Midwifery Follow-Up :: Ewan's Hospital Birth

First of all, I wanted to thank you for reading and offering your feedback on my recent series on why we're opting for a midwifery model of care. I know there are a variety of strong opinions in just about anything concerning pregnancy and birth, but the feedback (even from those who prefer to receive care from an OB) was largely positive. I ended up learning some new things myself, and got to hear from those of you who have great things to say about the medical care you've received (or about the great midwives you had)!

I received one question that I thought about addressing in the course of the series, but (because I was concerned about length) didn't get a chance to write about. I was asked about how it was to have Ewan's birth in a hospital setting with an OB, so I wanted to take some time to answer that inquiry.

I have and will continue to sing the accolades of Dr. J, our OB in Washington State. We didn't find her ourselves, but was referred by our midwives when we learned about Ewan's heart. When I called to set our first consultation, the receptionist went on and on for about 15-20 minutes about how wonderful Dr. J was without me even asking her for her opinion. She was confident I would love her, and our first meeting with the good doctor proved our receptionist right.

We had a lot of questions for her, most of which she answered before we even had a chance to ask them. She said something like this: When I took this job, I understood that I'd be working incredibly long hours and getting called out of a sound sleep in the middle of the night. I trust a woman's body. If a woman was meant to have a baby in six hours, she'd have a baby in six hours. As for episiotomies, I just don't cut them. There are women who I swear would tear to high heaven who never did, and women who had their seventh babies who I thought would stretch nicely, but I ended up taking over an hour to stitch them up afterward. If you're going to tear, it's better to just let you tear. Now if we get to the point where something doesn't look right, nobody is going to freak out. I will let you know what's going on and we'll talk about it, and I'll let you make your decision.

We were sold. And her actions in subsequent visits (and in our birth with Ewan) bore out the truth of what she told us at the beginning. What's more, she was incredibly proactive. Before we even had our first consultation with her, she got in touch with the doctor in charge of the NICU at the hospital where I'd be delivering to make sure they were set up to handle a baby with Ewan's condition. She got in touch with them again four weeks prior to my due date to make sure they were set and ready to go, and again when she sent us over to the hospital from her office. Again, she was totally amazing and on top of it.

The overall hospital experience, however, left something to be desired. While I understand people are human and while I do not expect perfection at every turn, I also am savvy enough to know that there are certain standards to be observed when caring for someone in a medical capacity. Take a look for instance at this picture my husband snapped with his BlackBerry while the nurse was getting my IV ready.

That's right. She's getting ready to put an IV in my arm, and is doing her prep work on a TRASH CAN. Even if the lid of that trash can had just been sanitized, is it really appropriate to stick a needle in someone's arm with materials that have been resting on top of a surface that says in big black letters WASTE ONLY?!

Fortunately, she was not our nurse for very long.

We had some great and incredibly caring nurses over the course of my labor, and nurses who (especially toward the end) kept asking me if I wanted any meds so I could be more comfortable. There are a whole host of reasons I won't get into here for rejecting medication, but one primary reason outweighed the rest: I didn't know how long Ewan would be with us, and I didn't want to be numb (literally or figuratively) to any of it.

When it came to post-partum care in the hospital, I had some fantastic nurses who were very patient and tender with me. Because of how quickly Ewan came out, I was one of those unfortunate ladies who tore to high heaven, as they say (north, south, east, and west) -- to the third degree. Ouch. They took amazing care of me. One nurse I was particularly thankful for since, when she was reviewing my chart to verify the course of post-partum medications, noted that I had a vaginal birth and not a c-section, so what was that drug (specifically for those recovering from c-section) doing listed on my regimen? I'm thankful she caught that error before I had something on board that I did not need.

And finally, there is something to be said for the NICU. I mentioned how our doctor was proactive in assuring that the NICU would be ready, not only with the right medications and supplies, but the staffing as well. When Ewan came, the doctor who was supposed to be in the NICU was nowhere to be found. The nurses attempted calling and paging him to no avail. And no one could find the medication to give Ewan that would ensure his PDA would remain open. When Ewan had to be intubated later that day, a nurse practitioner had to do it since the doctor was not there. When he was extubated a few days later at Children's, we learned the tube they used was too big for him and caused some lacerations and swelling to his windpipe.

Ewan at 1 day old. Poor little guy was pretty darn uncomfortable. (I can't look at this without crying.)

So, while we had some amazing people taking care of us, there were some areas of our care that were definitely lacking. I have no wish to disparage the hospital or any of the people who were taking care of us and as I said, I know people make mistakes. It happens. I'm incredibly fortunate to have gotten to have the birth experience I hoped for (even if the setting wasn't what I hoped for) and a supportive group of people around me. In our particular set of circumstances, most OBs wouldn't have given me the option of laboring and delivering naturally, but Dr. J did. My biggest regret is that Ewan was caused any pain as a result. But that's the truth of our experience.

* * *

I also wanted to mention that following the completion of this series, I got an e-mail from a friend of mine who is currently pregnant and living with her family in Scotland. She told me that the system over there works much differently than the United States. Every pregnant woman is automatically assigned to a midwife and only sees an OB if it's absolutely necessary. The midwives will deliver at a local hospital if that's what the family wants (or if it's necessary), or at a birthing center or home if they prefer. There really isn't the same kind of stigma around midwifery, or about choosing a midwife "instead" of an OB.

It's become a topic of interest to me to learn how babies are born in different areas of the world, and I know I've learned a lot from looking beyond the US to learn about how it works in other countries. I guess I don't have a whole lot to add beyond that, but it gives me some food for thought in any case.

Thanks again for hanging in there with me, and thanks for all the feedback you've offered! It's been fun to discuss your experiences and hear your thoughts.

I hope you all have a great weekend!

Why We Chose Midwifery Care :: Part 3 of 3

And one last time, the disclaimer ...

When it comes to having selected a midwifery model of care for my pregnancies, I speak only from my own experience. I claim no expertise in the fields of midwifery or obstetrics, and make no claims to know what is best for each individual pregnant woman and her family. Recognizing that a variety of experiences and reasons inform a woman's choice of who will provide her with the best care, I have nothing against any person who chooses an obstetrical model of care for her pregnancy and birth. I believe every woman should choose the form of care which she is convinced will provide the best experience and outcomes for her and for her family. 

* * * * *

Read Part 1
Read Part 2

Insanity: doing the same thing over and over again and expecting different results.

Albert Einstein

So. Assuming you've read the previous posts in this series, you may be thinking what I would probably be thinking at this point: that seeking out methods of health care outside the mainstream was and is a reaction against my prior experiences with modern medicine. That may be partly true, but there is much more that may be said about my reasons for choosing such alternative means of care now.

I related two experiences that stand out in terms of my relationship to the modern medical system, but it is important to note that they are not isolated. They are largely representative of what I came to be familiar with on a broader scale in subsequent visits. I found that I could roughly expect that the doctor would be running late, seem rushed, that I would have to repeat things I had already stated, or that things that I had said might be forgotten or dismissed as irrelevant. I came to expect that instead of a diagnosis and a treatment plan intended to achieve better health, I would get what was oftentimes a misplaced hypothesis that achieved no more than getting me to feel like a bit of a lab rat -- a body pumped full of pharmaceuticals that achieved nothing, or that were intended to mask the underlying cause. It appeared to me that the goal was not necessarily good health, but rather symptom management. The times when I did not feel like this were sadly and overwhelmingly the exception. 

Frustrated doesn't even begin to cover how I felt. The modern medical system -- for all the merits it may well possess -- failed me. Seven prescriptions, five doctors, two ER visits, two endoscopies, one CAT scan, and thousands of dollars later, and I was nowhere. But lest it be thought I'm coming down hard exclusively on doctors, it needs to be said that I recognize that they are operating within a system in which there are a number of factors at play that are out of their control, including but not limited to: insurance companies and their policies, hospital and/or clinic leadership and policies, pharmaceutical companies, federal regulations, and so on. I also recognize they are not the ones determining significant factors that directly impact my experience of the care I receive (e.g., how many patients they're scheduled to see in an hour, etc).

Seeking an alternative form a care came out of more than frustration and disappointment. When I was in good health and an infrequent participant in the medical system, I didn't have any problems with what I experienced. But being in and out of it on a very regular and frequent basis for a year revealed a host of weaknesses to me. The system as I experienced it was very broken, and I refused to believe that what I had experienced was the best that was available to me. So I went in search of system that would not only work, but that I could believe in.

When I did my research on some of the core premises of naturopathy, I found I agreed more with the foundational principles of this alternate form of care than I did in the more "modern" approach I had experienced. Naturopaths also abide by the promise to "first, do no harm" just like medical doctors do, but in addition to this there are five other principles that under gird the practice: the healing power of nature, discover and treat the cause -- not just the effect, treat the whole person, the physician is a teacher, and prevention is the best cure. I could add my Amen! to all of those.

Now, it should be said that when it comes to methods of treatment labeled as "alternative," or that otherwise veer from the norm of modern medicine, there are some utterly bizarre and questionable things out there -- things that, like many others who advocate the modern approach, I reject as forms of quackery. Those aren't at all the types of things I would support. For me, it really was finding a system that treats the whole person, that uses the gentlest and least invasive methods possible, and that produces the best overall results in my health (which for me, includes not losing my mind in the process). Midwifery, like naturopathy, is a method of care that meets those criteria in my assessment. In fact, the reasons I went to a naturopath and the reasons I'm now going to a midwife can be tied to just two root causes that go hand in hand, stemming from my previous experiences.

1. I want to use a method of care that is holistic (i.e., that treats the whole person) and effective, as well as a provider I can trust.
Though naturopathy is seen as an "alternative" form of medical care, it ended up being the most effective for me. For the cost of a few hundred dollars and over a period of just a few weeks, I got what thousands of dollars, multiple expensive tests (some of which were highly invasive, others of which involved ingesting copious amounts of nasty, thick liquids), and wasting months on end did not. In naturopathy, good health was presumed to be the norm and the ultimate goal. It was not just about getting rid of symptoms. In my naturopathic physician, I found someone who partnered with me in finding and addressing the root cause of whatever ailment it was that caused my health problems. I felt like he was on my team.

I see midwifery in a similar light. Instead of primarily being a medical event, pregnancy is seen as a healthy, normal part of life. Statistically speaking, pregnancy comes without significant complications for most women, meaning: most women don't require significant medical interventions. Fetal heart defects in my previous pregnancy excepted, I am one of those women. The pregnancy part is (relatively speaking) a breeze and my prior labor and delivery couldn't have been any more textbook. My OB in Washington noted that I had a body that was perfect for delivering babies naturally.

What's more, there tend to be significant differences in terms of the approach to care. Appointments with a midwife take more time. More than just the raw physical data is considered and discussed. In the hour we have together, we spend a lot of time talking not just about my overall physical health, (e.g., blood pressure, weight, baby's heartbeat, etc.) but also about how I am handling things emotionally. We talk about anything and everything impacting my overall well-being. When we had our first consultation with Kelli, the midwife we are seeing here in Florida, she told me: We will talk about your weight, your blood pressure, and your nutrition. We well do all the tests we need to and we will listen to the baby. But I also want to know about your heart and how you're feeling emotionally. She explained and affirmed what I already knew to be true: that these things as well as the others impacted one's pregnancy, labor, and delivery.

For me, this makes a substantial difference in terms of developing trust for the one providing my care. I am more relaxed even when the talk and procedures are medical in nature because my experience affirms that I am being seen and treated as a whole person. My pregnancy feels more like the beautiful, life-changing thing that it is instead of primarily being a medical event. I feel more at ease when I have the freedom to air whatever it is I'm feeling or thinking. The OB we saw in Washington for my pregnancy with Ewan was really great at accomplishing this same thing in the relatively short amount of time allotted for our visits together.

But we're in a very different place now, and I'm nearly halfway through this pregnancy. We know what kind of care we want, so seeking obstetric care is only a priority should something go awry.

Which brings me to my second point ...

2. My experiences at the doctor have led to a serious case of "white coat hypertension" and distrust.
Prior to dealing with my stomach issues five years ago, I had no problem going to the doctor. It didn't make me nervous in the least. I trusted my physicians implicitly and kept going back for my routine check-ups, or on the odd occasion that something didn't seem right.

The year that I spent dealing with my stomach issues changed all of that. I know there are good doctors out there -- great ones, even. I have seen some of them. But for the most part, I would have to describe the care I received over the course of that year as consistently mediocre. Not only were my health issues not resolved, I became frustrated and angry at how I was being treated, falling repeatedly through some fairly wide cracks and rifts in the system.

It is difficult to describe just how psychologically wearing this was on me. On top of being sick and exhausted, I wasn't getting the help I desperately needed and actively sought in order to get better. My quality of life was severely compromised. I felt dismissed and ignored, and there were many times I could tell that the guy with the stethoscope wasn't listening to me, but just ticking down the seconds until he could check me off his to-do list and get on to the next patient. I was pumped full of pharmaceuticals that weren't doing the job (and believe me, I said as much), but was instructed to keep taking them "just in case." Doctors that were working concurrently on my case routinely disagreed about the best approach to my care, and I got caught in the middle of the tug-of-war.

Since that year, I have absolutely hated going to the doctor, no matter the doctor and no matter the reason. I have no problem actually going when I know I need to go, whether it's for a routine check-up or I've got a medical issue that requires attention. But no matter how benign or routine the visit, I still become incredibly anxious.

Another result of this experience is that my capacity to trust doctors and the entire system of which they are a part eroded almost entirely. I am no longer willing to put up with the things I once patiently endured. Even when I know for sure I am seeing a good doctor and am able to reason with myself at length that I have no reason to be nervous (my OB from Washington being case in point), I will still get hypertensive. My heart will race, my blood pressure rise, and my breaths become short and shallow -- without fail (and all this before I even walk into the doctor's office).

I like being pregnant. Really!

I love being pregnant. I have no idea how many times I'll get to do this again, and I want to enjoy every blessed minute of it, aching hips and all. I want to be relaxed, and I want to receive the best possible care from an experienced provider. I would rather look forward to my prenatal visits than dread them. It's not only better for me, but for the child who depends on me, too.

When it comes to labor and delivery, I want to have someone there who I trust, not only with her level of expertise, but also with her demonstrated understanding of the sanctity of the event. After all, she's playing a key role in one of the most intimate and transforming life events that a person can experience. The last thing I want is it being reduced to anything less in the process. Like any good midwife, we will have an emergency hospital backup in place before I ever go into labor just in case things don't go as planned (and with this particular midwife, we have the added advantage that she has several years prior experience as an EMT). But in the more likely event that we do not require that backup, I look forward to having my next child in an atmosphere where I feel safe and relaxed, with a person who (by that time) I know well and who understands not only just about pregnancy and birth, but what James and I want and need from her in one of the most important events of our lives.

I know midwives aren't for everyone, and I know they aren't perfect, either. Like doctors, I am sure there are some less than stellar examples of the profession out there. It also should be said that I know a lot of women -- many friends, in fact -- who are more comfortable having their babies with an OB in a hospital setting and who certainly don't have the white coat issues that I experience at doctor's visits. More power to them, I say! Who am I to have a problem with it?

But when it comes to me, to the tiny sliver of universe I occupy and to the choices that are mine, I find that if I don't absolutely need it, the modern medical approach is almost certainly not the best for me. It produces in me too much anxiety and frustration to be good for my overall health, things that are especially important to avoid in pregnancy. My current midwife comes from a varied background, several years experience, and hasn't lost any moms or babies in her many years of attending births. I'm not sacrificing good prenatal care for the sake of an experience. I'm getting all the same scans, tests, and blood work that I would get if I were seeing an OB.

The truth is, I just feel a whole lot better about how I'm receiving those things. Like any expectant mom, my heart is in this. I've been through too much already to compromise on what I want, what is most important to me, and on what I'm convinced my family needs. For my own well-being and the well-being of my baby, I want and need someone alongside us for the journey who gets this, who practices her profession in a way that not only reassures me that she knows our hearts, but that hers is in it with us, too. 

Why We Chose Midwifery Care :: Part 2 of 3

Before I jump into the content of the current post, I'll add the same disclaimer up top that I included in the previous post:

When it comes to having selected a midwifery model of care for my pregnancies, I speak only from my own experience. I claim no expertise in the fields of midwifery or obstetrics, and make no claims to know what is best for each individual pregnant woman and her family. Recognizing that a variety of experiences and reasons inform a woman's choice of who will provide her with the best care, I have nothing against any person who chooses an obstetrical model of care for her pregnancy and birth. I believe every woman should choose the form of care which she is convinced will provide the best experience and outcomes for her and for her family. 

Read Part 1

* * * * *

By the time I had graduated from college and progressed into my mid-twenties, I had moved well beyond the childhood that was characterized by 7-Up, saltines, and long waits in the allergist's office waiting room. A six-year course of allergy shots through my junior high and high school years successfully did away with my severe allergies. I was eating healthy, exercising regularly, and taking vitamins. I had reached a point in my life where I felt vibrant and healthy, going to the doctor only for a routine yearly check-up.

July 2007

Early in the summer of 2006, I went to the doctor for a case of acid reflux. It didn't matter what I ate or when I ate it, or how many how much I consumed in the way of Tums, Pepto Bismol, or Rolaids. It was unrelenting. I went to my doctor, got a prescription for the acid reflux, and went on my way. The course of prescription treatment did its job -- for a little while. Within a few weeks, I was back in her office complaining of the same issue.

She prescribed the same course of treatment and since it had served me well in the past (this was not my first bout with acid reflux), and we thought we'd try it again. I took the sheet she had torn off her prescription pad, went to the pharmacy and had it filled. I took it gratefully, hoping I could experience relief in a few days. Instead of getting better however, it got worse. 

I went back again, explaining the latest round of meds had not only not worked, but that my symptoms had worsened. My stomach constantly hurt -- a burning, cramping hurt -- no matter what I ate or drank, or didn't eat or didn't drink. The pain was growing more persistent and more intense. New meds were added.

Over the course of the next several months, my symptoms continued to worsen. I continued to seek the help of my doctor, and other general practitioners as well -- not that I didn't trust my primary physician, but I thought perhaps a different perspective and a fresh set of eyes would help provide some insight into my condition. Over these months, prescriptions were added, dosages were modified, and my pain continued to worsen. The side effects of whatever I had increased. I was losing weight, suffering something with the rather unglamorous title of "leaky gut syndrome", a description apt enough that you can understand why I don't go into the details. My unexplained weight loss accelerated. Four pounds at first, then six, then nine. Then sixteen. Several months and six prescriptions later, and I wasn't any better. On top of that, I couldn't stay awake past six in the evening. My body was so fatigued. All the energy I once had was long gone.

One day, the pain was bad enough that I went to the ER. They put an IV in with a medication that helped me relax and relieved the pain I had. Though the nurses were incredibly caring and attentive, the doctor who saw me that day ended up charging me $600 for the sixty or so seconds of his time that it took him to write a prescription for vicodin (a drug that is notoriously hard on the stomach), and return to his very busy schedule.

I was finally referred to a specialist, another doctor who had a waiting list of several weeks. I went to his office and told him my symptoms, how long I had been dealing with them, and he proposed an endoscopy, a procedure in which a camera is fed down the esophagus and into the stomach so the doctor could see more specifically what might be going on in there. Finally -- someone was going to do some tests! Now we were getting somewhere. 

When I followed up with him for the results, he handed me a sheet of paper with pictures of my esophagus and stomach. The sheet said I had a hiatal hernia and gastric mucosal atrophy. Basically, my stomach was pushing up through my diaphragm, and the lining of my stomach was so damaged it had atrophied.

Would you like to treat this? he asked.

I was flabbergasted at the question. I thought it a ridiculous one, given the lengths I had gone to in seeking a solution, and how tired I was of dealing with stomach pain, unexplained weight loss, and more unpleasant symptoms than I could list. I answered him affirmatively and definitely. Of course I want to treat this, I replied. I'm miserable!

He said that basically he thought I had a "spastic" stomach that liked to squeeze a little too much, and then wrote me a low-dose prescription for an anti-depressant that he assured me would help the stomach to relax. With that, he whisked out of his office. Apparently, there was no time for questions -- for asking more specifics as to why I needed an anti-depressant for a gastrointestinal problem. I looked at the clock on the wall, hardly able to believe the blur of the visit that had just occurred. From the time the nurse had ushered me into the room and taken my blood pressure, to the time the doctor practically ran out the door was exactly four minutes. Four.

In the course of 8-10 months, I had seen five different physicians, taken seven different prescriptions (six of them concurrently), lost about thirty pounds by this point, still had no solutions, and was still in an incredible amount of pain. I was still obviously not healthy. On top of suffering with an unidentified and worsening condition, I felt like I was banging my head against a brick wall with the medical professionals whose help I sought. 

Frustrated, I sought a different form of treatment from a physician who had treated many people I knew personally. He came highly recommended. He was a naturopath. 

I went to his office and told him all of my story. And he listened. For a good thirty minutes, I sat opposite him in a blue velvet-covered chair and recounted the details of the previous ten or eleven months of gastric and medical misery I had endured. He took notes, asked clarifying questions. This was the first time in months I felt like someone was actually listening to me. At the end of it all, he rested his chin in his hand, and let out a hefty sigh. 

He affirmed what I already knew: whatever my condition was, it was not normal for a woman of my young age who, until that first bout with acid reflux, had been enjoying good health. He gave me an herbal intestinal repair complex, a natural supplement designed to help the stomach heal and repair the irritated and atrophied lining. He put me on an elimination diet -- a diet in which several potential problem-causing foods (e.g., sugar, alcohol, gluten, eggs, red meat, pork, dairy, etc.) are eliminated from the diet for three full weeks, the foods added back one at a time to see which foods specifically might be causing irritation. 

And he ordered extensive blood work. In the months and months I had been seeing doctors, this was the first time anyone had ordered blood work, the results of which showed that I was also severely anemic (my iron levels at about 25% of what they should be), had reduced thryoid function, reduced adrenal gland function, and a low red blood cell count. The elimination diet revealed an incredible sensitivity to gluten (e.g., anything made with wheat, kamut, spelt, barley, or rye) and to dairy. In addition to eliminating these things from my diet, I took supplements and treatments for my thyroid and adrenal glands. 

And over the course of just a few weeks of eating gluten- and dairy-free in conjunction with the supplements to get me back on track, my health improved considerably. I gained energy, and I had color back in my face. I could stay awake past six in the evening. My stomach no longer hurt, and I gained back about ten pounds. No more leaky gut! Follow-up blood work a few months later revealed things were back on course: my iron was normal, my red blood cell counts were healthy, my adrenal glands were functioning, and my thyroid was operating at optimal levels. I was healthy again!

Why We Chose Midwifery Care :: Part 1 of 3

When it comes to explaining how and why we chose a midwifery model of pregnancy and birthing care for our pregnancies, I have to go back in time a bit and share some stories with you. This series will be comprised of three parts. In Parts 1 and 2, I will describe two very different, but very important experiences I had going to various doctors. In Part 3, I will explain how these experiences changed how I think of modern medicine and the approaches used, and how it brings me to where I am today.

Before I do that, however, I will preclude the stories with a brief disclaimer:

When it comes to having selected a midwifery model of care for my pregnancies, I speak only from my own experience. I claim no expertise in the fields of midwifery or obstetrics, and make no claims to know what is best for each individual pregnant woman and her family. Recognizing that a variety of experiences and reasons inform a woman's choice of who will provide her with the best care, I have nothing against any person who chooses an obstetrical model of care for her pregnancy and birth. I believe every woman should choose the form of care which she is convinced will provide the best experience and outcomes for her and for her family. 

* * * * *

As a kid, I was in and out of the doctor. I was one of those kids who caught the flu bug pretty much every year and consequently spent at least two or three days at home on the couch with a glass of 7-Up and a big golden-colored Rubbermaid bowl nearby for those times when I just couldn't make it to the bathroom in time to get sick. An allergy sufferer, I knew waiting rooms well, and stick tests, shots, antibiotics, nose spray, inhalers, and being prescribed a daily course of multiple colorful medications. There is no doubt modern medicine helped me out of a compromised immune system and some of the most intense allergies our new local allergy specialist had ever seen. I needed medicine, and you had better believe I was grateful for it (and I still am).

7 years old

Fast forward a few years ... a senior in high school, I was on the way to Seattle for for a university preview weekend with some friends when we got in a pretty serious car accident. I was a backseat passenger and we hit another car going around 50 miles per hour. Though the car was totaled, we were all okay. The next morning, I woke up with an incredibly stiff neck, hardly able to move my head from left to right or back again without incredible pain. My mom made me an appointment with her chiropractor and my dad picked me up the next day and brought me home.

The chiropractor gave me a soft neck collar to wear and prescribed a frequent course of spinal adjustments and massage therapy to help with the soft tissue damage. It was severe enough that there was tingling in my arms and hands, numbness in my face, and a constant, throbbing pain at the back of my head like someone was repeatedly hitting me with a Louisville slugger. Though my tolerance for pain was fairly high, there were times it got to be more than I, or any dosage of ibuprofen could handle. At twice the recommended daily dosage, I was still in tears, unable to concentrate or to sleep. Though I put on a happy face in public, I was deeply miserable.

The chiropractor referred me to a neurologist to assess the extent of the soft tissue and nerve damage, and also for physical therapy. Like many specialists however, the neurology appointment came with a several weeks-long wait. So I continued going to the chiropractor (which helped me noticeably), getting twice weekly massages (which, sadly, are not as fun as they sound when dealing with that level of soft-tissue damage), and physical therapy appointments. These appointments came to comprise the whole of my after-school life.

After just a couple of weeks, I was obviously no longer able to manage the pain on my own, so I scheduled an appointment with our family doctor to discuss pain management and to see if there was anything else I could take to manage the pain -- at the very least, to help me sleep.

I told him about the accident, about the course of treatment I had already taken, and about how I was taking twice the daily recommended dosage of ibuprofen every day, and it wasn't even putting a dent in my pain.

I've got an idea, he said, smiling. If your neck is giving you problems, how about we just cut it off? He said it with a wry grin, obviously amused with his clever comment. But I was in no mood for the  particular brand of humor that involved amputation.

And for the pain, why don't you just take some ibuprofen?

While I was customarily patient and attentive with professionals whose help I was seeking, dealing with the unremitting and intense pain over the course of weeks had cut my patience short. I had no tolerance for his joke about "cutting it off." His instruction to take ibuprofen indicated to me that he really hadn't been listening attentively after all. I reminded him that in my account, I had shared that I was already at twice the recommended dosage (as published on the bottle), and that it wasn't putting a dent in my pain. I unashamedly and quickly added that while I was undergoing treatment to deal with the root of the problem, I was then and had been in a level of pain that was interfering with my studies, my activities, my relationships, and my sleep, and that I needed something more than ibuprofen if I was expected to function at all in my senior year of high school.

He was clearly taken aback by my impassioned reply. Though I cannot remember what he said in response, I remember walking away with prescriptions that would both help to manage the pain during the day, and that would help me to sleep at night. Given my childhood full of doctors offices and prescriptions, I was none too keen on taking drugs for much of anything unless, of course, they were absolutely needed. But these I knew I needed, and I took them gladly.

When I got home, my parents could hardly believe what he had said to me. The next day, my mom called the doctor's office and spoke with his nurse about what he had said to me, and how inappropriate it was to tell a girl who was obviously in a great deal of pain to just "cut it off" and to keep taking something that was not helping.

Well, she is going to a chiropractor, the nurse replied. The word "chiropractor" was dripping with obvious disapproval. And, she continued, informing my mother, The dosage of ibuprofen your daughter was taking is fine. It's not going to hurt her.

Yes, we are going to a chiropractor, and that is our option, my mom replied. And with how she was just treated in your office, is it any wonder?


Little did I know at the time that my frustration was not to end there.