Medicine in America

Recently I was told about a new blog...a mom venting about her coerced cesarean birth. She writes:

The experience made me see how combative the relationship with obstetricians and
their patients have become. In my case, my obstetrician Dr. Claudia Holland
burst into the operating room while I was strapped to the o.r. table, shouting
at me that she wanted my verbal consent because she "didn't want to be charged
with assault." Is this an incidence of a single individual with anger-management
problems or the current state of obstetrics in the U.S.?

Unfortunately, I don't see this kind of problem as simply an obstetrical problem. Its a rampant problem in medicine. There are some good, respectful Dr's out there. But unfortunately it seems that more often than not, Dr's expect to have cart blanche to do whatever they deem fit in the treatment of the patient.

I've gone toe to toe with my children's pediatrician over the issue of vaccinations. It started out that I wanted to delay vaccinations for my 4th child. My first 3 were nearly fully vaccinated (no chicken pox or pnemecoccal). But my 4th had a bit of a cold when he went in for his "2 month" well baby visit, and he was only 6 weeks old to boot, so I wanted to just wait until he was 3 months old to start. Just one itty bitty month...and as I said, I had a history of complying with vaccinations.

Well my pediatrician hit the roof, and yes, did her best to coerce me into having the injections done--including having me sign a form indicating that I was refusing the shots against medical advice, and my child could suffer dire consequences because of this. I later found the exact form on the AAP website, along with instructions about how it could be use to convince "waivering" parents to consent to vaccinations.

But I'm a stubborn type, and stood my ground. And then I went home and did what I should have done 3 children prior. I actually started researching vaccines. When I finally brought my son back when he was 4 months old (that's right, I didn't bring him back at 3 months), I only had 2 of the 5 shots done that had been planned.

And the whole thing has created a huge rift in my relationship with the pediatrician. I'm always nervous about what is going to happen when I take my son in--even though I refuse to see the particular Dr who blew up with me. As a result, he's now 27 months old, and hasn't been to the pediatrician since he was 9 months old. I don't think this is a good thing. I know he has a problem with learning to talk, and would like a referral to get speech therapy, but am just not sure I want to deal with the lecture that I think I will get.

Outrageous gas prices

Tulipgirl brought up the issue of gas prices on her blog, and I started to reply, but my reply ended being, well, a blog post...so here it is!

Prices are as high in my area as hers. I paid $60 to fill up our mini-van today. Whenever I do this my husband will say "why did you fill it up, prices are going to go down?" But my reasoning is always that they are probably going to go up--at least that is what I keep reading, so I'm going to "stock up" now!

I've got mixed feelings about the whole thing. Obviously the prices hurt my wallet. But I do think the gas companies have a right to make a profit. From what I've heard, they are making around $.90 per gallon in profit. The gas I bought today was $2.87/gallon--which apparently is just about as low as you can find it in my area. With $.90 profit in that, it amounts to a 30% profit for the oil companies. And this is where people are being drummed up in outrage. 30% mark-up!!! How outrageous!!!

The cost of most consumer products includes about 30% advertising and 30% mark-up. So the gas companies are getting their mark-up. Maybe. I doubt it a bit. Why do I think that? Well because of the other costs that go into gasoline, namely crude oil and taxes.

The government taxes gasoline so heavily, that well over 20% of the cost of your gasoline is taxes. That may actually be why there can be such a variation in prices across the nation--why states that are very far away from the oil refineries like Wyoming and thus have higher distribution costs--have lower gas prices (about $2.50/gallon) than states with refineries in them like Texas (about $2.90/gallon).

Yes, I've heard it said in many venues that there is close to $1/gallon in taxes in the cost of gas (the most recent data I could find on the web was from 2000, and indicated about $.50 per gallon--varied state to state).

Crude oil costs $72 per barrel today according to the nice folks at CBS news. Now that doesn't mean much to me...how big is a barrel of oil? Looked that one up too, and found a reference that says it is 42 gallons. From which you get about 19 gallons of gasoline.

But wait, doesn't that work out to the gasoline costing more than $3 per gallon even before profit and taxes are added in? Nope. Because the 23 gallons of "waste product" are sellable products. Like mineral oil or petroleum jelly, which are widely used in the cosmetics industry. So lets assume though that the $72 per barrel cost for crude oil is evenly distrubted to each gallon of initial 42 (which means we assume NO waste from the crude oil)...thats still $1.76 per gallon.

And remember, the profit in gasoline is not all going back to the "big oil companies." Your local gas station needs to make some money to pay the employees--your neighbors who might like to be able to feed their families. The 11 o'clock news tonight (4/28) reports that the average gas station makes $.10 per gallon profit on a cash purchase--but that gets cut to $.05 when a credit card is used due to the credit card surcharges. Either way you slice it, $.10 per gallon of the cost of gasoline is going to the local station.

So even if you take the 2000 data of $.50 per gallon in taxes, and add to that $1.76 in crude oil cost, and $.10 for the local station, you come to $2.36 per gallon. That means there is only $.51 left for production costs, distribution, advertising and profit in that $2.87 per gallon gasoline I purchased this afternoon.

What happened to $.90 per gallon profit? It certainly has gotten eaten away. I really think that most of that $.51 is going to actual production and distribution costs.

That's right. I don't really think that there is a lot of a profit margin in gasoline. At best, there is $.51, which amounts to only a bit higher than a 15% profit margin. How many companies could stay afloat on a 15% profit?

The profit margin is in other products sold by the petroleum industry. Perhaps keronsene, jet fuel, I don't know. I tend to think that it is in the other "petroleum products" that are sold to industry.

For example, lets take baby oil. Its over 99% mineral oil...and mineral oil is what? A by product of the purification of gasoline from crude oil. The petroleum industry sells mineral oil to the cosmetics industry, which uses it as a diluent in MANY cosmetic products. Anyway...straight baby oil sells for $2.19 for a 4 oz bottle on Amazon. com. That works out to $70.08 per gallon!

Why isn't there a public outcry about the outrageous profit margin in the sale of mineral oil? I will submit that the price of gasoline is used by politicians (and the media, not that THEY have an agenda...) to whip the public up into a frenzy because it is a product that is used by nearly all Americans, and in large quanities. It's easy, because quite frankly, most Americans don't bother to think analytically about these things.

I know that a lot of fuss has been made about oil executive salarys. And when they make "tens of millions per year" as was reported in one venue about Exxon, that is troubling.
But how much per gallon are those salaries really costing the average consumer? I've tried finding out how many gallons of gasoline are sold per year. Can't find it. I can find that there are about 300 million people in the US. So if 30 oil company execs each had a 10 million dollar pay cut, that would still only amount to $1 per person in the US. That's hardly significant. Especially when you consider that I would estimate that my family of 6 is purchasing well over 150 gallons of gasoline per person in a year.

Now don't get me wrong...its not that I think that oil execs should still keep making these obnoxious salaries. I'm just trying to point out that those salaries really aren't affecting gas prices significantly. What they are more likely significantly impacting are the salaries made by "rank & file" employees at the gas companies.

In the end, I think that really the most important contributor to current gas prices is OPEC. Oh, well that and environmentalists who will not let us drill for oil on our own turf.

Embracing Motherhood

As the mother of 4 small children, I'm pretty busy. The kids make messes. They can be trying at times. But I guess I just don't understand the fascination that the American Christian church has with separating mothers and children.

I mean this with all due respect...but when one balances the amount of activities where families are separated into age classifications in church as compared to those where full family participation is encouraged, the scales are sharply tipped to "division." I found it refreshing when I joined a new church about this time last year and was told that children were expected to worship with their parents on Sunday mornings. But then I've been puzzled when I related this to other moms in the church, and they stared at me blankly and said they'd never been told anything like this.

A common theme I hear in "parenting" advice is "date night, date night, date night." Couples must get away for the sake of their marriage. Church bulletins commonly advertise events "for moms only," "for couples only, no kids please."

I've even been frustrated to find that as I helped to start a local chapter of a national organization that is supposed to support mothers in their godly calling, most of the "support" given to the mothers has NOTHING to do with being a good mother. I've learned make sure I decorate with items in odd numbers, even numbers aren't as visually appealling. I've learned that integrating seemlying unrelated bits of knowledge is one of my spiritual gifts. I've learned that apparently it is too difficult to plan an "outside of the regular group meeting" social activity that involves even husbands, let alone children.

One time I asked my grandmother about this. She managed almost 59 years of marriage. Not all of them happy--every couple has their struggles. They even had a brief separation while they adapted to the change of my grandfather being retired. But she and my grandfather loved each other deeply. Her response to the concept of a "date night" was that this was a luxury that she and my grandfather rarely had until after their children were grown and out of the house--so that would be after over 30 years of marriage because their 5 children have a broad age range. Even as a mature couple, she commented in her reply to me that one of my cousins had been over that day, and the 3 of them had cleaned out the basement. And she felt that she'd built more lasting memories, strengthening of her marriage and general family ties in that day of "work" than she could build in several dates.

Do I have any solutions? I don't quite know. I'm going to be talking to the leader of lay ministries in my church about where I can best serve in ministry...but I'm seriously thinking that a new ministry of some sort that reaches out to families would be good.

My rant on Pitocin

I attended a birth yesterday. Second time mom, had a Pitocin induction with her first baby for medical cause, and did NOT want to "go there" again. Unfortunately the same medical cause ended up showing up again, so after an unsuccessful attempt at starting things with 3 doses of Cytotec (don't even get me started on the lack of informed consent on that one!), she was on to Pitocin.

Pitocin seems to be almost synonomous with hospital labors anymore. I wonder how many women who labor actually manage to get through without using it at some point. One client I had switched OB practices because she had been informed that when she arrived at the hospital in active labor she would be put on Pitocin. No waiting to see how labor was progressing and if it was really needed...it was just the policy of this practice to use Pitocin on all laboring women. Medical staff will often explain away any concerns with the use of Pitocin by saying that it is just a synthetic form of the same medication that your body produces. Which is true. But that doesn't mean that putting it into an IV is the same as letting your body produce it!

One of the major problems I have with the use of Pitocin is how strongly it is generally used. It is usually used at strengths MUCH greater than what the body would naturally produce. In the case of my client today, it got to nearly 3 times the strength the body would naturally produce. Here is an excerpt from the 3rd page of the package insert on Pitocin:

The initial dose should be 0.5 – 1 mU/min (equal to 3-6 ml of the dilute oxytocin solution per hour [10 units oxytocin in 1000 ml saline was suggested a few paragraphs earlier “piggy backed” with plain saline]). At 30-60 minute intervals the dose should be gradually increased in increments of 1-2 mU/min…[. Once] the desired frequency of contractions has been reached and labor has progressed to 5-6 cm dilation, the dose may be reduced by similar increments.

Studies of the concentrations of oxytocin in the maternal plasma during oxytocin infusion have shown that infusion rates up to 6 mU/min give the same oxytocin levels that are found in spontaneous labor. At term, higher infusion rates should be given with great care, and rates exceeding 9-10 mU/min are rarely required. Before term, when the sensitivity of the uterus is lower because of lower concentration of oxytocin receptors, a higher infusion rate may be required.

My client was started at a dose of 6 mU/min. That's right...she was started at a dose that 6 to 12 times the reccommended starting point. And this after getting 3 doses of Cytotec. Then the midwife put in orders for the drip rate to be increased by 2 mU every 15 minutes. The nurse seemed to get around to upping it every 30 minutes when it was first turned on, but then later in labor she was coming around after 20 minutes to increase the dose.

When I got to the hospital my client had been on Pitocin for 2 hours, and by that point she was up to 12 mU/min. So not only was she at twice the level that would be found in a natural labor, but she was definitely above that level that is supposedly "rarely required." Of course I haven't had a client yet that I've been with as a doula who got Pitocin and didn't get to this level. Sigh.

As I indicated above, they didn't stop there. This is where the nurse started showing up every 20 minutes to increase the dosage, and in short order it was at 16 mU/min. I'm not sure why, but at this point the nurse to stop increasing the Pitocin. I don't know if the midwife told her to stop because the contractions were coming more regularly, or if the nurse just got busy, or if it was because of concerns with the baby's tolerance of the Pitocin (I know that I noted at a certain point in the labor that the baby was having late decels, but I didn't want to write that in my notes, because if someone saw that they might say that I was "practicing medicine." I know that I wanted to note it somehow though, but looking back, I don't recall when exactly that was, or what I did to note it. The only thing I can come up with is a notation I made that the baby's heart rate was 104 10-minutes after the Pitocin was raised to 16.) 40 minutes passed between changes to the Pitocin level, and this change was to drop it back down to 12 mU/min. It stayed this way for the next hour, during which time the mom labored really well, contractions were coming 2 1/2 minutes apart, about 55-70 seconds long.

However, there was trouble with keeping a good reading of the baby's heart rate on the fetal monitor unless the monitor was manually held in place, and even the contractions weren't picking up well. The midwife started talking about internal monitors. We discussed options, and I pointed out to mom that since she was 5-6 cm dialated at this point, she could consider just turning the Pitocin off, then she wouldn't need the constant fetal monitor, and could use Doppler. I also offered to manually hold the monitor.

However, the midwife managed to convince her that it was imperetive that the internal monitors be placed, and part of what I think sold her on it was the promise that this would mean less fiddling around with the monitors. Yeah...okay. I've not had a doula client have an internal monitor scalp electrode placed, so I didn't have experience with that. The dang thing kept coming off! All told, she had 5 scalp electrodes placed in 4 hours. And it really irritates me that they call them a "scalp clip." I suppose that sounds better than the reality--"a corkscrew that we put into your baby's scalp." And YES, it hurts the baby! The heart rate would temporarily jump to over 200 every time one was placed.

So anyway...she got the first one placed, and what do you know, baby is having heartrate decelarations. The Pitocin was shut off STAT. After about 20 minutes things seemed to be stable with the baby, so what do they do? Turn the Pitocin back on at 6 mU/min. Didn't bother to ask the mom if she wanted them to do that. I pointed it out to her and asked her if she wanted Pitocin at this point. I don't really think she did...but I also think she didn't want to make too many waves.

So 20 minutes later the baby starts doing some NASTY decels. Down as low as 60, when usually much below 120 is "not good." I was scared. And feeling like pounding my head against the wall and screaming "you guys had a warning that this was going to happen!!! What in the world were you thinking???" Pitocin was back off again. I was honestly shocked that we weren't on the fast track to the OR. Seemed like half the available OB staff that was on the floor was in her room. Whispered instructions were given to a nurse to start counting equipment in the OR. Fortunately I will give that the OB who is the senior Dr. in the practice with the midwife is committed to avoiding cesarean, so he really worked with the baby to get the heartrate back to an acceptable range. Medication was given to stop contractions. And after about 10-15 minutes, the drama was over--at least the medical drama.

My client and her husband did really well during all of this. But understandably, it really shook them. They both cried. She was seriously wondering if continuing to labor was wise, or should she just go straight to cesarean.

Less than 30 minutes after the baby was stabilized, and while the mom is still very emotionally charged and trying to work through the "should I just have a cesarean?" question, the nurse quietly comes in and turns the Pitocin back on to 4 mU/min. BANGING MY HEAD!!!

I again let her know that the Pitocin is back on. This time she talks to the midwife about it. She isn't happy having it on. Midwife is "sweetly" insistant on the "need" to use it to get the baby out quickly. AAARGH! Mom is breaking down. She finally just can't deal with things anymore, and asks for an epidural. She REALLY didn't want one because of a previous bad experience, and she hadn't had one with her first. I really think that the emotions of the situation just left her unable to deal with things. And I don't blame her one bit. It also dawned on her that if she winded up with an emergency cesarean she would be put under general anesthesia unless she already had an epidural in place. She INSISTED that the Pitocin be turned off, so as the anesthesiologist was prepping the epidural, it was turned off.

Of course the nurse came back in and quietly turned it back on not 10 minutes later. Didn't ask Mom about it. She just asked for it to be turned off, and she didn't ask for it to be turned off because she couldn't deal with the pain, she asked for it to be turned off because she couldn't deal with the stress of wondering if it was going to make her baby crash again. But it was "only" 2 mU/min, so I think Mom just resigned herself to it when I told her it was back on. 30 minutes later it was up to 6 mU/min, then 15 minutes after that it was up to 10 mU/min.

And surprise, surprise...15 minutes later it is turned back off because of decels, and they are having her push even though she still has a lip of cervix, no urge to push, and baby is at 0 station (and in my experience, moms aren't ready to push until +2 station). I wasn't even sure she was "really" completely dialated, as she had been 8-9 cms just 30 minutes prior, and the midwife had this "let me see if I can stretch the cervix to 10" kind of hesitation before declaring her "complete."

Pushing wasn't really going well, the lip of cervix could not be reduced, and fortunately the baby's heart rate resolved, so midwife did one of the few reasonable things of the day, and told the mom to stop pushing and just rest until she felt an urge to push. Which she did an hour later, and in less than 10 minutes she pushed out her 8 lb 8 oz baby boy, Apgars of 9 & 9. But of course there was doubt as to whether she could actually push the baby out (since they expected the baby to be large, and the midwife had earlier been very insistant on how DANGEROUS it can be to deliver a large baby--never mind that she had pushed out her first baby at 8 lbs 7 oz with no incident), so the resident OB actually did the delivery (and overly agressive pulling!) so that vaccum could be used...of course she showed her strength by pushing so fast that they got the vacuum out of the package, but couldn't get it on before the head was half out (so it just laid on the bed unused--wonder if they will bill for a vacuum birth though?).

But hey, the joys of Pitocin don't end there. Despite the fact that mom had no significant bleeding, the midwife ordered that the remainder of the bag of Pitocin in saline be run into the mom. The drip rate was set at 250 mU/min. Here is what the package insert on Pitocin has to say about fast drip rates of Pitocin:

Water intoxication with convulsions, which is caused by the inherent antidiuretic effect of oxytocin, is a serious complication that may occur if large doses (40 to 50 milliunits /minute) are infused for long periods.

She was being dosed at 5 times the level that is listed on the package insert as considered a risk of causing water intoxication! And she was already seriously retaining fluid, as demonstrated by the very concentrated urine collection that had been made about 20 minutes before the birth. Of course the concentrated urine was interpretted as "she hasn't gotten enough fluid." Of course a logical person would certainly agree with that concept. (Rolling my eyes) She had "only" gotten 4 liters via IV plus what she's been drinking over the course of the last 20 hours. That is the equivalent of drinking more than 8 oz an hour around the clock--possibly closer to 12 oz, I didn't log how much she drank. Can you imagine how much you would be peeing if you drank that?

She wasn't dehydrated folks...she was OVER HYDRATED, and unable to get rid of it. But hey, the midwife ordered another bag of saline run into her.

The poor woman. She's going to have to leave the hospital with no shoes on, her feet will be so puffy.

Note: I have a Word document explaining how to figure out what dosage of Pitocin is being administered. Ask, and I'll e-mail it to you. If you are "lucky" the Pitocin is mixed as 30 Units in 500 mls of saline, then you can just read the IV pump to directly get the mU/minute. But if a different mix is used (such as the 10 Units in 1000 mls of saline that is reccommended on the package insert), then the charts I have in the Word document will help you to quickly find what dosage is being used. I STRONGLY urge pregnant women to take a copy of it and the package insert for Pitocin with them to the hospital in labor. If Pitocin is going to be used, ask the care provider if the dosing guidelines in the package insert are going to be followed, and if not, why not. Sometimes a "quick" labor is not as safe as a slow labor. Especially if your baby is thought to be compromised already, it may not really make sense to be trying to blast the baby out.

Women and marital relations...

I'm not sure why this is, but it seems to be a universal "truth" that once you get married, activity in the bedroom decreases. At least that is the subject of many jokes.

I've always found this to be sad when I've read about it. I believe that God has given a special gift to married couples to draw them closer together. When that gift is not enjoyed, I believe it can make for a less than satisfactory relationship. Research continues to bear out that people who are active in a monogomos relationship, they enjoy better health and longer lives.
This is perhaps somewhat niave of me...but when I was in my 20's, I'd always thought that the "not enjoying sex thing" was a "problem" of the older generation. "Surely younger women are more enlightened" went my reasoning. "They know it is okay and good to enjoy sex, so they allow themselves to do so." So when a friend who is about 10 years older than me started making pretty mild statements after I got engaged indicating that she had a lower drive than her husband and that I would encounter the same thing once I got married, I brushed them aside in my mind. "Surely she actually enjoys sex, she just doesn't want it as often as her husband."

I have to admit that I was completely floored when I first encountered women my own age who were quite unabashed about expressing their frustration at their husband's attempts at "getting things started." And especially when I heard comments like "I could never have sex again and die happy." Wow. Amazing. This thing that God created to be a unique bond between a husband and wife, something that really is intended to cement us together not just physically, but also emotionally, and here are Christian women saying they could quite happily do without.

So I decided to blog. ;-)

And that's where I got the BIGGEST surprise. I was surfing around trying to find links to support the idea that a healthy sex life improves your physical and emotional health (a concept that I know I've read about before), and indeed, I did find that, and mentioned it above. But the shock was on a website devoted to promoting the book Sex as Nature Intended It, I found more information than I expected. Some of course was right in line with what I thought, like a survey conducted by the book's author was reported to have found that:

In general, if a woman had wonderful lovemaking experiences with a man, she tended to speak glowingly of him and the relationship. On the other hand, if the sexual relationship was unsatisfactory, unfulfilling, and frustrating, she tended to be critical of the man and attributed their unhappy relationship to his faults. But perhaps, in many cases, it is actually the other way around. Perhaps the dissatisfying, displeasurable sex caused her to be much less tolerant of the man’s faults and nitpick him for things she might otherwise overlook if he were pleasing her in bed.

But as I said, I got a bit more than what I intended on--what I found was information on how male circumcision affects marriage and the female sexual experience. One researcher started a study, and came to a preliminary conclusion that men who were uncircumcized were more likely to avoid divorce, but unfortunately died before finalizing his research.

My husband and I did not have our sons circumcized for a variety of factors--the lack of a clear cut medical need (and here), lack of religious directive, knowledge that the original circumcision commanded to Abraham is not the same as the circumcision that is performed today, and the bottom line that it seemed to us to be an extremely painful elective cosmetic surgery that we felt our sons should be the ones to make the decision on (similarly, we do not have our daughters' ears pierced). But none of those factors had anything to do with the possible ramifications on divorce or the sexual experience their future spouses might have.

But according to what I read, the impact could possibly be significant. Dr. Christin Northrup, author of Women’s Bodies, Women’s Wisdom writes about the topic:

And intriguingly, because the area of sexual sensation is so localized in the tip [of the intact penis], the penis only has to travel a short distance to excite one set of nerves or another. In other words, it doesn't have to withdraw very far to receive pleasure on the outward stroke. This allows the penis to stay deep inside the vagina, keeping the man's pubic mound in close and frequent contact with a woman's clitoral area, which increases her pleasure and a sense of closeness....

The natural penis may be more comfortable for the vagina than the circumcised penis. The coronal ridge of the natural penis is more flexible; O'Hara likens it to the resiliency of Jell-O. The circumcised penile head is considerably harder--overly firm and compacted like an unripe tomato. This is because circumcision cuts away 33-50 percent of penile skin. As a result, the skin of the penile shaft can get stretched so tightly during an erection that it pulls down on the skin covering the glans, compressing the tissue of the penis head. The abnormally hardened coronal ridge can then be very uncomfortable to vaginal tissue during intercourse. Women sometimes experience a scraping feeling with each outward stroke and even report discomfort after intercourse or even the next day. The brain makes pain-relieving endorphins that may partially block any discomfort during intercourse itself. As a gynecologist, I can tell you that painful intercourse is a very common symptom in women, many of whom blame themselves or who feel that something is wrong with their sexual response....

Circumcised sex may cause the vagina to abnormally tense up and decrease its lubrication. Women report more problems with lubrication when having sex with circumcised men, possibly because of irritation from the harder tip and involuntary tensing against it, and also because the longer stroke length tends to remove lubrication from the vagina. Often an artificial lubricant is necessary.

This has certainly left me with a lot to ponder. According to Sex as Nature Intended It, it may actually be the woman that suffers the most in bed from male circumcision. A survey conducted for the book found that women who have had sex with both circumcized and intact men prefer intact men by a ratio of 9 to 1 (I have no idea of the validity of the methodology for the survey, having not read the book). Could it be that much of the dissatifaction with sex in marriage is set in the first 24 hours of a newborn boy's life?

Ironically, some of the women I've been in discussions with who were most vocal about not desiring sex, were also some of the most vocal proponents of circumcision.

I've been gone for a LONG time...

Not sure if any of you still read my blog...but yes, I'm still here. ;-)

I'm not even really sure that I can write this post. I've been putting it off for over 3 months now. I'm crying as I sit here now.

The last "real" post I made was on November 4. Yeah, I threw that thing up about Mexican food...but it wasn't "real," it was filler. Letting you all know that I was still here.

What I didn't know when I wrote that post was that my life was going to change very dramatically very soon. And the thing was, I even alluded in a way to what I was going to loose.

A few days after I wrote that post I got a call letting me know that my grandmother had been admitted to the hospital. At 78, nearly 79 years old, being admitted to the hospital happens. But this was the first time she'd been admitted since she and my grandfather had moved out of their home of over 40 years--a house that they had built, even living in the basement while finishing the first floor--and into a cottage in an assisted living community nearly 2 years prior. They'd moved because my grandfather was suffering from Alzheimers, and my grandmother from some hip and spine issues, so they just couldn't keep their home up. But my grandmother was a fiercely independent woman, and resented the high cost of living in the community, so in October she had moved them out into a private apartment. So "her," I had talked on the phone with her a week before the move and she seemed as vibrant as ever. But then her hospitalization soon after the move left my grandfather bewildered. So my aunts were having a bit of difficulty with him.

At the time I got the call my husband was recovering from mono (note to readers, you do NOT want mono when you are 44--it hits HARD and LONG), I was recovering from strep throat and perhaps a touch of mono myself. So I was already "down." In the days and weeks that followed we were to learn that my grandmother's condition was "serious," then she would bounce back, then she had perhaps 6 months, then finally the Friday before Thanksgiving we were told that she was worse off than the hospital Dr's had led my aunts & uncles to believe and "hospice care" had been approved for her. We had made plans to visit her over Thanksgiving when we found out that she had 6 months. When I got the call on Friday I spent some time crying with my husband. Somewhere deep inside I was sure though that I would see her the following Wednesday, and she wouldn't be *that* bad, and we would laugh, and hug, and talk like we had so many times before.

Stepping back a bit here...you need to understand that I haven't seen my mother since 1996, I have no idea where she currently lives. I met my husband in 1997. I also didn't see my mother from about 1978 until the day I graduated from high school in 1990. I had lived with my grandparents from when I was about 6 months old until I was about 5. When I struggled through years of abuse, I dreamed about running away to her house--even when her house was 350 miles from mine, I tried to calculate whether I could ride my bike to her house--could I tote enough food and a tent to make it? (Perhaps its good that I only recently learned about a man who ran home from college after he graduated--from Boston to Florida. That would have given me encouragement to try the bike ride!) While I was in college my grandparents house was my "home base." My grandmother was the first and only person I ever called "Mommy." She was my mom in the truest sense of the word. She loved and nurtured me, even when she knew my deepest, darkest secrets. She knew things about me that even my husband does not know.

So I got that call on Friday, and I was devastated. I cried to my husband that I wasn't sure how much more I could handle it...I did not want her to die, but the lingering illness was torture. What I wanted was not for her to die, but for her to miraculously recover!

On Monday she turned 79. That day I got a second phone call from my father to let me know that she wasn't doing well, he had called her to talk to her from his retirement home in Florida. By this time we had talked on the phone 3 times in one month, where as it is "normal" for us to go over a year between phone calls. I could hear the pain in his voice--a man that usually doesn't show emotion. He made some comment about "if you talk to her on the phone..." I don't remember now what it was that I was supposed to remember...I just know that I never even considered calling her. I'm not a "phone person," and I was going to be seeing her on Wednesday, so why go through the awkwardness? Oh how I regret that!

Wednesday was a short school day, so we intended to send the kids to school, then head out as soon as they got home. It was "grandparents day" in the second grade, and my daughter Jessica was eagerly anticipating her Nana & Poppop (my husband's parents) attending the festivities. Not quite 10 minutes before I would have left to take her to the bus stop, my father called. I knew when I saw his number on the caller ID what he was calling to say. There was just no other reason for him to be calling me so early in the morning. With a shaking and reluctant hand, I picked up the phone.

She had died in her sleep. I struggled not to break down crying right there...I didn't want to send my daughter off to school with the knowledge that her greatgrandma--who she loved--had died. I ran up stairs and threw myself into bed with my husband and sobbed. Getting a quick cry out of my system, I cleaned up my face, and went back downstairs. I quitely and perhaps somewhat robotically got Jessica to the bus stop, then broke down on one of the other mom's shoulders as the bus was pulling away. Jessica had questioned what was up with me, and I told her that I was just sad, and she shouldn't worry about it. She relayed this to her friend on the bus (the daughter of the mom I cried with), and her friend wondered if someone had died. Jessica told her that greatgrandma was very sick...but didn't really think that was it.

So we did go out to visit family...but for a funeral rather than to see my grandmother alive one last time. Because of the Thanksgiving holiday we had to delay the funeral longer than originally anticipated...it was not held until Monday, which was ironically my sister's birthday.

I then proceeded to fall into a period of depression. I tried to tell my Dr. about it, and he brushed me off..."call me again if you are still feeling this way in 2 months." I had just told him that I had lost the person who was most important to me in the world besides my husband and kids, and that I couldn't find the strength or energy to take any joy in the Christmas season or to do the necessary preparations. His response was completely inappropriate, though I did not realize it at the time. I'm coming out of it...am I totally out of the depression? I don't know. I have my moments.

And writing this blog...tough. I've gone through many tissues. I have not written it because I knew that to do so I would have to REALLY acknowledge my grandmother's death. Even as I wrote, I found myself so many times mentioning her in the present tense.

As for the allusion to her in my November 4 post...I mentioned at the end of the post 2 little girls and water on their bedroom floor. One of my grandmother's favorite stories to tell was about my sister and me "washing" our bedroom floor. She was sick, and had decided to nap while we did. We woke up, and she could not be roused. We wanted to help her, because we knew she was sick, so for some reason we decided to the washing our bedroom floor--which was linoleum--was just the thing to do. So we rummaged through our toy box and got out buckets. We filled those with water in the tub across the hallway from our bedroom, and carred them back and threw the water on the floor. Of course we hadn't picked up any of the MANY toys off the floor before doing this. And there was carpetting (red & orange & yellow & green shag--it was the 70's!) in the hallway, with one of those transition strips in our doorway. So we managed to get about 1/2" of water across our whole floor before our father came home from work and found us. And my grandmother would not let him punish us, because our motive was to help, not to be mischevious. Of course he still had to clean up the mess! (Yay grandma! Of course I would suggest that my sister and I should have been involved with the clean-up efforts.)

Ironically, I had a "bathtub" incident on Tuesday evening before my grandmother's death. Perhaps God's way of continuing the story to the next generation? I don't know. I wanted the kids to get a bath before our trip...and my husband works nights so this can be quite the task. I washed the boys. I took Sean, then about 22 months old, out of the tub and got him dressed in his bedroom while Jason continued playing in the tub. Once I got Sean into his PJ's he happily dove for his pillow and snuggled in...until he noticed that the bedroom door was open. Before I could react, he jumped up and ran from the room, and got right into the tub, PJ's and all! What a kid!

When I was in college and would visit, I would cringe in embarrassment as my grandmother bragged to anyone who would listen about "her granddaughter, the chemistry major...she'll analyze what's in those hoagies for you..." I'd both look forward to and dread the dozens of cookies she'd have waiting for me to frost at Christmas. Now I'd give anything to hear those words, and of course I always knew that she had those cookies waiting for me to frost because of all the years I hadn't frosted cookies as a child.

So to Grandma D, who taught me about sacrificial motherly love, sewing, cooking meatloaf and monkey bread, proofing yeast, picking vegetables from the garden, manograms, and so much more, who loaned me books ranging from The Handmaiden's Tale to Reclaiming and Championing your Inner Child, who always reminded me to "fight nice!" ... I love you, you will be in my heart forever!