Monday, October 10, 2011

Irritations

I have been standing up for myself, which is new for me, but long overdue.

As I mentioned last month, I had a repeat of the radio-frequency ablation of my celiac plexus that went badly, and the fellow hadn't done his homework before the procedure. I went to see the attending, and coached by my brother and my friend Katie, I asked to speak to the attending alone, I explained why I thought it was bad form, and unsafe, that the fellow hadn't read my chart. Of course, the attending had all kinds of rebuttals, but I stood firm, and used my RN skills and experience to rebut right back. As a patient I just didn't feel safe having an MD not know my story, my risks, my reasons for the procedure. How could he answer questions that I posed if he was unprepared? If he needed to prep, he could do so outside the room, before entered to consent me. It was shoddy. End of story. I know I was a thorn in the side of the attending. I don't care. It's not my job to be easy. I am living with a giant medical mistake, and it sucks. Fuck them.

Then at work, I had a difficult assignment one night, including a patient with twins in preterm labor. She was in pain and had terrible edema (swelling) from the waist down. Her covering MD was the perinatologist, whom I like very much, but he was scrubbing into a case in the OR when I had time to call him to ask him to assess her and see if I could get an order for pain meds. He asked me to call the second MD on call, who was, horrors, the MD who had delivered Tobey and left amniotic sac inside me and who is rude and likes to torture RNs. I sighed, took vitals, lined everything up and braced myself. I called him on our intercom devices and asked if we could talk. He responded snidely, as usual, and asked me to call him on the triage phone. I decided that I would walk to triage, rather than risk him hanging up on me. So I walked to triage and stood there, while he talked to other RNs, and he ignored, ignored, ignored, ignored, ignored me. Five minuted later, I begged for an audience, and he said, "I told you to call me." I went on to talk about my patient, he asked for vitals, which I responded were normal, and he berated me about hypertension/hypotension, as if I don't know the difference, and I walked out. I couldn't stand the treatment anymore. I walked to my Charge RN, and told her that the MD was not engaging with me and had basically told me to fuck off. He came after me and told her that I (!) was acting inappropriately and that she should assign a new RN. At that point, I lost it. No more "nice" Kara. It was liberating! I know it probably wasn't the place or time, but at some point, people need to know that they cannot just stomp on people because they are tired or angry or have low blood sugar. If he was busy, all he had to say was, "Kara, I will come to the room in 10/20/30 minutes. Call me sooner if her condition deteriorates." Fine. That would have been GREAT. But no, the passive-aggressive shit was out of control, and I WAS NOT TAKING IT. And at some point, I WILL have it out with him, privately, about how he needs to come down off his holier-than-thou doctor perch because he made one hell of a huge mistake with ME as the patient. I showed him compassion by not suing his ass. So fucking show ME some compassion on the floor.

I have also been thinking a great deal about losses, sadness, and respect. My life has changed radically for the better having my first mother back in my life. The more we talk, the more I find that we have in common: we lived very similar lives into our twenties. The more I share with her, the more I find that I am able to let go of my past, the things I have been holding onto so tightly. When I tell her about things I thought I wanted so much, she says, "Why?" and all of a sudden, it's true: I have permission to open my hands and let the cares fly away. How is it that she can understand me so well without knowing me? If I have no bond with her? If, as my husband likes to describe the empiricists' worldview, the uterus is made of inert metal and the fetus develops independently of its mother, unaffected by anything? It's fucking absurd. Thanks, I needed a good laugh this morning.

Ah, yes, and the feeding. Yes, feeding is important. How we feed and nurture babies is extremely important. But the first nine months that the fetus develops within the uterus is also important (hence my previous comment about the uterus not being made of inert metal, and the influence of hormones, etc.). Yes, I am certain that the future of science with reveal all kinds of things about the effects of the intrauterine environment on fetal brain development. We don't know those effects  now, but to say they don't exist is ridiculous. I speak about skin-to-skin and protocols and the importance of mother and newborn bonding because that's my job at work. There is science behind such protocols, and the peanut gallery loves to pelt with peanuts because they say I don't know my science. In the postpartum units at work, and in most hospitals, RNs work closely with mothers and babies on feeding, and hold classes, to make sure that feeding is working well. Eye-to-eye contact is important for that formation of attachment between caregivers and babies. Propping up bottles and lack of body contact isn't good for forming attachment. No. Agreed. We need to continue to work with parents on that. My husband was terrible with that and I had to take him to task over and over. He has his own issues with his family, being German, and not knowing how to be intimate with children or anyone for that matter. We were talking about that this morning, and he said that he's horribly sad for missing out on that with our children, because he will never get that time back.

Then I think about my own case. My mother was very stressed out during her pregnancy. I was born. My mother left. I was in the NICU. I had no primary caretaker for 10 weeks. I was probably propped up with a bottle, or an RN fed me, attentively or distractedly--who knows? I was given phenobarbitol to shut me up to stop me from crying sometimes. I was in foster care. When my aparents came to meet me at the agency, I was brought in with a bottle that had a hole that was huge, and that I had to gulp from or drown on the formula. My amom said it made her want to cry. From the beginning, she said I didn't want to cuddle, unless I was exhausted. I was always pushing away, "wanting to explore the world." Was it that, or did I already react against close touch? Who knows? I did bond to my parents, and I love them unreservedly, but I am also hugely anxious and worry about people leaving me all the time. To this day. I think I am invisible. To this day. Some of my anxiety is probably genetic, but some of it is undoubtedly shaped by my early experiences of loss and not having a primary caregiver.  Because I have probably some of the best aparents anyone could have, and I got them at 10 weeks old, if anything is "fixable"--because a child who is adopted before six months should be "fixable"--why wasn't I "fixed"? As in "issue free," just fine, no problems? I was told I was adopted from the beginning, so everything was fine according to the empirical plan. I didn't find out about the Primal Wound until I was 40. It's not like Nancy Verrier screwed me up all my life, I bowed to a cult of authority, and I am blind to reality. This is what I have LIVED. It's my truth.

No. I feel that reuniting with my mother and my brother put me on a path that has led me out of a dark valley, and now I stand on a ridge, looking down. I knew I was lost and anxious and depressed and sad, but I had no idea I was in that valley, and how blind and depressed I was for all of those years. How much sadness I had repressed, or how much anger and how much self-hatred I had. I asked for help, but no one knew how to help me because no one believed it had anything to do with my adoption. Just like the empiricists STILL want to say it doesn't. It has meant the world to me to have C acknowledge me as a person. I think that has a great deal to do with my ability to stand up for myself in a way I have not been able to do so before.

Being adopted before six months didn't "fix" me. Finding my family didn't "fix" me. There is no "fixing" me. What's broken is broken, but I can move ahead with the help of people who care about me.

If some people are unaffected by adoption, that is their gift. More power to them.

8 comments:

Anonymous said...

Good for you - it's really hard for me to stand up for myself but when I do it gives me such a feeling of power and bolsters my self-esteem.

Have you read or know anything about this book? The Secret Life of the Unborn Child by Tomas Verny MD and John Kelly. I was thinking about ordering it as the description sounded interesting.

Von said...

So understand.Being invisible doe shave it's advantages as Harry Potter knew but not many for adoptees! Upthemselves medics deserve all the help they can get, there is no excuse particularly in the area you work in.
No-one is unaffected by adoption whatever they may say now, tomorrow comes eventually.

ms. marginalia said...

ARGH! And here we go again...yes, Jean Mercer. Some infants have trouble bonding with their caregivers because their adoptive mothers are depressed. I am sure that some women have post-adoptive depression, although I think blaming it on the PW is specious. Yawn.

And I can tell you, for a FACT, that MY amom has never suffered from depression. She does not go that way. I have known her for 42+ years. Of course I wasn't cognitively "there" for my infancy, but all accounts from family and friends--and there were many people around--were all positive for that time. I am the one with the issue. Not she. She is the one who cared for my firstborn when I was down and out with PPD.

Wait. Am I actually putting a foot on this merry-go-round? Off, woman, off!

Trish said...

Glad to see you, I'd missed you. I am so happy to see that your growing relationship with your mother has contributed to so much emotional progress for you. Honestly, no one can speak your truth, and I am so glad that both of your mothers hear and believe you.

ms. marginalia said...

Thanks, Trish! I missed you, and I'd been thinking about how awesome you are and how much I wish there were more APs like you. Sigh.

The adopted ones: thanks for the hint about the book. I have *not* read it, but I will add it to my list of must reads. I am always interested in hearing what there is to know about intrauterine life; state of the field, etc. I love your blog, BTW!

Trish said...

{{blushing}}

There are more...and I am trying to convert the rest.

Lisa B. said...

Kara, the things you post about your experiences in the maternity ward are so interesting to me, having recently gone through all that myself (I have a 14-month old daughter). I missed all of the doctor/nurse/parents going-through-labor bonding/tension/expectations since my daughter was a frank breech scheduled C-section. (Her birth story: spinal block, no pain, 15 minutes later there she was, yelling away!) Anyway I am wondering...have you been medically involved with many births where you knew the baby was headed for adoption? (I've heard of ones where the adoptive parents are present and cut the cord, etc etc.) If so, did that stir up any strong private feelings for you, about your own memories or towards any of the parties involved? Lisa B.

ms. marginalia said...

Lisa, there are adoptions on my unit, but I recuse myself from those cases because of my intense feelings about it. I really don't think I am the best nurse in that situation because of being triggered. If I *have* to do it, I can, but I identify so closely with that baby I am in hell. In the three years I've worked there, I have only had to do it once. It was a c-section, preterm, the woman didn't even know she was pregnant. She walked into the ER and we couldn't stop contractions. We delivered her via emergency c-section for fetal distress. She had already placed one child eight years previously, but because she didn't know she was pregnant this time, there was no plan in place. She didn't even want to visit the baby in the NICU, but I insisted. I didn't follow up over the next few days.

In some ways, I think I subconsciously chose to be an L&D nurse to try to heal myself. Every day I witness birth and get to see that bond between mother and child, the one that I lost. I get to protect it and support it.