Tuesday, October 24, 2006

Anna Quindlen Newsweek 10/16/2006

Oct. 16, 2006 issue - For anyone who has spent a lifetime listening to the bumper-sticker rhetoric of abortion politics, hearing Renee Chelian describe how she does things at the Michigan clinics she oversees is, no question, a shock to the system. "We're not going to correct a woman when she says 'baby' instead of 'fetus' and 'killing' instead of 'termination'," says Chelian flatly.

"If it's her body, she gets to use her terminology. We have to speak the language of the patients, not of political positions. Women don't come to us and say, 'I'm having an abortion because it's my choice.' They say, 'I'm having an abortion because I can't have a baby.' And sometimes they feel sad about that."

These are some of the honest discussions taking place around America's most contentious personal moral and ethical issue. They're found in places like Northland Family Planning, where the counseling staff may suggest that a woman who is uncertain complete a pie chart with the heading "How much of you wants what?"

At clinics like Chelian's the staff deals with the actual, the difficult, sometimes the terribly necessary. But in the legislative world, it's all about strategy. When South Dakota's governor signed a measure banning almost all abortions, much of the second-guessing that followed could have concerned a tax cut. Would a more moderate approach have been better for the Republicans? Would the legislation push more female voters toward the Democrats? On Planet Spin, it was possible to forget completely that the legislation could change the destinies of many ordinary women. A coalition of nurses, teachers, doctors, ministers and other nonpoliticos finally brought the matter back to earth and onto the ballot for all the state's residents to consider in the November election.

Recently the House passed a bill that would make it a federal crime to accompany a minor seeking an abortion from a state that requires parental notification to one that does not. Like most abortion debates, this one had its stock characters: the grandmother imprisoned after helping a girl impregnated by her stepfather, the young woman victimized by the predatory older man. If those sound like plotlines from Lifetime movies, it may be because none of this had much to do with reality, with almost no chance of squaring the House and Senate versions of the law for a compromise that could be sent to the White House. But voting the bill out now gave House conservatives something to crow about just in time for the midterm races.

The conventional wisdom about parental-notification and consent laws was that they would cut down on abortion, which is why anti-abortion activists loved them. But earlier this year The New York Times ran a jaw-dropping analysis that found the laws had no significant impact on teenage abortion rates. (They also may be way behind the curve; at Chelian's clinic, young women already tell counselors that you can order an ulcer medication online that all their friends swear will cause a miscarriage.) The statutes did, however, have one unintended consequence. "We have parents who come in and want to force their daughters to have an abortion," Chelian says. "Their attitude is, 'If I can prevent you from having one, I can force you to have one.' And we have to tell them that that's not so. The mother will say, 'She's 14, I'm already taking care of her sister's baby, I can't take care of another one.' You know that it will be really hard for everyone."

Public pronouncements rarely make any of this sound hard for anyone, since they're too often based on mean-spirited assumptions. The gay-rights movement has shown over the last two decades that a powerful enemy of such misinformation is personal testimony, that coming out as an individual can combat the big lies about the group. In that spirit the current issue of Ms. magazine contains a list of the names of thousands of American women under the headline WE HAD ABORTIONS. It is riveting, even disconcerting, because telling their own abortion stories seems in direct opposition to the bedrock belief that this decision, above all, is not subject to the scrutiny of strangers.

It's that very determination to stay within the zone of privacy that has made abortion, and the women who choose it, such an easy mark for cheap mythology and easy demonization. And sometimes the triumphant talk of rights has overshadowed the complex responsibility women feel. "Having the right doesn't make the decision any easier," said one of the signatories of the Ms. magazine petition. Chelian notes that while most patients come to the clinic with their minds made up, that doesn't mean they are not conflicted. "Sometimes we're working with a person who feels like she's got nothing but bad choices," she says. "She doesn't want to have an abortion, but she doesn't want to have a baby. That's what I think people need to understand. You can be ambivalent about abortion and still decide to have one. And you can be ambivalent about abortion and still be pro-choice. Lots of people are."

URL: http://www.msnbc.msn.com/id/15173072/site/newsweek/

Thursday, October 05, 2006

The Story of My Surgery

September 13, 2006. A day that will always be seared into my memory. The day of my surgery to remove my acoustic neuroma (aka, head booger).

Believe it or not, I had little trouble sleeping the night before my surgery. We did have to get up at 4am to check in at the hospital by 6am, but I slept quite soundly up until then. I didn’t expect to. And when we got up before the crack of dawn, I still wasn’t feeling nervous.

The drive into Boston was eerily quiet. Not much traffic that early. Brett and I didn’t talk much in the car. I think we were both in our own worlds, thinking about this surgery from very different perspectives.

We get to the hospital around 5:45am, and I need a pit stop before going up to surgical admitting. While my mind may not be nervous, my insides are starting to betray me. We soon go upstairs to admitting. The waiting area for outpatient surgery is already pretty full. I am somewhat envious of all those people there for such minor procedures that they can go home the same day. I check in and we head over to the inpatient waiting area. We are the only ones there. Shortly, another older couple joins us, and then by a younger couple with their young child – he couldn’t have even been 2 years old. I was heartbroken, watching the little boy play quietly, wondering what had gone so wrong in his young life that he required surgery. And I was heartbroken for his parents, having to watch their baby go through something so awful. I tried to flip through my magazine, but it wasn’t working. I couldn’t read the letters on the page. Fortunately, there wasn’t a lot of time to fret – I was quickly called back to the pre-op area. The first among the inpatient surgical patients. Brett has to stay in the waiting room for now.

I follow a very nice nurse, Eleanor, back to pre-op. It is a huge bright, white room filled with curtained off stretchers. My first task is to remove all clothing and change into the requisite hospital garb – gown, robe, and slippers. Eleanor then returns to go through her pre-op checklist. I confirm, three times, that I am there to have a left AN removed, and she uses a Sharpie to write the word “YES” behind my left ear. Don’t want those docs attacking the wrong side! After all the requisite vitals (again, my body betrays that maybe I am a little nervous when my blood pressure is much higher than normal), I sign all the papers saying I will consent to the surgery today.

Finally, around 6:15am, Brett is allowed back to wait with me. But we only have about five minutes before the woman from Transport shows up to wheel me off. Brett and I try to say a decent good-bye, but it’s hard with Stern Transport Woman (STW) watching. And then it’s time for me to be off. STW takes my stretcher and pushes me through the Big Silver Doors, down a hallway, and through another set of locked doors. I am now in the surgical wing. I try to look around, but it’s hard with no glasses and I’m starting to feel a bit queasy and shaky (it doesn’t help that I haven’t been allowed to eat or drink anything since the night before). I do notice that both sides of the corridor and lined with surgical suites, and all available hall space is occupied with all sorts of bizarre equipment. STW pushes me, without speaking, for what feels like hours. Finally, we stop at O.R. 27. I’m wheeled around in a small holding area outside the O.R. so my back is to the O.R. doors. STW goes behind me to poke her head into the O.R., announces my presence, and unceremoniously leaves.

A few minutes later, the anesthesiologist (Dr. Kamdar) comes out. She’s young, and quite attractive. It is her job to start some of my IV lines, as well as get my final consent for the anesthesia. At this point, I am starting to freak a little. My stomach is all uptight and I have to remind myself to breathe at times. Dr. Kamdar starts working on the back of my right hand to start an IV (a BIG one), and a nurse comes out to go through everything with me – again. Finally, I sign the last of the paperwork. I guess this is really happening! Now that I’ve signed all the consents, Dr. Kamdar asks if I’d like some medication to help me relax and I agree. It takes effect pretty quickly – I feel kind of tingly all over, like I’ve had a couple glasses of wine. I’m still freaking out, but breathing is a bit easier now.

Dr. Kamdar then shoots my right wrist full of Novocain so she can put in the arterial line. I can’t watch, but try to ask her a few questions (how many people are in the O.R.? What kind of anesthesia do you use?) to distract myself. She’s having trouble with my veins (I’m somewhat dehydrated because I couldn’t eat or drink that morning) so I probably should be letting her concentrate, but I really feel like I need someone to talk to me. She’s been working on my wrist for several minutes when I start to feel very light-headed. I try to ride it out, but finally have to tell Dr. Kamdar that I feel like I’m going to pass out. She quickly pushes a medication into my IV, and a few moments later I’m feeling better. It’s all very unreal at this point. Shortly after, the arterial line is done, and Dr. Kamdar straps my wrist to a soft board so I don’t accidentally move the wrong way and dislodge a large line in a major artery. That could be bad.

Now Dr. deBros, the senior anesthesiologist, comes out. We chit-chat a few minutes, and then he starts discussing the anesthesia protocols with Dr. Kamdar. I listen, amazed that he has a specific protocol he likes to use for AN patients. What really gets my attention, though, is when he describes the dosage of a specific med to push when the surgeon is about to start drilling the skull to put me under a bit deeper – otherwise, he says, the patient can reflexively startle and move a bit from the noise. (I later find out that Dr. deBros specializes in anesthesia for neurosurgery cases.) I actually find myself reassured that this team is so experienced with ANs that even the anesthesiologist has developed a specialized protocol. At this point, Dr. Kamdar has given up on starting the other IVs she needs, saying my veins are too collapsed from dehydration and she’ll finish up after I’m under to minimize my discomfort. Then she and Dr. deBros disappear into the O.R., leaving me alone in the waiting area.

I have no idea how much time passes, but I don’t think it’s too long. A nurse finally comes out, and says it’s time to go in. And just like that, I’m wheeled into the O.R. I wanted to remember to look around and really take it all in and remember it, but I think the meds are starting to play with my brain. I note that the O.R. is very large, and there are lots of large, white, shiny pieces of equipment all over. And enormous lights over the operating table. My stretcher is wheeled over so that it’s right next to the operating table. I hear someone say out loud “In the room at 7:45am.” Then a couple nurses appear right next to me. One asks if I can slide myself over to the table, or if I need them to do it for me. I reply that I can do it, and proceed to (somewhat awkwardly) move myself over. The nurse remarks how strong I am, and quickly covers me with warm blankets and puts towels under my elbows on the little armrest jutting out from the table. To my right, I see someone I think is one of the surgeons pacing back and forth and muttering to himself. In a very disconnected way, it again hits me that this is actually real.

Dr. Kamdar is back, near my head. She places a mask over my nose and mouth, telling me they’re starting to give me some oxygen. I’m grateful that she just holds the mask a bit away from my face – I somehow know that I’d freak with claustrophobia (though I’m not usually claustrophobic) if the thing were strapped down tight. The air in the mask suddenly starts to smell different and I wonder if Dr. Kamdar is starting to put me under, hoping that she’d tell me if first if she was.

There’s a hive of activity around me. I can hear it. I will myself to open my eyes and they do for a brief second. I see a woman standing to my right, writing on a clipboard, before my eyes decide they really don’t want to be open. I lose sense of the activity. Then it comes back, though I have no idea how much time has passed. I hear people talking about what I think are medication doses. My head hurts, A LOT, and I say so. But I don’t know if I actually say the words, or if it’s just in my head. Somewhere back in the deep recesses of my brain, I finally realize I must be in Post-Op Recovery. And I’m convinced it’s 5pm, which is good – it means the surgery went faster than expected. And then I pass out again. Suddenly, I’ve got the dry heaves, which is exceptionally miserable and kills my head, and them I’m out again. (Looking back, that’s probably when they took out my breathing tube.)


My stretcher starts moving. It’s not a good feeling. I really don’t want the world around me to be moving. I feel like I’m spinning. I close my eyes and try to pass out again, but it’s not working. After what feels like a three-hour trip through hell, I stop moving. I’m in a room – ICU. My brain is working enough again to realize what’s going on. The room is buzzing with nurses, doctors, and other people. I look around a bit and see the clock on the wall – it says 9:00. For a minute I’m very confused. Is it 9pm or 9am? I thought I was only supposed to spend an hour in Recovery. Did something go wrong?

The doctors notice I’m alert and start talking to me and asking me questions. I’m actually pain-free – good meds! I pass the initial neurological assessment, which is great. I can actually feel both sides of my face moving – is it possible my facial nerve wasn’t damaged? That would be amazing. But my left hand is numb. I tell this to the doctor, and he looks concerned. He examines my hand and arm and finds that I have a pressure bruise on my elbow that is causing problems with the nerve going down to my hand. He seems disappointed, but not concerned.

I ask to see Brett. But, again, I’m not sure if I say the words out loud or just in my head. I think I’ve been given IV morphine, and it’s starting to make me very sleepy again. I start to doze off, and then Brett’s suddenly standing at the foot of the bed, talking to the ICU nurse. Everyone else has left. Brett and I talk for a few minutes (about what, I have no idea) and then I’m dozing off again. By the time I can get my eyes open again, Brett has gone and I’m left in the ICU, with a wonderful nurse, to recover.


Day by day by day… I feel a little better every day. And I never did figure out why I thought it was 5pm when I was in recovery. Trick of the meds, I guess.