Saturday, June 28, 2008

medical ethics: part I

lest you think that i was so greatly effected by seemingly unimportant issues at the end of my pregnancy, think again. unfortunately we received some questionable, if not spectacularly bad, medical care, too.

ever since we lost jesper, we have had the same plan for pregnancies. increase monitoring. plan for a home birth, but induce labor at 40 weeks.

when i was pregnant with nate, i called around to nearly all the OBs in santa fe trying to find someone who would "follow along" so that if we got to 40 weeks we wouldn't have any problem getting someone to agree to induction. see even with a recommendation from a perinatologist, if we were to walk in to L&D off the street at 40 weeks but not in active labor there was always a chance that we could be turned away. even though, in theory, by turning us away the hospital and doctors would be opening themselves up to a certain amount of liability.

with nate i could not find anyone who would agree to follow along. so when we got to 40 weeks, my midwives had to call in a personal favor with a family practice doctor they know in order to get us into the hospital. "stressful" is an understatement.

with willow, i actually found someone (family practice) who agreed to follow along. she had been recommended by several people. so around 3 or 4 months pregnant, we went to see her and have a good talk. everything seemed great. she said it would be no problem, that she does it all the time. she said "come back at about 34 weeks.

we went back to see her at 33 weeks. it made me a little nervous that she didn't exactly know why we were even in her office at 33 weeks. she had been faxed some, but not all, of the various test results. but seriously, did the file not say anything about what she had agreed to? it also made me a bit nervous that she didn't want to see us more frequently. i thought she'd at least want to get to know us. instead she said to come back at 39 weeks if i was still pregnant.

despite my reservations, i kept reminding myself that we had not ever even met either of the doctors who had delivered both jesper and nate. so at least this time, we had met the doctor, right?

so we went back to see her at 39 weeks. this time our midwife came with us. my file had been faxed over.

at 37 weeks we had done the standard group B strep test. it came back positive. this is not uncommon. the usual medical treatment is prophylactic antibiotics during labor. the goal is to decrease the amount of GBS present in the birth canal during the small window of time that the baby is passing through. but it is not an unproblematic treatment, and it is not a guarantee of anything. having done the research and having a major issue with prophylactic antibiotics for anything, i choose to not take the antibiotics during labor for GBS. i don't have a problem with antibiotics for an actual medical reason, but simply having GBS isn't necessarily a medical mandate.

it wasn't until the 39 week appointment that we had the chance to discussion my GBS status and my choice to not take the antibiotics during labor. this is the point at which the doctor said she might have a problem with our decision.

since you probably don't want to hear all the minute details, i'll just say that at 39 weeks pregnant i was basically fired by my back-up doctor. at 39 weeks. it has something to do with the "standard of care" and how she has to give the care she feels is appropriate. i'm not exactly sure why that overrides the care i'm willing to accept, but that's the reason i've been given by quite a few people.

i offered an alternative to systemic antibiotics. she said no. i offered to sign a waiver, she said no. i offered to stay an extra 48 hours (something she originally said they would want to do in lieu of antibiotics, and i said wasn't my first choice--ever slept in a birthing bed?), she said no. but she did say, "if you think we can see eye-to-eye by tuesday, give me a call." really? i was the one coming to the table with alternatives and compromises, she had nothing but "standard of care" and "i'm the doctor, you're an idiot." and so . . . seeing eye-to-eye . . . would have been? yeah, it would have been me agreeing to take prophylactic antibiotics during labor. yeah, that wasn't going to happen.

and exactly how ethical is it for a doctor to fire a patient at 39 weeks pregnant for this reason? to leave them in the lurch when there is a direct recommendation from a perinatologist to induce by 40 weeks? knowing full well that it will take a small miracle to find a new doctor. when the only reason for it is a disagreement in treatment plan? since when are patients not allowed to refuse debatable or questionable treatment?

so then i had to find a new doctor at 39 weeks.

let no one ever tell you that getting through life is about what you know; it is all about who you know. luckily, we know someone who is a nurse for the local OB, dr. combs. in absolute desperation and with no expectation that we would get anywhere, i called mrs. fox and asked for a huge favor. i told her the whole story. she already knows our history of loss. she told me to have my midwife fax over my file and that she would personally put it on the OB's desk so that she could decide whether or not to take us. ultimately, she did agree to take us. and for that we are more grateful than they will probably ever really know. "thank you" doesn't seem enough.

we went to one appointment on tuesday afternoon, and went to the hospital wednesday evening for our scheduled induction. willow was born a mere 48 hours later.

yes, the end result was perfect. but, really, was the stress necessary?

Thursday, June 26, 2008

new pictures

well, i'm only a week late in posting this picture. this was taken at 3 weeks. now, sniff-sniff, she's already 4 weeks old!


and this exhibit is titled "contortionist baby." i love the positions little babies can put themselves into. makes me wish i were that flexible again. i think life would be much easier if we could be so bendable.


i'm trying to get better about taking and, more importantly, posting pictures.

Monday, June 23, 2008

third time's a charm . . . we hope

so here's the story of our new mud room cabinets. now, some might say that i brought this on myself.

my dad is a pretty active guy. he goes a little stir crazy if he has nothing to keep him busy. so we take advantage of that by finding things for him to do while he is here. how else would we get any home improvement projects done? so this time we decided to have him install some pantry and utility cabinets in the mud room. the only hitch was that this project was to be done right when the new baby was also scheduled to be done. and since i wasn't the one installing the cabinets it shouldn't be a big deal.

we ordered the cabinets on March 18. that's right, waaaaay in advance. we were told the earlier we ordered the better off we'd be. we talked about damaged cabinets with the Lowe's sales person. we were told about 1 in 5 cabinets is damaged, since we were ordering 5 cabinets we anticipated that we'd have at least one damaged bad enough to require replacement. we asked how long it would take to get a replacement. we were told two weeks.

so may came and the cabinets were originally supposed to be delivered on the 13th. we were told the truck would be here between noon and 6 pm. nothing i love more than a "narrow" delivery window. so we spent the afternoon at home. unable to go anywhere because we had to wait for the cabinets. and we waited. and we waited. and we waited. 6 pm came and went. and since Kraftmaid is back east 6 pm here is too late there to call and find out anything. so i called Lowe's. they said they would call the manufacturer, but got the same info i got--it's too late, they are closed. the Lowe's sales person did say that they sometimes will deliver as late as 8 pm. so we waited some more. by 10 pm i was certain they weren't coming that day.

please note, there was no phone call from the driver to say anything. but i did call the manufacturer and left them a message asking where my cabinets were.

we got a call the next morning at 7:15 am. i just love wake-up calls, don't you? the driver said they would be at the house within 30 minutes. apparently they had gotten lost the day before. why didn't they call? i guess because they felt 8 pm was too late. my feeling? better a late phone call than no phone call at all. so cabinets delivered bright and early in the morning.

since the cabinets were delivered earlier than the original 2 week redelivery window, i figured we had a little bit of time. we opened and inspected the cabinets a few days after they were delivered. to no one's surprise there was one cabinet damaged bad enough to require replacement. so i called on sunday to request that very thing. i was told 10 days to get it here.

at some point, after not hearing from anyone, i called to find out a delivery date. that's when i was told it would be June 10. since i doubt you are keeping track of dates, i will tell you that June 10 is actually 3 weeks after the replacement was ordered. June 10 was also about 3 days after my parents were scheduled to leave. (bye, bye, installer!) and there was absolutely nothing i could do about it. Kraftmaid said the cabinet was done and in transit--which means it was on a train and would later be transfered to a truck for delivery. Lowe's just kept saying "it was an estimate." and "it's a manufacturer problem." cold comfort.

after spending the better part of the day on the phone with Lowe's, i was cut a check for $300. i asked for an installer and was told they couldn't do it because their installers are 3rd party and won't come into a half-done project. and there was absolutely nothing they could do about getting it here any sooner. so the $300 was intended to cover the cost of us having to find our own installer should we need it.

the day i spent on the phone with Lowe's? yeah, that was the day before we went into the hospital for our scheduled labor induction. eh, what's a little bit more stress when you are nearly 40 weeks pregnant.

my biggest complaint is that i asked and was told 2 weeks. then when i reordered, i was told 10 days. i asked for a reason. i was very clear about my reason. and i was very clear about my questions. and i was still given very false information. had i known it could take 3 weeks, i would have allowed time for that. but i was told, very specifically, 2 weeks. not 3 weeks. not "it's an estimate." not anything of the sort.

oh, the third time? right. the new cabinet was delivered on June 10. the cabinet they hauled away was white. top, bottom, inside and outside. the new one is white on the outside, BIRCH on the inside. and BIRCH on the bottom. i could install it, but it would not match the cabinets that are already installed. and if it weren't for the birch bottom, you might never notice that the interiors are different colors, but the bottom kind of makes it obvious that something isn't right.

so i called Lowe's, again. the manager said he would look into it. turns out Kraftmaid, sometime in March, changed their product line, and he didn't know it. now the birch interior and bottoms are the "standard." i laughed when he told me. he said, "i'm glad you are laughing, because i'm angry." i don't know what he had to do, but supposedly there is a completely white cabinet in transit, again. we haven't heard a delivery date yet. but we have a birch interior cabinet on the porch until it comes.

so hopefully, the third time will be the charm. fingers crossed.

(and maybe one of these days i'll get pictures of my new cabinets posted.)

Thursday, June 12, 2008

again?

so i said i would post about the many issues that came up toward the end of my recent pregnancy. none of them were particularly pregnancy-oriented, but the fact that i was already stressed out about the pregnancy only made them worse to deal with. well, this is one of them.

on jesper's birthday (april 28) on our way down to albuquerque to go to the aquarium with nate, i got a speeding ticket. it was only the second speeding ticket of my life. the first ticket i got a few weeks after jesper's still birth when we were taking my mom, who had stayed a bit longer than originally planned, to the airport.

my first thought when the cop pulled me over was, "is this somehow a message from jesper?" but what was he trying to say if it was a message? "slow down"? or just "i'm here"?

normally, i wouldn't have cared too much about the ticket. in fact when i got the first ticket those 5 years ago, i just kept saying "it's only money." because at the time that's what i kept telling myself. it's only money. i didn't change my driving habits. it didn't effect me in any way other than my pocketbook, despite what that officer would liked to have lectured me about. jeff saw him contemplating that very lecture and was ready to step in and explain what had recently happened, but it wasn't necessary. he gave me the ticket and backed off.

the problem this time came in the paperwork. the officer asked, "would you like to pay the penalty assessment or request a court date." to which i said, "i am in no position to decide that right now." and i wasn't. not that day. and the fact that the officer had checked the "penalty assessment" box and told me to sign the bottom would not typically have been a problem.

except that the officer had written down two different speeds on the ticket. there are a series of boxes that the officer fills in (name, address, infraction, etc). and then there is the description part of the form. in the boxes the officer wrote that i was going 63 in a 45 mph zone. in the description, he wrote that i was going 63 in a 55 mph zone. kind of a big difference. and since, when the ticket is entered into the system, they only enter the information in the boxes (not the description), it was entered that i was going 63 in a 45! (when the officer came up to the window of the car he verbally said i was going 63 in a 55, and i was in a 55 mph zone, so the 45 is not even slightly correct).

since this was only my second ticket ever, i didn't know what "penalty assessment" meant--that i was pleading guilty on the spot. had i known that--had the officer EXPLAINED that at the time--i might have chosen the court date instead. but he could afford the two seconds it required to explain that to me.

so here's the problem, how to correct a speeding ticket when it has conflicting information on it and the information that has been entered in the system is the one spot where it is wrong.

we saw the error within minutes of the stop, but too late to find the officer again. i called the SF sheriff's office to ask what to do the next day. i was told i should contest it. i was even given "instructions" as to how to go about that.

in the course of my calls and conversations, i spoke to no less than 7 different people and got no less than 7 different answers. the general consensus? everyone attached to the sheriff's office said if it is wrong, it should be fixed. everyone attached to the courts, that i could actually speak to, said, "we can't give you legal advice. but we don't do what they are telling you to do."

quite a few people never called me back. including a judge and a lawyer.

the one lawyer that did call me back refused to actually listen to the situation. then told me to go stand in line at the courthouse to speak to a judge. (i was 9 mos pregnant at the time!) except that i had been told how to get it done and "standing in line at the courthouse" wasn't it. plus i had been told that without a case pending (which mine wasn't because i had already technically pled guilty by "agreeing" to the penalty assessment with my signature) i wasn't going to be able to speak to a judge. not to mention that there was some mixed information about which court i should go to. some said magistrate court, some said district court.

ultimately, i paid the ticket because i just couldn't get a straight answer from anyone. and the one answer i got that made sense and seemed right, i could not get accomplished because of unreturned phone calls and "alternate" versions of what i should do and whether it was even a possibility to get it corrected.

i gave up. i paid the ticket the day we went to the hospital for induction. i gave it my best shot, and got no where. admittedly there was probably more i could have done, but i just couldn't afford the energy and stress and heartache that it required.

i did call my insurance carrier to ask if it would effect my rates. the first person i spoke to said, "yes, but i can't tell you how much because it would effect it until november. and i can't tell you this far in advance." stupid, but whatever. i called back again later and got someone else who said, "no, it probably won't. you have VIP coverage, and half the time they don't even check for tickets upon policy renewal. plus, the speed wasn't ridiculously high. so no big deal." we will have to wait and see whether our rates are effected come november.

interestingly, in one of my many conversations, i mentioned that the 28th was the 5th anniversary of my son's still birth. but i also said that, at the time, i didn't mention it because i don't like to "use" his birthday as a way of getting out of things. and that's what it feels like. sure, i could say it, but the truth is, i was going 63 mph in a 55 mph zone. and he got me. what difference does it make what day of the week, month or year it is? i wasn't distracted (by anything other than the preschooler in the back seat) by the day. i set my cruise control for a bit over the speed limit and he got me. but i was truthful with him when he asked what i wanted to do. i simply was not in any position or place, emotionally or mentally, to choose that day at that moment whether to pay the fine or go to court. and would it have really taken so much more from him to explain the differences and the ramifications of those differences? no, it wouldn't have, but he didn't.

want to know what i was told? a Santa Fe County Sheriff Deputy that i *should* bring it up. not that i'm using it, but that maybe the officer's response to me would have been different given the circumstances. but how do i say it without tears? especially on that day--or anywhere near it? and the tears make me feel like i am using it to get out of a ticket.

but now i know. far more than i did before.

Sunday, June 8, 2008

willow and her boo boo


my little girl had quite the ordeal after she was born. we tried to minimize the trauma as much as possible, but it backfired. so here she is with an IV in her arm so the md's could administer a few doses of antibiotics for what turned out to be absolutely nothing.

ultimately, she's ok. she has suffered no major ill effects from the antibiotics or the IV (just minor things).

though in this picture she looks quite cheeky--maybe even to the point of being swollen--but it was taken at a weird angle when she was laying on her side.

last pregnancy picture


amazing what a few weeks will do. i took a picture of my belly at 31 weeks, well this is the one my mom took at nearly 40 weeks. when you are looking down on the belly it never looks quite as big as it looks to someone else.

and i never would have guessed that there was a 9 lb-er in there! i didn't even get new stretch marks.

does it make me sad to say this is my last pregnancy picture? a bit, but not as much as you might imagine. this pregnancy was hard, physically. and labor and delivery were harder still. i have definitely reached a point where i can say, "i'm done having babies." and be happy about it. after nate i did *not* feel done. sure there are parts i will miss. especially, feeling my baby moving around in my belly--there is just something magical about it, a connection so deep and primal and direct, a feeling that gets lost, or at least more distant, the minute they are born.

p.s. ignore the messy background and my dad--who is working his chiropractic magic on my very pregnant body. love you daddy!

Friday, June 6, 2008

Willow Jane DeWitt Golden


miss willow made her first appearance at 8:39 pm on May 30, 2008. At birth, she weighed 9 lbs 1.4 oz and was 19.75 inches long.


big brother nate is pretty thrilled with his baby sister. he had more of an issue with mama and papa being gone for a couple of days more than with the addition of his sister. but we are headed for another adjustment period after his grandparents go home.

labor with willow lasted 48 hours and contained 2.5 hours of pushing. physically, i am healing pretty well so far. emotionally, i think it might take a bit more time (but more details on that will follow later). despite all the pain, the end result is exactly what we hoped for all along, a healthy, beautiful baby to bring home and love.

willow nurses great and sleeps great, too. we have been really lucky. we are just working on becoming a family.

Sunday, May 25, 2008

towards the end

i'd love to say that i'm feeling chatty and want to post, but right now that isn't the case.

all is well with baby willow, but i'm just stressed out and nervous. maybe after she is born i will be able to report all the ups and downs of these last few weeks. none of my stress is directly related to the baby. all of it is directly related to what i will classify as "other crap" imposing itself upon me. if it isn't one thing it is another.

i'm ready for all of this to be done. all i can think of is that maybe if i weren't pregnant none of this would be as bad as it is. but being pregnant makes it all seem that much worse.

so that's all i've got for now. by the end of the week i should have some baby news. until then, i'll be quiet and trying to reduce the stress that is hanging around.

Friday, April 25, 2008

this day

i can't believe it has been 5 long years since Jesper was in my belly.

yesterday was the last day he was alive. i spent the day sad for knowing what was coming for him.

today was the day he died. and i spent the day in absolute mourning for all of it. for knowing, in hind sight, that i let the window of opportunity go those long years ago. for knowing now, how naive and blind i was. and for the absolute loss we all feel, even Nate.

i still feel like a failure. i don't know that this one feeling is ever going to go away. and really, i guess, it shouldn't because it would mean i have stopped being his mother. and i don't want to live to see the day when i don't somehow feel responsible for him. the same goes for Nate and Willow.

there is a strange phenomenon this year. the dates and days of the week line up exactly again. the 25th, the date he died, is a friday which is the day he died. the 28th is again a monday. i have been wondering why this phenomenon seems to be having any effect whatsoever on how acutely i feel it this year. (something is definitely having an effect. i can't seem to contain the tears this year. though i am now 8 months pregnant, so i suppose it could be hormonal. but i know i'm not alone in feeling this intensity this year.)

i think i have figured out why. this year, there is no ambiguity. five years ago *yesterday* was the last day he was alive. five years ago *today* was the day he died. period. somehow when the date and the day of the week don't coincide, it doesn't feel the same. there is a measure of ambiguity in, "well, he died on a friday but the date was the 25th that year, and this year that friday is the 23rd." like my brain isn't sure which is more important the day or the date. so as i relive it this year (as i do every april), it is that much more concrete and present.

i find myself much more effected by the date of his death this year, too. i don't usually focus on when he died, so much as when he was born. i guess because that's the "official" day somehow. but the truth is i pretty much know when he died. his birthday has been a really sad day for us, and i have a very hard time "celebrating" it when Nate wants cake and candles. i think some part of me might be trying to separate the two. to mourn him on the day he died and reserve his birthday for whatever small celebration nate requires. and i think i'd like that. to be able to make his birthday a true celebration of his short life and what he brought to us instead of being sad from one end of april to the other. this year with the day and date lining up spot-on, it seems that much easier to do. i'm hoping to be able to have a bit of a repeat next year even without the day/date phenomenon in action. take the 25th as a day for mourning and keep the 28th as a day for celebrating.

unfortunately, it means that we will likely be doing the mourning nearly alone because the people around who do remember are expecting our grief on monday, not now. that's been the pattern in the past. but maybe that's okay, too. maybe it's okay for others to move on a bit and be allowed to celebrate his life with us instead of forever being asked to mourn his death.

(i will admit that the idea for separating the grief of his loss and the celebration of his life did not entirely come of my own head. i know a woman online who lost one of her twins. one was born still while the other lives and thrives today. they had to come up with some way of making their birthday a happy occasion, while still allowing themselves to mourn the loss of their son. so they celebrate on their birthday and mourn on the day of his funeral. i didn't think this would ever apply to me, but i see this year how it can and how it might actually be a good thing. so, thank you carolyn for your inspiration.)

Saturday, April 5, 2008

the truth

i'll come clean and say that i am more nervous and scared about this pregnancy than i would otherwise like to admit. while i would like to say that i'm ok, and most of the time i do, i really am getting to the point of nervousness.

we start biophysical profiles on wednesday. i thought i might not need that reassurance this time, but i guess i do. i also need jeff there for me. so we are sending nate to play at a friend's house while we go to the appointments.

we also start seeing our back-up doctor this week. i'm slightly annoyed to be running to this appointment and that one, but i'm also relieved that we have so many chances to make sure things are going ok.

don't get me wrong. i'm not worried specifically about willow. i have no reason to be. she moves constantly and consistently. she has the hiccups, but only once or twice a day. she's even been head down the last few days.

so there you are. and here i am. nervous. a bit scared. but trying hard not to be. trying to stay sane and rational until she is born.