Knowing better.

Still on the Zachary's birthday high. . . . .

photo credit

October 22, 2006

"Pregnancy turns your bladder into the most useless organ ever."

Harry looked over at me and my very pregnant self sitting in the passenger seat of his car and laughed. "What's that supposed to mean?"

"Exactly what I said!" I replied with a chuckle, "It can't hold much of anything, and if you do so much as sneeze you wish you'd wore a Depends."

Harry kept driving while shaking his head. "Not the Depends, babe!" He glanced over at me and we both laughed out loud. "Not a sexy image to give your husband. At all."

"Don't make me laugh!" I playfully scolded him and then looked down. "Aww man!"

We both cackled again, and then instinctively looked over our shoulders to be sure we hadn't awoken 16-month-old Isaiah who was fast asleep in his car seat behind us.

I thought for a moment as the wheels turned beneath the car. "Hey, babe?" Harry raised is eyebrows in response. "What if I don't just have a faulty bladder? Like, what if this is amniotic fluid? You know. . like my water is slowly breaking."

"I thought when your water broke it was like a water balloon?" he countered while hitting the blinker. Then, for emphasis, he slapped his hands on the steering wheel and said, "SPLASH!" After which he looked over in my direction. "Like that."

"No, I'm for real, you goofball! And it isn't necessarily like a water balloon. Although, I don't really know first hand since they broke my water for me last time."

"See? Don't call me a goofball! Why don't you just call Tracey? I'm not your OB."

"I know I'm probably tripping, but you're right. I'm no OB either," I said as I pulled out my cell phone. "Dang. And it's Sunday. But I guess when you catch babies for a living, this is your thing."

We were on our way home from a lovely dinner with Lesley M., her husband and three other Grady doctor friends/fams that evening when this whole conversation transpired. I was two days shy of my due date with Zachary and, other than feeling like my bladder would explode 24-7, I felt pretty darn great for the entire pregnancy. Even still, I know that I have a tendency to undercall things when it comes to my own health. I went ahead and called Tracey L., my OB-slash-med school classmate-slash-very good friend, to discuss my questions. She promptly instructed me to go to the labor and delivery to get checked out.

Damn.

I threw my stuff in a bag (nope on baby #2, you don't already have it packed) and headed to the hospital. By 10 PM, I was checked in and by 10:45 I was being checked by the nurse.

"Chile, you don't have nothin' goin' on in there!" the nurse teased. "That cervix is as tight as a drum. We'll see you back in like two weeks." She laughed at her own joke which was, in my opinion--one point five days before my due date--only a '2' on a funniness scale of 1 to 10.

"Hey, do you think you could draw my blood just in case I do go into labor? Like my CBC and platelets so that I can get an epidural right away if something happens in the next 48 hours?" I knew that the anesthesia guys needed to be sure you had normal clotting before harpooning your spine.

Let's just be clear here. I'm not one of those super-bad moms who toughed it out sans analgesia. Well, I take that back. For the first 12 hours of labor with Isaiah I thought I was going to be one of those "Yeah, girl, I did it natural!" moms, but 12 seconds after entering otherworldly pain-free bliss, I wondered what I was thinking and changed my tune big time. This time, I didn't want any delays in pain relief, just in case things didn't happen as Nurse Know-it-all predicted.

"Chile please! You ain't goin' into no labor no time soon. That wasn't amniotic fluid and your cervix could not be more closed. That baby boy wants to float a little longer." She laughed one more time. I know she didn't mean to be annoying. But she was. Very.

Then, as obnoxious as it sounds, I decided to pull the faculty card, since I was at one of our teaching hospitals. "I'm actually on the Emory faculty," I said (eeewww, name-droppy and lame, I know!)"Would it be okay if--"

She didn't even let me finish. "Then you should know better, Dr. Manning. Go home and get some rest. And enjoy these next two weeks before he gets here. You know, they're a lot easier to care for in there than on the outside." Seeing as she was about twenty years older than me, there wasn't much more I could say.

And so, that was that. I was discharged at 11:30 PM, overnight bag and all. No blood draw. No "baby on the way!" phone calls to my parents. No amniotic fluid leak. Just a bladder that didn't enjoy having 8 pounds of baby pouncing on top of it every five seconds. Good night, Dr. Manning. See you in two weeks (when you have to get induced.) Ha. Ha.

Now.

By now, y'all have to know how Seinfeld-ish my life is. So clearly you know what happened next, right? Claro que si!

1:45 AM. Awaken suddenly with intense need to bear down, as in the feeling immediately preceding #2. (I worked hard to find a non-disgusting way to say that on this blog. I hope this was acceptable.) Left the bathroom after nothing happened and got back in bed. Exactly eleven minutes later, it happened again.

Hmmm.

And again. And again. Eleven minutes on the dot. I woke Harry up and told him flatly, "Dude, I think I'm in labor." Just like that. Then I added, "But my cervix was 'tight as a drum' less than 3 hours ago according to the L and D nurse, so no need in waking up. I'm going to just hang out downstairs and watch TV. I'll call Tracey, and then we can go to the hospital after we take Isaiah to daycare."

After one obligatory, "Are you sure?" my sleep-loving husband turned over and zonked out. (Can't you tell this wasn't our first baby?)

And so. I watched two DVR'd episodes of Entourage. Another of America's Next Top Model. I cleaned and cut up some collard greens. Did a load of laundry. And even made a turkey meat loaf. All while timing these intermittent episodes of feeling the need to do #2 without it actually being because of #2. (My description of contractions.)

7AM the bear-downs have evolved to uncomfortable. We quickly get Isaiah dressed and fed. Then get ourselves dressed and fed. (Can you believe that I was vain enough to shave my legs that morning? Ha ha ha!) Finally, by 8 AM, we are in the car and on the way to drop Isaiah at daycare and then to the hospital. Bear-downs officially hurt.

8:25 AM, Isaiah nearly thrown into daycare like a 16-month-old football (terrible, I know.) Bear-downs getting slightly un-bear-able. Oooh weee. Oooh wee.

8:45 completely at standstill in Atlanta Monday morning rush-hour traffic. Officially miserable.What. Were. We. Thinking? Harry did his best to make things better. He spent half the time trying to make me laugh and the other half rubbing my leg and saying the kinds of things that sweet husbands are supposed to say while you're in labor.

"Sssssh! Shssssshh! Sssshhhhssshh!" (That's me trying to breath through the contractions in the passenger seat.)

"What in the world are you doing?" Harry asked me with a chuckle.

"Breathing . . . .sshshh! shhssshhh! sshhhhh!" I replied. I was unable to hide my amusement with the situation so burst out laughing, too.

With both pregnancies, we never got our act together enough to go to any kind of birthing classes. All I could remember was what I once heard my grandmother say-- "Whether you get lessons or not, that baby is coming out of you." This became my mantra (read:excuse) for not giving up an evening or weekend to learn the proper way to breath/manage pain/etc.

Instead, I resorted to what I'd seen those women do with the doulas on "A Baby Story." It was a pretty darn hilariously awkward thing to see.

By the time we reached Emory Crawford Long Hospital at 9 AM, the bear-downs were every 5 minutes. The pain was mind-numbing, and I intensely wished I hadn't turned to Bravo during the parts on TLC's Baby Story when some very granola, yet knowledgeable midwife explained how to redirect one's mind away from the excruciating pain of an 8 pound human being forcing his way out of a very small, yet allegedly expandable trap door.

"Wait! What if I see one of our residents?" I asked Harry in terror. This was totally possible since it was the 9 o'clock hour at one of the Emory teaching hospitals. I looked at myself. Feet slid into sneakers that were unlaced. Nonmaternity Seven jeans unzipped halfway. Nonmaternity t-shirt with high rise in the front and low rise in the back (kind of like the t-shirt equivalent of a mullet.) Fortunately, I had my hair in braids, which was the only thing that looked even half-way presentable.

"Please don't let me see any residents. . . .Please don't let me see any med students," I muttered under my breath in between contractions, giggles and goofy breaths. The whole sight was pretty ridiculous, I'm sure. Harry and I could not stop laughing.

"Heeeeey Dr. M!"

O.M.(expletive)G.

It was a pack of residents and medical students. Walking in my direction. Waving. All jovial and chatty. Just as they approached, I felt a bear-down coming on. Lawd, lawd, lawd.

"Ummm, hey guys," I said with a wince. "Umm. . turns out, I'm in labor. Sooo. . .yeah. . . I'd better go before I have a baby in this hallway."

And before they could reply, I was around the corner. Mullet shirt and all.

When I get to the L and D, the nurse checks me and asks, "Aren't you a doctor? Honey, you're almost 8 centimeters! Now you know you should know better."

That was the second time I'd heard those words in 24 hours.

"Listen," I cut to the chase, "I need you to draw my blood right away so that I can get an epidural."

She laughed out loud. At me. So not with me. "Oh, honey, it's too late for that. You're there already."

This was the moment where I suddenly understood every single patient who went off on a health care professional when their agenda did not line up with that of the caregiver. Every drop of "professional" flew out of the window. All I could think of was the fact that Isaiah A. Manning was weighed just two seconds after I pushed him out, and that scale read "9 pounds and 2 ounces." This kid could be a ten pounder for all I knew.

"Oh, hells no!" I firmly declared. Harry looked at me sternly. I didn't care, so repeated myself. "Oh hells no, I'm getting something!"

She laughed again. Then she slapped my arm a few times and commenced to try to insert an IV in my arm. 3 times. Unsuccessfully. Oh hells no.

"Please, let me just put it in so you can draw my blood," I said. "I can do it. Give me the catheter."

Wait. Really? Yeah. That's what I said. I'm not proud of it.

"I can't let you place your own IV," the nurse responded.

"That doesn't make sense. Let me just do it because I'm about to jump off this table if nobody gives me something for this pain."

Harry leaned in to my ear and whisper, "Wow, you are being SO obnoxious."

The nurse knew she was in control of this. Despite my foul behavior. After what felt like 100 years, I finally received my IV, along with some kind of narcotic that made me start hallucinating. But not enough to stop demanding an epidural. Now I was just high and demanding.

Once Tracey L. arrived, I launched into begging. "Please, please, please call anesthesia. Please, Tracey. Remember? Isaiah was a 9-pounder. I'm scared. Please, please call them." I was on the verge of obnoxious, hallucinatory tears. "And tell them I'm faculty." Ugggh. There it was again.

The nurse rolled her eyes very obviously. I knew I deserved it, so I didn't get mad. When anesthesia arrived, I realized that I knew the anesthesiologist. Yes!

"Give me something! Anything!" I pleaded. "My first child was almost ten pounds!" I felt the need to exaggerate to make things move along. Plus I was hallucinating, remember?

A few moments later, I received what definitely wasn't an epidural, but what I'd like to call an "epidural-lite." And I am the first to admit--I should have just sucked it up considering literally one minute after they taped it in place, I rolled on my back to push.

Three pushes later, Zachary was here.

The main thing I remember is being so spaced out from Demerol that all I could say was (through trippy tears), "Awwwww, I love him! He's such a little pooda!! But I feel like I'm loopy so take him!" (Which my mom was very happy to do.)

7 pounds and 14.5 ounces. Not quite a ten-pounder, but definitely a respectable size to request an epidural-lite.

****

Okay, so today, I'm reflecting on how frustrating it can be for patients when the caregivers have one agenda and they have another. This experience made me realize how important it is to keep this in mind with every patient I encounter. Like, for some people, their agenda is as simple as "I'm a healthy person who took off work because I think this is strep throat and I need antibiotics" while as the doctor you think it's a straight forward case of allergic rhinitis with sore throat secondary to post nasal drip. If you don't reflect on the patient's agenda, you write them off as "demanding" or "antibiotic-seeking" or "annoying" or all of the above.

I'm not saying the nurse who saw me that Sunday was wrong to say no to a blood draw. But maybe a little more discussion would have been good. And even though I was able to get the epidural-lite, as a patient, I could have done a better job at recognizing the nurse's agenda to follow protocol. And I'm sure that my behavior didn't exactly help her IV placement skills too much.

In the end, it all comes down to listening, doesn't it? Just respecting each other enough to get where the other person is coming from. That's important for doctors, yes. But probably just as important for everyone else, too.

As for the birthing classes, while they do seem like a good idea for most folks, the fact that I didn't take any makes the story even more Seinfeld-esque, which I dig. And. My grandmother was sho'nuff right:
"Whether you get lessons or not, that baby's coming out of you."

And I'm so glad he did.