Love is an Iceberg?

Every year I think I'm gonna be less sappy about my son’s Christmas birthday, and it just gets worse by the year.  My children were all conceived with the miracle of in vitro fertilization and I've blogged that already.  (See "The Unplannable Planned Pregnancy" Feb 22, 2013)

The Sunday before Christmas our Priest had announced that a family had lost their son in a tragic car accident while he was retuning from a ski trip. It sounded as if the family was young, and really devastated.  He was asking as many parishioners as possible to go to that Monday mass. My husband and I exchanged looks, saying a whole conversation in a minute.  His dad was killed in a car wreck when Chris was 11. He's never gotten over it, I suppose you never do.  His pain has been so palpable at times, that it can still dissolve him into tears to this day.  Initially, I thought I would try my best and go to this funeral for this family. We had gotten an email about it as well with their name, I didn't know them, I thought to myself, and if I had time I'd go... But we were gonna be at Church Tuesday from 4pm until after midnight all told.  I decided that that was enough.

It was Christmas eve.  My daughter sang at the 5pm mass, and we all came back at midnight to hear my husband play trumpet at the midnight mass.  We came early. Sat in the 2nd or 3rd row closest to the trumpets in the left side of the church. (Most Catholic Churches are in the shape of a cross, use your imagination). Jonah was clearly asleep and not waking anytime soon and Jake and Jordan sat on either side.  I checked my Facebook and thought I'd show Jake my "note" about him and just how much I love and value him and why I get so teary eyed every birthday.  He read it and whispered an exasperated "Oh, Mom!".  The music began.

A family walked in shortly before mass, a fairly big group, with many extended relatives. Then I saw her. They were sitting down directly across from us.  Grieving mothers all walk the same, bent over from the weight of it, holding on to her husband on one arm, and her oldest son in the other, trying to control her sobs. There we were. 10 years from now. The mother and father looked to be in their mid fifties, the oldest looked about 20, the daughter 17-18, and a missing son.  A father, clearly broken and trying to control his emotions so hard he had his hand clamped across his mouth.  The daughter cried audibly while hugging parishioners as she followed closely behind.

The mass begun.  I don't remember a word of it.  I thought of my friend who was trying to make sense of her life after loosing a daughter (my sons age) in the May 20 tornado.  I thought of this mother across from me.  I thought of Mary, the mother of Jesus, and that walk.  I thought of myself. Tears uncontrollably poured down my cheeks.  Jake leaned over to me and said, "That's that family, isn't it, Mom."  I nodded.  He kept watching.  I said quietly in his ear, "That's what grief looks like, Jakey.  That's how much she loves her son." He put his head on my shoulder and covered it in quiet tears.  The daughter across from us had done nearly the same thing.

Now, my daughter pulls my ear down, and says "What's wrong with that family? Mommy, why are you and Jakey crying?" All I could say is, "That is how much your mother loves you. If you were ever taken away, it would destroy us, just like it is them."

"It's that family, Mom."

Nodding, yes.

"So then there were 2 boys and 1..."

Nodding, yes.

She grips my hand super hard, starts crying and doesn't let go.  My mind has now drifted to my husband up there trying to play some pretty difficult material while 1/3 rd of the church is now crying, wondering if he's figured out what we had.  Mass has ended.  It's Christmas.  I have my gift, that woman doesn't.  Jordan takes off across the church making a bee-line for this grieving mother, whom I've never met, and I'm panicked about what could come out of an 8 year old mouth at a time like this.  I left Jonah sleeping with Jake and I tried to catch up to her as she approached this family.

She said, "I don't know you.  My mom doesn't even know you. I'm so so sorry about your son. (At this point, the father takes his hand away from his mouth and strokes her hair.)  We will pray for you so much." And concluded her simple, yet heartfelt sentiment with a great big bear hug to this mom, and the dad joined around them in a group hug. We all cried.  I think I mumbled something to her as well, but she won't remember me.  She will remember that little 8 year old girl who left them and went straight to the feet of Mary, lit a candle and prayed earnestly for them.

I gathered my family. Tight.  I approached my husband tentatively as I had moderate control of myself by now.  He looked at us inquisitively, and Jake threw his arms around his dad and all he could get out is, "It's all so overwhelming."  Fortunately, Chris was oblivious to all of what had occurred in mass.  Jordan told him through tears and we left.

I had all three kids in the van, and trying to lighten the mood, somewhat, had put on some Christmas carols.  I asked the kids what they were hoping to see under the tree when they wake up.  I got various answers and said in an effort to try to connect what they had witnessed earlier, "Tonight you saw a very hard, and painful, dark side of love, tomorrow, you will be surrounded with laughter, surprises, love and friends, and thoughtful gifts given to you by people who love you very very much. You thought you knew what love was, what it felt like, now you now love on a much deeper level."

At which point Jake responded, "I've been reading about icebergs and ships running into them because they didn't know they were there.  Like, you only think you know what an iceberg looks like, but it goes deeper and wider than you think."

"Exactly."

"So, Mom, love is an iceberg."

"Well,  Jake, someday it will be a battlefield, but that's not for about 6 years or so.  But tonight, yes, love is an iceberg."

"Mom, I love you deep and wide and more than you can see. Oh, and hey, what do you want for Christmas?"

Not a single thing.

Stick a Fork in Me (The appropriate use for obstetrical silverware)

There has been a post circulating the Facebook circuit called "Olivia's Law".  This is an article meant to infuriate mothers and initiate a "call to action to end the use of forceps".  I unfortunately have had to grieve with families in the loss of a newborn and it is a pain that is unlike any other.  I can't imagine having a nursery, an embroidered diaper bag and no baby.  Furthermore, I am a mother and like every momma grizzly, I want to protect my children from harm.

However, I am a board certified Ob/Gyn.  I am able to separate my emotions from the facts on this particular subject.  I have found NO Ob's that have offered an opinion on this proposed "law".  I know that this blog is risky business, but I have to speak the truth on this subject.  My job is super fantastically happy, except for when it's not.  Sometimes babies die.  Sometimes we know why, sometimes we don't, but this I know:  I have never killed a baby with the use of forceps. 

The cliff notes regarding this case are as follows: a mother reportedly 4'11'' (and by the pictures provided appears that the father of the baby is a man about 6'0") is post dates.  She reportedly asked her OB for a cesarean section, as she felt the the baby was too big and was denied her request.  She went in for an induction and reportedly pushed for many hours, was horrendously off of her labor curve, forceps were applied.  The couple claims that they heard a cracking noise, that the mother was literally pulled off of the bed with the force he used, that the baby was not able to be delivered vaginally, she was rushed for an emergent cesarean section and that her baby suffered a fractured skull and subsequently was pulled off of life support.  It is also of note, that the doctor they chose has reportedly had his license suspended or revoked (according to some sources) in two states.

This case is not the forceps fault.  They did not jump out of the sterile bag, and into this woman's vagina for the sole purpose of killing her baby.  This case appears (as I have not heard a formal statement from the doctor on this case so what I'm hearing is one sided, thus far) to be a series of bad decisions.

Problem number one: research your doctor.  Know how he or she thinks and how they feel about operative delivery.  Ask questions before you are 42 weeks.

Problem number two: listen to your patient.  If my patient thinks the baby won't fit, I don't argue with them.  They live in that body, not me.  Induce them at 39 weeks in the hopes that a smaller baby has a better chance of fitting while minimizing any prematurity risks.

Problem number three:  Friedman's labor curve.  You are either on it, or you're not.  If you are not, there's usually a darn good reason why.  One you don't want to find out about in an emergency.

Problem number four:  if you apply any method of operative delivery and the fetus does not move, you are done. You don't try to pull the Mom off of the bed with a vacuum or forceps. 

Whether this physician chose forceps or a vacuum, the result would have been the same.  I have seen skull fractures, as brain bleeds, skin trauma and other issues happen with the vacuum.   I have also seen flawless forcep applications with smooth deliveries of healthy pink little babies.  I use both.  And I use them sparingly and when appropriate.  It either fits, or it doesn't.  If it doesn't, put the spoons away and grab a knife and have a safe delivery.

I ask those of you who think that the vacuum is such a "safe alternative" to delivery to do this experiment.  The next time you get in the shower, put some shampoo in your hair, apply a suction cup and try to lift your head.  It will pop off and provide no lift power.  Or better yet, take a toilet plunger and suck it onto your leg and try to lift it.  See how much force it takes over that one spot to lift it.  Now grab a set of large salad tongs, place them around your knee and do it.  The force is evenly distributed and requires much less pulling to achieve the same effect.

On an abrupting baby with a ton of blood pouring out and a head full of hair, those forceps are all that kid has. You don't have the 6-10 minutes it takes to go "to the back" for an emergent c/s.  You can apply a vacuum with a bunch of pop offs and get an impressive hematoma on his head or you can gently apply the forceps around his head and with one gentle pull, save his life.  I've done it.  Medicine is an art.  It is also science.  It is also intuition.  You can't legislate these things.  At least I sure hope not.

Being in the Now, Nowdays

You know, I just wasted about 3 minutes watching a video of people watching their phones.  It was created to make us all feel guilty about the amount of time that we spend online.  And it worked.  But, as I laid in bed, trying to sleep, I felt this blog boiling in me that I will share with you.

I can promise you.  If there is anyone on the planet that hates technology, it is me.  And, I married an engineer.  I suppose if I hadn't, I'd be typing this on a typewriter or word processor and taking it to Kinko's to make copies and pass it around, via the U.S. Postal service.  When digital photography came out, I was mad.  It seemed like cheating, and it a lot of ways it is.  I wanted to preserve the craft of photography for "real photographers".  I've been rethinking that as I wandered my way through this blog in my brain.  Technology has made pretty good photography (to almost anyone with an iphone and a brain) available, and given many the opportunity to explore the art that wouldn't have been able to otherwise.  My kids have no concept of film.  I shot my film camera one day, and my son was behind me taking digital photos with my phone.  And some of his shots were pretty darn good.
He was proud.  (And I have yet to develop that film canister)

I agree that your children and your spouse, when they need you, should have your undivided attention. How often does that happen?  When I started residency, when you were on call (before the wussy work hour restriction rules) you stayed at the hospital.  From 0600 Friday until 1700 Monday.  We couldn't text.  We couldn't remotely check labs, or watch a fetal heart monitor. Most of the residents had  one cell phone per family.  Sometimes it wasn't your lucky day to have one.  So, as long as you could get to a land line (read: pay phone) you could venture out.  Over the course of 4 years, we learned the beauty of an alpha numeric text page, which was heaven.  Being able to remotely check labs, fetal heart monitoring, and communicate with nursing means that when I'm on call, I'm also at ballet, the baseball fields, violin and anywhere else I need to be.  Sometimes that means I'm in the neighbors pool, with my kids.  Do I check for texts? YOU BET.  Are they all nursing or medically related?  Nope. This leads me to my next point.

Texting and widespread cell phone use also means that you can communicate with your long distance family in Ohio, and New York, and Tulsa, from your neighbors pool.  When I was in college, we sent letters.  They took days to get to the destination.  Now, when Jonsey learned to swim, I sent off a little video.  And, I'm not ashamed to say it.  My kids psyche is hardly damaged over this.  It also means that my kids can text Grandmas and Aunts and Uncles with their news of the day.  It also means when my husband is gonna be 2 hrs late getting home, he can shoot me a quick text from the middle of an oilfield.  In the past, I would have been pacing and calling ER's to check and see if he was alive.  It means we can coordinate schedules so that we can all be together.

There is a part of that video where it is inferred that you shut off your phone and take nature in.  How about you video that pleasant beach with the birds chirping and sun setting so you can see it whenever you want?  It does not mean that you are any less there.  I did that last year and posted it on Facebook while I was in Sag Harbor, NY.  It got about 50 hits in a day. It means you can bring others there with you.  Then turn it on vibrate, stick it in your back pocket and enjoy the scenery.

Which leads me to my final point on this subject, connecting with friends on Facebook.  When I opened my Facebook account, I did so because I was visiting family and they all had a Facebook.  At the time, they were living in Kansas City, MO.  We all met many years ago in Warren, Ohio.  I saw people on there I hadn't seen in years.  Why?  It's not because we didn't like each other, there just weren't enough hours to write letters and call to maintain some of those friendships, while making new friends in new cities some 25 years later. It has been a joy and added so much to my life to be able to talk to my childhood friends and share life, as it is now with them.  It's wonderful to see their children (many of whom look scaringly like I remember their parents) and view a slice of their lives.  When we go "home" there is usually 1 week to see both sides of the family and try to contact a few friends.  Now, before I go home this next time, I'm gonna coordinate a way to get together as a small group.  This doesn't make me some kind of social deprivate. I would argue that organizing a get together in a town 1200 miles away while sitting at the chick-fil-a while your kids play makes me quite the social butterfly.  Could I talk to the other Mothers there?  Of course.  And I do make small talk with them, while they are texting their best friend in Idaho.

Technology has expanded my circle, which is both good and bad sometimes.  It is mostly good, however, because of how I manage my time.  And knowing what and who you say/post to.  If I was 43 twenty-five years ago.  I would have about 2 friends, like my mom, and most of her friends that had about 2-3 friends.  That was all you could manage.  Did my Mom like a lot of people, sure, but she wasn't going to send out 200 Birthday cards a year, much less 757 of them.  I still have, as most of us, a trusted few, but there are a lot more people cheering me on than I ever thought possible.  A couple of them I only became friends with because of technology.  I have one friend in particular that I got to know while sharing "pleasantries" while coordinating weekly lessons, "pleasantries" turned into extended texts, then into real conversation, and a friendship.  I have about 750 people that take 10 seconds to wish me "Happy Birthday", congratulate me on my Wedding anniversary, wish me luck at a new job, and check on me through a devistating tornado.  I have found "friends" that I knew in high school that I have more in common with now than I ever did back then, what an unexpected treasure I have found!

Like everything else used in excess, it can be harmful to forming healthy relationships in "real time".  It is implied somehow that taking a "selfie" of you and your best friend having a toast makes you not connected to each other because you are using your phones?  Some of my funniest moments have been captured (actually me and the kids) taking endless "selfies" and unscripted videos.

I am not ashamed to have an online presence, I can do it while I'm with my kids, my bestie, and my husband. And, I have enough functional brain cells left that I can even keep a coherent conversation with an 10 year old while checking on a laboring patient.  Ask him, he'd rather I text than leave the dinner table.  Every. Single. Time.  I won't put "my phone away for the rest of the day" as the video would ask, but I will use it responsibly, carefully and strive to make myself available to my spouse, family and friends in the best way I know how.