Monday, May 10, 2010

The Arduous Adventure Turned Impossible Issue

[Some adventures are for women only . . . Enter at your own risk]

This is what happens when you become an adventurer. Call it being knighted or going through a rite of passage.

You learn to live without; you feel an acute sense of homelessness; you feel like a nobody in a culture you can’t quite grasp; you learn the streets by name and figure out how to wake up, dress, pack, disembark and hop on the next train in a matter of a few minutes; you learn to decrease the weight and number of items carried on an airplane; you learn to be flexible due to flight delays and acts of God; you drag your young child behind you and he becomes better at this game than you are; and in all these ways you find the limits of your mortality.

If you’re me, you aren’t writing much these days because you’re trying to strike a balance between the mundane, the insane and what’s really on your brain, meanwhile bleeding for two months. I know. Too Much Information.

But I’m not finished explaining the life of an adventurer in the medical minefields of Sweden!

Phil and I had been going through a rough time (those times always come). We barely spoke. Being in the same room was a strain. We asked our friends to pray for us.

One day, as Phil and I drove to a friend’s house in Malmö and Hunter was with some other friends, I asked Phil, “Are you going through a mid-life crisis? If you are, I’d like to know.”

“Of course I’m going through a mid-life crisis!” Phil said, “Every man goes through a mid-life crisis when his wife is going through menopause!”

“Menopause!” I exclaimed, “What makes you think I’m going through menopause?!!!” His explanation, something he’ read on-line, was less than convincing.

Nevertheless, our relationship started improving--almost like falling in love all over again (those times can be repeated, you know!). What exactly did our friends pray?

I woke up one morning, after having to visit the bathroom about four times in the night and something seemed different. In this case, I suspected I was pregnant. “This,” I thought to myself, “is what happens when you become an adventurer.”

I didn’t say anything to Phil for several days, but I thought of all the people I knew who wanted a child more than anything in the world. I wondered if Phil would go for adopting the child out. I couldn't tell anyone in the family this crazy idea because they would all try to talk me out of it. Even so, I decided to do things differently this time and tell the child it was welcome in this world. A few days later, when I was pretty sure, I told Phil (HE, of all people, was delighted).

We didn’t tell anyone about the pregnancy because it was too early, but we were pretty sure. For reference, this was February 2010 and the harshest, snowiest, blowingest winter in the region of Skåne, Sweden since the 1980’s. Strangely, I’d brought a test from The States, just in case. After waiting longer than necessary, I decided to take the test and it was positive. Though we had already started discussing the what-ifs and the irony against Phil’s suspecting menopause, it was still a shock. Not only did our minds reel, but we had to rethink the whole process of going back and forth to Sweden. This could change everything.

My second daughter is getting married in September. I imagined her threatening to kill me when she found out we’d be finding a suitable maternity dress for me to wear as mother of the bride. She wanted to kill me six years ago when Hunter displaced her as baby of the family.

Should we still go on the ski trip? Should we plan to go back to the States sooner for longer than we thought? Should I try the Batsu (sauna) on the Sound where you bake at 90 degrees Celsius before dunking three times in the frozen sea? How would I continue my chauffer duties with a growing belly when I already drive with the seat pushed against the steering wheel? What about the spontaneous trip to Morocco? Would that be too much?

I went to the local doctor's clinic for a confirmation test. My landlord’s mother also entered the clinic and sat down beside me. She chatted in Swedish, telling me why she was there, producing a glass black pepper spice jar full of her own urine, telling me she thought she had an infection. She wanted to know why I was there. While I searched for simple Swedish words to tell her not too much, she said, “Du vet inte (You know not),” and in that awkwardness, we fell silent in those close waiting room chairs.

The nurse called me in before my friend. The nurses’ office is right off of the waiting room and they don’t close the door when they ask personal questions at full voice. But I lowered my voice to state that I thought I was pregnant. “Oh, we don’t deal with that, here! You must go to a midwife. But you can only call once per day between 9 and 10 am. Here’s the number. Congratulations!” And I walked out the door, waving meekly at my landlord’s mother on my way out.

I managed to call the midwife a week or so later. My number on the call waiting line was 3. I listened to the repeated Swedish announcement that my number was still 3, then 2, still 2, still 2, etc, until I was still 1 and a real person picked up the phone. Several times during the wait, I wanted to hang up and forget about it. I have a prepaid phone card. Waiting costs.

Though I am learning Swedish, the midwife couldn’t understand me and was forced to help me in English, a language she felt uncomfortable speaking, but spoke well enough for me. The fact that I didn’t have a Swedish number caused a problem. I’m an untraceable foreigner. This didn’t make things any easier and it is taking too much of her one hour call-in time. So, what is my name, how do I spell it (saying letters is not easy in another language) and we went through this process three times to get it right.

The most important question a Swede asks anyone else, because this is the question of number one importance in life: “What is your birthdate?” After I answered, there was silence. I figured she was writing it all down. “We would worry about your age,” she finally said. “Do you want to keep it?” Ah, the other question known by many around the world to be so easily answered “nej” by Swedes.

“I keep and love all my accidents,” I said, feeling emotional and sentimental, suddenly. It was, of course, impossible to get an appointment for three weeks.

I told her I would be going to Morocco for a week and would like to have the pregnancy verified before the trip. She realized this was taking entirely too long and was too complicated. She offered to call me back with a possible appointment in another city. There I was, again in the maze of socialized medicine. I was warned that I would have to pay three times the usual amount because I didn’t have a Swedish number.

Out the window, I could see the Oresund Bridge, the longest in Europe, the salty Sound mirroring the blue sky, ships and ferries inching past, the tall turning torso, people walking their dogs and jogging through the beach/park, and airplanes approaching for landings at the Copenhagen airport. I was in a fourth story apartment--the home of a new friend from Russia, who didn’t understand why I was taking so long on the phone when the tea was ready. When I hung up, I wondered if I should tell her. I did because the phone rang again with two appointment times—one before the trip and one after. She was the first to know besides the three nurses. I hardly knew this woman I told.

Everything slows down when you find out you are pregnant. At least it does for me. I’m aware of an intense hunger that needs to be monitored and faithfully fed. All my bad eating habits suddenly go out the window. I must be disciplined because there is a new life inside me and I’m much older than when I first started motherhood. I get shaky between meals and can no longer open jar lids for lack of physical strength. My problem with inattention and absent-mindedness goes away. My mind is clear and deliberate; my actions are more efficient.

When I arrived for the appointment, it was difficult to find the building. Thankfully, there is usually a map in every parking lot. The buildings on the map are numbered. An enlarged number appears on every building corresponding to the numbers on the map. This was good, because I couldn’t understand the word used for maternity clinic. Finding the entrance was a nearly impossible maze through a garden.

The posters on the walls were aimed at very young people who might be in tentative relationships or new at this. I felt new but not because of my age. There was no sign pointing to the reception desk and no one at the desk when I found it. There were adorable photographs of tiny babies in artsy studio poses that made me feel like a grandmother. Someone finally told me where the midwife was and told me she was behind one of the doors off of the waiting room. A very pregnant, obviously Swedish blond, still slender everywhere else, sat on the couch beside me watching a video about the birthing process. She looked alone and nervous. Even this mental snapshot made me realize how “on your own” a person is in Sweden.

I pretended to read one of my writing magazines.

When the door opened, I asked after the midwife and found it to be her. She was surprised to see me because she had called to cancel “if I wanted” due to the fact that this first appointment would be so basic, practically unnecessary. I persisted because I knew no other way to get into the system.

This midwife in a white coat, surrounded by models of growing fetuses and removable uteruses, slumped toward me on her side of a 50’s style office desk and ran through the questions about age and keeping babies. She spoke as if she were an unconcerned human speaking to the lost and stupid. I dutifully acted the expected part.

In answer to her question, I stated that I was not interested in the worry that amniocentesis causes and that I keep all my accidents. She was glad I had thought about it. She told me again that this appointment was really unnecessary, because all she does on the first prenatal appointment is tell me not to smoke and drink and that there won’t be anymore appointments before the 12th week. You're only 8 weeks along, by everyone’s calculations, so I should be on my way to Morocco (or the edge of a cliff for that matter). Do I have any questions?

“Yes. I’d like to make sure I’m really pregnant.” I said. The hunger, the clarity, the shakiness—it had all stopped between Tuesday and the Friday I’m sitting across from a sterile-faced woman. But I forgot to tell her that I felt all those things once. I reached in my purse, copying my landlord’s mother’s example, and produce a sample in a peanut butter jar. She goes to another room. There is the sound of a dropped glass jar. I jump as if the firing squad shot me. She comes back with my sample in a Styrofoam cup, a flat stick resting on the rim.

“It’s negative,” she said, disgusted, as if I have now proven how much of a waste of time this appointment was.

“You’ve been through this before. You have three children already. Do you feel anything?”

In my discomfort and unfamiliarity, and then, shock, I said, feebly, as if I’ve been caught doing wrong, “No.”

“We won’t be charging you for this appointment,” she said. I thanked her and retraced my steps to the car and went home.

Two days later I was on a plane to Morocco and absolutely nothing happened to my body except that a Swedish

midwife proved there was nothing there and believed there never was.

The trip to Morocco was an on-site photographic class and tour. We walked all day from morning to night and ate too much because we didn’t know what to order. We were having a blast. Underneath it all, I grieved. No pregnancy of mine had ever ended before I beheld the wonder of the child in my arms. This thought would grip me while other members of the group laughed from their dinner wine or when I saw a baby hammocked on a mother’s back. Mothers in Morocco were not always young.

My husband and I talked about what happened at the midwife’s office and I had expressed relief mixed with a great sadness. He was sad, too, but we were both so caught up in the trip, we weren’t really worrying about it right then. After all, maybe we had simply imagined the whole thing.

Midway through the trip, I started bleeding. It was intermittently light and heavy one day and the next. The only pain I had was in my lower back. I figured it was due to walking so much and carrying camera equipment.

We picked Hunter up from our friends’ place on Friday night. We enjoyed a restful weekend, going over photos and building Legos with Hunter. It was mid-March.

I had another mid-wife appointment scheduled for that Monday after I picked Hunter up from school. It was tricky telling him I needed to go to the Doctor’s office without letting him in on what was going on, especially since this office was not the one we usually visit in Höllviken, but one in Vellinge. He wondered why there were so many photos of babies on the walls. In the last few weeks, he had been expressing the wish to have a baby sibling in the family and becoming rather clingy, as if he knew something was up.

The mid-wife I had spoken to was not in, I was told by another one. “You are the one who went to Morocco?” I was asked with a smile of interest. Great. My new title.

Answering in the affirmative, I was then told, “Oh, yes, we cancelled your appointment after talking with the mid-wife from Trelleborg. The test was negative, right?” I nodded. “Yes, we talked about it and decided to cancel your appointment.”

There was nothing more to do than turn around and leave. I made no fuss. I did not plead my case. But bleeding had started in earnest, more than I’d ever bled before, and I had slept much of the day while Hunter was in school. There was no one to guide me through the miscarriage.

Except the internet. On the internet, you can find people asking questions for which there seem to be no answers because they post their queries after multiple doctor visits, lab tests and sonograms, and being told there is nothing to be done, that these things are normal. And there are those who are simply wanting to know how long to wait before trying again. There is such a thing as a natural miscarriage to be simply waited out at home. People have logged the gory details of their progress. I figured I could wait this out on my own, since I could find no medical professional to believe me.

After a month of waiting it out on my own, I finally called the midwife during call-in times. She was aghast. She thought the test was negative! She thought . . .! Pulling herself together she said she would call in to the women’s clinic in Malmö to give them my fake-temporary Swedish number so I could be seen as an emergency. Again, I would have to call in my own emergency, but she did call in the silly number.

Obtaining an emergency appointment felt like a form of dying on the other end of the line before a decision was reached. I had to explain my symptoms to the receptionist from the beginning. She needed to find my fake number then grill me on why the number didn’t fit my birth year. I was to be accountable for why the midwives did not respond better to my case. I was to answer for myself if this was truly an emergency or could it wait two months out. Throughout the conversation, I became more aware of my responsibility and more decisive.

After seeing the same sob stories on internet news threads, and feeling misrepresented by the medical field in Sweden, I started confiding in a few women friends. I still didn’t want to tell my mother or my daughters. What drives a person to slink away from the very people who can provide useful stories from their own experiences, I have no idea. My friends grew worried for me, asking if I’d had an appointment yet and what did I expect to DO?

Phil left on a business trip to Israel. I wondered what I would do if something happened to him on that trip. I was feeling less and less sure of myself and of being able to carry out my set of responsibilities, let alone those things he takes care of on a regular basis when we’re together in Sweden (Phil makes breakfast and takes Hunter to school on the city bus, for starters. The first day Phil was gone, Hunter said, “Oh no! What are we going to do without Daddy? Like, what will happen if my computer gets a black screen?!!!”)

To check in to the emergency Kvinnakliniken (The women’s clinic), I needed my passport and the exact amount of money to be paid. These were facts drilled into me more than any given expectation for the appointment. My fake number still didn’t match my birth year, so the process took longer until they could give me a new number and delete the other as well as maintain my file. Furthermore, my first credit card didn’t work, for some reason. Three attempts and a second card finally worked. The trouble was the last two cards I had on hand took money directly out of certain accounts and Phil had not told me which accounts he preferred I use. A call to Israel during business hours while dealing with the check-in receptionist is a double no-no. Sweat, bother and worry.

How soon can I use a bathroom, for goodness sake?! I had already walked a half mile from my parking space to the clinic. Now this half hour hassle.

The receptionist stapled my receipts and pointed toward an ominous set of double doors where I was expected to take a number and sit in a cramped, grey waiting room where women in varying conditions flipped through mangled magazines and breathed in the stale, oxygen-deprived air. It was obvious that the group of us were multi-lingual internationals with a myriad of human symptoms generated from the same organs in our bodies--that it didn’t take much to fall through the cracks of the system. That the one who faints first gets the most attention.

A slender nurse called me into her laboratory. While she took my temperature and checked my blood pressure, I noted the hard lines in her face and the years of cigarette smoke gravelling her vocal chords. When she asked to see my passport, she looked at it and in awe, said in her deep, alto voice, “The United States of America . . . .”

That phrase gripped me for a moment, as if I should put my hand on my heart and recite the pledge of allegiance. It gripped me to realize people still idealized my country of origin and that I knew why. It gripped me because I felt worried that the country I love may not be the country I return to.

She took blood from my finger and from a vein in my arm. Though I said I didn’t need a band-aid, she insisted I use it anyway. “What, you don’t want me bleeding all over the place?” I teased.

“This is your responsibility,” she said, reminding me of what every person in this process had said up to this point, “I don’t have the time [to worry about it].”

I was sent back to the stifling room. A young mother limped in with her tiny newborn. Her own mother fussed about her, positioning the baby pram, arranging blankets, moving magazines out of the way and answering the nurse’s questions. I wondered if I would attend to my daughters the same way someday.

The doctor herself called the name on my chart the way most Swedes say my name, “Yulyen Moonts?” She introduced herself and asked if it would be okay that an intern be present. Since this is the story of my life and I wanted to get on with the appointment, I acquiesced.

The process of seeing the doctor is fairly different from the U.S., as you might imagine. For instance, I was directed to disrobe in a tiny corner of a large room behind a curtain that does not fully close. The doctor, nurse and intern remained in the room, speaking Swedish. They called out directions to me while I dressed. I was expected to emerge without a paper gown or covering, to embark the dreaded table contraption, and to maneuver into position as three people watched.

I was examined and given an ultrasound in the same space of time. The doctor pointed aspects of my body out to me on the screen. I was directed back to my changing quarters where I dressed while the nurse, doctor and intern discussed my case in the same room. It seemed strangely natural, efficient and third world. I was seated next to the desk by the doctor who spoke kindly to me, asking me about the past few months, and looking at the calendar I had kept. I was told that, indeed, I had been pregnant and my body was trying to get back to normal.

Someone believed me.

The doctor told me, as she ushered me out to the hall, I should be able to go home and be fine. I shouldn’t need to do any drastic procedures, but that I should call back if I had any more trouble. The nurse took more blood, and then sent me away with my band aids. This was the most positive Swedish medical experience I’d had in a long time. I was almost giddy.

One week later, after Phil was stranded along with thousands of other European travelers due to the Icelandic volcano eruption (he inched his way my plane and train,—standing room only--increasing his five day business trip by five more days), I started bleeding again, worse than before. I started pleading with the Lord to be able to touch the hem of his garment. I felt a greater level of empathy for the woman (and those women on the internet) who dealt with an “issue of blood” for over 12 years.

My heart broke for the many around me who have had nothing but trouble trying to conceive even a first child. I wasn’t even trying to conceive!

My friends were starting to get mad. They couldn’t believe that medical professionals would turn me out without finding and fixing the problem. They thought I should get another appointment, be persistent, even bothersome, if need be. So I went back in to be questioned by a nurse (another intern in tow), tested in all the same ways again, told my hemoglobin were better than good, and sent off to buy some over-the-counter-blood-stopping pills at the pharmacy.

The pills were as sugar pills, having no effect.

After weeks of the same and a few close call explosions in public places, I left Hunter with a friend and went to emergency after hours (this means after four pm). Even the waiting room was empty. I was given the battery of blood tests and told to return in the morning to a scheduled appointment with a doctor for another exam. Phil wanted to know if I was hemorrhaging.

The next morning it was the same place, same scenario, different female doctor, MALE intern shadow. Sigh. I was examined by both the doctor and the intern because the intern would be receiving his own patients the next day. Double sigh. Double the pain.

“There are a lot of parts left,” the short, dark-haired doctor told me after I was dressed and sitting beside the desk. The nurse came back in with a foil strip of tiny red pills. “It appears your body has not been able to flush the parts out. It will continue this way if we don’t try something else. It is always a difficult decision deciding to wait awhile longer before using a surgical procedure,” (the same procedure used to perform abortions).

“Take these pills, (I don’t know what they are called in English), three times daily,” she continued, “and I’ll set up an appointment two weeks from now for another examination to make sure there are no more parts and no infection.”

As I left with a new diagnosis and the strip of red pills, she warned me, “The pills will hurt. Take pain killers.”

Parts, pain and a busy schedule. Joy. My faith was running thin. I took some ibuprofen and Tylenol along with the little red pill (used mainly for hemorrhaging women after childbirth) and cancelled all my appointments for the next day. I felt better on all those pain meds than I had for awhile. My body felt stressed, but there was no pain.

By the next evening, the bleeding had stopped.

So, I’m at the end of a four month process. Spring has arrived in Sweden, but the temperature is not warming very quickly. I’m looking forward to feeling the warmth of spring outside and the lift of spring in my body so I can enjoy a bit more of Sweden before we leave again. I’m hoping the next appointment will be my last over these issues for a long time. But I’ll have to keep watch. I’m still a bit of a spring chicken.