Sunday, March 18, 2018

Thoughts on Labor & Delivery #8: Repair

 Shortly thereafter, our familial bonding was interrupted by the pediatrics team needing to examine the baby and start her IV.  Studies in postpartum medical care have demonstrated significant medical benefit for both mom and baby when the baby is placed directly on mom’s skin following birth and allowed to remain there for at least 1 hour.  I was concerned that we would not get to reap the benefits of that practice given the concern for infection, but she did her part and came out literally kicking and screaming.

I kissed Allie goodbye and instructed PIC to go with her for her IV.  I didn’t want anyone trading their less perfect baby for ours.

It was then that I first noticed the team of doctors staring at my exposed womanhood.  They didn’t look as celebratory as I felt.  They weren’t really doing much actually… In fact, the resident wasn’t moving, she had taken over for the intern and done the lion’s share of the work associated with delivery (second to me, obviously) but now she stood fairly still.  I heard her ask for the senior resident to be sent in.  He took a peek and in turn asked for the attending to be sent in.  Super.

“So… what’s the deal?” I had previously been told that 70% of first time moms tear.   Another statistic that I had been determined to defy, however by this point I had come to the realization that if I did tear, I couldn’t feel it… so whatever.  Predictably, I had 2 small tears.  What I had not anticipated was the type of tear – the resident informed me afterwards that it involved an artery.  She wasn’t moving because she was watching my heartbeat with each spray of blood and in good doctor fashion decided to hold pressure. 

She told me one of the attendings offered her some advice: that she should change into sterile gloves before beginning the repair. Because of her station in the hierarchy, her lot in life is to smile, nod and thank the attending for the insightful and helpful commentary regardless of whether it was actually either of those things. She pointed out to me that she felt it was more important to control the bleeding than to change to the appropriate wardrobe, but it looks as though we all still have things to learn.

The repair took well over an hour as the tissue was very friable (read: tears easily) and the bleeding just kept happening. Given that my magical epidural was still fully functioning and I was only a torso, I didn’t mind.  I also had crackers. 

Once the repair was completed, the doctor moved to her next task – to examine the placenta to ensure nothing was wrong.  Placentas are disgusting. I know that there are a whole host of different belief systems that think the placenta is extremely important: some eat it, some save it and some even bury it beneath the doorstep (not kidding!). In medical school, they often allow medical students to deliver the placenta when they are first starting out on the OB service because 1. Its hard to mess up and 2. It makes you feel included and 3. No one else wants to.  I have seen and handled plenty and had no sadness about parting with my own, sight unseen. My belief system is that it should operate like any other internal organ: it should stay hidden, do its job with no maintenance.  Once it has completed its function, I have no more use for it… and certainly zero desire to eat it. 

Apparently my placenta sensed my ambivalence and was not quite ready to cede her ground. One portion of it tore slightly and what should have been a quick visual inspection on the way to the lab became a thorough examination and ultimately a quest to find the missing piece… despite the many marvels of modern technology, this had to be accomplished by inserting an entire hand and just poking around my innards.  Honestly, this portion of the experience hurt worse than most of labor. 

In typical Katie fashion, I needed to speak endlessly in order to deal with my pain.  Unfortunately for my OB, PIC and my new child were still off getting IV’s or coffee or whatever. She was my sole audience and despite needing to talk, I had nothing new to say. We had been together a solid 3 hours at this point (she stayed late to do my repair #blessed) and nothing major had changed apart from the life altering circumstance of having a child and then nearly bleeding out. 

Clearly, those in charge of interior design on the Labor and Delivery wing had foreseen exactly this circumstance. First of all, there were sea life creatures on the ceiling and despite all of my medical education I could come up with no reasoning for this apart from mere distraction.   I commented on that waste of thousands of dollars adding outlines of marine animals to an already ugly drop ceiling. Then the starfish photo again caught my attention. 

Starfishes have to be the MOST useless creatures on the planet, can they even swim?  As far as I know they have no ability to capture food and must instead simply injest whatever floats into their… mouth? hole?  I’m really not sure what the proper descriptor for their food trap is.  What does it say about me that my reference point for whether a creature matters is their ability to eat?  I like to eat.  It’s really terrible that Tripler doesn’t have an after hours kitchen service.  Are starfishes edible?  They don’t look like they would taste good.  They’re fairly aesthetically pleasing – that must be their sole purpose in life, to be a source of beauty for everyone to admire.  Much like women in the olden days. Seen and not heard. I would not have survived in that time.  Do you think starfishes feel pain?  I wonder how they give birth.  With all the money I spent getting a bachelor’s degree in biology, shouldn’t I have at least a working knowledge of how a starfish gives birth?  I mean, I’m just guessing it comes out the same hole as the food goes in, or maybe there’s two holes?  Why didn’t the guy taking the picture aim at the other side of the dang fish – at least then I could have made an educated guess? Oh yeah, modesty.  Wouldn’t want anyone getting all offended looking at fish hoo-has.

I managed to distract myself enough to get through it and hopefully managed to distract the OB enough that she was entertained and only 35% hating her life for working 3 hours late but not so much that she didn’t do a thorough job spelunking for retained placenta.

She finished her job, and went home (likely to enjoy some silence).  For the first time in 9 months, I was alone.  PIC and Allie were off doing IV things, or maybe cruising for chicks? They had certainly been gone a long time.  I sat patiently in silence with no one to talk to for at least 5 years (or so it seemed) My epidural was shut off but apparently you don’t instantly bounce back to functional, so I was immobilized.  Comfortable, though.  My phone was out of reach so I was really more alone than I had been since 2005 when my parents decided my brother and I were old enough to co-own a cell phone.

At this point, those waiting with bated breath on the east coast had last heard an update of “time to push” over 3 hours ago. 

I would like to make it clear that this delay was not my fault.  Having just pushed a human out of my body, I had done my part. PR was not my arena.

Finally they came back.  My family was reunited… and someone could hand me snacks and a cell phone. 

Babies also benefit from skin to skin with their dad!
(Please ignore the scar on his chest... I once dropped a power drill on him from a ladder...
maybe someday I will write about my adventures in carpentry)

We finally alerted the world of Allie’s birth; first the families, then her name sakes, then more friends and family. 

Her official instagram debut picture.

One uncle told us “Congratulations! Can’t wait to meet her! Open up a college account now so when people want to give you gifts you will have a place for them.” My response: “Oh, thank you, but she’s far too pretty to go to college” was quickly nixed.

Skeptical tiny human, who is unimpressed by her IV. 

All was right with the world.

Tuesday, March 13, 2018

Thoughts on Labor & Delivery #7: Pushing

I was pumped with Tylenol (to bring down the fever), Zofran (to stop the feeling that I was going to throw up), Unasyn (antibiotics for the chorioamnionitis) and given an emesis basin (just in case).  PIC was instructed to offer me sips of water and he requested a cool rag for my forehead.  Time to suck it up and push.

TMI? Here I am so thrilled to be ready to push.
I was really scared for this part, but it was actually not painful.  I could be a salesman for epidurals at this point.  My contractions felt like dull rectal and pelvic pressure – like needing to have a bowel movement, but a stronger sensation and involving more real estate. 

As each contraction would escalate, I was instructed to push in bouts of 10 seconds at a time. “Push, 2, 3, 4, …” you get the picture.  Each push involved holding my breath and bearing down as though trying to poop.  I got a 2 second break in between which was barely enough time to inhale another large breath before the command “Push, 2, 3…” was repeated.  Unfortunately, the nurse in charge of counting was a slow counter.  I was oxygen deprived by 8, fading by 9 and gasping for air before she had finished saying 10.  For some reason, I did not advocate for myself, figuring this was just the way it was.  I needed to push for 10 seconds.  Luckily, the OB noticed and said we should only push for 7.  “Thank goodness” I responded, “I was about to pass out by the time we got to 10”. 

After the first 2 contractions, I began to feel better.  Likely, the medicines kicking in, but it felt good to be doing something to help speed the process.  The doctor complimented my pushing skills, a sentiment echoed by everyone else in the room, she promised I was doing very well and moving the baby further down with each push. 

“Not to brag or anything, but I’m not surprised… I’ve been pooping my whole life, so I have had lots of practice.” 

I broke out laughing in the middle of one push, thinking of the scene from The Office where Jim and Pam are having their baby.  In the world of the fake documentary, the cameras aren’t allowed in the delivery room so it is audio only while Pam is pushing, but you hear Jim telling her enthusiastically to push only to be corrected by a nurse that she shouldn’t push now, so Jim yells “No. Don’t push  Don’t push, PULL!”

It’s rare that patients laugh during pushes (although apparently it isn’t counter productive!) and the OB curiously asked why.  After explaining and planting that seed in her brain, of course she accidentally instructed me to pull during the next contraction.  (I didn’t though).

And so it continued with all of us joking and talking, interrupted every 3 minutes by a wave of seriousness through the room while I focused on pushing.

Push, 2… 3…

Me, to PIC: “Yeah, I’m feeling rather ambivalent about this whole baby thing right now, I don’t want to do it any more.”  Doctor to me “Yeah, that’s totally an option, we will just leave and you just suck her back up in there.” 

Push, 2… 3…

PIC to me, “Do you want me to rub your shoulders?”  (Here’s a fun game for every pregnant woman to try, pretty much anything father of baby says to you towards the end of pregnancy can be made into an innuendo, as follows)  Me to PIC, “That’s what got us into this in the first place!”  (Another example, ‘wanna watch netflix?’ ‘that’s what got us into this in the first place!’ – bonus points for saying it in front of other people and getting him to blush!)

Push, 2… 3…

(At this point, we are down to the final minutes of baby inside me, so pediatrics has been paged and the room has approximately 15 healthcare professionals in it) Me, to PIC “I think this is the most naked I have been with this many people in the room since my own birth!”  Doctor, to PIC “I bet that’s a pretty reassuring thing to hear from the mother of your child.” 

I honestly don’t remember all of the banter that preceded delivery.   Trust me, if you talk as much as I do, you learn to tune yourself out.  I do remember that as pushing proceeded, the rectal and pelvic pressure which had previously lightened between pushes began to grow more and more intense, without any breaks.  I was joking less between pushes and closing my eyes when I did push.  Finally, after a push, the pressure was slightly less and even less with the next push.  I laid there, eyes closed, awaiting further instructions.  PIC was the one to give them, “Look at her, honey.  She’s beautiful”

I opened my eyes and was surprised to see that she had already been placed on my chest.  “Oh, a baby!”  Were the first words I ever spoke to her.  (Thank goodness my toenails were painted and legs shaved or else this “insightful” exclamation would have been her only first impression of me). 

6:16 PM, August 10th 2018. Aloiya Karmen Brickner entered the world, vocally announcing her presence before she was even completely out.  She was still kicking me in the ribs while serenading me… which induced a mild panic attack that maybe another one was hiding in there and I was about to get a BOGO deal that I was entirely unprepared for. Thankfully, she was just a tall girl: 21 inches. 7lbs 12 ounces. Of note, she also crushed her APGARs.

She seemed equally surprised to see me.

I had pushed for less than 15 minutes.  I considered it a personal victory. 

More importantly, the kitchen was open until 7, it was only 6:16.  I could order dinner!  I waited to declare this for a few moments of cuddling and admiring so that the staff would see that I was a good mom in addition to a good pusher. 

When I told PIC to give me the menu at around 6:40, we were informed that the kitchen stops taking room service orders at 5.  Cue exhaustion and hormone induced rage. However, in the midst of labor, they had delivered a tray to my room!! When you don’t order, they assume you still want to eat. Cue transition to overwhelming love and gratitude.  It turns out, that when you don’t order, they send you what you ordered for the last meal… so I had a tray full of vegetable broth, jello, a (now-melted) popsicle, black coffee and juice just waiting for me to dig in!   Cue transition to despair and self-pity… Also, now is probably a good time for anyone who potentially could have made the cut to be a stand-in for PIC and thus in the room with me to thank him for his service on the front lines, as I am no fun when I am slightly inconvenienced and hungry, let alone exhausted and starving. 

For what its worth, those of you out there reading, nodding emphatically and silently exclaiming “dodged a bullet there!”, I am well aware of this character flaw.  Like you, I don’t enjoy it.  I’m aware that I can be unpleasant when the Mr. Hyde side of my personality is unveiled by low blood sugar.  Unfortunately, although partially responsible, I am also unable to stop it.  Like you, I just have to strap in for the roller coaster ride and hope that it’s just a lot of scary ups and downs before coasting into the station instead of a launch into orbit ending in fiery disaster.

Luckily, we had packed snacks in our hospital bag, so PIC fed me crackers while I held Aloiya.  My first maternal attempt at multitasking.  I was already mother of the year in my head.  We marveled over the tiny human we had made while I dropped crumbs on her head.

Monday, March 12, 2018

Thoughts on Labor & Delivery #6: Deceleration

I’ve listened to enough fetal heart rate monitors over the years to develop an ability to hear the difference between normal and abnormal without looking at the screen.  Suddenly, baby girl’s heart rate was noticeably abnormal.  Before I could even ask PIC to look at the screen the room flooded with my nurse, another nurse, two doctors, a random guy who was apparently just “there to help” and probably some more people that I didn’t mentally catalogue because I was too focused on the slow thump-thump-thump-thump.  

PIC was not recruited to help reposition this time but rather elbowed out of the way as I was laid flat on my back by two nurses within a matter of seconds.  My vitals were assessed, and an oxygen mask was placed on my face and cranked up to full blast.  After a short eternity the thump-thump returned to the faster thumpity-thumpity-thumpity and a collective sigh of relief filled the room. 

Drops in fetal heart rate (known as decelerations) are occasionally normal, but when no trigger is known and when the slowing is prolonged it is never a good sign.  It was decided I should remain on my back and keep the oxygen going.  My room remained full of an excess of medical professionals – never reassuring. The gravity of the situation hit me: there was a tiny human being inside of me and she was not ok.  I prayed silently and tried to take deep breaths of the oxygen.  She needed me to breathe deeply and stay calm. 

The obstetrician decided this would be a good time for a cervical exam and declared that I was now officially at 5 centimeters.  (After a mere 18 hours of laboring…) I resigned myself to needing a C-section and a whole new sort of panic set in.  If you have never seen a C-section (but may someday need one) my advice to you is to never ever, ever watch one.   All surgeries seem somewhat barbaric, but of all that I have seen, these are the worst.  After the incision is made wide enough to reach into, the surgeons on opposite sides of the table insert their hands and lean back in order to tear the opening wider and it invariably makes me cringe every time I see it.  This is done because tissue will heal better when torn than when cut, but I think that is far easier to trust when it isn’t your tissue. 

No one else had made the jump to needing a C-section yet. As usual, I was getting ahead of myself and worrying about things that weren’t ready to be worried about. 

Despite minimal exertion, I rapidly became exhausted.  My hands were shaking badly and the oxygen kept sliding off of my face.  PIC noticed first and asked if I was ok.  “I think so, just really shaky.”

This alerted the nurse to my change in status – “Are you just shaky or are you cold?  I could get you a warm blanket and check your temperature.” 

Cold seemed like the wrong answer… I wasn’t cold, so I told her there was no need to check my temperature… but I did want a warm blanket – those are one of the best parts of being in the hospital.  I figured I was shaky due to the adrenaline of what had just happened.  The nurse postulated that maybe I was shaky because I had begun the transition into active labor – meaning I was potentially 6 cm now and likely only had 4-5 hours left before it was time to push! 

Then I was freezing, shivering and shaking uncontrollably.  I definitely was about to throw up. Something was wrong.  My whole body felt terrible and I had a growing sensation of dread.  I could not verbalize what exactly was causing my anxiety so I just repeated over and over “I don’t feel well. No, I really don’t feel good.  Something is wrong.”

At about that time, the OB doctor returned to the room. During labor they monitor both the baby’s heart rate and the mom’s contractions (as well as the rest of mom’s vitals).  My contractions were too rapid – they were occurring one on top of another without any time in between, which is too much stress for the uterus and also bad for the baby.  They turned down the rate of the drug stimulating my uterus to contract and waited. 

No change.

The way in which they monitor the mom’s contractions is with a monitor strapped to the outside of the belly. It allows them to see when the contractions are happening, but (contrary to popular belief) does not give much other information.  (For those of you about to labor, read: size of spike on the monitor does not necessarily correlate to size of contraction… so if you have a really painful one and someone helpfully comments that it was not very big at all, gently remind them of the disconnect between monitor and actual contraction, then, you know, feel free to punch them if it will help).  To monitor the strength of contractions, they need to use an IUPC: intra-uterine pressure catheter.  Just another thing that gets inserted (painlessly, I’m sure) into the uterus.

The doctor mentioned needing an IUPC to determine why my uterus had suddenly kicked into overdrive. (Paraphrased).  The nurse took my temperature: 97.70 F.  “That’s not right.” I helpfully informed her.  Given my current near-death appearance, she hadn’t handed me the thermometer and instead held it herself… barely between my lips.    “We can try it again if you want” she said, rather skeptically. 

We did.  It was 102.40F.

I now had a fever and a rapid heart rate. Two of my vital signs had changed and unfortunately, the baby’s heart rate was starting to increase beyond the normal range too.  Signs of infection during a delivery are usually considered chorioamnionitis (a medical way of saying an infection inside the uterus).  Often mom will show signs but baby will not, which is less concerning.  Once baby is effected, the whole situation becomes more serious.  In a former life as a pediatrics intern, I had been paged to multiple deliveries where mom was diagnosed with chorio, but baby had not ever shown symptoms… since we were already passed that, I assumed the pediatrics team would be present at the time of delivery… likely a million hours from now. 

The OB-GYN doctor prepped to place the IUPC, but stopped quickly upon reaching inside the missile silo.  “We won’t be needing this.  You’re 10 cm and completely effaced.  It is time to push.” 

Um, excuse me? “I was 5 cm… like an hour ago”

“Yeah, it’s no wonder you feel so crappy. You were progressing rather rapidly.  It’s time to have a baby.”

I took mental stock of myself: still nauseated, chilly and exhausted.  If I had ever felt that I could push a baby out of my hoo-ha, I most certainly did not feel that way now. I was sure that I was going to push for a bit, pass out and then need a C-section.  (I didn’t know it then, but the OB was also fairly convinced that I would end up requiring a C-section, but bless her professionalism, she remained positive and encouraging.)

The room got busy.  Many people busied themselves bringing in a sterile table covered in what looked like mid-evil torture devices that were modernized into blue plastic forms, a few more played transformer with my bed so that I was further reclined with my legs elevated in handy leg holders up nice and high so I couldn’t run away even if I could summon the strength to my lower half. 

“Pediatrics will be here, right? I mean if it is chorio, they should be here.”  After some discussion that I tuned out while trying to focus on keeping myself alive and fully mentally present it was decided that they should be present. 

The doctor, having removed her brutus the buckeye name badge holster and put on gloves, had done all that was required of her to prepare for the delivery.  She kept one eye on the chaos of preparations around her and the other on ground zero while we chatted about where she was from in Ohio, which Honolulu bars showed the Ohio State games and how non-ohioans simply didn’t get it. 

As preparations were finalized, a nurse helpfully reminded me that the normal pushing time for first time moms is anywhere from 1-3 hours.  I looked at the clock to assess if the kitchen would still be serving dinner at the end of 1-3 hours.  It would not. 

Mentally I told myself that I was getting this baby out in under an hour.  I had no reason to believe that this ‘first time mom’ statistic would break for me when none of the others had, but what can I say, blind optimism is apparently deeply engrained in who I am. “I don’t think I can push for that long… I really don’t feel okay.”

PIC assured me that I could.  My doctor informed me that in the past 10 minutes I had gone from 1+ to 2+ (the baby had moved further down in the birth canal without me doing any pushing… a good sign that my uterus was ready to evict even if I couldn’t push).  She told me “I can see her hair.”  

For as long as I can remember, my rule for any significant other in the delivery room was that they could be present but had to stay “behind the 50-yard line”.  I couldn’t imagine wanting anyone to see the disaster that would certainly be my bottom half during that time.  … I also couldn’t imagine them wanting to see it, but in the off chance that they did, I was sure my dignity would override their wishes.  So when PIC asked if he could look to see this theoretical baby’s hair, I surprised even myself when I consented. (Also, a million bonus points to him for asking… even in that situation.  It was his baby about to make her way into the world and I was distracted enough that I likely wouldn’t have noticed even if he hadn’t asked. Goodness knows there were plenty of other people doing far more than looking at this point! But, he respected my wishes and asked permission first anyways – a quality that I will highly value as he helps me raise our daughter.) He confirmed that he could see her hair and did not comment on anything else he may have seen.  Further bonus points. 

Tuesday, March 6, 2018

Thoughts on Labor & Delivery #5: Flatulence

Given the effectiveness of my pain control (and my new “do whatever you want, I can’t feel it anyways” outlook on life) the doctor decided that this would be the ideal time to break my water, so she pulled out her handy crochet hook that likely costs more than 140,932 craft store crochet hooks – only the best for me and my water! and with one graceful motion it was suddenly high tide.

Having seen enough births in medical school, I did not feel compelled to watch this particular portion of the miracle of life, but I was promptly informed that the fluid was clear (a sign that baby is doing well and not in any distress) and did not smell (a sign that no one in the room would be needing nose plugs for delivery – and, more importantly, that there is no infection).   My ever-attentive nurse gathered up all evidence that my bed had previously been flooded, wiped me off (I think… she spent a lot of time down there but as I couldn’t feel anything, my interpretation of her actions was limited to context clues) and got me all tucked back in. 

The best part of the epidural?  I subsequently took a nap. In labor.  It’s worth it for that alone honestly, because once this adorable creature emerges and is given the option to scream whenever she likes, sleep is a long lost dream, just like your formerly flat stomach and once stable emotional state.

After the nap, it was time for some entertainment.  We reclined and watched the psychotic antics of Katherine Heigl.  We snacked on clear liquids and in our dimly lit hospital room it was just another relaxing evening.

 Our contented and calm environment was shattered with the loudest and longest fart I have ever heard.  It was at least 30 seconds long and was as loud as a whoopee cushion in a cartoon movie.  It could not have been real. PIC and I looked at each other wide-eyed and sniffed cautiously – the air was suspiciously odorless. “Was that in the hall?” I asked him.  He didn’t know. 

About 20 minutes later it happened again.  Equally alarming, but slightly less startling this time – we wouldn’t be taken completely by surprise twice! We were prepared to localize.  “Hon, I think that came from you...” PIC said (…with all of the vigor one would use to poke an unknown object that could quite easily turn out to be a bee hive full of deranged insects).  He might have suspected as much with the last offense but in sparing my feelings decided not to say so.  Smart guy.

I didn’t think I still had it in me to be embarrassed by my bodily functions after peeing myself publicly during a cross country race (or dealing with the consequences of consuming tarnished food in India).  It turns out that was not the case.  Did you know your digestive tract has its own separate nervous system?  It is known as the enteric plexus.  Generally, it just functions to do things that you don’t actually need to think about to do, such as push food from stomach to colon, colon to exit – and there, luckily, your real brain takes over.

My enteric plexus had gone rogue. 

I expressed my concerns to the labor nurse during one of her many visits to my room.  She was not at all alarmed and oddly enough, seemed pleased.  “That’s a great sign! It means the baby is moving lower and her head is pushing the gas in your bowels as she moves down.” 

Labor nurses are a rare breed… they likely encounter far more grossness than any other specialty, all with a smile on their faces.  No matter how many times I asked for popsicles, I was given them promptly. They asked about my pain almost every thirty minutes and never once doubted my rating on the scale.  They could even handle questions about phantom farts without flinching.  I wonder how they screen for that particular gift in the interview process?

At this point I had been largely paralyzed for several hours.  The epidural didn’t make it impossible to move, but my movements were limited to lateral shifting – lifting my hefty leg up in the air or repositioning it took far more effort than I had to give.  Unfortunately, laying motionless and straight-legged in bed is not ideal for preparing the pelvis to eject a fetus so according to my nurse it was time to try the peanut ball.

The peanut ball is a medicine ball that has been caught in the middle of mitosis.  Or, for a less nerdy explanation, it looks like two medicine balls that have been mushed together to form the shape of… a peanut. This contraption is used to “open my pelvis”; while laying on one side said ball is shoved between my thighs in order to prop one leg up.  I did my best to lift my leg with my own strength while PIC and my nurse positioned me but ultimately realized that was fruitless and refocused my attention on my sphincter to contain any phantom farts. It took a good 15 minutes, but finally I was propped on my right side, left leg rising to the ceiling at an acute angle, and covered with the blanket for the ultimate visual effect that I had been riding a pig, fallen over and decided to nap then and there. 

A downside to working in the medical field is that all of your coworkers are also medical.  Which means they see your name on the list of admitted patients and realize that it is only thirty steps farther from their usual coffee break to come say hello and offer well wishes for your labor – how convenient!  There I was, horizontally straddling a gargantuan purple plastic peanut, unable to feel even a breeze below the waist should my blanket happen to fall and leave me exposed, facing away from the door to the rest of the hospital, staring at a stupid framed picture of a starfish when I hear PIC say “Oh, hello Sir!”.

To reword a John Green quote, the Venn diagram of people he needs to address as Sir and people I don’t want to see my bare bottom is a circle.

It was lucky I was facing the wall so that our well-intentioned visitor could not see the daggers I was shooting with my eyes to accompany the expression that I was hoping said “Please stand up casually and readjust my blankets so that I know whoever is not politely avoiding the ‘full moon’ being presented to them as though I were a baboon in heat”.

The expression did nothing to convey my wishes, but good manners dictate that one should not stand fully behind someone while conversing so our visitor was obligated to circle around to a vantage point where my face was visible and my derriere was not.  Turns out, it was PIC’s boss, another anesthesiologist in the hospital.  We had met previously in a less compromising position and he was used to seeing patients in various states and maintaining some level of professionalism, so I felt slightly reassured and had a comfortable conversation. 

My sphincter had other plans for us all.

By this point, we had become quite the flatulence connoisseurs and this was the most noteworthy yet. It was loud and clear with variety of pitch as though my bottom were improvising a trombone solo in a jazz ensemble.  It would be something to brag about if I weren’t too busy looking for a way to inject air into my IV line and mercy kill myself. 

Amazingly, his professionalism held.  He didn’t even pause from what he was saying to look incredulously at the creature responsible for such a noise.  I breathed easier… until the true strength of my enteric nervous system revealed itself as putrid air wafted up my nostrils. I fought to maintain composure as the cloud of invisible death engulfed me.  I prayed he was out of range. 

“I am so sorry,” I squeaked out “I am no longer in control of my own body”.  He did not address my transgression to pardon nor condemn, but he did excuse himself fairly quickly thereafter. Dignity: 0, Baby girl: at least 16, but who’s counting?!

There was nothing to do but ponder exactly how many people would hear that story and how far away he had to walk before it was safe to breathe again until the nurse came in and informed me it was time to roll to the other side. 

“Full disclosure, I may have accidentally pooped myself.” Dignity: 0, Baby girl: 17. The scent was strong enough still that I was unconvinced that it was simply gas escaping.

Nurse: “Oh, it happens a lot at this point, you can’t control it, I’ll check”. Her eyes did not appear to be watering, which I took as a good sign.  “No, nothing down here – do you feel like you pooped?” 

Dignity: 0, Baby girl: 18.

“Sure smelled like it.”

We repositioned without any surprises escaping and now my imaginary rodeo horse was going the opposite direction and I was on my left side, facing the door and able to see any intruders (aka people wanting to be nice and say hello).