Beginning again with Lent

Sometimes I look forward to Lent as a time of much needed renewal, and I plan ahead for it.  Other years, especially when Lent arrives early, I am caught off-guard. This year was in between. I did some prep, like signing up for a women's reflection group at our parish and ordering the devotional workbook, but when Ash Wednesday arrived last week, I still felt like Lent snuck up on me. A week in still feels like the beginning. 

Part of my lack of preparation on Ash Wednesday was due to being out of town the week before. We went to the mountains of North Carolina to see the house my husband designed for our cousins (they had a vision; he drew it). When we booked the trip (made possible by super sale airline tix), we laughed about it being our Mardi Gras celebration, And it was a lot of fun, until I broke my wrist at the roller rink Saturday night. The story should be that I slid while trying to win roller derby or that my husband tried to do snap the whip and sent me flying, but in reality, a reckless teen took me out from behind. Ironically, I had been trying hard to be cautious because I remember my mom breaking her tailbone while roller skating when I was a kid, and I wanted to be able to sit comfortably on the plane ride home.

After a trip to the ER (the benefit of a small town hospital - no wait at the ER even on Saturday night!), we continued to enjoy the time with family - unplugged, playing cards, making music around the campfire, etc. With my arm splinted up and wrapped in a trash bag, I even got in the hot tub. I just couldn't take a hike to a waterfall or sleep well, which was too bad because they had great mattresses. 

We returned home on Monday and had a Mardi Gras party on Tuesday as a fundraiser for our daughter, who was raising money for the Leukemia and Lymphoma Society. Our son did almost all of the gumbo prep and dessert baking and decorating with purple, green, and gold balloons and streamers. We STILL have beads left from our stay in Mississippi. A friend brought king cake, and I bossed the kids around with my arm splinted. I don't recommend Mardi Gras parties on the actual Fat Tuesday because you are left with leftovers. All those delicious things begging to be eaten on the fast day maybe makes the sacrifice more penitential.

Fortunately, I was able to get in to see our primary doctor Tuesday about my wrist to get a referral to an orthopedic surgeon by Thursday and surgery scheduled for Monday.  Now that we are in the civilian sector for medical care, I have some strong thoughts about insurance/medical issues - and my lesson this time is to call all the involved parties and talk to a person, even if on hold for hours, to make sure all the necessary paperwork gets submitted. I may have traumatized my girls by uttering a primal scream in the car Friday afternoon - after hanging up the phone -  when I thought I was going to have to reschedule surgery because some paperwork was submitted with wrong codes (Was my strong reaction a symptom of perimenopause or low blood sugar from foregoing lunch that day?). Thankfully, someone stayed after hours to correct it and get everything submitted. Maybe she heard my quivering voice mail. Thank you, kind human being.

So I had the weekend to be grateful and to continue to endure the pain of bone on bone grating in my wrist. I did not open my Lenten devotional until Sunday afternoon, after the priest had given me a blessing after Mass on my husband's sweet request. In the prayer he reminded me to unite me suffering to the Cross.  

I am not always thoughtful about offering it up, although I remind my children of this practice. I had been intentional about not ruining our vacation with complaints about pain, although I did feel sort of nauseous the rest of the weekend. And the ache in my arm, which ranged from dull ache to stabbing pain depending on how I moved or how much ibuprofen was in my system, made me think with compassion on all those who suffer chronic pain and how tiring it must be, but I didn't think of offering my pain. Perhaps it seems too transactional - I forego complaining, so God takes away someone else's pain. I know that's not the theological explanation, but it seems that way. 

Now in the second week of Lent - with a plate in my wrist after surgery on Monday (I am typing with one hand) - I am more intentionally offering up the pain and inconvenience of being one handed as one of my Lenten practices, or at least acknowledging the pain as a reminder of the suffering of others. The priest's comment has me thinking of the nails that would have been driven through Christ's wrists. When I woke up to shooting pain in my arm on Monday night I again thought about crucifixion as a horrific way to die. If breaking my wrist was enough to make me pass out from a vagal response, how could I have endured the worse pain of being beaten, broken, and carrying a cross.  

Before my surgery on Sunday night I had trouble sleeping. This was a minor surgery, but I was kept awake by anxiety nightmares about surgeries gone wrong. I dreamed I drank something and aspirated while anesthetized - although I was completely alert in my dream. Even though risk is minimal, it exists, and it's a reminder of the finitude of life. In the morning I texted messages of love to all the kids and gave extra hugs to those here. I regretted I wasn't more sympathetic when our boys had their ACL surgeries. I probably didn't recognize their nervousness enough.

Soon enough, surely by the end of Lent, this pain will fade, unlike the chronic pain that others suffer.  We've also started our other ways to fast, pray, and give, For instance, we have substituted the divine mercy chaplet for the rosary at bedtime, and that prayer is another reminder to think of the suffering of others above my own. We aren't eating sweets or meat or drinking alcohol - which I haven't wanted since being hurt, so it's not much of a sacrifice. My daughter added drinking milk, which I'm not sure is a spiritual practice, but she doesn't like it, so it is some kind of discipline for her.  This year I'm not doing the cheap coffee thing - partly because we are stocked up on coffee right now. Nor am I really cutting back on media, because I have done that already from a lack of time.  Instead we are trying to buy less and live on what we have. I thought I'd do the buy nothing thing during Lent, but we have some birthdays coming up, and the youngest needs new cleats for soccer and an Easter dress, etc, so instead I'm just trying to buy nothing unnecessary - of course, I bought pillows for the new chairs on Ash Wednesday - so not doing so well on that.

I'm not loving my Lent devotional so far, but I think I will enjoy the group at church. I have missed my ecumenical Thursday morning Bible study because I'm teaching on Thursdays. However, since I finished the Bible in a Year in February, I've started the Catechism in a Year. Already behind with that, but I am just listening to a few episodes now and then, rather than treating it as a daily obligation. I do need something good to read (I just finished a good YA novel about the 1989 overthrow of the Ceausescus, I Must Betray You by Ruta Sepetys. Definitely reads like a YA book, but it offers a good insight into life in the oppressive Communist regime in Romania.)

For giving, we've got our list of groups we give to financially, but I've also got snack bags for the people asking for money at the intersections. And we're talking about signing up for some family service project. Giving time is probably one of the harder disciplines.

If I grow in any way this Lent, may it be that I give up my urge to be in control and recognize my dependence, my need to of repair - I can't heal myself. I can't get through the day without help. I have to give up things I did with two hands like tying my shoes for a time. Fasting from things - meat and sweets and alcohol and shopping - is just a way of clearing the weeds for mediating time with Christ. May I use the freed time for that, for listening rather than telling and asking. Still hoping for clarity about what's next. Still learning to be grateful for our many gifts, still learning to be less self-centered, more aware of others' needs, still learning to love God and neighbor more wholly.

And here are some things I've been grateful for:

A trip to a farm to horseback ride with dear friends

   

A boy who had a birthday:

Swinging

Time in the mountains

breaking my left wrist and not my right

Young ladies lovely within

Pregnancy Journal

I got a call yesterday from the nurse at my ob/gyn.

"We just heard from the perinatalogist with results from your exam and tests."

A little pit of panic opened up inside. The perinatalogist did blood work and the in-depth 3D ultrasound. The US photos looked good, but were the blood tests pointing to a problem?

"Based on your history of pre-term labor, they want you to start Makena shots as soon as possible."

What? My history? I have had 6 children. The first one was born at 35 weeks. The others were, in order, 38 weeks (an estimate because I never menstruated before he was conceived), almost 41 weeks, 41 weeks, 41 weeks and 40 weeks.  Yes, the first was early. But he weighed 6 lbs 11 oz, and other than being a little jaundiced, having some reflux, and being born with no eyebrows, he was fine.

He was born 3 days after I returned from a trans-Atlantic flight to England with my mom. We spent a week traipsing about the Cotswolds with my sister who was spending a semester at Oxford.  Flights were only $300 from Boston, and we were living in Rhode Island at the time.  I begged permission from a doctor at the Navy base (silly to say "my dr" because I never saw the same person twice) who said, "If you were 36 weeks, I'd say no, but go ahead and have a good time."  It was too wonderful of an opportunity to pass up.  One of the most memorable moments was my mother pronouncing the word "uterus" as we crossed paths with a group of young male students out for some ale. We were having some conversation about what would happen if I fell down, and my mom was explaining how the water in the uterus protected the baby.  I also discussing with my sister making a pit stop near the White Horse of Uffington. It was so foggy that we could have just squatted in the grass with privacy. No need for shrubbery. Did we or didn't we? And then there was the day we were exploring a little village and happened upon a church and an old rectory. I think it was the parish of Katherine Mansfield, but I've been known to mix details.  As we were strolling through the garden, the elderly inhabitant of the Olde Rectory shooed us away, informing us that visitors were welcome at the Rectory, not the Olde Rectory.

So anyway, I came home after a grand week, and turned right around to head back to Boston to meet up with my husband's brother and best friend from college. If I had had any understanding of contractions, I might have recognized signs of prodromal labor as we did the historical Boston walking tour, miles of it.  In retrospect, I might have prevented pre-term labor with an little sit-down and water.

But nonetheless, since then, I have never been encouraged to take progesterone or its new commercial variety, Makena, during any of my other pregnancies. In fact, I remember being told not to worry too much about being pre-term with the second one.  Of course, medical policies shift and change (no soft cheeses or sprouts?), but I see this recommendation as an example of why our medical system is broken.

Some issues:
1. I had never heard of Makena, so I did a little research.  These shots, given weekly starting around 20 weeks, cost about $700- $1440 a piece, and could run upwards of $30,000 per pregnancy for 18-20 shots. Meanwhile, shots of compounded progesterone are about $15 - so a total pregnancy cost of around $300.  Apparently these are now hard to find.  I have government healthcare through the military. Why should I pass on this cost to the taxpayers if I don't really need these shots?

2. One of the side effects of the shots is that they could cause pre-term labor and miscarriage, which they are supposed to prevent.  I know these lists of side effects are legally required and could be very rare if nonexistent. I don't doubt that the shot can help people who are at high risk of pre-term labor.  But I don't truly believe that I am high risk.

3. The perinatalogist offered me at least 4 different tests for genetic disorders. I could have said, let's do them all right there. Instead I agreed to do the AFP test, which I have declined in the past because of its high rate of false positive results.  If something amiss is indicated, then maybe we'll opt for additional testing, although another ultrasound may be sufficient to determine if we need to be prepared for anything unusual at delivery. He pointed out that one test comes from two different companies, one of which is significantly cheaper if our insurance declines to cover the other.  I get the feeling he can order up any test he wants and pass off the cost to insurance companies.

4. Why haven't my other doctors warned me of preterm labor or prescribed weekly shots? Am I really at risk or should I have stayed home back in 1997?

5. I intend to decline the shots. But as I was thinking about my little bit of research while I was jogging yesterday, I felt a little uncertain. What if I do go into preterm labor? Every pregnancy is different.  If I start having contractions and then deliver at 34 weeks or earlier, how awful will I feel about turning these shots down?  Doctors have a corner on emotional blackmail. If you don't do what they recommend and the worst comes true, you are responsible for whatever terrible outcome occurs.  I've thought about pointing out that these shots shouldn't be taken by someone with diabetes, and since I have tested on the border of gestational diabetes 3/6 times (I've failed the 1 hour glucose test every pregnancy), this is a pretty good excuse.

6. Pregnancy is a time of great anxiety, much of it irrational, and I'm sure doctors feel pressured to make sure everything turns out perfectly for their patients because of the history of parents pursuing legal action for those times when things aren't perfect.  The last time I saw a civilian doctor, with number 5, I had to start paying an extra $15 "education fee" halfway through the pregnancy because the doctor's malpractice insurance kept going up through no fault of his own. Another dr. friend told me about how a lot of OB doctors are leaving the field or not doing high risk deliveries anymore for the same reason.  So I get why doctors feel obligated to offer these tests and preventative medications.  I just wish they would give a straight answer about the real risks and benefits.

7. I was questioned by the nurse at my first appointment about why I didn't come for care until my 13th week. I couldn't really go into the whole reason - Well, I thought I was only 12 weeks, and my appointment originally was scheduled for the week before, and I hesitated before making the appointment because I thought I might miscarry/didn't want to admit I was pregnant, etc, etc. And I wasn't in a hurry to start the monthly dr's appointments.  -  So I told the nurse that I had trouble getting an appointment that fit my schedule. I knew not much happened at that first appointment. I had already picked up my prenatal vitamins weeks before at the clinic on base, so I was taking vitamins. Do you really need more than one appointment in your first trimester? Probably only if you might potentially terminate the pregnancy.

8. Found myself at a coffee shop table with a new mom in the spouses' book club.  I asked her where she delivered and which doctor she saw. Her dr. is in the same practice as the doctor I went to see.  She proceeded to tell me a lot of information about her birth plan, her labor, what she thought went well and what she would've preferred to have been different. She obviously had done a lot of research on pregnancy and delivery. I felt a little deceptive because I didn't admit that I have six other kids and that I'm probably 15 years her senior. Maybe she knew. I also kind of like pretending this is my first baby when I'm standing in line in the grocery store while the kids are in school, even though by the overflowing abundance of my cart it should be obvious that I have other kids at home.  Every baby is kind of like a first baby. This is my first baby as an AMA patient (advanced maternal age - shouldn't that be older than me?)

9. It seems to me that there's a lot of unnecessary procedure in maternity care - not to mention unnecessary stuff in maternity/baby productland. The only things I've really want to buy are a baby jogger and a car seat.  But I'm also susceptible to anxieties and fears for this baby and for myself.  Like every pregnant lady, I really kind of appreciate going to the doctor monthly for the reassurance that everything is fine, the baby is growing, your body is working as it should, even though for a normal pregnancy, those appointments seem a bit unnecessary.

10. I think I have begun to feel the baby move - or is it just a gas bubble? I want to trust that this pregnancy, labor, and delivery will be just as unremarkable and have the same happy ending as the others. But being out of practice and much older has me undeniably worried that some misfortune will befall us this time around. We have been incredibly blessed with healthy kids and uncomplicated deliveries. May the blessings continue.