Issues Revisited
by Karla ° Monday, July 10, 2006
On July 5th, while visiting my OB’s office, I received information that has left me in a state of confused anguish.

Since my regular OB was away, I saw a stand in. He was actually really kind and compassionate. Of course, being new to my file, he asked a lot of questions about my history, what happened to Ava, the subsequent miscarriage, how this pregnancy is progressing, etc.

When I explained what happened to Ava, (precipitous labour, aspirated meconium, small structural defect that may have made it difficult for her to cope with the quick progression of labour where contractions where literally on top of one another), he basically delivered a blow that I wasn’t expecting.

He indicated that this supposed “structural defect” was so insignificant there was no way he could see how it would impact her during labour. Basically, he was shocked it was even added as a “possible” contributing factor.

To take a step back, the issue with her heart was originally explained as something very minor that you or I may even have without knowing it. It was also explained that it may or may not have been a contributing factor to her death because the thought was that she very well could have led a completely normal life and never have known about what the autopsy called “Prominent Endocardial Blood Vessels in the Region of the Limbus of the Foremen Ovale”. This still begs the questions however, why this new OB felt compelled to completely dismiss it.
I’ve tried googling the heart issue many a times. Not being the least bit knowledgeable about the intricacies of a heart, I have never fully understood exactly what it means.

So now, I feel like a complete jackass because a) the closure we thought we had has been completely shattered. If her heart couldn't have been a factor, then basically her death is unexplained and b) I never did get a second opinion on the matter.

I never got a second opinion because in Canada, without sounding like I an arrogant snob here, the hospitals I was dealing with are among the best in the country. Ava’s autopsy was performed at The Hospital for Sick Children. I believe this is one of the top six pediatric centres in the world, certainly the best in Canada. I delivered at Mount Sinai hospital, which has the largest obstetrical program in this country, as well as the finest high-risk birth centres and Neonatal Intensive Care Units in this country. Even a book entitled “The Best Hospitals in America” acclaims this teaching hospital as “the best all-around hospital in the country”. If I am dealing with the best of the best (and I am grateful I live in Toronto for that reason), there really wasn’t anywhere to go for a second opinion. Besides, I never once believed I was in the midst of anything that could be considered malpractice, negligent or wrong doing.

So what do I do? Revisiting and opening up such an emotional issue right now when it’s so important for me to stay calm and stress free during this pregnancy seems like such a bad idea. On the same hand, I feel like this new information is important to pursue because that closure I once felt is gone, and the hole left behind feels large and ominous.

I’m just so confused. This news was a big shock on top of my already fragile mindset.

I’m finally considering seeking professional help. I think it’s time. I never sought any help or support, either professionally or from family after Ava died, and I suddenly feel like I am crumbling. Nightmares have started creeping into my daily thoughts and I can’t stop reliving the trauma of the day Ava was born and died and I can't seem to stop replaying over and over the day I collapsed by her tiny little lambskin coffin wishing she would miraculously come back to me. I feel like I am reliving those terrible days following her death where the second I had a moment to myself to think, flashback memories caused my heart to pound and made breathing difficult. To cope I did mindless other things to keep my mind busy until I literally crashed from sheer exhaustion.

I knew being pregnant again wouldn’t be a cure-all, but I never expected it to reopen the wounds I thought had long ago begun to heal. And I certainly never expected to have to reconsider why my first baby is dead.

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I am so sorry that you are going through this right now. Yopu are in my thoughts and prayers.
Posted by Anonymous Anonymous :  July 10, 2006

Karla, if you think it is time to seek outside help, then by all means don't feel that you are being "weak" or unable to handle things.

All I can say about the "stand in" doctor is that there may have been issues, with him not having been present or knowing certain details, that he may not be correct about. If it would make you feel better (which may not really be possible?) by all means seek out a second opinion or a review of what happened.

Thinking about you and wishing you the best.
Posted by Blogger Gina :  July 10, 2006

Oh Karla. I hardly know what to say, but I wish that I could somehow be there to support you. By all means - look for outside help. We are not meant to go through life trying to fix all our problems ourselves. We are meant to be in community, supporting each other and learning from each other. Don't try to live through this alone.
Posted by Blogger Heather :  July 10, 2006

I'm not sure what to say, either. I'm kinda mad at that new doctor, b/c it doesn't really seem his place, not knowing anything about your previous pregnancy, to add his two cents' worth. It scares me to think there may not ever be a definitive answer for you, but I would hope that you might find some closure somehow regardless of the outcome. I do hope you find what you're looking for. It doesn't seem right at all for you to have to be going through this. You and Mark are just too nice and wonderful for all of this stress and heartache.
Posted by Blogger Christi :  July 10, 2006

Seeking help is a good thing. You need to focus on the baby you are carrying right now. It needs you to be healthy..

Opinions are like assholes....everyone has them. That Dr was offering HIS. Nothing more, nothing less. I've seen what he did a few times w/ other Drs and he's doing nothing but making a quick glance on some information in a chart and then acting like he has all the knowledge there is to have and without thinking, blurts out his thoughts without any care to consequences that it may cause.
The information that you had about Ava is all you need for now. Him sharing his opinion doesn't negate that information or your experience. If the time ever comes for you to seek more because you are not satisfied with what you have, you'll know when it's time.
Keep in mind too dear friend that you are a bundle of hormones now. That stuff is pulsing through your veins like wildfire and even under the best of circumstances you'd be dealing with fears and moods. Getting help is probably good but there is nothing wrong with you, ok? Grief doesn't go away - it just changes. Love you :) Above all - be gentle with yourself.
Posted by Blogger Wash Lady :  July 10, 2006

Wash lady, you makes a lot of sense. (((Karla)))
Posted by Blogger Julia :  July 11, 2006

What a strange thing for him to say. Medicine isn't exact, as much as we'd all like to think so. I'm sorry he opened up this painful wound, best wishes from over here Erin and I send our love and support.
Posted by Blogger NegZero :  July 11, 2006

Remember too, in that hospital, you had the best of the best who were actually there at the time, who could examine and see and know from first hand experience. You are just hearing now from someone who had never met you, never known what you’ve been through, basically doing little more than thinking out loud, puzzling over what (to him!) was a mere academic, clinical question.

It may very well be that your reaction to this man is the best indictor that you need to find someone with which to talk this over. It took me many, many years to realize that pushing emotions deeper and deeper inside wasn’t the same thing as “getting over” them.

Messy Muse and I send hugs and prayers from the heat.
Posted by Blogger methatiam :  July 11, 2006


emotional post......u are s very strong women, I don't know u but that's what I do can be jackasses that's forsure and that I totally understand from experiance.....get a second opinion......if that's what u feel u need then u do that!! :)
Posted by Blogger rachael :  July 11, 2006

Thinking of you Karla. Wish I had some cure-all words.
Posted by Anonymous Kristin :  July 11, 2006

Karla, we followed your blog on your pregnancy with Ava and have been following this one since the start. You have exhibited such strength and grace in the face of adversity, and we know it's in you to continue this way. Please try to stay positive and focused on the here and now, and the beautiful life you are now carrying. No doubt hearing things from doctors and strangers alike that cast a doubt on what you thought you knew about Ava's passing is disturbing, but try to rediscover your courage and human resolve to stand up to whatever truths might reveal themselves to you. Remember not to let what anyone thinks affect your health and mental state--if you can't do it alone, know that it's OK to seek professional help. You are not alone. You are surrounded by so many, with so much love and hope. Hang in, and do your best to stay focused on you and yours, and the beautiful future that matter what...
Posted by Anonymous Anonymous :  July 11, 2006

Maybe, just maybe, was this doctor trying to give a back-handed sort of assurance that if the baby you are carrying now had the same slight heart problem, you would not have to worry that his might happen again? Doctors rarely have tact. They don't teach it.

Strong people seek out help.
Posted by Blogger Judy :  July 12, 2006

karla I think that getting help is a great idea it might help you feel better. I am not sure why that doctor felt the need to tell you that when you have seen plenty of doctors that never mentioned the autopsy might not be right. Ask your normal OB about it and go from there.

Email me if you need to talk you know where I am!
Posted by Blogger TBG :  July 12, 2006

Karla, I'm so sorry. I honestly agree with many of the opinions expressed here... talk to your OB and see what he says. It might make you feel a little better. Also, if you feel like you need to talk to someone, either professional or otherwise, by all means, do it! If not for you, for this little life that you're carrying. Good luck!

I didn't read your other comments...I want to leave mine with a fresh mind, so this may have been said already...
I think right now you should focus on the life inside of you, and if you feel the need (I think it's a gread idea!!) seek some professional help. I don't think doing further investigation into Ava's death is going to be beneficial right now though, because no matter what you find out, the entire process is going to stress you out tremendously!!
Just focus on what's on your plate now, because lord knows it's plenty! If you feel the need, do more checking on Ava after your baby comes, when you feel more centered. And when that time comes, you may not even want to reopen the book...
I've never been through what you've been through, so I won't even pretend to understand...but this is just my advice...
Posted by Blogger a :  July 14, 2006

Karla, I had chills through this entire entry. *your blog does that to me alot!*

I have learned since having Makily that ALL doctors have differing opinions on what may or may not be the end all be all diagnosis. I had one doctor tell me Makily would be nothing more than a vegetable while another said there was no way of knowing. Makily smiles, laughs, plays, watches TV and sits up....last I checked broccoli wasnt doing that.

I know that I would be just as stressed and confused as you are and I WOULD WANT TO KNOW what caused Ava's death. I would talk to your obgyn again about it and let her know what the stand in doctor said. It may just be a differing opinion and doctors do that ALOT. Another thing I have learned is that sometimes even the doctors don't know for sure. That is so hard to accept. They put their pants on one leg at a time and make mistakes just like the rest of us do. I stopped putting my full trust in doctors a long time ago. I know that is a negative way of looking at it but when I realized they werent perfect and were sometimes just as confused as I was then it helped alot.

Hang in there. I think counseling is a HUGE step in the right direction. I think you have post traumatic stress from everything that happened to Ava. I had it with Makily for a long time and the "heart pounding, can't catch your breathe" feeling happened ALL THE TIME. I would relive her birth, her struggling to breath, all of it. It made me crazy. It wasnt until I got help that it got better.

Love and prayers,
Posted by Blogger Patyrish :  July 17, 2006

I agree, remeber your stand in doctor is an OB doctor not a doctor that has any expertise in diagnosing any problems with the child he nver met or had anything to do with. Hang in there and don't loose hope in doctors, they aren't all bad, most of them are wonderful. Do what your heart is telling you to do about getting help. You are the only one who knows what you need.!
Posted by Blogger Donna :  July 17, 2006

I read this blog back when it was fresh, but I haven't forgotten it or you. I just didn't know what to say then, and I still don't, but I just wanted you to know that I heard.
Posted by Blogger Anvilcloud :  July 18, 2006


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