my tale of D&C - not what you might think

I wrote this in 2020 but it felt too personal and I hesitated then. After last week and the decision in Texas and US Supreme Court I feel more alright publishing it now.

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It's a story - about something that people have an opinion about - or at least they think they do. It's really about definitions of words and what they mean to people. And of course, about medical codes and how they influence medical treatments today. 

I never wanted to write this post. I'm a bit personal about a few of my personal failures. However, at times my friends tell me that it's not really failures (per se), and it might make a difference talking and being open about them ("since you are a PhD, an educated woman and having agency" - their words). 

I also have had conversations with Trump voters and ended up having a similar reaction where they were surprised that their pro-life/anti-abortion stance had a negative impact on medical decisions, so I am trying to be more comfortable with this blog post.

Years ago I went for an investigation of my female reproductive parts as part of trying to have children. It involved trace dye in the fallopian tubes and then it was a "routine ultra sound of the uterus", which shouldn't have been an issue since I go to annual checkups and having everything cleared. However, during this routine checkup I of course asked the nurse (I'm an idiot, did I tell you? a nosy PhD person... with an ultra sound wand up her private parts... trying to make it less weird and more regular....) "does it look normal"?

The answer she gave, while she looked at me and trying to give a normal face (bless her heart) was "the doctor will call you with the results in the afternoon".

So when I left the visit and started to drive to work (since the appointment was in the morning - it was supposed to be a routine appointment as usual), all I kept thinking was "there's something there because otherwise she would've said it was all fine".

The physician (MD - I can't refer him as a doctor in this blog post since I'm the PhD and also a "doctor" and it played tricks with me) called me in the afternoon - and one of the more surrealistic conversations that I've had took place. Note, the MD and I are at this point well aware that I'm a trained microbiologist PhD working with cancer - sure it's pediatric cancer but some of it overlap...  Anyhow, his comment is that the ultrasound shows a growth and it should be taken out. "It's not definitively cancerous, but it wasn't there when we checked last".

Physcian doesn't think it is cancerous, however it has grown in less than two years so it's recommended to take it out for women who are of child bearing age to check for malignant cells - especially if trying to become pregnant.

The kicker, for me who is not grown up in the US health system, is that the physician tells me that due to my cycle they can only remove the growth the day after tomorrow or otherwise I would have to wait another 20 or so days. 

Why? Because due to the procedure being coded as an D&C, it can only be prescribed at certain days of a woman's cycle to be sure it is not "that kind of D&C"*, since the hospital is a Catholic hospital and they do not perform abortions. This means that they can't do anything with "a growth" in the uterus between day - say 10 - and the menses. During this time the "growth" could be a fetus, and since abortions aren't allowed, there are no D&C/surgeries allowed. (While the physician might not think this is best for the patient, their insurance and hospital admittance privileges do not allow it.)

The main issue of course is that D&C means "Dilation and curettage". It's used to describe a surgical procedure in which the cervix is opened (dilated) and a thin instrument is inserted into the uterus. This instrument is used to remove tissue from the inside of the uterus (curettage). It is used for ANY tissue in the uterus, which make sense when thinking about it from a medical procedure. "Something" is removed from a part in the body. It's not known what "something" is when removing it since that is often why it's removed, it shouldn't be there.

In short, I needed a abnormal growth removed. The tumor could be benign or malign, that wasn't the key issue. The key issue was that the surgery to take out the growth was only allowed being taking out between days in my cycle when contraception had not taken place (example of possible contraception day 11 to day 28 in a woman's cycle) for the hospital to allow it due to the place and the medical coding. 

It would be alright to let this growth grow more while waiting since hospital rules does not allow abortions even though this was 100% not an abortion but would be coded similarly in the medical chart and to insurance.

Long story short; it wasn't a fetus, it was a growth that turned out to be benign when I got the result five weeks later. "No malignant cells were found in your tissue." Good for me. But it could've been different.

The other obvious issue (apart from being alright to let potential malicious growths grow bigger while waiting) is the conversation of what the term "abortion" means when throwing it around in the "public setting" (when voting on it) vs the "legal and medical setting". This is also how people view "6 weeks pregnant".

Let's just reiterate that medical profession and legal profession have made a few standards that don't correlate exactly to what "the public" thinks it means. Pregnancy is such a thing. You are considered 6 weeks pregnant in legal and medical view - 6 weeks after your last menstruation's first day. That has nothing to do with "embryo development".

It's presumed that you have a 28 day cycle and that you ovulate on day 11-15 (looking at real data this is not accurate at some ovulate at day 6 and some at day 28). The whole pregnancy counting is furthermore based on the fact that since medical professionals know people ovulate at different times in their cycle and the ONLY thing an outsider knows is "when there was bleeding" (lots of religions make this a conversation with man & wife since there are cleansing parts after a wife has bled...) the pregnancy will be counted from the first day you bled last. Knowing full well that there is NO chance anyone is pregnant at that point (menses literary means the uterus is empty of a fetus), it's the way to start the calendar/counting and doesn't mean much for accuracy of start of conception or delivery date.

This means that at "6 weeks pregnant" most embryos are between 2 and 3 weeks. It also means that many  people might have discovered that they missed their period with a few days. However, back to the overall "misconception about menstruation" it's not that uncommon to have a few days extra/less of your cycle based on stress, food intake, global travel etc. And that is if your are lucky to have a "regular cycle", which is probably 50% or less of all at any given time.

Anyway, I wanted to not get side tracked into the other parts of legislature regarding abortion (might be another post down the line) as there is a disconnect between "what public think is general cases" and "what the medical reality is". And also how these legislatures affect health and medical decisions of pregnant people. 

To have a miscarriage that doesn't expel, but where the fetus is dead or dying, and not being allowed a D&C is fatal for the woman carrying the fetus. But for this post, let's leave it as "it's more complicated as a lot of Texas and other governmental people say it is".

TLDR; remember situation today was intentionally created

TLRD (too long, didn't read) is a great acronym for when things get carried away in explanations and then in the end of a long rant you want to make it easier to grasp "what is it I wanted to say".

I really had planned writing about #covid19 and how international travel has made me be very tired lately.

However, as with best laid plans, they aren't where you end up. I'll write about the covid19 things later. For tonight I feel that I want to clarify something that's been eating me up when listening and being asked to comment on current situation in the USA.

As an immigrant in the USA, living for over 13 years in the South of USA, I feel that I have gathered a lot of information and insight into things that I barely grasped when moving.

I grew up in an intellectual family in Sweden. Lots of reading, lots of politics, lots of knowledge of history. My formative years were times discussing South Africa (apartheid), the Palestine-Israel conflict, USA in Vietnam, colonial powers in general (France and Algeria for example) and Chilean (really several South American countries) dictatorship. I thought I had grasped quite a lot as a protected white native Swede. As one does when reading and meeting a lot of people and discussing on a theoretical level.

However, as usual, when living in the place where things happen - you grasp a different angle. You are forced to encounter situations that you never thought would happen (especially not when you perceive yourself as "knowing"). And most of all, you learn to be humble to a degree that is leaving you with only a few choices. One of them is "I will listen to and accept the reality that these people describe to me is their reality".

And that's what happened when I moved to the South.

I realized after half a year living in the South that something was off. What? Well, at starters I didn't - at the time - feel that my reality was that different from living in Sweden. (In hindsight, which is as we all know 20/20, that's a given red flag that something is strange..... ) My city where I lived was demographically very different from the Sweden city I grew up in.

To make it easy; my home city was easily 90% white, my new city was over 60% African-American. Despite this, the bars and restaurants (and church and work) where I hung out were probably at least 80% white. Or at least "as similar to my home town that I didn't feel that it was too different".

This gave me pause and made me question a few things. Mainly where I was hanging out, why this was and if there was something else on how this was happening.

(side note; it was like this partly because at the time I hung out with other white immigrants at the places they showed me, and then some other places where "middle-class/affluent" people frequented.)

After a few more years in the South I had gathered anecdotal evidence that I'm "passing as an American, specifically a white American woman" and that this fact opened a lot of doors for me. Note, the doors that opened were also where people greeted me as "you're not a real immigrant" since it was perception I spoke English as a native language in my home country Sweden (we speak Swedish), and I am a Christian, and - of course - being white.

However, that's not the point of this blog post. The points of this blog post are to link to a few articles that explain fundamental historical facts that has made the situation we are in today. Where African-Americans and People of Colour (PoC) are more likely to get shot, get arrested, get non-invited for interviews, get looked upon with distrust etc.

It's too long (as I mentioned in the beginning, it's a long story) for me to be succinct.

I mainly want you to know one fact I've learned after all this time living in the South.

It's intentional politics that have gotten us where we are. It's intentional to hinder non-whites and non-wanted people from voting. From owning their own homes. From having the thriving neighborhoods that once were. From excluding a lot of the history about this from schools and public education. (Like the fact that schools in Oklahoma didn't include the Tulsa Massacre in 1921 in the public school curriculum until this fall in 2020 (and who knows how that will happen now with covid).)

The reconstruction after the civil war, the backlash, the Jim Crow laws and the Civil Rights Movement and voting rights. And that are the voting rights that are hot contested in the USA today. It's not like in Sweden, and other EU countries, where you are automatically registered to vote on your 18th birthday - no action required. Nope, there is a process to get registered to vote, and on top of that the voting day is a regular work day with complications to get time off if you aren't a salaried worker.

And the fact that USA system, while it is a lot based on income and that there are a lot of poor white people as well, is based on a right that was for a very long time classifying a non-white African-American as 3/5 of a person. And that the District of Columbia being classified a district and not a state, therefore not having representation in the House of Representatives, is stemming from the fact that there was only "State representatives from real States, and slaves and servants" living there, and since the State representatives and their aides had voting in their home states - there was no need for the other people to have voting/representation rights.

To me, there is no way to see all these historical facts and not draw the conclusion - this is not "natural" this is a "created, systematical way of excluding people that are not wanted".

At the bottom are some links for further reading. There are many many more. And if you ever come by Memphis - the National Civil Rights Museum is a must. It'll take you more than 3 hours to go through it and you will still learn more things afterwards. There is a lot to take in. And it will not be easy. It is difficult things to see and understand.

Final comment; "If not now, when?" There is no waiting. It will be painful to acknowledge that regardless of your own intention or wanting, if you are white - there is a huge burden to take on and work on making things right and just. Nothing else to say or make excuses. It's something we just have to do. And it starts by listening to other peoples' experiences and acknowledging that there are a lot of things we have to change. Now.

Links to read:
Segregation myth - Richard Rothstein This is a GREAT explanation and video interview of the systematic idea behind suburbs among other things
NY Times 1619 project 
Role of Highways in America - The Atlantic
Highway protests - Facing South
Reconstruction era - black congress members
Breaking up slave families