Backstory # 4. Complications are Complicated (AKA "Why I Didn't Sue Anyone ...)

It is an (American) legal corollary of Godwin's Law: the bigger the medical complication, the greater the chance that at least one doctor will be sued. It doesn't really matter if it was true malpractice or not. It only matters if something went wrong. Therefore it's no surprise that I have been asked by numerous people if I was going to sue the OB who perforated my uterus during my D&E surgery or the anesthesiologist for my D&E and emergency laparoscopy.

When people learn I didn't sue anyone, they either express shock at my naivete, or conclude I must have found Jesus. Never mind that I'm the same old agnostic cranky pants I always have been outside of this subject. Cut me off in traffic and I want to cut you off right back, and my kids in the backseat probably just learned a new swear word, too. As for being too trusting or naive ... I'm an editor, for chrissakes. We aren't exactly known for our rosy world view.

The truth is, I thought about suing after my D&E went wrong. I think it was reasonable to do so. Usually a pregnancy termination for medical reasons is the last sad chapter in a particular sort of heart-breaking story. A dilation and evacuation (D&E) doesn't typically effect future fertility at all. While the emotional recovery takes a long, long time, from a physical standpoint, the procedure has a quick recovery time.

But with me the D&E was not the end, but the kickoff to any even more difficult set of experiences. Before the uterine perforation, I had sailed through a vaginal delivery for Big A. But the perforation placed me in the high risk, c-section-only category for future pregnancies. Then, during the laparoscopy done to repair the perf, the general anesthesia failed. I heard conversations going on about me in the OR, struggled with the pain of incisions being cut and instruments being placed, and felt like I was suffocating from the intubation tube. And since I was paralyzed from the anesthesia, I was unable to let anyone know what was happening. (See my "Backstory 3" post for more details on all that.)

Finally, while I was told that another pregnancy was likely safe so long as I waited 3-4 months to conceive, avoided labor, and had a planned c section, this turned out to be incorrect. Little A shoved her feet through my perf scar during the 35th week of pregnancy. It happened at home, before onset of labor -- an extremely perilous situation. In addition to nearly killing Little A and me, the uterine rupture also effectively ended my ability to have more children.

So ... My point is that the doctor's slip of a hand with a surgical instrument during my D&E had terrible implications for me and my family. In light of that, thinking about the possibility of suing somebody in the first raw days after my injury was just spectacular. It really, really helped me cope. I highly recommend it to anyone in a similar situation.

Any medical professionals reading this are now recoiling in horror. But, I'll say it again -- I did not sue. I'm not advocating that patients always sue. I'm just saying that the energy burst that comes with the desire to sue is good. It can wrench you free from the haze of hurt and shock and compel you to have real conversations with your doctor.Unfortunately, the type of conversations patients crave when they have bad complications scare the bejesus out of most medical professionals. But I think talking openly after an accident actually benefits the doctor as much as it does the patient. Most of the time, the patient discovers that the people working on them struggled with incomplete information. They learn that the procedure was tricky, and that what occurred was a rare but honest mistake. In those circumstances, I think the majority of people eventually come to the conclusion that they had crappy luck, but ok medical care. This is a scenario most people can ultimately forgive.

By contrast, the thing that fills you with vindictive resolve is the sense that someone is more concerned with covering their ass than helping you. If people had refused to talk (or talked down) to me after the perforation, things might have gone differently in the lawsuit department. Here's the thing health professionals need to realize: patients will assume the way you are treated after a bad complication exactly mirrors the way you were treated during the procedure that had a poor outcome. So a lot of honesty is in order. And a little bit of sympathy and niceness goes a long way, too.

The doctors who were involved in my D&E did not all behave perfectly afterwards. But, they behaved quite well. I never caught anyone in an obvious lie. Most of the time, I felt my questions were not ducked. For instance, Dr. Surgeon told me "I perforated you" rather than "Your uterus was really thin because of pregnancy, and it tore easily." Both statements are true, but the first one showed that Dr. Surgeon was not trying to deny her part in the damage. She also said, "Ultimately when something like this occurs, it is operator error." That's probably the polar opposite of what lawyers would advise a doctor to state, but let me tell you, that sentence alone really made me want to give Dr. Surgeon the benefit of the doubt.

Still, Dr. Surgeon didn't help me track down my anesthesiologist (whose name I initially couldn't recall) after I told her that I woke up during the procedure. In fact, her demeanor changed markedly when I described what I remembered occurring. She froze up, and I could almost see the thought balloon over her head that read "Oh shit, she's crazy! She's gonna sue everybody!" Dr. Surgeon told me she couldn't remember my anesthesiologist's name, which struck me as implausible, given that my perforation was a rare occurrence (first perf in ten years of the surgery, she said) and therefore likely a memorable experience. I'm sure she could have at least looked that detail up, but she never offered to do so.

Worse, Dr. Surgeon never apologized. To this day that stings. Saying she was sorry wasn't required for me not to sue. But, it would have been the decent thing to do. She caused a lot of damage. On purpose or not, it was permanent damage.

The anesthesiologist did better. I wrote him a letter describing what I'd experienced. I told him I needed to know what happened because I now had a full-blown anesthesia phobia and this was a wee bit problematic, given that I wanted to get pregnant again and was staring down a mandatory c section.

Dr. Anesthesia called me two days after I mailed him the letter. The first words out of his mouth were, "I remember your case well, and I'm so sorry. We all just wanted to help you, but it sounds like we made things worse!"He said he recalled my blood pressure was quite unstable shortly after the D&E converted to an emergency laparoscopy after the perforation. He said he had to change types of anesthesia at the onset of the lap, and then he had to immediately lighten the drugs to stabilize my BP. Dr. Anesthesia guessed that was when I was likely awake. He was ordering my chart to refresh his memory, and would call me back to talk things over again when it arrived. He said he'd try his best to help me piece together the chain of events and also give me pointers on how to relate my medical history to other anesthesiologists, so something like this wouldn't occur in future surgeries. And before he hung up, he said he was sorry once again.

The night the anesthesiologist called me was the first time in the month since the D&E when I didn't suffer from insomnia or anxiety attacks. I don't think this is a coincidence. Finally somebody who was in the room with me when everything went to crap was expressing sadness and sympathy about what happened. Even better, Dr. Anesthesia didn't try to minimize my trauma. He got that I was suffering, and unlike Dr. Surgeon, nothing in his statements or demeanor made me feel that he thought I was crazy or a wimp for feeling the way I did. He sounded like he was suffering at the thought of it all, too.

And that is how I started to move away from the idea of suing anyone. It was incremental. I got more and more information, and none of it indicated carelessness or negligence. I could slowly step away from the need to blame someone for what happened. Little by little, I accepted the notion that sometimes accidents happen. It is the most terrifying of ideas -- the concept that full control of any situation is more myth than reality. But in this case, I do think I was mostly just ... unlucky.

Complications like mine are complicated to live with. Time passing and having a healthy baby now, despite the terror and difficulties that came with that, certainly help me feel a bit better when I look back on what happened last year. But, the truth is I will never really be completely over what happened. I was permanently changed, both physically and emotionally by what occurred. It cannot be erased.

Sometimes I wonder if the doctors involved in my case ever think of me. If they do, I hope they realize that as much as it is possible for me to do so, I have forgiven them. I really do wish them well.

I also pray they are never so unlucky again with a patient as they were with me.

Oh Won't You Be My Neighbor?

Last week our favorite neighbors moved away. They are the kind of family that included parents both DH and I liked as people, and a child that Big A adored. As any play-date veteran knows, that combination of parent/child compatibility is somewhat rare, and the fact that it existed just across the street from us was especially precious. We play dated regularly and watched each other's homes during vacations. Most memorably, these were the people who took in Big A the day my uterus ruptured and DH had to rush me to the hospital. I'm sure that watching my toddler (who was sick, to boot) on the last Saturday before Christmas with no warning was a colossal inconvenience. But they never complained, and in fact expressed gratitude that they happened to be home when my pregnancy shit hit the fan. Now, that's a good neighbor.

Our beloved ex-neighbors are attempting what I call "the golden exit." This is a scenario that anyone living in the San Francisco Bay Area knows: Sell your ramshackle property and move someplace far, far away, where your 25 percent stake in a house here translates into a 80-100 percent stake in the purchase of a bigger, nicer, newer home. When you live where the median home price is over a half million dollars, most young families who are lucky enough to be able to buy a house are doing so by taking on mongo mortgages. House payments then become the #1 determinant in our life decisions. They drag many a woman back from maternity leave before she is ready, or cause families to go into massive credit-card debt if they decide to try the single-income, parent-at-home route for awhile. It's inevitable that mortgages become the symbol of all that is hectic, frantic, and stressful in Bay Area life. It's no wonder that lower-cost housing is the siren song of the Red States.

Still, even though every family out here at least considers the golden exit in passing. most don't do it. People have problems staying here, but there are also obstacles to leaving. First, Bay Area residents are unable to tolerate any weather. Sure, we knit jaunty little scarves in winter, but we often wear them outside without jackets, because the Bay Area doesn't do ice or snow. And after the rainy season is over, you can count on it being dry for months and months. As someone who grew up in cloudy Upstate New York, this was a revelation to me when I first arrived. But, as with anything, revelation quickly turns to expectation. Everyone here cultivates ridiculously picky expectations about how the weather should treat them. When you utter, "Whoah, it's a little muggy!" when it is 30 percent humidity and 72 degrees, you are screwed. Moving to Saint Louis or Chicago is just out of the question.

The other big problem is that people are drawn to the Bay Area because of the wide variety of jobs, the ethnic diversity, and tolerant/liberal social values. If those things float your boat, it's hard to find a better boat than this. Sure, you can head to Seattle, Portland, Boston, or New York. Those are great places. But, those urban centers also have more expensive housing that would make the no-mortgage goal impossible for most. So in the end, most of us stay put and dream on about possibly leaving later.

So I'm bidding my ex-neighbors a fond farewell and wishing them luck in their relocation to Texas.* May they find the benefits of moving outweighing the losses. I'm also praying that the new neighbors who take their place will be even a fraction as great as these ones were.



*Texas, as in the state of mind rather than the geographical state. I refer to anything more than 30 miles away from the California coast as Social Texas, because once you go inland, the majority of people tend to be much more conservative than on the coast. Yeah, I know that would make me a wine-drinking, organic-food loving, latte-craving yuppie according to certain folks out there. To which I say ... yeah. For better or worse, that's probably me in more ways than not. Whatever. That's why I don't live in Social Texas (anymore), k?

Priorities

DH, the A's, and I were out for a rambling Sunday jaunt with some friends. Our friends also have an infant, and all of the kids seemed just a trifle cranky during the walk. That meant we stopped every 8 seconds to pop back in a pacifier, wipe a nose, or calm some screaminess. A hiking loop that is only a few miles long took us over an hour to complete. Speediness, thy name is not family.

After the hike we visited one of our favorite ice cream parlors. The ice cream made Big A twirl around the sidewalks and nearly collide with many pedestrians and their dogs (some of whom she yelled "BAAAAD DOG!"at because she is afraid of dogs) until we found our way to a playground where the sugar seizure could run its course. Finally everyone was hungry again, so we walked to the super market to pick up something for dinner.

Big A spied one of those shopping carts that look like a car and can carry two kids at the same time. They are gargantuan and incredibly hard to steer, so naturally Big A loves them as much as I despise them. Once we had the cart, we fell into our usual routine of throwing anything into it that looked or smelled good. It was only after we paid for everything that it occurred to us our car was not parked in the supermarket lot. It was back by the ice cream parlor, several blocks away.

We got some snickers on the way back to the car as we lumbered along, baby in our arms and a 12-pack of beer safely strapped into the stroller.

Perpetual Motion Girl

That's my Big A -- always on the move! Since I've posted several pics of Little A now, I feel like I should throw up some of Big A too, just to be fair.

(Throw up on the page, not throw up as in vomit. Though in a house with a baby and a preschooler, people tend to be well acquainted with the full spectrum of throw-up possibilities.)

Happy Five Months, Little A!

Little A is five months old today! Sometimes, comparing pictures says it all. The first photo was taken at five days old. The second photo is from last week.

Little A weighed 4 pounds, 13 ounces when we took her home from the hospital. She had a tiny meow rather than a proper cry back then, and due to her jaundice, DH took to calling her our little tangerine. At first we had to finger feed her every two hours around the clock because she couldn't nurse properly.

But the jaundice faded, she developed a strong cry (though she is so mild she barely uses it) and at some point she got the hang of nursing the old fashioned way. And next thing I know, somehow my little kitten of a baby weighs almost 15 pounds!

Amazing.

Eating, eating, eating ...

Cecily over at And I Wasted All That Birth Control recently wrote about trying to eat better, and boy can I relate to her thoughts on the joy of Whole Foods. Especially this time of year, a trip to an organic produce department is almost psychedelic: Ooooh, the colors! Also, the sense of well being that comes with eating tasty, healthy food on a regular basis is indeed wonderful unto itself.

It has been awhile since I've frequented Whole Foods (mostly because of it's "Whole Paycheck" downside), but I think now might be a good time for me to head over and get inspired by the fruits and veggies once again. They say kids are supposed to motivate their parents to try to lead better lives. But for me, kids have brought the worst eating habits of my life. When I was pregnant, to even look at a salad was to wretch or feel my rib cage melt from heartburn. The only things I could choke down on a regular basis while gestating were cheeseburgers and cookies. Breastfeeding also leaves me in the precarious of state of perpetual starvation, and so it seems entirely logical to have dessert after every meal -- even after snacks, if the whim strikes me.

After I weaned Big A and my appetite did get more normal for awhile, but family-related roadblocks to good eating continued. By then I was working full time again and too frazzled to cook properly. Enter the prepackaged dinners and takeout to solve that issue. Still, in between the junk there was still a decent share of fruits and veggies. At least until I got pregnant with my trisomy 18 baby and went through the medical termination. After that, it was a superhuman effort to just get out of bed, take care of Big A, not get a divorce, jump off a bridge, etc. All thought regarding healthy eating went out the window, where it stayed throughout Little A's dicey, tense pregnancy.

But now the fact that I'm still eating dessert after every meal (which happen to still consist mostly of cheeseburgers) is starting to bug me. I guess the good news is that life has become normal enough for me to worry about regular-type stuff like this. On the other hand ... the idea of giving up 5 desserts a day is gonna be a big challenge. Sugar, how I love thee!

Crosses on a Hill

In a town not far from where I live there are about three thousand crosses on a hill, a memorial to the soldiers lost and a protest against the Iraq War. While I pass the area fairly often, I am usually driving on an adjacent freeway, so the most I get is a quick peek before it disappears in a blur behind me.

But this weekend DH and I were out enjoying the glorious spring weather at a nearby park. We exited the freeway, Big A making silly jokes and DH and I laughing at them, and Little A joining in the conversation from time to time with husky little coos that were so gorgeous that my toes curled up in my sandals at hearing them. It was a sweet little counterpoint for all the other boring or annoying times a family inevitably experiences in the car together.

We must have taken a wrong turn at the freeway exit, because suddenly we were directly beside all the crosses on the hill. It was startling, to see so many gleaming white sticks planted in the earth. I squinted, thought of the dead soldiers for a moment, and looked away.

"What are those?" Big A asked from the back seat.

"Crosses," I said.

"What for?"

"For the people who died in the war," DH said.

I cringed at DH's choice of the word "dead." I held my breath and waited to hear Big A's next question -- "What's dead?" But, for once she seemed satisfied with knowing just what the crosses were, and after a few more random questions, she was on to the next subject.

While I put it off for one more day, I know the time is fast approaching when I will have to have the death conversation with Big A. She's only three and a half years old but notices so much these days. Not just physical things, like spots on a bug, or the colors of the different roses in the garden. She also figured out by herself that a high-pitched cry means that Little A is hungry, whereas a low keening cry means the baby desires company. Sometimes when I am reading the paper or making coffee I will look up and find her staring at me, soaking in ... something. A thing I can't see in myself, but she sees.

Yes, the death conversation is coming. And even though I know that at some point she has to learn that we are mortal, that this is a fundamental thing that must shape her sense of meaning in her life, I will still mourn her learning of it. How I wish there would be no more crosses on that hill -- or any hill, for that matter. What a difference that would make.