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".

Playoffs and re-entry into the world

It's been one of the things I've really liked after New Years 2020 and we got 2021. While it was still a ranging pandemic, while I was still stressed out about my family and friends on the other side of the planet (and close by me here in the USA) not having access to the vaccine, it was a fantastic thing to get some sports to divert attention. I am of course talking about NHL and hockey.

I can easily say that some of the better moments in my life have been inspired by/due to/influenced by hockey like going to a game, talking to new acquaintances and mentioning hockey or hanging out in the bloggosphere and get a sense of community with other hockey nerds (being from Sweden in this case and reading and commenting on this blogg). 

Anyway, the story for this blog post is two-fold. First "vacation weekend from the house since covid last year in March" (with partner and not visiting parents) was a weekend to Nashville to watch hockey - and that the Predators clinching a playoff spot. SO NICE to see live hockey! And to interact with people around us and talk geeky/nerdy talk on who would win and hopes and dreams. I can't wait to do it again!

Secondly, now it's PLAYOFFS. I decided to go through my shirt collection and finding the ones for the teams in the playoffs and also noting how many shirts I really have.... jerseys I only have Kessel 81 Leafs. There will be another one this year, question is Nylander 88 or someone else (Matthews maybe, Sandin in the wings). Shirts have come my way, mainly because of bets. As in "play offs - I bet you this team will win in the play off round, if not I'll buy a shirt and wear it for a day". Needless to say I don't place these bets with Bruins players. (I was surprised I didn't get a Kessel Pens shirt after he won the Cup but apparently not.)

So here is the photo of "my shirts from each team - with exception of saying I have a lot more leafs shirts and jersey but thought that was obvious so I focused on the other teams and also having more than one Canucks shirt.... ".

The second from the left top row is my tshirt from when I lived in Vancouver in 2000. I wear it seldom since it's old school and the logo will fall off soon due to age. The Habs tank top had a friend in a tank top from Preds (a little more low cut) but neither has a name on it. And the Red Wings shirt is the one from a challenge when I moved to the USA and my lab mate was annoyed I didn't have an american NHL team since "you live in America now". I picked Red Wings then since it had 13 swedes on the roster. Vegas Knights is not technically a bet since I bought it before the first game had been played when I visited the "armory" in Vegas in August.

And here is the photo of the shirts for the names - it's all about the names  :) Couldn't resist Jagr in Florida for $3 when I knew Panthers were going into the play offs this year. The Subban 76 and Forsberg to the right are both Nashville. The 33 and 22 Sedins are Canucks. And 81 Kessel represents the Leafs plethora of shirts. In hindsight I should've added my Sundin13 since that is my most precious shirt (was too lazy?).

While it will be amazing to get Playoffs again this year (last year was so weird and not only because I was in quarantine), I'm dreaming about game and successes. It's also a great reminder that I get super nervous in the first round (since my lovely team the Leafs have a tendency to not get out of first round.... 2004 was the last time... and let's not talk about actually winning the cup (1967)).

With that all said - SO HAPPY ABOUT SILLY THINGS LIKE SPORTS! Have a great Playoffs everyone.

I'm hoping Leafs will get out of first round against Habs! And I'll wear my Predators, Wild and Florida shirts in the first round too!

(A photo of me in Nashville watching the clinching game wearing the Subban shirt.... :) )

Giving away note cards - for charity donations

First, I can't believe I haven't written anything in 2021. I've missed blogging, and writing and all. However, for this post I'll keep it short and simple.

I usually make note cards with photos that I've taken over the years. I give them to friends, family and colleagues as holiday presents and such. However, I want to expand and thought this would be a good opportunity in times of need of others.

If you donate $20 to a charity (my personal favorites are Doctor's without Borders, my local food bank and local homeless support who all get a monthly contributions), and then send me a message on twitter or an email with your address, I'll send you a pack of note cards.

It's a pack of 6 cards 3.5x5 with envelopes.

Here are what they look like - frozen lake in Sweden, frozen light pole at Niagara falls, late summer lake in Alaska, southern bridge over Mississippi river, summer beach from Miami, French olive trees (only one photoshopped for colours).

I have 10 of these packs! Let me know if you are interested.

A range of emotions (count down to New Year pt 2)

 Let's be absolutely clear. I'm shattered emotionally. My inner being is being torn between screaming into the void WHAT DOES IT MATTER THAT WE KNOW ALL OF THIS SINCE YOU DON'T LISTEN and whisper softly "say good bye to the people/things you care about since they will not survive this".

It's difficult to explain how I feel looking at my diary from February, and also the entries from April where I state things like "come May 1st we will be on lock down in Memphis and it will be too late to stop the spread in the poor community where they can't work from home". And the April one stating "the USA will see a spread and deaths in the fall that people won't comprehend".

Not to mention the most heartbreaking one where I wrote in July estimating by my (negative yet apparently pretty accurate) predictions on how exponential spread would go in numbers in the USA and then the deaths to follow. Notably I was wrong as in even I were too optimistic on the speed for cases in September.

I did write a small comment to myself in August - the time I was quarantining in my hotel room in Stockholm and had to acknowledge that my emotions after going through the transAtlantic flight experience were pretty high and unstable. (That's something for part 3 since it will take longer to explain the absolute rollercoaster that went on inside my body for 30 hours while going from safe house aka home in a controlled space to a controlled hotel room via four airports with vastly disparate rules and actions.)

Anyway, my comment in August was that we would see the highest number of the year after Thanksgiving. That said, it's not rocket science so I won't pat myself on the back too much. And also that the uptick in cases after school and all the activities in Septebmer would lead into more cases in the fall.... and then thanksgiving.... and then hoping that the fact that cases were up would mean we didn't have to discuss Christmas. Here I was wrong, and I had put a note saying (probably too optimistic, people are great at rationalizing "not me and my family but everyone else is needing to do X, Y, K".

And then looking at my diary entries of Sweden in the fall "once the cold sets in". Yes, not difficult to predict that the cases were going up - yet difficult to read right now when looking at the numbers and knowing my family is so far away only reachable with international air travel.

Long and the short of it is this; it's extremely tiresome seeing a situation play out in front of your eyes - knowing that the people you love are in danger - because everyone seems to need to "experience the horror themselves" before acknowledging the situation.

The lack of understanding the full notion - I don't have to die from a car crash to know that I should keep seatbelt on and drive the speed limit. Again, IF it ONLY affected you when you make the stupid choice I wouldn't care as much (individual freedom and all) but when your choice of freedom puts MY life in danger, that's where I fricking draw the line.

(Right now, I'm not mentioning the vaccine and the people who don't want to take it. I'm too angry and you know, there's not enough vaccines to go around so if people say no to vaccines, that means I move up the line to get the vaccine faster.... and therefore I guess I should just accept your fricking freedom to say no? Another day I'll delve in why this argument is not a proper bioethical choice and not the right one for me.) 

For right now, I've spent 9 months actively not wishing ill on people who are in power and who have put too many people at risk and have been the cause of so many (unnecessary) deaths. I'm only human and there's a limit for my compassion at this point. That's what I am doing this Holiday season - asking for grace and compassion so when I come back after January 1st, I can stand to meet all these people around me who spout lies, confusion and hate regarding the vaccine and the virus. And with stand to meet, I mean I can meet them with a compassionate face and giving them love as my neighbour and turning the other cheek since there is NO other way out of this. I know that. 

Why? Because it's a fricking airborne infectious disease and it spreads between people regardless if I like or dislike them. And the only way it will stop killing and hurting people is if we get enough people vaccinated and keeping the infection rates down. 

And the only way to do this (if we aren't a dictatorship like China where they welded the doors shut) is to do the tried and executed way of telling people to stay at home, give them financial ways to do it, give them hope and add in incentives for companies to keep going - OH and GIVE them Vaccines for free to help!

It's not like I'm advocating for a mandatory vaccine to be able to fly on a plane, see hockey, visit grandmother in a home, have a job, going to a restaurant or sing in a church choir. Where I live, LAND OF THE FREE, this will not happen. But separate businesses will start enforcing these rules and it will be uneven, inequitable and lots of families and children will suffer. But let's not listen to the Infectious Disease experts.

You go with your freedom. Me? I will continue to give money and effort to the poor and my community. And I will live alone* in my house and Work From Home. Wear my mask to the few times I go to the store and live a good life without travel or friends over to party.

I will lose a lot of family and friends due to the virus. And that will make me sad. And most of all, kinda convinced that the world would be better with me as a dictator. (obviously a joke, please see the section of "trying to fricking cope with this PREDICTABLE year where nothing was stopped")

Part 3 of Count Down to New Year will be less bitter. See this as my one time venting and who knows how long this will stay. 

*with my bubble man 

Giving for others - Thankful for my blessings (countdown to new years pt1)

 I wrote a couple of things for Thanksgiving, but they seem fitting for my take on 2020 and how I've tried to handle the Covid situation. Let's say I'm going to do a couple of COVID 2020 DEBRIEF POSTS. That's how it feels right now.

I didn't even pay attention that I had written this post before. 

So, if you want to know the spcifics of what I'm grateful fore - go to the November post. I only have one (that's bad).

My ket point, and this was where I got stuck in "I'm not bragging but want to share and maybe you would like to do something similar" was when mentioning how much of my salary this year has gone to others/charity. I've given more this year than ever. Why? Partly becasue I have not spent any money on travel or restaurants. No theatre nor opera performance. I haven't been to an art opening and I haven't purchased any paintings, photo cards or any other things that I usually buy when going to local art galleries, vernissages, art festivals as such.

However, I have given to these things regularly during the year:

local theatre company

globally to Doctors without borders 

Kiva - microloans all over the world

Currently 5% of Gross income. Most of that money otherwise spent on travel, restaurants and experiences (and HOCKEY). Mainly this has been easy since I decided that if we didn't go out to eat, drink and travel - I could spend a good portion of that money on others who will be in need of it since clearly I could spend it before, so why shouldn't I spend it on people who need it now?

• I've also tried "two birds with one stone" and purchased at least 12 races of virtual races for good causes (charity). This has been a way for me to keep motivated to get out of the house and walk/run when the weather was 100F in the summer, and to keep going when it turned more rainy and dark in the fall. (I am tempted to post a list of the races with photos of all the medals, yet I don't want to come off as a bragging person but someone who want to share happy things! It's been the beacon of entusiasm when it was 100F degrees outside, and it's been similar for running in the mornings in Nov/Dec when it's 37F in the mornings...... I'm no a morning runner....)

I'm not stating this to feel good about myself (only). It's been a help for me to find my footing in a world full of uncertainty and not being in control (apart from over my very tiny part of working from home reality). 

I said short and sweet, so I will stop here. If you have the opportunity of giving to someone else - local foodbank, a venmo for a friendly server, a virtual race that gives to opportunities for women in law (Ruth Bader Ginsburg race....) or anything else that goes to someone out there in need of support - please consider it this holiday season. If there ever was a time to use those "Christmas present money" on others rather than on some unused little gadget, now is the time.

Here are a few links to places where your money will do a lot of good:

www.kiva.org

https://www.msf.org/donate

local food bank - for me it's MidSouth Food bank: https://www.midsouthfoodbank.org/

Purchase to help trafficking women getting out and a new life: https://thistleandbee.org

I've also given to local Arts organizations to keep the hope that there will be theatre, opera and art as painting in 2021.

And any local organization that will help service people with tips, work and other normal things. We had a "server Go fund Me" pop up in April for all the laid off Servers in the city area.

Overall though, my thing for this Holiday Season is "Give to someone else additional to you and the gift recipient". This is of course said if the gift recipient is well off/not having a rough time with covid. 

For some of my family and friends this year, I give hard cold cash since that's the best gift they can get from me right now.

Be good, be safe and do to others what you want done to you. I'll write the bitterness post soon.... ;)