After a fairly lackluster winter, we had our first big snowstorm yesterday.
Today, the world beyond my windows is gorgeous. Because the snow was preceded by ice, the tree branches bend low and glitter in the sunlight as if they’re encased in glass. Temperatures have yet to rise above freezing, so the snow still lies heavy on the evergreens. I’m unsure of the total accumulation – I’d estimate somewhere between 8 to 12 inches – but the fields are blanketed white, and the remaining hay bales in our neighbor’s field look like marshmallows tipped on their sides. The sun came out today, in a bright blue sky broken by puffy white clouds. To step outside is to experience “the white way of delight,” as my daughters say, quoting from Anne of Green Gables.
Last week, my eldest daughter asked me to send her to boarding school in Florida.
She was joking, I think. But then again, it’s February. Apparently it’s not easy to be a Vermont kid in February.
I’m not sure if I can still call this “stick season,” since snow has lain on the ground for a week now. The most accurate definition of stick season is the period of time between the fall of the last golden leaves and the fall of the first sparkling snow. It’s not really a season at all – just a week or two between late October and early November, a time when the view out our windows displays only grey sticks against the grey sky.
But early this morning as the sun was rising and I was feeding the baby, I couldn’t see the icy snow on the ground; all I could see were the bare branches of the aspen trees outside my window.
Our families know us best. The people who live with us, who see us first thing in the morning and last thing in the evening, who have front row seats to what bubbles up when we’re squeezed – they’re the ones with the true insights into our character.
This is why, whenever a non-family-member says to me, “Oh, you always seem so patient, so calm, like you have it all together!” I picture my daughters rolling on the floor, laughing. They know the wild-eyed woman who stands in our mudroom, waving her arms frantically and yelling, “Time to go! We’re running late! You should’ve used the bathroom ten minutes ago when I told you to! GET IN THE CAR NOW!!!”
And it’s also why I took notice when my daughters started doing impressions of our family around the dinner table.
These impressions are not mean-spirited, and are always performed in the presence of those being imitated. Sometimes they begin in a haphazard fashion and spread around the table at random; sometimes they take the form of an organized game, in which everyone performs an impression of one particular family member, who judges the best impersonator.
What emerged from their impressions of me is that my family thinks I sigh a lot.
My five-year-old daughter awoke in the middle of the night calling for me. As I tucked her back into bed, she was in a sweetly groggy, half-asleep state.
“Mommy,” she said, looking up from her pillow, “who should I be in my dream?”
It was such a beautiful, strange question that it caught me off guard.
“Well,” I ventured, with the sense that my answer might be vitally important, “why don’t you be yourself?”
This seemed to satisfy her. “Okay,” she nodded, closing her eyes. “I’ll just be Abigail.”
As if it were that simple.
For my first two decades of life, I was adept at molding myself into whomever others wanted me to be. My goal was approval: I could walk into a room, sense the prevailing winds, and do or say whatever would make the majority happy.
It hit me in my early 20s: I had navigated college, graduate school, and my early career, but I wasn’t certain that I’d ever had a single original opinion. What did I really think about anything? I’d spent my entire life asking who I should be, instead of who I was. Had anybody told me to just be myself, I wouldn’t have known where to start.
At this point I was teaching third grade at a private girls’ school in New York City. I was 25 years old. (I look back now and marvel at how anybody ever trusted my 25-year-old self with a classroom full of eight-year-old girls, but we all survived.)
It was the year 2000. This year, a threshold to a new century, was also a threshold moment in my own life. It was the year that I started taking baby steps towards my self. I was a year post-recovery from an eating disorder. I’d been dating my future husband for a year, and had begun attending a church that would be pivotal in shaping my faith. I was beginning to accept that I needed to make the best choices for me, regardless of whether I’d make everyone else happy.
I remained a mess of insecurities, bitterness, and confusion – things I struggle with mightily even today, mind you – but the steering wheel was starting to turn that would alter the course of my life ever so gradually, like a gigantic cruise ship changing course.
In the fall of 2000, Nadia walked into my third grade classroom. She was a bright, energetic eight-year-old, so it was a shock when, in November, she was diagnosed with Ewing’s sarcoma in her jaw.
Nadia was the first person I’d known with cancer. I remember Nadia’s mother, Judi, who seemed so strong despite the obvious emotional pain she was suffering. I remember Nadia during the various stages of her treatment – chemotherapy, surgery to remove part of her jaw and replace it with part of her shin bone, and more chemo – who seemed so strong despite the obvious physical pain she was suffering. She missed a lot of school that year, and on a handful of occasions I visited her apartment after school to work with her one-on-one, so that she wouldn’t fall too far behind.
In my memories, Nadia’s cancer ended with the school year: She completed her treatment, the cancer was gone, and the prognosis was excellent.
Five years later, after I got married and quit teaching, I left New York. We moved across the country to Berkeley, California so that my husband could go to graduate school. Much like the photographs that we packed into boxes and have never re-opened, the seven-year chapter of my life that happened mostly between East 86thand East 96thStreets was boxed away in the attic of my mind.
But sometimes Nadia slipped out. Every once in a while – when I added another name to the list of people I know with cancer, for instance, or when I read my daughters Patricia Polacco’s powerful picture book about childhood cancer, The Lemonade Club– I’d wonder how Nadia was doing.
This February, while searching for something completely different on the internet, a book popped up: Motherhood Exaggerated, by Judith Hannan.
That’s Nadia’s mom! I thought. I’d forgotten that Judi Hannan was a writer. I clicked for more information. In 2012, she’d written an entire book about Nadia’s journey through cancer.
I ordered a copy of Motherhood Exaggerated, and for the week that it took me to read I could hardly concentrate on anything else. It is a gorgeous book. On one level, it’s about parenting a sick child and how the effects of a life-threatening illness continue long after the illness itself has retreated, but it’s also about the broader themes of life, love, suffering, and the struggle for hope.
I read Motherhood Exaggerated as someone who’d been there but hadn’t fully experienced all aspects of Nadia’s illness. I read between the lines, recalling the bits of my own story that intersected with Nadia and her family. The book resurrected places and people I’d packed away in my mental attic years ago.
Then, one night, I turned a page and found myself.
“Ms. Cinquegrana [my maiden name] is young. She exudes a quiet serenity, which is a soothing contrast to the bubbly smiles and cheerleading attitude of hospital personnel…. Ms. Cinquegrana is always unflustered by Nadia’s appearance or latest medical crises. On the three or four occasions that she has come to our home to work with Nadia in the past few months, I would sneak peeks of her sitting with Nadia on the floor. Their bodies are always learning toward one another; their quiet talk is punctuated occasionally by giggles. It is a vision I cherish; their time together is a true oasis for Nadia.”
Don’t we all sometimes wish we could know how others see us? This was my chance, and it was a flattering portrait. But after reading that paragraph about my 25-year-old self, my first reaction was: It’s a lie.
I don’t mean that Judi Hannan wasn’t being honest. But what she saw, what she describes, was my “game face.” I know that this quietly serene, unflustered young teacher was a seething cauldron of conflict under the surface. Reading Judi’s description of me only drove home the degree to which my inside hadn’t matched my outside.
Don’t get me wrong: If this was my game face, it was an appropriate one. I’m glad that I was able to be a true oasis for Nadia. This same game face would serve me well less than a year later, when the lower school headmistress pulled me out of class one morning to tell me: “A plane’s just crashed into the World Trade Center. We don’t know what’s going on, but it’s not good, and it’s probably going to affect some of our parents. Our job is to keep the girls calm and in school for as long as possible.”
I’m not suggesting that we wear all of our emotions like a wardrobe; restraint and self-control are often the best choice, particularly when dealing with children. I only wish that I’d actually felt the “quiet serenity” I was somehow able to exude; that it had been my personal state, rather than a professional mask.
If I could reach back through time to Ms. Cinquegrana, I would tell her that she still has some rocky years ahead on the journey towards selfhood. September 11, and her marriage ten months later, will shake the ground beneath her. She’ll lose her bearings on who she’s supposed to be. She’ll quit teaching and enroll in a graduate program for photography – an interlude that, 15 years later, she still can’t quite understand. Then she’ll close the door on New York, move to California, and start having children.
It will be those children, those four little girls born in six years, who will force her to take her self seriously – because when you have four pairs of eyes studying you for guidance on how to be a person, it’s impossible to conceal that your inside doesn’t match your outside.
One night in Vermont, when all my girls were in bed, I read this line in Jonathan Safran Foer’s novel Everything is Illuminated: “Try to live so that you can always tell the truth.”
And I thought: YES, THAT is who I would like to be, and teach my daughters to be.
I no longer wanted to put on a happy face…or a kind face, or a brave face. That’s exhausting. Instead, I wanted to actually become happy, kind, and brave.
I don’t think it was an accident that Motherhood Exaggerated popped up on my laptop screen at the start of Lent, sending me on a voyage into the past, opening the boxes in my mental attic and plumbing the depths of who I was, who I am.
Lent is a time to take stock of our insides. If someone sacrifices themselves to save your life, chances are that you will take stock; you will think hard about how to live the life that’s been given back to you.
That’s the story of Jesus and Easter.
Lent is a time when I ask myself, “Do I really believe this crazy thing?” And when the answer is YES, my next question is, “If this is the truth, is my life telling the truth? Does my inside match my outside?”
The answer is always NO, of course — for all of us, I suspect. But when I look back, I can see that every year the distance between YES and NO gets a little smaller. It is a slow, often painful process, learning how to be myself. I have become more patient with this; it takes a long time to turn a cruise ship around, and it’s not even my hands on the wheel.
One night at the end of December, I attended a film screening and discussion at Middlebury’s Town Hall Theater. This is not how I typically spend my evenings, and I would have missed the event completely were it not for a friend who invited me as part of her birthday celebration.
The film being shown was The Kindergarten Teacher, about which I knew nothing in advance. I assumed it would be a charming, lighthearted depiction of the agony and ecstasy involved in shepherding children through their first year of formal schooling (something I know a bit about, as I’m in the midst of homeschooling my kindergartener.)
The big draw for me was that the film’s star, Maggie Gyllenhaal, would be present for a question-and-answer session with her husband, Peter Sarsgaard. I have admired the talent of both of these actors in their past films — and I admired the calm, quiet way in which I witnessed them navigate The Vermont Book Store with their two daughters a couple of years ago. (Although when I returned home from that shopping trip, a little star-struck, to report my celebrity sighting – in Vermont! – the 23-year-old Middlebury College graduate who was living with us at the time looked at me blankly before saying, “Maggie Gyllenhaal…? Wait – is she related to Jake Gyllenhaal?”)
The Kindergarten Teacher was not a charming, lighthearted film. True to its title, it was the story of a kindergarten teacher, but this kindergarten teacher – a 40-something woman in the Manhattan suburbs – harbors an unfulfilled longing for poetry and culture. She’s taking continuing education poetry classes, but her poems receive lukewarm responses. Her husband is supportive but seems baffled by her longings; her two teenaged children barely look up from their devices to speak to her. So, when she discovers that one of her kindergarten students is a poet prodigy, she’s determined to nurture his talent – a goal that turns increasingly dark: In the film’s climax, she kidnaps her student in a perverse attempt to keep the little boy artistically pure.
Maggie Gyllenhaal acts beautifully in the title role, building sympathy with her audience so that we wince when she begins making horrible decisions. The Kindergarten Teacher is not an easy film to watch, but I’m glad that I did: It was well made and thought provoking.
And the discussion that followed the film was perhaps more thought provoking than the film itself.
“This is a film about what happens when women are silenced,” Maggie Gyllenhaal declared in her opening comments.
And although I admire her talent and her parenting, I thought, “Huh?!?”
On the second day of 2019, because everyone else had returned to school but our homeschooling family was taking a full second week of vacation, because our eldest daughter complained that “we never go anywhere,” and because we needed a change of scenery, we packed the minivan for an overnight trip to the Boston suburbs. It was a hastily conceived voyage, designed loosely around the goals of:
Providing some sort of enrichment for our children
Spending time with extended family
Getting our youngest daughter to quit begging us to visit an American Girl doll store
That we were able to accomplish all of those things in less than 36 hours and live to tell about it seems near-miraculous. And it turned out to be a journey through the landscape of the American girl.
“I want to play you a song, to see if you know it,” my husband said to me at breakfast last week.
My husband is what we jokingly call a “binge listener”—he’ll latch on to a song or the oeuvre of a particular artist, and listen to it on repeat for weeks on end, until the rest of us are clutching our heads in desperation, praying that he’ll move on to a new obsession.
If my husband and I shared musical tastes, it wouldn’t be so bad. To be fair, there are artists that weagree on, but over the nearly two decades that we’ve known each other, our tastes have diverged dramatically. When I’m able to listen to music thatIenjoy (rather than what my daughters are demanding from the backseat), it’s usually something in the alternative/folk genre; anything heartbreaking with a banjo, fiddle, and a twangy voice will do. My husband, on the other hand, likes music that he can play (on repeat) while he works: jazz, classical, rhythm and blues. One of his constants throughout our relationship — and a song that I will never be able to embrace, no matter how much I love my husband — is Joe Jackson’s “Steppin’ Out.”
So, as my husband hunted down his latest favorite on his tablet and pressed “play,” I braced myself.
Our family has been making an effort to spend less time online these days, but the other morning – right before a full day of dropping two daughters at gymnastics, running errands, picking up a daughter’s friend, and taking five girls to the lake – I decided to take a quick peek at Facebook.
When I first saw the news headline that had been posted by three friends, my first thought was: That HAS to be a mistake. Or some kind of sick joke.
To say that they were dear friends may seem strange, since we hadn’t seen them in person since 2011 (aside from a Skype session I did with Lora back in 2014.) We’d met them in 2009 at our church in Berkeley and for a couple of years our worlds collided. Lora volunteered with Project Peace, the nonprofit I was working for at the time, and Ryan and my husband met several times to discuss both the business and spiritual aspects of Ryan’s future plans. Then they moved to Georgia in order to start ReWoven, and we moved to Vermont. Their family was out West, so whenever they returned to the States they flew right over us.
But there are some people with whom you continue to feel connected despite time and distance; the Smiths were like that. We kept up with them through their regular email updates: they were building relationships within their community and with Azeri rug weavers, they were so committed to Georgia that they became dual citizens, and just this past fall they finally moved into the house that they’d built in Marneuli.
Aside from these updates, Lora and I kept up an irregular email correspondence, mostly about things like childbirth and childrearing (since she seemed to assume I knew anything about either!)
If you’re getting the impression that Ryan and Lora were filled with light and life and love, you’d be correct. But they were also shadowed by death. Their first daughter, Shannon, died in 2012 at just nine days old. When Caleb was born in 2014, we all rejoiced. But then Lora suffered through several miscarriages – the most recent one this past September. I marveled at the strength and faith with which Lora handled these losses; despite her pain – or perhaps because of it – she poured herself into caring for other mothers and children. Still, I always hoped that she’d have some great, joyful miracle in her life – maybe another child, maybe something else – just anything to counter-balance the suffering. Because, you know, she deserved it.
Wouldn’t it be nice if life’s mathematics worked out so neatly?
What happened instead does not compute. It is senseless, violent, horrific, brutal. After I read the news, I took my daughters to gymnastics, ran errands, picked up friends, and went to the lake feeling like someone had punched me in the gut; I couldn’t breathe right. The lake was so lovely, with swallowtail butterflies flitting around and laying their eggs on the sand, and I couldn’t understand why the world wasn’t howling with anguish. Why didn’t the sky rain down fire at the moment of their deaths?
I still don’t understand. Just like I don’t understand why Lora lost her babies when so many of us were praying for them. And the only way I know how to process my lack of understanding is to sit in the discomfort of knowing that life’s mathematics are much more than what we can see or imagine.
Lora knew this, so I leave you with the words that she wrote to me after Shannon’s death:
I don’t know why, I guess it’s just a way I’ve looked at the world in a broad scope for so long. But I guess I’m an optomist at heart and have always looked at the ‘bright side’ of things. And never reaized until I’m writing this to you, that even in this, I am seeing the best part… Shannon in heaven, by-passing this life of ups and downs and getting to live and dwell in perfect love and peace forever. She’s lucky. I still want her here and to be her parent, but that’s not happening, and I’m having my own roller coaster of emotions with that fact.
I think these words express how so many of us are feeling about losing the Smiths. Below, I’ve also reposted something I wrote after Shannon’s death, which seems to still apply as we wrestle with “the best part” of this latest loss.
THOUGHTS AFTER A FIGHT
Some weeks, faith feels like the middle miles of a marathon, or the transition stage of childbirth, or 4:30 PM everyday in our house: when you say to yourself, “I just don’t think I’m going to make it.” This has been one of those weeks.
A beautiful baby’s fight ended this morning. We met her parents several years ago at our church in California. Around the same time we moved to Vermont, they moved overseas to work as missionaries — missionaries with a deep respect for their host culture, who wanted to know their community and be helpful in meaningful ways. Her mama started work as an English teacher at a local school, and her papa was researching various business ventures. Shortly after they moved, they sent out an email announcing the happy news that they were expecting their first child. And shortly after that, the trouble started: about halfway through the pregnancy, her mama started leaking amniotic fluid. She was put on bed rest and received various treatments, but things didn’t improve. Miraculously, despite low fluid levels, the baby continued to thrive. And then, about a week ago, their baby girl was delivered two months early. She was born with a systemic infection that affected her vital organs, and a lung condition that prevented oxygen from being absorbed into her bloodstream. This sweet newborn was put on a ventilator in intensive care, where she fought for her life. Hundreds of people all over the world were praying for her by this point. Her life ended today, at 9 days old.
Her parents’ faith, as expressed in their email updates, appears to be Teflon-strong. But then, they’ve been in the middle of a fight. I know from experience that, faith-wise, it’s often harder to watch a fight from the sidelines than to be one of the participants — at least while the fight’s going on. When you’re dodging blows and trying to land punches, you don’t have time to think about whether it’s fair.
Here’s what I think, though (not that anybody’s asking): What’s up with THIS, God?!? Here’s a faithful couple that’s just trying to do everything you told them to do — to love and serve others — and what did it get them? Stranded in a faraway country with a high risk pregnancy and a premature baby, THAT’S what it got them. This was your chance to pull out all the stops, move some mountains. Miracle Time! WHERE WERE YOU?!?
This type of situation is where my faith starts to fray. And I know I’m not alone. Of course, there’s lotsof suffering in the world, and all of it is tragic. But when it’s a baby or young child who is sick, suffering, dying — someone who’s barely had the chance to live — what’s the point? I can’t think of anything more unjust. As a mother, I can barely process these stories, because they’re the worst of my worst-case scenarios. Then I look at my three healthy daughters, and it’s an embarrassment of riches. It’s. Just. Not. Fair.
Frankly, God doesn’t give me a whole lot of help here. One example of many, which we tend to gloss over in the joy of Christmas, is that a direct consequence of Jesus’s birth was the Slaughter of the Innocents: King Herod ordering that all babies under age two be killed. What’s up with THAT, God?!?
I have no good answers. I have nothing helpful to say to our friends, these mourning parents, other than: “I’m so sorry. We’re still praying for you.”
But it’s not all radio silence from God, either. Because, the same week that this baby girl was born, I happened to be reading Annie Dillard’s essay, “Teaching a Stone to Talk,” in which she writes:
It is difficult to undo our own damage, and to recall to our presence that which we have asked to leave….What have we been doing all these centuries but trying to call God back to the mountain, or, failing that, raise a peep out of anything that isn’t us?…At a certain point you say to the woods, to the sea, to the mountains, the world, Now I am ready. Now I will stop and be wholly attentive. You empty yourself and wait, listening. After a time you hear it: there is nothing there….There is a vibrancy to the silence, a suppression, as if someone were gagging the world.
Oddly, reading this passage started to reweave my fraying faith. Annie Dillard reminded me that when we wait for answers that don’t come, it’s not because that’s just how things are; it’s because things are wrong. People end up in trouble far from home, babies get sick and die, and nature itself is gagging.
Wait a minute, you may be thinking, that’s the GOOD news? Well, yes. That things are horribly wrong at this moment in history doesn’t disprove the existence of God, or his ultimate goodness. Because the wrong-ness of a baby having to fight for life, and of nature’s silence as recorded by Annie Dillard, IS answered, almost directly, by Isaiah 55:8-13 (This is for my mom: See, Mom, I’m listening!) I’m going to quote the entire passage, because it’s good stuff:
“For my thoughts are not your thoughts, neither are your ways my ways,” declares the Lord. “As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts. As the rain and the snow come down from heaven and do not return to it without watering the earth and making it bud and flourish, so that it yields seed for the sower and bread for the eater, so is my word that goes out from my mouth: It will not return to me empty, but will accomplish what I desire and achieve the purpose for which I sent it. You will go out in joy and be led forth in peace; the mountains and hills will burst into song before you, and all the trees of the field will clap their hands. Instead of the thornbush will grow the pine tree, and instead of briers the myrtle will grow. This will be for the Lord’s renown, for an everlasting sign, which will not be destroyed.”
I’ve mentioned before that Erick and I help our daughters — and ourselves — grapple with the unanswerable questions of sadness and fear by paraphrasing from The Return of the King: One day everything sad will come untrue. Praying for this baby, and then reading Annie Dillard and Isaiah, I realized that I often dwell in the everything sad, but I have so little vision for the will come untrue. Isaiah 55 helped me color in that vision a bit. Mountains and hills bursting into song? Trees clapping their hands? I tend to read that as poetic hyperbole, but what if it’s literal? I can hardly imagine singing mountains or clapping trees that don’t look like some corny CGI effect, and every day I see mountains and trees when I look out my window. What if that’s what actually happens when nature regains its voice?
And if mountains are singing and trees are clapping, what might this baby girl be doing on that day? You will go out in joy and be led forth in peace.
I usually forget to remember that when we pray, we’re praying for eternity. Not just for what will happen tomorrow, or next week, or next year. Our prayers stretch out of time through forever. My thoughts are not your thoughts, neither are your ways my ways. God has all the time in the world to make wrong things right, sad things untrue. And when that’s what we’re praying for, I have to believe that the answer will always, eventually, be YES.
“I think those hens are about to start a #MeToo movement,” my husband said, coming in one night after tucking our chickens into their coop.
Yes, spring fever has struck our poultry. Watching the chickens and ducks act on their hormonal urges, I can almost hear the voice of Friend Owl in Bambi: “Nearly everybody gets ‘twitterpated’ in the spring!”
In that Disney-fied, animated world, being “twitterpated” involves a lot of animals fluttering their eyelashes, blushing under their fur, and slinking off into the flowers. That is not the truth; at least, not in our poultry yard.
Today is Mother’s Day, and for the past couple of days I’ve been walking around thinking about mothers who won’t have the chance to be celebrated today, because their birth stories ended badly. I dedicate this to them, with the prayer that we will advocate for quality maternal and child healthcare throughout the world AND right where we live. Every mother should have the chance to celebrate Mother’s Day.
It’s a miracle that I’m sitting here, typing this right now, because I should be dead.
That’s not an exaggeration; I’m not trying on a dramatic opening line for effect. I should be dead, and in any other time or place, I would be.
I’ve never written about the circumstances of our first daughter’s birth before, because my husband Erick was the one writing all the updates during and after, so here goes:
I had a fairly easy, uneventful first pregnancy. No morning sickness, no notable symptoms of any kind aside from an insatiable craving for movie theater popcorn. When they took the 20-week ultrasound, the doctors noticed that our baby was a little on the small side, but nobody worried much about it. “You’re a small person,” they said, by way of explanation.
Then my doctor went to Korea for six weeks. The two substitute doctors I saw in the interim noted that the baby was still measuring small, “But you’re a small person,” they kept saying. Other than smallness, both the baby and I seemed healthy.
When my regular doctor came back and the baby was still lagging behind in size, he was nervous. This doctor, who saw me through three pregnancies, is long on brains and short on bedside manner — which was fine by me. Imagine a very, very pessimistic, Korean Mr. Miyagi, and you’ve captured him. (His introduction to genetic testing was: “Sometimes, baby is born with no brain.”). He sent me to a specialist in high-risk pregnancies for another ultrasound, and he prescribed a weekly non-stress test (where you sit for an hour while a nurse monitors the baby’s heart rate — then it was boring, now I’d call it a vacation). The baby continued to measure small, but everything else was a-okay. I tried to eat more and move less.
Skip ahead to Saturday, November 17, 2007 — two weeks before my due date. I noticed my heart racing a little bit that morning, and my ankles and feet were suddenly very swollen, but I didn’t think much of it; both seemed within the realm of normal third trimester symptoms.
The next morning, which was to be the day of my baby shower, I woke up with what I thought was heartburn. Again, a normal pregnancy discomfort. Skipped church, did some work on the couch, sent Erick out for Tums and 7-Up. A few hours later, when the heartburn seemed to be getting worse, Erick suggested I call the advice nurse. I did so, reluctantly: I have this fear of annoying nurses with silly concerns, which comes from decades of people-pleasing. But I figured that maybe she could hook me up with some prescription-strength Tums. “You’re pregnant with chest pain,” the nurse told me bluntly. “You need to go to the ER.”
We obediently went to the ER (me looking at my watch in annoyance to see how much time was left until my baby shower). When the intake nurse took my blood pressure, it was much higher than usual — much higher than it had been at my checkup three days earlier. I noted this, but he told me that increased blood pressure was normal in late pregnancy. The EKG was normal. I was sent to the outpatient clinic.
It was at this point that my “heartburn” became excruciating. The people in the waiting room thought I was in labor, and, having been through three subsequent labors, I can tell you that the pain was right up there. I remember very little from this point on, just that they took my blood pressure again and it was even higher than before. Suddenly, a nurse was running with me in a wheelchair over to Labor & Delivery, cursing the people at the ER who hadn’t thought to send me directly there in the first place.
The Labor & Delivery nurses hooked me up and started running tests. These nurses were amazing; I remember asking them two things: “Can you please make the pain go away?” and “Do you think I can make my baby shower? It starts in 30 minutes.” They made the pain go away, but one of the kind nurses said, “Honey, I think you’re going to miss your baby shower.”
It turns out I had sudden, severe preeclampsia. Preeclampsia is pregnancy-induced high blood pressure. In my case, preeclampsia was combined with a condition called HELLP Syndrome, which is an acronym for Hemolysis (the breakdown of red blood cells), Elevated Liver enzymes, and Low Platelets. Possible outcomes of this combo include hemorrhage, liver and kidney failure (my “heartburn” was, in fact, my liver swelling), pulmonary edema, stoke…and death. The only cure is to deliver the baby immediately. Fiona was delivered via emergency c-section. At 37.5 weeks, she was full term, but she weighed in at 3 lbs. 11 oz. She spent one night in the Neonatal Intensive Care Unit for observation, and was released the next day, completely healthy.
Because I was recovering from a rather traumatic birth, and because I suddenly had a 3 lb. 11 oz. baby to care for, I didn’t initially spend a lot of time reflecting upon what had just happened. And I still don’t, since that baby was followed very quickly by three others. But here’s what I know now:
The causes of preeclampsia and HELLP Syndrome are unknown. Researchers currently suspect insufficient blood flow to the uterus, immune system problems, or poor diet as possible causes. My case was a little strange, both because of its sudden and severe onset, and also because I had only one of the usual risk factors for preeclampsia: that this was my first pregnancy. Nobody has ever been able to explain Fiona’s tiny size, other than that it must have had something to do with the preeclampsia. (And our other three daughters weren’t exactly linebackers when they were born).
According to the Preeclampsia Foundation, preeclampsia affects at least 5-8% of all pregnancies, and HELLP Syndrome accompanies 15-20% of cases of severe preeclampsia. While preeclampsia rarely causes maternal death in the developed world these days, it is a leading cause of worldwide maternal and infant deaths. Conservative estimates are that preeclampsia is responsible for 76,000 maternal and 500,000 infant deaths worldwide per year.
It’s not just the numbers that get me. Since Fiona’s birth, I’ve read several accounts of preeclamptic women in third world countries who died (along with their unborn children) while waiting for medical care outside of health centers. I’ve even read of a woman who died from preeclampsia in this country during the last century. So, every once in a while, I will stop and think, “If I’d been born in just about any other time or place, I would be dead right now. And so would Fiona.”
I’m writing this on March 8, International Women’s Day. (It’s a shame I didn’t write it in time to actually post on International Women’s Day, but that’s how life is these days). Thinking about International Women’s Day got me reflecting on Fiona’s birth, because even though this is a personal story, the conclusions I draw from it are quite global:
1. I amso stinking grateful for health care. Sure, the hospital made a few snafus in my case (they should’ve sent me to Labor & Delivery right away, for instance), but Fiona and I were able to get quick and appropriate medical attention to save our lives. The nurses and doctors who cared for us were competent and compassionate, and during most of the experience I had confidence that everything would turn out okay. It did; I came out on the other side, and followed up with three completely normal and healthy pregnancies, labors, and deliveries. So I think of myself as a “Dead Mom Walking.” Then I look around and realize that I know a whole lot of Dead Moms Walking: women who, like me, would be dead had they not received appropriate medical care during their pregnancies and deliveries. I bet you know a bunch of Dead Moms Walking — you may even be a Dead Mom Walking. Childbirth is, and always has been, a very risky proposition; it’s a luxury that, in this time and place, most of us go into it covered by the assurance that everything will likely be well.
2. I think it’s absolutely unacceptable that so many women in the world don’t have access to the health care that I do. Why are so many women and babies still dying from a condition that my baby and I lived through? A condition that can be cured by a timely c-section? Why are some of these women dying on the sidewalk outside of health care centers? I can imagine why; if I’d had to walk to the hospital, or if we’d had to take time to figure out how to pay for my care, or if the hospital didn’t have the capacity to do c-sections, it would have been too late. I believe this reality fits squarely into the definition of “injustice.”
There are a few excellent initiatives and organizations involved in preeclampsia research, and working to address the imbalances in maternal health care, like the aforementioned Preeclampsia Foundation, The United Nations Foundation, and the Million Moms Challenge. I wish there were more. I would love to see those 5- and 6-digit death figures diminish to near zero: more Dead Moms Walking, less dead moms. If I were First Lady, or Miss America, or Angelina Jolie, this would be “my issue.” And I guess, even though I’m just me, it still is my issue.