A Bad Day...

Where do I begin? I had two appointments scheduled today to deal with issues surrounding both of my children. The first was a prenatal appointment and while I was planning on discussing some pretty significant concerns surrounding my care, felt it would go relatively well. The second appointment was the annual IFSP for My Girl's Early Intervention Services. This meeting was slated to be a challenge as I was prepared to "fight" to keep her SLT and OT services on a weekly basis. My preparedness was all backwards and I am sitting here still recovering from the hearty cry my first appointment of the day caused.

What I am about to write is my interpretation and take-away from my appointment this morning with my local group. I realize every story has two sides, that each party has their own reality and views any particular situation through their own personal lens. My personal documentation of today's events is in no way intended to defame or smear.

I will admit there was no rehearsal on my part nor did I have a list of notes with me to keep me on track. This meeting was sincerely a "heart-to-heart" and those were the words I used with Dr. C when he entered the room. My agenda, so to speak, was strictly to convey my concerns, fears and wishes as a patient in a thoughtful and sincere manner.

My first point was that it would mean a great deal to me if Dr. C was the physician who delivered my baby. I should have known when I got a lecture about how over-worked he feels that I should have packed up my stuff and left. I mean, how professional is it to unload the burden of your hectic work schedule on your patient? I learned he is on-call 50% of the time. He is scheduled to work the weekend before Christmas (although he mentioned he was traveling with his family this weekend too), the weekend after Christmas, New Year's Eve and New Year's Day. The only time off he is getting this year is Christmas Eve and Christmas Day. The practice is responsible for six hospitals, dealing with high-risk calls coming from the home base of Lankenau, sister hospitals, Paoli, Bryn Mawr, Riddle and two others, Pottstown and Montgomery. He needs to be on-call for transports and in fact, has women right now on antepartum who could deliver at a moment's notice. He even told me he is considering not delivering any longer, it's just too much.

Okay, well, sorry I asked. So the bottom line is unless my c-section is scheduled, there is a 50/50 chance that Dr. C will be the one on-call to deliver me.

The conversation transitioned to my amniotic fluid level and the non-stress tests that Dr. Davis feels should be preformed weekly. I explained that while I expressed concerns about my contractions and uterine irritability to Dr. G, I was always brushed off, given the same canned answer about more than five contractions in an hour. I explained to Dr. C that while I've really tried to like Dr. G, realizing he is regarded as a fine doctor and that I need to put my personal differences and opinions aside, always feeling as if I am being talked down to with a condescending tone is hard to take week after week. Not to mention the fact that I felt like my concerns were never properly acknowledged and always minimized.

Because of this, I made an appointment to be evaluated by Dr. Davis. His team happened to, as part of the normal protocol, scan my baby (which my local group hadn't done since 20 weeks) and check my fluid level. I explained that since this discovery of borderline fluid last week, I have increased my fluids and started the Procardia around the clock. This combination has helped curb my uterine irritability.

Somehow, the conversation turned to the fact that I was not recommended by my local group for a Transabdominal Cerclage (TAC). That I was spearheading my care, which is unheard of and not a good way for anyone to seek medical care. The doctor is the doctor, not the patient. The literature does not support a woman like me to have a TAC. Dr. C then indicated that I should have tried a TVC and if that failed, then consider something more drastic. I was flabbergasted! I pushed him back asking him if what he was saying was that I needed to have another micro-preemie or worse yet, lose a baby due to a failed transvaginal cerclage?! I reminded him that I sought other opinions and that Dr. Davis was not the only physician to confirm my lack of "stitchable cervix". In fact, Hubby later reminded me that it was Dr. C who gave me the name of the doc downtown who was ready to perform a TAC on me as well.

I told Dr. C that not once did he check me to confirm that a TVC would be feasible. He then went on as usual, quoting literature stating that there is no way to confirm cervical competency in a non-pregnant woman. At this point I mentioned my instinct, that I knew in my heart the only way to carry a pregnancy to term (or closer to term than last time) was with a TAC. Dr. C informed me that my instinct was worthless and the only reason Dr. Davis placed my TAC was because I was dealing with Post Traumatic Stress.

Basically, something that women on Abbyloppers do all the time, consult an MFM along with a primary OB/Peri, was seen as a personal slight against my local group. Dr. C indicated that the relationship should be based on trust to which I responded that it's a little hard to trust someone who I sought help from on a Tuesday only to learn on a Friday that my membranes were bulging. I told him that pregnancy for me is HELL, that I trust no one and nothing and that my faith in the TAC has only truly become concrete as I've seen each passing week, beginning with the week I delivered my daughter.

It looks like my group never supported me, never valued me as an educated patient involved in my own care. They were offended that I would continue to see Dr. Davis, that I would put two doctors against each other. I defended that by explaining to Dr. C that he and his own colleague can't even agree, that their differing opinions are as good as being seen by two independent practices right there.

For some reason, stupid me allowed Dr. C to finish the exam. I allowed him to check my fluid level, to check my cervix. He wrote me orders for weekly AFIs and NSTs. I cried the whole time. Dr. C tried to scare me into thinking it was unrealistic to rely on Dr. Davis to be available to deliver me. How ridiculous for me to call him when it's time and expect him to meet me at the hospital and perform my c-section. How ridiculous.

So while I didn't officially blow up, didn't storm out with my chart in hand, didn't stop the Director of Development on my way out as we passed in the hall (thankfully he was distracted and didn't notice me) I left with tears streaming down my face, confused and torn yet knowing in my heart it's time to find a new group if I want to deliver in the system.

My emotional ties to delivering at Lankenau are many. The most important thing for me is the NICU team. This is where My Girl was born and while I could go to the other three hospitals in the system and end up with the same neonatologists, the nurses would all be different. I wanted the comfort of familiarity in the event we ended up with a significant NICU stay. Thankfully, with each passing week, the level of care is slowly (in theory) diminishing. Once I get to 32 weeks, I will no longer require a level 3 nursery.

Last week upon leaving my appointment I ran into a woman from the Development Office. She told me to call when I am ready to deliver, that she would hook me up with the brand new, top notch suite on the new L&D floor. Ironically, it sounds like the room that the part of the NICU where My Girl spent her first months of life, overlooking the seminary: a view that brought us great comfort.

And finally, coming full circle, I really wanted to breastfeed Baby Boy in the Lactation Room off the NICU that is named for and dedicated in honor of My Girl.

Lankenau Hospital has always held a special place in our hearts. It is the place where Our Girl was born far too early, the place where her life was stabilized and the place where she fought so hard to live. It is the place that we are forever indebted too, the place where our charitable hearts are. We take pride in knowing that our story has been instrumental in assisting the hospital secure $1,250,000 in donations for the NICU. It's hard to leave this behind and deliver elsewhere.

I called my support mom, Lori, the woman who helped me through My Girl's birth. Her son was born 12 years ago at 23 weeks. Lori and I talk several times a week and she was just the person I needed to help me through today. She had me pull over as I was driving in hysterics. She calmly helped me through and eventually I stopped sobbing.

Tomorrow, once my head is a little less foggy, I need to reassess and decide what course I am going to take. Do I deliver with Dr. Davis, all the way in New Jersey? Do I stick with the group that clearly doesn't value me as a patient? Or do I find a new group in the system?