient choices.

But since when did a person become a number in a happiness equation? Since when did a person become merely a composite of statistical risk factors? Since when did a person lose all capacity for meaningful comprehension of the reality of their situation, and the ability to develop their own meaningful, individual response to their situation? Somehow, in all this, I became defined by diabetes, rather than being permitted the freedom to define my own response to the reality of my situation. Somehow, in all of this pressure to control diabetes, "I don't have any current complaints for which I would like to seek a doctor's expertise" lost preference to "the doctor would really like to see you now," presumably because they think I will fall apart at any moment OR that I am too incompetent to understand the complexity of my condition.

I apply two caveats here. One is that I understand individuals make bad choices, and individuals sometimes fail in their understanding of their situation. Individuals with diabetes are no exception to that rule. But that doesn't mean individuals with diabetes are necessarily incapable of making a reasonable response that happens to be different from public health initiatives directed at the treatment of their bodies. It also doesn't mean that doctors are responsible for controlling the behavior of a poorly-informed or bad-choice-making patient.

Because I know I am flying in the face of my doctor's recommendation (which should not be dismissed lightly!), I can't tell you how often I have sat awake at night over the last few months, wondering what I am missing, and whether I am being stubborn or unreasonable simply because I don't like my doctor's bedside manner (which is, admittedly, a huge burden to me). And the conclusion that I have come to over and over again is the same: I think I am about as likely to be hit by lightning tomorrow as I am to derive benefit from an office visit at this particular moment in time.

Finally, my endocrinologist is a very skilled physician. If I were having a problem with which I desired help, there is no doubt in my mind that I would happily seek out his expertise to assist with its treatment. It's just that, in spite of my ongoing health condition, the problem is managed about as well as I think it's ever going to be, and I don't see anything for which I am at risk that needs to be monitored or tested for right now (especially given how closely I am being monitored for hypertension and so forth by my OB at this point). I don't need his expertise, because I know just about everything about diabetes that is relevant for me at this point, my 31st week of my third pregnancy.

Again, I ask. Am I missing something? Since I don't need my endocrinologist's help to manage my blood sugars, why else would I go see him right now? Does anyone else feel like they are treated this way sometimes? Is my endocrinologist uniquely patronizing, or does this happen everywhere?

Saturday, April 14, 2012

Week 31: An Unexpected Turn of Events

And when I say an unexpected turn of events, what I really mean is an unexpected turn of the child inside my belly.

I went to an appointment with my OB on Friday, at which point I was 31 weeks pregnant, and he informed me that the baby was head up, bum down. What a funny feeling! Both the Pious One and Braveheart were firmly head down, as far as I knew, the entire time I was pregnant. I did pelvic tilts just in case, but it never seemed to matter much. The Statesman, however, apparently decided to try it out.

I confessed to my OB that his movements had felt different for at least a few days, possibly up to a week, and I wondered whether he might have turned. When I told my doctor this, he said, in his charming French-speaking African way, "Ah, mama know best. That's where we go wrong, if we fail to listen to mama." Is it surprising that I enjoy this man more and more every time I go to see him?

Today, while I was sitting very still during a lecture on the immaterial aspects of thought that was becoming increasingly difficult to understand, my attention turned to the Statesman. I attempted some palpation and found that, with a few pokes and squeezes, I was able to determine the contours of his head, his upper back, and his arm. Oh, my - it was unbelievable to be able to visualize such a tiny baby inside my belly. And he really is still pretty tiny! Based on a rough estimate from a non-skilled non-professional, I would say his head is probably only the size of a large-ish tomato.

So it's pelvic tilts for me. No one is really worried about the breech positioning right now, and I don't think anyone will worry about it until 36 or 37 weeks. In the meantime, though, I'd like the Statesman to be used to and comfortable with the standard head-down positioning so he doesn't decide, when it's too late, that he'd like to try out something new!

My blood sugars are still good and stable. A few lows, not so many highs, and I really can't go more than 3 hours with a little something, but it's been this way for weeks and it feels pretty good to be in a stable pattern.

Thursday, April 12, 2012

The Second of My Irritations These Days

In the last chapter of the saga with my endocrinologist, I was left with a very bitter taste in my mouth. My A1C was good anyway, and since he hadn't been helping me to get it there, I left the office feeling like he was probably not going to be the best person to help me get some stability back into my the swings of my blood sugar life. I've done it before by myself, after all. Beyond that, because his office doesn't accept Medicaid, I will pay out of pocket for it every time I go see him. Pay $200 to be told that things look fine but that I probably shouldn't have any more children anyway? Yeah, that didn't sound like a good time to me, either.

Well, all of these things combined led me to believe that I really didn't need to see him again a short one month later in February, despite my scheduled appointment. I cancelled that appointment, and was told by the receptionist that it was weird he had wanted to see me again in just one month, since normally pregnant women are seen every two. Excellent.

And since things were going pretty well with my blood sugars in March and an A1C at my OB's office confirmed the fact, I felt the same way two months out. Besides, during my first pregnancy, I only saw the endocrinologist every 3 months, and I didn't have any help from anyone adjusting my insulin rates. That pregnancy was perfectly healthy, and I don't have any regrets.

Well, we're coming up on three months, and I have a decision to make. Do I go, or do I stay?

I've been sending my blood sugars to him two times per week, despite the fact that I feel pretty comfortable making changes on my own, when I need to. From my perspective, I do it mostly to prove to him that things are going fine. My OB can check my A1C, so I don't need to see him for that reason. Since my student-husband was recently informed that he will not have a teaching position at the university next year, owing to budget cuts and re-organization, I am inclined to save the money that we have, which, come May, will only be bleeding from our savings account until at least September 2013.

I decided to cancel my appointment. Perhaps he'll offer to see me for free, if my health is really that important to him and he really thinks it's in danger, but I doubt it. I certainly don't think there's any danger to my health, and if he decides it's not worth his time to look at my blood sugars, since I'm not paying for office visits, I will not lose any sleep over it. I have visited an endocrinologist every three months for my entire life and never been told anything (except an A1C) in any one visit that I felt could not have waited for another three. I feel very confident that an adverse effect to my health is extremely unlikely as a result of one more missed office visit, and as a bonus, I won't have to hear him gripe to me about how I shouldn't be pregnant anyway.

Hey, that feels a lot better...

Wednesday, April 11, 2012

Chapter 5, In Which I Am Either Treated Unjustly and Unreasonably or I Completely Miss the Mark

I either have a good reason to be frustrated or I am totally missing something about my situation. In any case, since I can't manage to turn my attitude around, I'll just tell you what's making me frustrated these days. I mean, besides the fact that my back hurts and I'm tired at the end of every day, and I'm looking at three children in diapers and cribs come June unless my oldest son does something really amazing before then.

We went to see the maternal-fetal specialist again at the end of last week. The news from the pessimist on the Statesman's kidney is she still thinks it's probably something much more horrible than what it most likely is, but after 2 1/2 months and four ultrasounds, we just aren't going to know anything more until the baby is born. As the weeks pass and we gain more information, I find her doomsday scenarios less alarming and more irritating. It makes me surmise all kinds of horrible things about her, some of which I have expressed here but which are probably not appropriate to express at all, given the attack it presents to both her character and her professional capacity.

In any case, she has, on at least two occasion, implied that whatever may or may not be wrong with my son is almost certainly a result of my inability to manage my blood sugars. Because she's "seen this kind of problem with Type I diabetics before" (never mind the fact that we don't actually KNOW WHAT THE PROBLEM IS). The only thing that does is make me feel like a bad mom, since I have and continue to do my absolute best to control my blood sugars AND I've done this two times successfully already. Plus it's annoying me.

She has failed to give a comprehensive reasoning for suspecting that her diagnosis is still the correct one, in spite of the direct and specific reasoning of the pediatric urologist. Her only manner of explanation for the discrepancy was, "oh, well, he's just really laidback." Yeah, either that or you are...well never mind. Her apparent failure to either a) reason through it or b) accept that someone else might know better is puzzling, and also annoying.

She has asked me to come to see her, without any intention of doing anything about anything until the baby is at least 32 weeks, every 2-4 weeks ("We used to try to intervene, but it usually didn't work out well"). That is extremely inconvenient and expensive (not to me directly, but I know someone is paying out the nose for it), which is extremely annoying.

And, after having looked extensively at this child's kidneys on four separate occasions over the course of 2 1/2 months, she still can't tell me exactly what's wrong. Because, "well, we can only see so much on ultrasound." In my head, I'm screaming, THEN WHY DO YOU EVEN BOTHER?!

I have to be honest, and perhaps this is the source of my frustration: this whole experience feels more like a problem-solving game for her than actual care for me and my child (that may have crossed the line, but it's as mean as I'm going to get). "Pin the tail on the diagnosis without regard for the expense, anxiety, inconvenience, and complete lack of treatment options available to the parents", or something like that. I'm tired of being treated like a Type I diabetic who's having a baby. I want to be treated like a human being who is more than the composite of statistical risk factors. I'm tired of being treated like a passive disaster waiting to happen. I want to be treated like someone who is, even if to a limited extent, capable and desirous of the best possible outcome for myself and this baby. I'm tired of continually being prepared for the worst without respect for the most likely. Even a Type I diabetic with sub-optimal control is, all things considered, more statistically likely to have a healthy baby than not (if we're looking at strict percentages).

Tell me, what am I missing?

Until then, with the Silly Old Bear, I say: Bother.

Monday, April 9, 2012

Happy Easter!

This is the feast of victory for our God! Happy Easter!


Sorry for the long silence. I am still pregnant (30 weeks). I will post more soon. I am weary of cynicism, and hoping that I might be able to find a way to put a positive spin on things in spite of all of the frustrating, irritating things that have happened over the last two weeks, so as to salvage my sanity for the rest of this pregnancy. I will soon!