Daily Archives: October 5, 2017

Abortion After 20 Weeks

A few days ago, I received an email from one of the many pro-choice organizations I follow. The email was in panic mode:

“URGENT! Your signature needed! Our reproductive rights are being threatened again!”

Two days ago, Congress passed a bill banning elective abortion after 20 weeks gestation. “Elective,” meaning not due to conditions dangerous to the mother (such as preeclampsia or eclampsia), or fetal demise, or fetal malformations that are incompatible with life. Those are still possible. Just not, “I don’t want to have this baby.” I haven’t read the full text of the bill, so I don’t know what other exceptions there are. Stay tuned.

I took a deep breath and wrote a letter, but not the kind they wanted or were expecting.

You see, I have a lot of personal history surrounding both abortion and fetuses, and from where I stand, it’s not so simple. Truth be told, it’s never simple to curtail any life, no matter how tiny or how tenuous.

When I was a 16 year old virgin, in 1970, I was drugged, dragged into a dark basement, and raped so violently that after two reconstructive surgeries my nether parts are still not normal. I ran away, partially because the much older man who did the rapes was then sharing me with his friends and as a young person with Asperger Syndrome I didn’t know what to do, and partially because my mother’s abuse escalated around that time, probably due to my increased vulnerability. I fled from Massachusetts to California, where instead of peace and love I found more rape.

I missed a couple of periods. My breasts were swollen. I had no idea what was going on, since there was no such thing as sex education in the schools at that time, and my parents were phobic about anything having to do with sex. I went to a mobile street clinic and discovered I was pregnant.

Being California, there were choices. I could have the baby and keep it; I could have the baby and give it away; or I could have an abortion. I couldn’t fathom either of the first, so I settled upon the latter.

My pregnancy was past 11 weeks by the time I discovered it. California law required that pregnancies over 12 weeks be terminated in the hospital rather than the clinic because of the different technique necessary and the increased danger of perforation of the uterus. The soonest they could schedule me was in two weeks, at almost 14 weeks of pregnancy.

I’m glad they did it in the hospital, because they knocked me out. All I remember is the OB resident coming to see me afterward in tears, ranting at me about “people thinking they can use abortion as birth control.” I had no idea what he was talking about, or why he was so upset.

Fast forward to 1988.

I was a second year resident in Pediatrics at a big city hospital. My Neonatology rotation included participation on the Perinatal Ethics Committee, which deliberated on matters concerning difficult pregnancies and how to handle them.

There was a woman in her fifth month of pregnancy on the inpatient Obstetrics ward. She was 38 years old and had been pregnant already many times, and had miscarried every time. Her underlying problem was high blood pressure, which prevented proper blood flow to the placenta. She routinely miscarried between 18 and 24 weeks. At that time, and mostly until this day, for specific reasons, 24 weeks was considered the lower limit of fetal viability. Efforts to work around those limits are ongoing, but for the most part not practicable.

But she desperately wanted her baby. The perinatal team knew her well and liked her in spite of her challenges. They felt that if it were technically possible to save her baby, then we had a mandate to do all we could to deliver her a living child.

Now, this lady was no married, upper class, healthy white person. She was black, intellectually disabled, and chronically ill with severe hypertension due to lupus. She was unmarried, lived in a rough part of town, and had a criminal record for theft. In other words, a high-risk prospective parent under any circumstances, and especially for a very premature delivery. What was the prognosis, really, for her to safely and effectively parent a tiny preemie who would, if she survived, need intensive care in the hospital for months and intense home care for years afterward? Not so good. We debated the issue for hours and hours. The lady really desperately wanted her baby, but we were literally not certain we could deliver a viable baby for her, and certainly not a healthy one.

What should we do?

One thing in favor was stress. Normally we think of all kinds of stress as undesirable. We’re always thinking up new ways to combat stress in our lives. But stress is the premature baby’s friend. Stress in utero leads to increased stress hormone production by both mother and fetus, and this speeds the maturation of the fetal lungs. That was one good thing. After the lungs, the greatest challenges are the kidneys, and the skin. In utero, the placenta takes care of fetal waste, but undeveloped kidneys are something we have not learned to adequately deal with on the outside. Likewise, no need for skin inside, but here in the big world, without skin we quickly dehydrate and without its protective barrier, bacteria get in and wreak havoc.

These things don’t finish their development until the middle of the 23rd week. Our job was to keep this lady pregnant until the end of that week, if possible.

The plan was to do thrice-daily ultrasounds of the maternal-fetal circulation. Her problem had historically been that because of her hypertension, her placenta would become calcified, leading to a net reversal of blood flow so that instead of her blood going to the fetus, the blood flow became reversed, so the fetus became starved of oxygen and died. We put her on complete bed rest with high levels of supplemental oxygen, to keep the pregnancy going until that precious 24th week, at least.

In our cutting-edge neonatal ICU we boasted well over 90% survival at 26 weeks, unheard of at that time. That’s because our hospital pioneered the use of pig surfactant, a substance that, when blown into the stiff lungs of a tiny preemie, caused those lungs to become suddenly functional. It was nothing less than miraculous.

(Part of that miracle is that it was discovered by an Orthodox Jewish postdoctoral fellow, who would come into the hospital at all hours to blow a tube of pig lung secretions down a baby’s tube.)

This almost entirely eliminated the biggest barrier to survival of premature babies, the lungs, unmasking the next big challenges, which were and still remain, skin and kidneys. (We don’t have artificial substitutes for either kidneys or skin, but believe me, they’re working on it.) So we knew that if we could get this little girl past that 23rd week, between the stress and the surfactant we’d stand a pretty good chance for having her grow up.

The neonatal team was on call for the moment the blood flow in her placenta reversed. If she made it to 24 weeks, we’d deliver by Cesarian section and then, if she breathed spontaneously or with minimal intervention, we’d go all out. If she did not breathe, we would not intubate her. That was the compromise we worked out.

As it turns out, she never made it to 24 weeks. At 23 1/2, placental blood flow reversed. We had a quick conference and reconvened in the delivery room, where the fetus was removed by Cesarian section and handed off to the attending neonatologist, who happened to be me.

Squirming in the surgical towel they handed me was the tiniest human I have ever seen. I placed her on the scale: 325 grams, about a third of a pound. I’ve had burgers bigger than that! Her eyes were open, and she had all her fingers and toes. She was perfect.

As I laid her very carefully on the cold scale, a hole opened in her tiny face and a huge wail came out! She cried lustily, and I shrugged as I handed her to the NICU nurse.

“She wants to live,” I observed.

“Damn right she does,” said the nurse protectively, placing her in the warm incubator. “Let’s roll!” And they took her to the NICU, where she endured many challenges but never gave up.

I followed her until she was nearly 3 years old, then lost track. She didn’t have it easy. Her mother predictably dropped out of the picture, but her aunt took over and did a great job with her. She never had any of the really disastrous preemie problems (brain bleeds, oxygen toxicity, gut problems, sepsis.) We figured the stress she endured prenatally might have helped. Or maybe, as in the Jewish way of thinking, her soul really, really needed this particular vehicle in order to accomplish its mission.

No matter. After holding that little tiny life in my hand, watching her hang onto that life for all she was worth and actually grow up, there’s no way I’m going to say that a 20+ week fetus does not feel, or is not alive.


The Dumb Question of the Year

Yesterday was my every-other-month appointment with Dr. Goodenough, and I’m still amazed at how much we cover during the course of 30 minutes. He always encourages me to talk about Will, and it all comes tumbling out without permission from my brain. I get to talking and I can’t shut up! Not that I mind talking about him…in fact, I love to reminisce about the good times, which is what I’m remembering more and more instead of the sad times. Last week, on the 27th, it would have been our 37th wedding anniversary, and while the day itself was very difficult, I recovered within a short time and am back to normal.

Anyway, I’d noticed that on my last visit to Dr. G, he’d changed my diagnosis to—of all things—Grief. Hmmm. The health system that governs the mental health clinic I go to has a patient portal which, among other things, provides brief notes about office visits; I like to check it when I go to Dr. G or get services such as labs and other tests. I was curious about this new diagnosis and asked him if that was in the DSM.

“Yes”, he replied, smiling. “It’s a legitimate diagnosis. Don’t worry, it’s not pathological, we just make note of it because it’s important in mental health.”

And then I asked it: the dumb question of the year. “So that means I’m not bipolar one anymore?”

Dr. G’s facial expressions are generally inscrutable when he’s not smiling, but it was clear he was struggling not to laugh. He composed himself quickly, however, and said “No, not at all. It’s just that grief complicates bipolar, as you know.” In the meantime, I was kicking myself on the inside for being so stupid. I didn’t want him to think I was stupid. I’ve always been very professional in my discussions with him—I don’t even swear in session—and here I’d gone and said something really, really ridiculous even though I know better.

The good news is, I’m very stable and I don’t have to go in for four months. Of course I’m to call if something goes sideways during that stretch, but unless my brain totally shits the bed I expect life to go on as it has for the past 15 months. I’ve got my HappyLight ready to go if I start slipping into SAD, which hasn’t happened yet because our early fall weather has been spectacular for the most part. I even organized my room the other day for the first time after Will died, which makes it much more pleasant to be in. It wasn’t dirty, just cluttered with crap all over the dresser, the nightstands, the table. I also had about 15 items of clothing draped over his recliner.

Speaking of clothing…it’s time to get rid of Will’s things. I’ve felt that coming on for some time. I’ve also taken off my wedding band and only wear the anniversary ring now; the wedding ring is too big for my finger and I’ve almost lost it several times. Besides, I’m not ready yet to advertise my single status. I may never be. It doesn’t matter right now. Today is a day to rejoice in beautiful blue skies and changing leaves, to enjoy my family and my life. And not to ask dumb questions. Haha!

 

 

 

Bad/Good

Feeling terrible. Woke up with a cortisol hangover. My son is moving into fear again, some crazy story about a woman being hogtied behind his building that a neighbor told him of course has his fight or flight activated. So that’s where my anxiety is coming from 😥

Also I’m wondering if my mood stayed ate fluctuating, or acting up, it always happens during the change of seasons. Mania or mixed phase in the fall, depression in the spring. Tired. Very tired.

Just got a phone call as I was typing this, and I had a very pleasant conversation with a lady from United Airlines about a pretty big refund that seemed to have disappeared. We figured it out, it left me feeling airier and better! Interactions with people can have you feeling bad but then interactions with people can leave you feeling good as well.

Mental Health Ninjas

I got cocky yesterday. I was swimming along, going with the flow, had things managed and anxiety to a dull roar. (I was actually able to make phone calls, which should have been made Tuesday but that day, I was borderline psychotic with anxiety.) Nothing catastrophic happened. i was feeling okay.

Then I got home and that damned band of anxiety ninjas launched a full scale assault on my senses. I literally felt like my bones were trying to pry their way out of my skin. There was no trigger. I was in my safe space. I was drinking water all day, so not caffeine to set it off. No sweets. Just…ninja attack. I took a Xanax. It did nothing. So I took another, knowing that’d make my bedtime dose short but hey, what’s a couple of hours trying to nod off compared to anxiety so bad you even feel like your child is a threat and it sets off fight or flight impulses.

Eventually, the spell passed, but it took almost 4 hours to regain equilibrium and by then, I was so stressed, my stomch was hurting. Frustrating.

Today is another wet and gloomy one, three in a row. We need the rain, even if all we get is short bursts. I only mowed my lawn twice the entire spring and summer, that’s how dry it has been. But much as I love the sound of rain and not having sunlight piercing my corneas…It does impact my energy and mood so gloomy days are a bit rocky for me.

This one started on a somber note. Spook’s kitten, Sachel, passed away. The mama refused to feed him, he refused to eat even kitten chow or milk, and I guess even with me using a kitty syringe to feed him nutrigel and mooshy food, it wasn’t enough to sustain him. Now I am terrified Adelitas is going to go the same way, though he is at least warming a bit to the idea of powdered milk and he will drink some water. Any day that starts out with having to tell your 8 year old her kitten died is not a good day. I buried him after she left and put a flower on his grave so she can have her own ceremony later.

Ran some errands before coming to the shop. Frankly, I am amazed how much I remembered to do, even some of it before I left home because hey, I have internet, I can submit an invoice from there…But of course there’s one thing I can’t remember so I had to send R a text and he will undoubtedly give me shit for not remembering that one thing. I remembered everything else. Give me some credit for that. With the holes in my memory these days, I’m lucky if I remember to put on pants. (I wish that was a joke.)

I kinda spruced myself up today with a pretty shirt, some eyeliner and earrings, a bracelet. Think it’s my way of saying, “Look, you selfish bitch, that poor kitten is dead and you’re alive, so show some damned signs of life and be thankful you have one.”

Back to making the donuts. Which means sitting here watching TV shows and firing off a message to an ebay seller about a defective product. Woohoo, I am a whirlwind. I guess compared to others, I am a sloth but the functionality I manage, lackluster as it can be…I take a little satisfaction in it.

A little. Too much and then people will think I am all cured if my exterior is all shiny. If only they could spend some time in the darkness hidden by that exterior they might learn some empathy.


Turndown

Well, my oldest isn’t going to Disney after all.  They turned her down after her phone interview yesterday. She was really upset when she first got the news, but she’s calmed down now and is putting her nose to the grindstone in her classes to make sure she gets the main thing done, which is to graduate on time in May. But it was so sad for her.

I am still managing fine and have lost now nine pounds since Labor Day.  I really feel good that I’m seeing results so quickly. Only 99 more pounds to go :).

So sleepy.  I can’t decide whether I need to go back to bed or not.  I have a free day so far except for Bob’s laundry so I am seriously thinking about it.  I also could work on my short story for  fiction, so we will see what I wind up doing.  And I need to go to the grocery store.  I think I will try to do that this morning so Bob has milk for his Slimfast.

Hope everyone has a good rest of the week.

 


Worries… Wish me luck my friends.

Having trouble, friends! My sweet, fallen brother’s birthday, the mass shooting, and the very worst for me: awful worries about my son, perhaps not warranted but still in my solar plexus and in my heart. Full of worries about my son. He was attacked by a gang a few months ago. Even though he is as strong as an ox and healthy, thank goodness and all that is good and hopeful on this earth and in this universe, he is still living with the after effects of the attack 😥 Will he be alright? Will his life be good? Will he be loved and healthy and happy? Yes, yes, and yes I insistently tell myself!

And then I read this is not the worst mass shooting in modern history, that was in Black Wall Street, where 100’s of African Americans were killed for being too prosperous. The Native Americans were given blankets with smallpox. No gun control, can’t even talk about it, not even on the day of the Las Vegas shooting! I’m so tired of all this. I can not deal with it. Too much violence. Too much inequality, injustice, just plain disgustedness. I am sad and disappointed and heart broken because of these and so many other things. Please, I’m drowning!

I don’t know what to do to stop all this awful stuff from happening.

It’s just too much for me. I feel like I’m drowning in the negativity of these heinous events. That there’s no hope for humankind. How can we do all these terrible things, treat our fellow human beings in terrible ways? Is there any hope? The racist, white supremacist, anti feminist ultra conservative path that the US and much of the world are taking is pretty unintelligible and abhorrent to a person like me who is a humanist, a feminist, and someone who believes, truly believes that love is the answer.

But it seems like either no one is asking any questions or they are asking the wrong questions, because no one is getting LOVE as the answer. They are getting hate, and divisiveness, and fear, and anger. And all these negative emotions are making me feel very afraid. I don’t like this world we live in. I don’t like our gun toting, bigoted, racist, classist, anti feminist society. And the more I read and see the more hopeless and afraid I become.

Maybe I just need to unplug from media, social and otherwise. I think I will only read scientific articles from now on or articles about meditation, yoga, good positive things. No more politics, no more mass killings, absolutely no more 45. That’s it I’m done. I don’t want to live in fear anymore. The world will just have to go on without me, it will anyway. I will try to make my immediate surroundings full of love and acceptance, in fact I won’t just try, I will do it! I will give love and acceptance to all my loved ones. I will be the change I want to see in the world. Then I will have peace and give peace and love to one and all I encounter.

So Namaste friends and may Peace and Love be with you. And wish me luck in my absolutely heartfelt quest to live a loving, peaceful and positive life.