Wednesday, September 08, 2021

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.


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".