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The Reports Of My Death Have Been Greatly Exaggerated

I think I'm just going to pitch a tent in Evil Insurance Company, Inc.'s parking lot.  I might as well.  I'm going to be there an awful lot in the next few weeks.

Dr. DoesNotSuck does not think that my increased blood pressure is due to stress or salt, but she does feel it warrants close monitoring.  I won a pee test at all future appointments and am to report to the office in all haste if my blood pressure hits the bad numbers or I feel in any way icky ("Hi, I'd like to see the doctor on call.  I have a not-so-fresh feeling...?").  We're both going to take The Big Fancy Perinatologist Place's word for it when they say my heart isn't failing.  So far I've had chest X-rays, CT, EKG, and some test to determine cardiac function where they smeared ultrasound glop from my tits to my neck, and the only thing everybody keeps coming up with is "not dead yet, status unlikely to change."

Evil Insurance Company, Inc. and I are going to have some serious words about Nurse GateKeeper.  The way I look at it, I didn't transfer from the midwives to the OB/GYNs just to have my care overseen by some idiot nurse.

Maybe I Should Have Said "Bring (A Smaller Amount of) It On"

The funny thing about Evil Insurance Company, Inc. is that people who aren't from the greater Seattle area find it implausible that you could cram that much suck into one insurance company while the locals email me and say "Evil Insurance Company, Inc.'s real name is __________, isn't it?"  They always get it on the first guess and they are never wrong.

As proof that you absolutely can cram that much suck into one insurance company (and a positively unlimited quantity into a certain nurse), let me tell you about last week.  When my fingers got a little puffy, Sam resisted the urge to say "Damn, do you need some biscuits and gravy with those sausages?" and instead bought me a temporary wedding ring in a much bigger size.

I grew/puffed out of it in less than a day.  I thought this was strange.  I mean, I understand that gaining weight and having swollen fingers is pretty typical pregnancy shit, but this was very abrupt, and also accompanied by the sudden onset of Braxton Hicks contractions.  Huh.  So I emailed Dr. DoesNotSuck.

All together now: "And then Nurse GateKeeper intercepted the email and..."

...and said to eat less salt.  I thought this was pretty weak logic, especially since I hadn't developed a three-salt-lick-a-day-habit recently, so I found it unlikely that the sudden puffing was salt related, but I wasn't that worried about it, so I just went on about my day.

My day included the multiple pregnancy class at the Big Fancy Perinatologist Place, where I was informed that I should always tell my doctor about rapidly swelling hands, as it could be a sign of increased blood pressure, which could be bad.  Huh.  I checked my blood pressure at home, and damned if it hadn't gone up about 20 points (top and bottom numbers) in a week.

Goddamnit.

The next morning I drove down to Evil Insurance Company, Inc. and demanded to see their doctor on call.  "I got bad advice from the nurse," I said.  The doctor disagreed, saying Nurse GateKeeper was a fine nurse, bla bla bla.  Of course, she also said that the salt issue had nothing to do with the current puffiness, which kind of completely contradicts Nurse GateKeeper's advice, doesn't it?  Also, my blood pressure was still up.  It wasn't "Oh My God!" up, but it had definitely risen.  She ran some bloodwork to rule out preeclampsia, and then asked me what I was so worried about.

I need a hat that says "Please Read My Chart Before You Make An Ass Of Yourself."  Since I don't have such a hat, I decided to be brutally honest and said "I'm worried that something will go wrong and y'all will miss it because of Nurse GateKeeper, and they will die."  Come on, lady.  Gravida 4, para 0, high risk multiple gestation, what the fuck do you think I'm worried about?  The weather?

And then she suggested that I see a shrink.  I'm pretty sure that made my blood pressure shoot up another five points right there.

I'm considering getting a note from my shrink that says that Manic Depression does not cause swollen hands.

What I'd really like to know is this: Considering my reproductive history, exactly what level of anxiety would they consider acceptable?

Huge Waterfall

Lately I've been feeling a bit conflicted. 

It's probably just as well that I've never put much stock in the experience of being pregnant, because if I did, I'd probably be pretty bummed right about now.  Although it may sound odd considering the lengths Sam and I have gone to in our efforts to knock me up, neither of us have ever had much invested in the idea of pregnancy itself.  What we're interested in is the theoretical end result: children.  Our mutual interest in results rather than process is probably what led us to get married in jeans and t-shirts in front of a judge.  We wanted to be married, not have a wedding.

So, in light of that, I am frequently pretty goddamned zen about the whole ELM "Welcome to Your Crappy Pregnancy" thing.  I usually get through my day with an attitude that is probably closest to Kuzco's in Emperor's New Groove just before he and Pacha went over the edge:

Kuzco: Don't tell me. We're about to go over a huge waterfall.
Pacha: Yep.
Kuzco: Sharp rocks at the bottom?
Pacha: Most likely.
Kuzco: Bring it on.

This seems to serve me well, especially when the ordinary pregnancy crap (edema, sciatica, carpal tunnel, Braxton Hicks contractions) decides to join the slightly less than ordinary pregnancy crap (Manic Depression, tachycardia, etc) and throw a good old fashioned hoedown, which it seems to be doing on a fairly regular basis.

For the most part, I can manage to shrug it off, occasionally throwing caution to the wind and muttering "Come on, is that all you've got?"  Never ask this, by the way.

Sometimes, however, the reality of being effectively disabled by pregnancy is a little overwhelming.  Have I mentioned that I have a parking pass now?  That I make my decisions on where to shop based on which stores have those nifty little electric carts?  That I am currently engaged in a minor struggle at work over what constitutes a reasonable accomodation?

This is not exactly how I pictured pregnancy.

At the end of the day, however, I alway return to Kuzco: Bring it on.  I can do this.  I can do anything, as long as Fitz-Hume and Millbarge are okay and as far as anybody can tell, they are. 

They do not appear to suffer from my temporary lack of stamina and in fact spent the entire Big Anatomy Ultrasound enthusiastically punching and kicking eachother.  The ultrasound tech said she'd never seen a fetus with such a well developed bicep as the one Millbarge was currently flexing in order to pop Fitz-Hume in the kisser.  Neither of them appear to have Spina Bifida or any other detectable abnormalities.  Their growth is right on target.  The chaos affecting my body doesn't seem to bother them in the least. 

It's as if they exist in the eye of a hurricane.

I Think My ELM Is Elevated

The good news is that after a day of testing at The Big Fancy Perinatologist Place, it has been determined that my (racing) heart is completely fine.  The bad news is that the official diagnosis is "Ha ha, you're fucked!"

All kidding aside, I have been told that this pregnancy is just going to be really unpleasant from here on out.  My heart is going to race, I'm going to pant like a porn star and I'm going to feel like refried ass because that happens to be what my body does when it's pregnant.  Who knew?  I am mostly okay with that, because I've also been told that Fitz-Hume and Millbarge are absolutely, unquestionably and quite verifiably fine.  I guess my uterus knows what it's doing in there, although I'm less than thrilled with its plan to take over the entire rest of the body and just basically fuck with all available systems for nine months.

I have mixed feelings about finding out that my Expected Level of Misery just went way up. 

I distinctly recall once saying "Look, I don't care; I'll gestate in the seventh level of hell if I have to."  Who knew I'd be taken up on that?

Curious Comfort

Quick, everybody look surprised: Nurse Gatekeeper faxed my records to The Big Fancy Perinatologist Place.  Well, I probably shouldn't get too optimistic.  She faxed somebody's records to The Big Fancy Perinatologist Place, and the committee that reviews the records and decides whether or not to accept you as a patient deigned to grant me an appointment this very week.

I have mixed feelings about the appointment.  I am the kind of person who resists eating the last cookie in the box because the taste is never as sweet as the satisfaction of still having the cookie.  If one of The Big Fancy Perinatologists can help me, that will be several steps beyond fantastic, but if they can't, I will have lost the security of still having a last resort.

While I was grilling Dr. Eyelashes about the CT last week, he said something that was oddly reassuring.  When I asked him what we would do if I didn't have a Pulmonary Embolism, he hesitated.  "Well, we need to rule it out.  If we can, then it's entirely possible that this may be what pregnancy is like for you."  He frowned and corrected himself.  "I'm sorry.  Clearly, this is what pregnancy has been like for you.  What we might need to do is figure out a way to make this more tolerable."

Maybe he's right.  Maybe I'm just fucked, but not in a medically correctable way.  Maybe this is what happens to my body during pregnancy.  I don't have much to compare this to, so I really don't know.  I have to admit that as a diagnosis, "Ha ha, you're fucked!" does leave a little to be desired.  What I appreciated was Dr. Eyelashes' willingness to acknowledge that this whole tachycardia/huffypuffiness has been something less than enjoyable and his desire to help make the experience bearable, if possible.

In other news, the anemia has gotten slightly better.  After three months of listening to Evil Insurance Company's advice on the best way to deal with anemia ("Eat a balanced diet and take iron supplements."), I decided that my medical advice on the matter was just as valid as theirs and came up with my own plan, mostly consisting of "Start at the nose and eat your way through a cow."  Darned if it doesn't seem to be working.

Drinking From The Firehose

Well, yesterday was not so great.  The shortness of breath was worse than ever before, so I decided to suck it up and go to Urgent Care.  Remind me to never do that again.  Seriously, if I fall out of a tree and break my arm, I would rather set it myself using old gift wrap spools and popsicle sticks than go back to that roiling den of idiots.

After being told that the anemia wasn't bad enough to be causing the shortness of breath and tachycardia I was experiencing, I was given four diagnoses:

1. OMG, you're dying (of asthma)!  Oh, wait.  No, you're not.
2. OMG, you're dying (of heart failure)!  Oh, wait.  No, you're not.
3. OMG, you're dying (of a pulmonary embolism)!  Oh, wait.  No, you're not.
4. Fuck if I know.  You should just relax.

The good news is that my asthma is under control, my heart is just fine, and I do not have a pulmonary embolism.  The bad news is that after running bloodwork and doing an ultrasound of my legs (which would probably tickle if I were ticklish), the only way to rule out a pulmonary embolism was to do a CT scan of my chest.  CT scans = radiation = hello, isn't radiation a superbad idea when you're pregnant?

I did not want to do it.  I left the hospital AMA, went to my OB/GYN's office and demanded to see a real doctor for a second opinion.  Nurse GateKeeper (of course) tried to deflect me, but I just sat patiently, huffing and puffing, until she trotted me in to see Dr. Eyelashes.  Dr. Eyelashes said (nutshell) "Look, I know the whole x-rays-during-pregnancy thing is less than ideal, but if you have a pulmonary embolism and die, that's a whole lot worse for the fetuses in the long run than a small amount of radiation.  Go back and do the CT."

So I did.  It sucked.  When it came back negative, I was so angry at myself for consenting to the goddamned test that I could not even speak for a while.  Then I opened my mouth and said "So, now what?"  The doctor said "Well, you're fine.  You can go home." 

(My discharge instructions said "Come back if you have any further problems with shortness of breath."  Yeeeah.  On what planet do they think they've competantly resolved the problems I already have?) 

Not thrilled with this answer, I said "And how am I supposed to function?  How am I supposed to work?  How am I supposed to go grocery shopping when I can't walk across the parking lot?  I can't even get up to pee without feeling like I'm suffocating.  What is the plan?"

"Um.  We don't have one.  Anyway, your blood oxygen is fine."

"Yeah, I know it's fine, but isn't the degree of effort it takes my body to achieve 'fine' kind of troublesome?"

"Um.  Follow up with the OB/GYNs.  Soon."

Sam said "So, that's it?  You're just giving up?"

"Um.  Nooooo, I'm not giving up.  Would you like some anxiety medication?"

"This is not related to anxiety.  My heart rate is elevated when I'm perfectly relaxed.  I gasp for air in my sleep." 

Isn't it amazing that my symptoms are verifiable, measurable, completely abnormal and alarming enough to warrant a motherfucking CT scan and yet able to be passed off as 'all in my head' when it turns out that the doctor isn't smart enough to figure out the cause?

Since we had clearly reached the end of this buffoon's competance, we left.

Sam took me out for pizza and then I cried for hours and hours about what a shitty mother I'm already turning out to be, how I endangered Fitz-Hume and Millbarge's health on some idiot's say so, how much I suck at being pregnant, OMG, what if they're born with horns and a tail or something?  (Inappropriate internal monologue: "Like Hellboy?  That would actually be kind of cool."  Me: "Shut up, you!  Can't you see I'm wallowing in self hatred, here?"), etc.  It was not a high point.  The high point was probably when the doctor was trying to locate Fitz-Hume and Millbarge's hearts via doppler and I very politely pointed out that he was totally aiming the wand at the wrong place.

I felt somewhat better upon consulting Dr. Google about x-rays during pregnancy.  If I'm reading that chart correctly, I would have to do a metric buttload of chest CTs in a row to actually harm Fitz-Hume and Millbarge.

Of course, I felt somewhat worse upon noticing that during the course of my day long stay, the wiz kids at Urgent Care had managed to expose me to a known (and well documented) allergen and caused a 2"x4" spot of really nasty contact dermatitis.  I guess that's Evil Insurance Company, Inc.'s version of a parting gift. 

I think I'd rather have Rice-A-Roni.

Oh, and a treatment plan.

Delusions of Adequacy

Well, before everyone packs my bag so I can go the the Emergency Room, do I need to remind you what happened the last time I took a trip to the ER?  Considering that the dipshits fine medical personnel at Evil Insurance Company, Inc.'s hospitals were falling all over themselves to convince me that 25 was a perfectly nifty hematocrit, I don't think they'd be all that willing to help me now. 

Besides, going to the Evil Insurance Company, Inc.'s Emergency Room when you're sick is kind of like stepping in front of the fire hose because you're dying of thirst.  Sure, you get all kinds of wet, but it doesn't really solve the problem.

I've already spoken to the intake people at The Big Fancy Perinatologist Place ("Is this your first pregnancy?"), and as soon as they receive my records from Evil Insurance Company, Inc., we'll be in business. 

The punchline, of course, is that the person responsible for faxing my records is (naturally) Nurse GateKeeper.  When she left me a message about the referral, she somehow managed to add extra digits to the phone number, so I'll be impressed if she can manage to fax my records anywhere without setting them on fire.  This ought to be good.

Lies, Damn Lies, And What Nurse Gatekeeper Said

Oh, that woman.

Somehow, her endless bullshit has tipped past annoying and gone straight into entertaining.

While attempting to reach Dr. DoesNotSuck about the anemia and related complications, I ran afoul of Nurse Gatekeeper, instead.  Our email volleys became increasingly ridiculous as the week wore on.  Let me nutshell it for you.

Akeeyu: Still breathless and exhausted, unable to walk any distance, heart pounding, concerned about long term success of this pregnancy due to complications, bla bla bla, end of rope, please advise.

Nurse Gatekeeper: Are you taking iron supplements?

Akeeyu: Why yes, and let me outline my exciting regimen of Massive Iron Overdose in great detail.

Nurse Gatekeeper: You're doing it wrong.

Akeeyu: See, that's interesting, because your email gives me Iron Supplement Blackout Bingo, in that I have now been told (by Evil Insurance Company's doctors, nurses and midwives) to take iron with or without this, that, and the other.  I have jumped through every hoop, tried every combination of foods, supplements, and holding my mouth like this, and I'm still anemic.

Nurse Gatekeeper: You're still doing it wrong.  Try leafy green vegetables.

Akeeyu: Leafy green...what?  Do you mean like spinach or broccoli?  I know that both of those have iron, but they also contain calcium, which blocks iron absorption, so I haven't been relying on them as iron sources.

Nurse Gatekeeper: Does not compute!  Iron!  Spinach!  You should see a GP!

Akeeyu: I already asked my GP about this issue.  She referred me back to Dr. DoesNotSuck. Is there some other doctor I should be seeing?

Some Other Random Nurse, apparently stepping in for Nurse Gatekeeper, whose circuits I am thrilled to have overloaded: No, there is no other doctor you should be seeing.  Iron supplements should fix the anemia right up.  Please contact us if you have any further problems with exhaustion or dizziness.

Yes, because y'all have done such a goddamned bang up job addressing THIS problem.  Good God.  Can you imagine being an LPN and actually telling a pregnant woman that a GP and an OB/GYN are the last and final words on all things pregnancy related?  With a straight face, I mean.

I remember telling Sam that I would do anything necessary to secure proper care for Fitz-Hume and Millbarge.  I would do whatever it took, up to and including walking through fire.  When I said this, I wasn't expecting the outright stupidity of trying to wring an answer out of Nurse GateKeeper and her ilk.  Given a choice, I'd pick the fire.

The upside is that I have managed to secure a referral for a Perinatologist.  Getting an appointment before the earth crashes into the sun, well, that's the next step, but luckily Dr. BrightEyes has offered his assistance in the matter.  The downside, of course, is that the anemia has progressed (or failed to progress, I suppose) well past the point of absurdity.  From what I understand, it is not normal for a woman who is four months pregnant (even with two) to be unable to walk through a grocery store unaided.  It is not normal to be breathless while driving.  It is not normal for my heart to beat so rapidly that it keeps me up at night.

I feel an odd mixture of gratitude and concern for my heart.   It's desperately pinballing an inadequate (and dwindling) supply of hemoglobin around my body in order to keep me, Fitz-Hume and Millbarge sufficiently oxygenated.  I am impressed at the lengths my heart is currently going to, but sometimes I worry about how long it can keep working at this pace.

I worry about the possibility of a previa-related bleed, given my already ridiculous lack of blood.  I worry about surviving birth, either natural or medically assisted, with no stamina and no reserves.  I worry that my body will decide to offload Fitz-Hume and/or Millbarge in some misguided attempt to prioritize resources.  I worry that the only plan Evil Insurance Company, Inc. has put forth so far seems to consist of "Well, when you're on death's door, then we'll probably do...I don't know, something."

Mostly I worry because my medical Spidey Sense only goes off when something is wrong, and damned if the thing doesn't curently sound like a Hurricane Siren.

Like Tag Team Wrestling, But Without The Tag

Depending on your point of view, I am fine, or I'm not. 

Fitz-Hume and Millbarge are still alive and kicking, which is excellent.  At seventeen weeks, it's really quite stunning for all involved parties. 

Less excellent is the laundry list of complications currently having a party in my body.  Let's review:

• Anemia: No improvement whatsoever, and the resulting exhaustion has completely flattened me.  Some aspects of my CBC have taken turns in the wrong direction.  There is no explanation for this.  I am pursuing a second opinion. 
• Heart and Respiration: Persistantly elevated (due to the anemia).  To GPs, I present as someone in respiratory distress, which has led to an awful lot of fun when trying to obtain proper treatment for...
• Asthma: Flaring up like a motherfucker.
• Thyroid: Still screwed up.
• Sciatica, Round Ligament Pain and Mystery Cramps: Sure, why not?
• Placenta: Still hanging out squarely above the cervix.  There goes the neighborhood.
• Father: Still dead.  I lack the capacity to describe the experience of gestating the only grandchildren when one of the grandparents has recently died.
• Manic Depression: I am so fucked.

It's the last one that's hitting especially hard.  My primary triggers are stress, insomnia, and hormonal fluctuations, none of which are currently in short supply. 

If your only experience with Manic Depression is the As Seen On Television! version, I should tell you that it's nothing like that.  I look and act perfectly normal, but my internal settings are very off.  It's a bit like watching television with the sound turned all the way down: You know there should be sound, but you can't hear it.  In this case, I know there should be emotions involved other than crippling anxiety and overwhelming sadness, but I can't feel them.

Right now the only thing penetrating is love.  My mother's, my husband's, and our combined love for Fitz-Hume and Millbarge.

I still tell them what I told them in the hospital: "I'm taking care of you, and people are taking care of me, so everything's okay."