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| If you are reading this: Stop reading it.
This means you. I know where you sleep.
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| Dear Shannon,
I love Shannon.
Shannon is the coolest.
Shannon says my xanga sucks ass.
But Shannon sucks ass.
Take the Shannon.
Shannon is sick.
Which means Shannon is defenseless.
This has been the crappiest (most crappy?) post I've ever made.
Gah.
I'm doing laundry in the living learning center. One of my suitemates just walked in. He's pretty cool. One of the closest things to a friend I've got here. I wonder what he would say to that? Probably, really? I don't even know that kid.
hahaaha.
Okay Shannon wants me to look at something on her site. Cornify? what?
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| Just when I think maybe I'm okay with the democrats stimulus plan, I find that the plan includes $350 million for childcare on military bases and $335 million to prevent STDs.
Really? What do those have to do with stimulating the budget? This is the problem with omnibus spending bills: you can slip in whatever crap you want and make it look like the other team just opposes the stimulus.
Fucking politics. This would be a good time for Obama to make good on his commitment to revamp how the game is played.
In other news, I applaud Obamas plan to limit compensation for companies receiving bailout money.
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| There is nothing like taking two women's studies courses in a semester to really make you dislike having been born male.
I honestly wish that I could stop looking at pornography but honestly it has become such an ingrained part of my sexuality that I don't think its really feasible at this point. But at least there is the guilt to torment me now.
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| This is stolen. And copywritten so please don't yoink it or have me arrested. It belongs to JAMA and/or Cory Donovan MD.
Babies Having Babies
Week by week I watch Sarah's belly grow. She is accompanied by her mother, and they are prompt for Sarah's prenatal visits. The 35-year-old mother and the 15-year-old girl sit side by side in the examination room chairs, Sarah getting bigger, rounder, and puffier week after week. Her mother listens earnestly to all of the instructions, sending sidelong glances at Sarah to punctuate the important information. Sarah's face is cherubic with big blue eyes and long lashes. She starts to waddle instead of walk. Her feet hanging off the examination table grow swollen, and she stops tying the laces of her sneakers.
"Babies having babies," my preceptor sighs as we watch mother and daughter make their way back to the lobby. I am in the middle of a nine-month elective during my third year of medical school at a clinic in rural Minnesota.
Sarah seems so serious at every visit. Quiet and calm, she looks more at her hands on her belly than at anything else in the examination room. She nods but lets her mother ask the questions and make the plans. When asked directly about her body, even after 32 weeks of pregnancy, she turns her head to her shoulder, looks at the floor, and shrugs, embarrassed. She is not openly curious about the ordeal of childbirth. There is no expansive sigh when she rises from her chair or when she completes the climb onto the examination table. Sarah lacks the high drama and nervous tension of the other pregnant teenagers I’ve met. Her arms lie soft and still across the "I’m pregnant, what's your excuse?" sparkling T-shirt. I am pretty certain that the calm will vanish as contractions set in.
Not long ago I witnessed a terrified patient as she delivered, her husband cowering beside the bed, her mother clutching the daughter's white-knuckled hand. She harshly and profanely rejected their encouraging and supporting words. Her yells echoed all the way to the pediatric wing. She physically struggled with the nurses and became deaf to my preceptor's instructions, ultimately pushing too hard too soon, causing a large tear that is still vivid in my memory. I don't want Sarah's delivery to be like that.
By Friday, well into her 41st week, Sarah is scheduled for an early-morning induction. On the obstetrics floor a gaggle of 14- and 15-year-olds spills out of the family waiting room strangely transplanted from their school environment. Slouched against one another, braided and dressed in layers of pastel T-shirts, they speak enthusiastically over the noise they create. Backpacks sit against the tiled wall and US Weekly and People magazines are piled around them. I assume they’ve taken the day off from school; I imagine that it will be a long wait. First-baby inductions are often slow. Even with my relative inexperience, I predict an extended vigil, but judging from the way they’ve settled into the hall they seem prepared.
In the maternity room, Sarah is flanked by her mother, who looks like she is about to burst into tears as she clutches Sarah's hand. Her mother scolds a mop-haired kid with acne when he backs into a vase as he attempts to make more room around the bed.
"Time for a cervical check," I say. I gather that he is the boyfriend when he grabs Sarah's hand possessively.
"I think we can break the amniotic sac," I say. My preceptor agrees and reaches for the crochet-like plastic hook.
The boyfriend grimaces and sways from one foot to the other. Sarah smiles and thanks me.
Shortly after one in the afternoon we get the call that Sarah is fully dilated and ready to push. We discard the clinic schedule and our laboratory coats and then hurry to the hospital. The wide-eyed teenagers, now armed with balloons and flowers in their hall fortress, grow quiet as my preceptor and I appear.
In the birthing suite Sarah's legs are held aloft by her mother and a nurse. She smiles across her knees at me in recognition, no panic in her eyes, intrathecal anesthesia in place. As the contraction comes she focuses intensely on her breathing. Gowned and gloved, we wait 15 minutes until the baby's head is visible. Sarah pushes and yells in pain only once.
"Keep focused on your breathing," says the nurse, one of Sarah's feet supported in her experienced hands. We all begin unconsciously to mimic Sarah's rhythmic breathing, holding our breath as Sarah holds hers. Then Sarah takes a deep breath and pushes. Her face turns bright pink and mottled with her effort. She appears decades more mature than her peers in the hall. In the face of pain and a challenging new experience she becomes determined. Her mother trembles as she clutches Sarah's right foot. The teenaged father, also shaking, backs away from the scene before him.
A few more breaths and pushes, then a gush of pink fluid; the head, shoulders, and legs slip into my extended arms. "Your daughter is beautiful," I say as the infant wriggles in my lap. "Beautiful" takes into consideration the cone head, the white vernix, and the blue hands of the newly born. The baby is very large, a solid nine pounds eight ounces.
The new grandmother starts crying, as does the father. Sarah closes her eyes for a moment and then peers over her knees to catch a glimpse of her new baby.
The baby pinks up as she cries. With the vernix wiped off and her molded head covered with a knitted pink hat, she is picture ready in her mother's arms. Sarah beams, but is as quiet as ever. The boyfriend is overcome again with happy tears, and Sarah's mother snaps photographs.
Between the flashes I watch Sarah watch her baby. She folds the newborn gently into her arms and rocks her slowly. She adjusts the hat and lets her baby's small fingers curl around her own. As she slips into her new role as mother, she stands in stark contrast to her peers in the hall.
As I remove my gloves, I consider that women have delivered babies at 15 years of age since the beginning of humanity. However, this is no longer the norm, and I worry about this quiet young woman and her new daughter. High school is a difficult time, let alone adding the complications of a young, dependent life. Employment opportunities for young women without completing high school are few and far between. Her future now holds many additional challenges. What would have been different if Sarah had taken a different path, if her mom had brought her in for birth control, if the school had done a better job with sex education, if our culture were more open to dealing with the realities of teen sexuality? Will the inner strength Sarah demonstrated in the delivery last through the day-to-day challenges she will now face?
I leave Sarah surrounded by her family, with her baby in her arms. I move through the group of excited teenagers, my mask dangling, the adrenaline spent. The girls prepare to visit their friend and hardly look up as I pass. I spot another pregnant belly beneath a long green T-shirt stretched tight. I hope that this other young woman, and I for that matter, will share her friend's inner strength when the time comes.
-Cory A Donovan MD | | |
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