Units, units, units

So at my last ultrasound, I was having my level of amniotic fluid checked to make sure everything is alright. I was told everything is fine .... and I am quite sure that it is. And yet ......

I was taking a sneak peak at my own chart while waiting for the doctors and I noticed that the volume was reported in cm. Yes cm. Not ccm. So I asked the ultrasound technician what the volume was measured in. She replied that it was in cm. I pointed out that cm was not a unit of volume but her response was a flippant "Yes it is". Hmmmm. I chose not to argue. But I wondered what world she was from.

A nurse told me the same thing. "cm is a unit of volume." I hope they are a little bit more careful in their units before administering my drugs.

I then asked another ultrasound technician who told me that units are important and, as long as they put the right measurements in the right fields, a formula will give the correct volume .... in cm. Double hmmmm. Really? How does one know when they have a gross error? This makes me a bit nervous. Magic formulas always make me nervous. Especially magic formulas that give results of volume in units of length.

I finally asked my doctor. She was at least chagrin, replying that she used to understand the reason, but that she couldn't remember. Fine. Hopefully she'll be able to supply an answer for me at my next appointment ... if for nothing more than to satisfy my curiosity.

As a trained engineer, this concerns me. The first question I was trained to ask myself after completing any calculation is "Do I have the correct units?" The second question is, "Does this value make sense?" The third question is, "Can I explain it?" So these four educated people, who are taking my baby's health in their hands, have violated all three of my principles for calculation.

To measure fluid levels, the technician divides your uterus into four quadrants and then measures the height of each quadrant vertically, and roughly in the center of its x-plane. I say roughly because these locations are done by eye. Now keep in mind they are trying to get an approximation of an extremely irregularly shaped 3D volume from a 2D image. I am uncertain how they determine where on the z-plane to take the cross sectional measurement. However, these lengths are (rightly) measured in cm. The measurements are then put into a formula that supposedly plunks out the estimated volume .... in cm. Excluding the incorrect units, I contemplate the uncertainty of these measurements. How accurate can the method be for such an irregular shape as the shape of my fluid inside my uterus and around my baby? Is there a standard magnification these measurements are taken at? What is expected for user error? How much does this depend on the mother's weight? What if the baby is moving during measurements? Etc., etc., etc. At best, I would think we are on the order of 50% error.

So I am merely wondering about how the measurement is made and why volume is reported in cm. I am not really concerned about my actual test. Darren is fine. And I am doing alright, too. I would hope that someone, somewhere and at sometime understood the problem and gave it the best shot an engineer can give in order for hospitals to universally use this method.

But, the whole thing reminds me of a engineering joke we used to tell in college: A king decides to improve prosperity of his country by increasing the dairy production and he forms a council of a biologist, sociologist and an engineer. The biologist says "we should undertake a program of selective breeding to enhance the milk production traits of our cows." The sociologist says "we should study the behavior of our cows, how they interact with their keepers, surroundings, and each other, to minimize their stress which reduces milk production." The engineer goes to the blackboard and says "Let's assume the cow is a sphere ...."

Punchy

I am feeling rather celebratory! On Wednesday my ultrasound went well, showing that my cervix is still holding on and that my funnel width has decreased. For those of you who are unsure what that means, I borrowed the following image from a sonogram instructional website. When I was admitted to the hospital, my cervical length was zero, but it has somehow managed to lengthen to a whopping 0.5 cm! (A healthy cervical length is 3.0-2.5 cm).

http://www.sonographers.ca/COW.php?post=19

I have been gloriously stable! It is now 12:20am and today I go home! I am down right punchy! My own bed - with my own husband - with snuggles in the morning - and a window with trees outside instead of a helicopter pad - and a banjo - and loud music! I am looking forward to seeing my home. Only three more weeks of bed rest and then anything goes. Three weeks seems like nothing, all the sudden. My fingers are crossed that I'll make it to 35 weeks and that he is born shortly after that. I've had enough.

I know I have had enough because I am tired and uncomfortable. I mostly I know I have had enough because I have come to think of my nurses as .... friends. I joke around a lot with them. As I got my weekly shot, I said "Damn, your a pain in my ass!" Not an intelligent thing to say when you are getting a shot. A nurse shaking with laughter makes for a bigger pain in the ass. We laughed when I put pillows in my bed to make it look like I was sleeping when I was in the shower, and when I blew up hospital gloves and closed them in the door to look like a stuck hand. The nurses have joked with me as well. And I have learned not only their names, but the names of their spouses and children. So thank you nurses and friends who have helped make the best of my stay at DHMC.

May I not return until delivery in (more than) three weeks!

31 Weeks!

Today marks 31 weeks! Can you believe it? I have been in bed for 77 days and have been in the hospital for 31. Somehow it seems surreal that Darren is still growing in me! There is a hope that they may release me next Sunday, though I would still be on bed rest at home. However, I have remained fairly stable, though I have had a couple of incidents where I was unsure if my contractions would subside.

Most of the time I am exceedingly grateful for my stability, but there is a vague part of me that is slightly embarrassed. It may sound silly, but I am pretty convinced I will actually make it to 41 weeks without delivering - which seems so anticlimactic. What a drama this all seems. Sometimes I truly wonder if I am over reacting or being a wimp, especially when I feel fine. But deep inside, I know that isn't really the case. No one is hospitalized for 31 days for no cause. I do think I would have delivered without the weekly shot of drugs to stop and prevent further preterm labor. And I do believe that laying down for 77 days has prevented gravity from causing my cervix to dilate further. And I am grateful that I was given surfactant for the baby's lungs to develop faster. And I did find it a comfort to have so many ultrasounds to determine Darren is not only holding on, but actually thriving. And I am grateful for the security and safety I feel in the hospital regarding my own health. So if I make it to 41 weeks, I shall be grateful for all the safe guards I was provided and I will rejoice in the birth of my son. Even if the whole experience has been incredibly humbling.

I am feeling rather emotional about the whole thing. It has been rather intense. So please, no jokes or jests if I do make it to term. I don't think I would be a very good sport. But feel free to rejoice with us.

Psychological Danger

Has it really been six days since my last post? Goodness! I have been trying to think of something interesting to write about for days now, but all I could come up with everyday was "pulled through". I couldn't post that. "Pulled through" isn't even mine - it is from Diaries of Adam and Eve by Mark Twain. (By the way, this is one of the best books I have ever read. It is absolutely hysterical, and somehow it truly captivates female and male sentiments perfectly. It only takes an hour or so to read and can be downloaded for free: http://free-ebook-download.org/The-Diaries-of-Adam-and-Eve.html .) But "pulled through" is entirely accurate.

I am used to the monotony and seclusion from society that hospital captivity really provides, which worries me. I am in great psychological danger. Craig Haney refers to the negative effects of incarceration as institutionalization. You know what I mean - the inability to adjust to the real world after getting out - like the guy in Shawshank Redemption. You see, there is a rhythm to life here.

I wake up every morning at about 6:00. Some resident comes around and asks the same questions every day. "Any bleeding? Cramping or tenderness? Contractions? Leaking of fluids? Blurry vision? Head aches? Cramps in your legs? Is your baby moving?" Then they feel your belly for a bit and leave. The nurse comes in, repeats the questions, takes your vital signs. You eat your institution breakfast. About 8:00 you're hooked up to fetal monitors to watch contractions and the baby's heart beat. Shower and free time until noon. More institution food (though I sometimes have a visitor bearing gifts). Nap. Free time till supper. Shift change and the new nurse comes in, you're asked the same old questions and your vital signs are taken. You thank God the machines indicate you are still alive. You settle in for the night and the whole thing starts over in the morning.

All day you lay in a bed that automatically and periodically changes the pressure under you so you don't get bed sores and your legs are stuck in these pressurized "leg puffers" that keep up your circulation.

My psychological danger? My release. Will I sleep without leg puffers inflating and deflating every five seconds all night long? I may doubt my baby's health without hearing the nice little heart beat for an hour every day. I may be strangely lazy and ask John to get me things just out of my reach. I need my institution provided water container that measures how many quarts I drink through its straw. Really. I may become all dehydrated and shriveled without it. Oh, Lord, how will I ever survive without the little Styrofoam cups of ice cream? How will I handle grocery shopping - with three kids - or driving in 12A "traffic"? And what about my hospital induced hopeless addiction to Young Riders?!? How will I know I am alive without a machine to tell me so twice a day? And how will I get anywhere? WALK!?! Ahhhh! I have become like George in the Seinfeld episode where he gets a wheelchair so that people will always be nice to him! There are so many things that I won't know what to do with myself! Discipline to give and diapers to change and snacks to fix and meals to prepare and dishes to wash and laundry to do and tickles to dispense and skinned knees to kiss and on and on and on! Oh my word, I am so overwhelmed.

Oh. It is post lunch nap time. Phew.

Hospital Experiences

Today is my 66th consecutive day of laying in bed. And I have spent 23 of those days in the hospital. You have all sorts of different kinds of experiences in the hospital than when you are living in the outside world. During an extended stay in the maternity ward, you hear lots and lots of screaming. It is a strange thing to hear another woman screaming in the throws of labor pains. And you'd think that I would get used to it after 23 days of it. But I haven't. The screaming doesn't make me feel dread or fear. But I feel uncomfortable listening to something so intimate and private as birth. It is a feeling akin to when you hear two people in bed. It made me wonder if I did that when I deliver. John told me I don't yell, but I swear like a sailor. Funny, that somehow doesn't surprise me at all.

Sometimes you find yourself sharing experiences with strangers that are exceedingly triste. These experiences aren't your everyday interaction with strangers. One day I ended up crying with a family who had lost their child; I made them a card and gave them our contact info for support, but a card from me seems so pale and insignificant next to the hurt they were feeling. And I have seen tears streaming down other peoples faces - leaving me to assume the worst.

But there is plenty of laughter in the hospital too. Perhaps the most has come from an evening of wheelchair racing with Megan. I am only aloud to leave the ward with a "reasonable" adult - no joke, it says "reasonable" in my file. But Megan had them fooled and she wheeled me down to the front door of the hospital late one evening. There are about 100 chairs there for general use, but Megan was a tad nervous about taking one. I promised it wasn't a big deal, and so we found two that vaguely fit us. (Believe it or not, there was even a huge one; it must have been a double wide.) Very serenely, we wheeled past security, whistling and looking all innocent. And then we headed to the long corridor over by the doctors offices. Now mind you, I think if I had a Gatorade in my fist and sweatbands around my wrists and forehead, I would stand a chance. But no. I pretty much stink at using a wheelchair. I got creamed not once, not twice but three times! Much to my embarrassment the third time, I even had a handicap. So mortifying. We have a rematch scheduled for this evening, but I still have no sweatbands or Gatorade so I fear my future is doomed.

There are sweet experiences with some of the children in my life, too. Seth made me a spectacular banner with trucks down it's length. Cora made me a great card with her name (which she wrote herself) and lots of glitter. I received Secret Garden from a friends daughter. She had recently read it, loved it, and thought I might too. And I got a beautiful card from another friends daughter, complete with pictures of a "bango", a quilt with blank blocks for me to color, and a crying baby Darren - crying because he was just born. And another child brought me a pine cone to sniff since I haven't been outside in some time. What amazes me is their sense of compassion with no inkling of obligation.

Some things are actually exciting. I think now that I am nearing 30 weeks, I am finally starting to think this pregnancy will end with life and smiles and joy. I am finally starting feel excited. Yesterday's ultrasound confirmed that my cervix is holding steady! And I was able to have a 3D ultrasound image done. I think Darren looked like Cora, but John was unsure. It is exciting just to wait and see.

Miracle of Miracles

I was checked today and had a miracle of miracles! My cervix actually lengthened! According to the doctors that is very unusual. Though my cervix is still very weak and dilated, I am counting my blessings. And so you might wonder what this means. Unfortunately, it doesn't mean it is safe for me to go home. But I have a new found joy of joys .... I can walk down the (very short) hall to get my own drinks and use the microwave. I found my thirst was absolutely insatiable! Absolutely unquenchable! And I even considered brushing out my perma-bedhead hair just to go to the little closet of a room. After all, I might actually see another human being who is not wearing scrubs! There are glorious treasures in this room ..... ice cream and juice, puddings and popsicles, milk and crackers! And I, a woman of great progress, have the new found freedom to get these treasures myself. I wonder if this is how women felt when they first were given the right to vote.

Most importantly, it means that Darren and I are doing unbelievably well, all considering. So thank you for all your prayers ..... and thank goodness I somehow have managed to behave myself. It seems to really be paying off.

The Roommate

I've been warned I am getting a roommate - another "long timer", most likely. (The nurses call us "long timers".) I love people, and yet I dread having a roommate. I don't have a fear of not liking her, or of her driving me crazy, or of her keeping me up all night long with snoring. I dread it because she is a stranger. Over the years, I have learned some tactics for keeping my spirits up. Excersizing. Hiking. Picking flowers. Bed rest has taught me the importance of friends and family. Visits have been my greatest tool to combating depression. And visits are suddenly being ripped away from me. I know it is technically okay to have visitors and I hope you all continue to come. But all intimate and personal conversation is suddenly gone. How am I supposed to call John and tell him how much I love him and cry and tell how much bed rest sucks and that I feel miserable he is missing all of Darren's kicking - with a complete stranger sitting a couple of feet away from me? Connecting with my husband is already a challenge. How am I supposed to confess all my greatest fears to my friends? How can I expect my friends to tell me anything personal? Or my husband? And God help me when the kids come to visit all hyped up on hospital ice cream cups and then slide around the floor on the IV stand - while that stranger is trying to sleep! And should I move all the art they have plastered all over the walls?

I want to be kind - really kind from the depths of me. I want to be kind with an I-know-this-really-sucks-and-I-wish-the-best-for-you-and-yours compassion. I want to be generous with a sure-I'll-give-up-the-window-side-of-the-room attitude. How can I feel so selfish?

Still, here's to hoping the situation is only for a day or two.

Asherman's Syndrome

Several people asked me what Asherman's Syndrome is, how it has effected me and what the fall out has been. Though this is a vulnerable story, I share it because Asherman's syndrome is so rare, which creates a feeling of isolation for those who do get it. Also, there is a need for greater awareness of women's health issues.

I had two healthy full term pregnancies before this one. My son is 5 and my daughter is 3.5. However, after each delivery, I had retained placenta. Unfortunately, both times it was undiscovered for weeks; both times I got uterine infections and had D&Cs. After my daughter, not all the retained product was removed during the first D&C and a second D&C was performed a week later. Months went by uneventfully but my cycles did not return. The doctors assured me this was normal since I was breastfeeding. But I felt them. Every 28 days I had excruciating pain, literally bringing me to my knees in tears. The writhing pain would last for about 2 days. My ob-gyns were unable to diagnose me. Once they thought I had a stomach bug. Then it was gas. Then it was constipation. Finally, after seeing several doctors and months of incredible pain, I had a hysterosalpingogram (HSG). I had Asherman's Syndrome, class IV. The condition is very hard to diagnose because it is not easily detectable by ultrasound.

Asherman's Syndrome is an acquired condition. It is characterized by adhesions (scar tissue) resulting from uterine trauma (ie. retained placenta, uterine infection, an overly aggressive D&C, a missed miscarriage or an elective abortion). In many cases the walls of the uterus grow together. It can be likened to a balloon left in a hot car and melted. This was true in my case and I had less than 5% of my uterine cavity left. Because it is a physical problem, your hormones still allow you to ovulate and the remaining endometrial lining still thickens and sheds (menstruation). However, my scarring prevented the lining from shedding through the cervix. Rather, it backwashed up my fallopian tube, into my abdomen and was reabsorbed into my body causing my monthly pain.

Asherman's is rare and must be treated by a very experienced physician to prevent worsening the condition. There are only a handful of specialists in the U.S. After several misdiagnoses and an unsatisfactory treatment plan at my local facility, I began commuting to Newton Wellesley Hospital's Center for Minimally Invasive Gynecological Surgery. I had two surgeries and several in-office procedures to irradicate my adhesions.

Though Asherman's often results in infertility, I had no problems getting pregnant after treatment. My third pregnancy failed during the second trimester and I was forced to have another D&C after which I hemorrhaged - all a complete nightmare. My fourth pregnancy I had a missed miscarriage and yet another D&C. The specialists were unable to tell me why my pregnancies failed. None of the data following my two miscarriages was conclusive, though I felt it was from my Asherman's.

John and I decided we were blessed to have two children and agreed to stop. I was stunned to find I was pregnant with Darren. So, are my current problems related to Asherman's? We don't know. This pregnancy I have been diagnosed with an incompetent cervix, which can be caused by repeated intrauterine procedures performed through the cervical entrance. However, no data proves or disproves that is true in my case. An incompetent cervix can also be caused hormonally. We simply don't know which is true for me.

Asherman's is difficult for many reasons. It simultaneously attacks you physically, sexually, emotionally and spiritually. It attacks your marriage. It attacks your family. It makes you wonder about life and death and God and community. It makes you ask existential questions. But, amazingly, my experience made me grow as a person; it has given me a broader and healthier perspective of the world around me.

Along the way, I learned the female body is incredibly amazing and even more complex than anyone realizes. The female body is strong and amazingly resilient. It is beautiful. Conception and birth are true miracles. I learned people have no control over life or death. I learned doctors don't have all the answers and that, in many ways, medicine is a soft science. I learned my doctors are doing the best they can to help my family and me, though they don't always get it right. Through these realizations, much of my anger and frustration has been alleviated. I have come to believe that doctors have my best interest in mind. I learned to extend a little more grace.

Asherman's has taught me to value relationships in a much deeper way than I ever have before. I have a stronger belief and commitment to community and friendship. I have a healthier view of marriage. I have a much stronger belief in a God and different idea of who that God is.

This is only one story of many, but I hope it helps in a small way. Please feel free to post questions or comments. And if you have Asherman's Syndrome or an incompetent cervix I hope this helps you to feel not so alone.

Bed Rest Survival Tips

Should you ever go on bed rest, I highly recommend the Mobile Welder Café! Today Cathy came over with a fantastic spread of chicken salad with hints of pineapple, celery sticks with dressing, crackers and cheese and a fantastic fruit salad. Perhaps the biggest treat of all was the 18 oz of dried pineapple. For some reason, pineapple is doubly as tasty this pregnancy. The spread was a good change from the over cooked hospital food I ate last night. And over a scrum-didily-umptious lunch, the Mobile Welder Café also provides delightful companionship.

And should you ever go on bed rest, I highly recommend massage therapy. Being in bed all the time (except for the joyous occasions to rise for the bathroom - not a privilege granted to all bed-rest-doomed women) makes your whole body ache. In particular, my hips and shoulders were very sore from my limited mobility. But the massage therapist came today and my pain was greatly relieved after only a half hour of working on my muscles. Most amazing was my immediate hip relief! I almost feel limber!

Also, should you ever experience any extended amount of time in the hospital for anything, I highly recommend getting some plants. I was lucky enough to receive three: a Christmas cactus, some tulips and some daffodils. The tulips were mere buds last night. We woke together at dawn, the tulips and I. As I opened my eyes, they slowly blossomed into beautiful purple flowers. Everyone should wake with the flowers at least once in their lives. I am looking forward my daffodils following suit.

All these things help to keep depression at bay. A special thank you to all my friends who have cared for me. You all make me believe in the goodness of God, even when the road looks bleak ahead.

Not all days in the hospital are so luxurious. Not all days are filled with such pleasures. But I am now 28 weeks and 3 days. My next goal is to make it to 32 weeks before Darren is born. I pray God lets me hold him when he is born; I don't want to see him whisked away, even for his own good. I look forward to the intimacy of those first few moments and hours when John and I gaze at him in awe, all snuggled up close. I pray that cuddly time will be right away.

Another Day

Today officially marks 28 weeks of pregnancy down. And we made it to 2011. Not much planned for the day. John brought the kids in to see me yesterday and brought some pictures of them all making snowmen and snow forts out in the back yard. It was bittersweet to see. I saw them all happy and having fun, but I also saw the blank space where I wanted to be. Some days it feels like I am missing a whole chapter of my children's lives. I have to remind myself to behave because I don't want to end up like the guy in One Flew Over the Cuckoo's Nest. It wouldn't do my family much good if I end up with a lobotomy for misconduct.