Taking A Stand

     

    Our healthcare providers are supposed to be compassionate, trusting, knowledgeable, and understanding, but what do you do when you feel a void that leaves you feeling compromised? Like every field, customer service should be top-notch and efficient when interacting with patients. Every person wants the experience that they are genuinely cared for, receive individualized care, be heard. I have had some excellent experiences and more recently, some not so good experiences. It is necessary to self-advocate to ensure that open communication is maintained between yourself and the healthcare provider. Each person should have a supportive team in their lives that provides reassurance that your best interest is kept in mind. My team of health professionals has been amazing which made it difficult when I had my insurance company changed. Who likes change by the way? Change feels intimidating. Daunting. Inescapable. Unnecessary. However, some changes can be good. I tried to approach the change to my insurance changing with a positive attitude in 2020. My excellent OBGYN had just delivered my son in 2019 and I did not think anyone could replace her, but I had to brace myself for the change. I discovered that another facility in my area had a particular doctor that was well-received by many other Black females and was told that she was caring. Indeed, she was caring and I immediately made a connection with her that reassured me that this change was going to be well until I learned that she was leaving the practice. The inner voice screamed "No!" but my response was like Ruth to Naomi, "Where you go, I will follow!" Even in our first meeting, she made the initiation to set me up with an appointment to help me find a nutritionist that has deeply changed my life and 20lbs lighter. I was also assigned an endocrinologist to monitor my insulin more closely though I was not labeled a diabetic; but borderline. During the transition, I intended to switch; however, felt disappointed that I was temporarily "stuck" at the new provider due to insurance not being accepted now that she had moved on to another location. Again, I tried to embrace this change and though I was provided another replacement doctor, I thought that I would be in good hands. I received surprising news on August 1, that we would be expecting Baby #3! When a woman sees the two blue lines on the stick, her thoughts are not "I have tissue forming" but rather "I'm having a baby!" I instantly felt all of the emotions as the two lines stared back at me while hearing the cheers and jumping feet of my two little ones under five surrounding me and my husband smiling so tenderly, "I am going to be a father again!" It is amazing how one thought transpires into a million other thoughts, hopes, and dreams, that are also met with some uncertainties of "What if?" I had a miscarriage in 2018, so my mind reflected briefly on my traumatic experience. I quickly rejected that thought "what if" and whispered a prayer "God have your way!" I proceeded to go throughout my day by taking the children to the water park with a mommy friend and her children. I vowed to keep our secret between my husband and I, so I decided not to share this good news bubbling up on the inside. Each move I made, each meal I ate, each intention to drink more water, was also keeping in mind my "little secret." Eight weeks went by, and I had started committing to weekly prenatal exercises and low-cardio. Until one day, I noticed light bleeding. It went away, but I instantly started praying and pleading the blood of Jesus over our child. I stopped working out. The bleeding stopped. I was coming up on my eight-week ultrasound so I informed my practice about seeing the light blood, how it stopped, and I did not feel any pain. My doctor asked for me to come in earlier that morning. Due to COVID restrictions, my husband could not come with me, so I went alone. I was led down the long hallway to the ultrasound room where I laid back as the warm jelly was applied and there I saw the two little numbs where arms would form and two little numbs where the legs would be and the early formation of the head. I did not see tissue, I saw our baby. Every mom knows when something is not right. The ultrasound technician looked at me with horror. She remained silent until she offered the words, "Take care. Go ahead and get dressed and I will take you to see the doctor." What was happening? What is wrong with my baby? Filled with uncertainty, I got dressed and entered the next room, met by a doctor who offered routine words "I send my condolences. You saw the ultrasound and you do know right?" I was dumbfounded, "Know what?" "The fetus measurement did not line up with your eight-weeks and there was no heartbeat which tells me the fetus died at six weeks and stopped growing. Now you can choose one of three options today: let your body release the tissue, an office procedure (DNC), or you can take a pill that will help release the tissue. Which do you prefer?" This was not some question of whether I want a slice of chocolate cake, strawberry cupcake, or banana pudding? I needed time to process this. I needed answers. I wanted to scream, cry, shout, all at the same time. How could I be going through this a second time? This time I saw the baby on the screen unlike my first time when I bled out at home and miscarried before making it to the OBGYN. I just sat there. Unable to respond to her blank looks at me. She was waiting on my response. Finally, she broke the silence. I could have you to do a repeat ultrasound on next week to give you reassurance of what happened today. Some patients have found this peaceful to help with their decision but I do not want to give you false hope. Is this something you want to do? Yes. I gathered my items, checked out, and left. I sat in the car and cried. I got home and told my husband and he continued to speak faith. We will believe God to the end. I remembered how God had showed up so many times before. How He brought us our two miracles even when told we would not conceive. I thought of WHO GOD WAS, IS, and ALWAYS would be: A Miracle worker. We reached out to a few individuals who we knew would bombard heaven and stand in the gap believing God with us. We had crazy faith! Our friend in Chicago texted me a video of a woman's testimony of how there was no heartbeat, but her and her husband had three more ultrasounds, and then there was a heartbeat. I spoke, "God you are no respecter of persons, you are the same God! I believe!"

Our next appointment came, and to our disappointment and disbelief, we fought back the tears when it was reported "still no heartbeat." The doctor's response was "Are you ready to move forward now that you have reassurance of last week's report?" No sensitivity. I quickly said "No." Surely, she was only following routine procedures but not connecting with me as a patient, much less as a human, a woman who had just experienced the loss of her baby. Her response, "You know that you can not just keep the tissue inside." I sat across from her in her office and explained that I chose to wait for the natural release to happen on its own. That was the least invasive way. She scheduled me for another week to follow up. Within that next week, on September 16, my 36th birthday, the baby was released at home from my body. It startled me at first and I felt sad, hurt, and angry. I did not feel like celebrating. I kept wondering why me? I just laid in the bed. My friend called to check on me and was encouraging after sharing her story. Her words stuck to me "Your baby is with Jesus. The shell was inside of you that had to be released. You can't walk around carrying a dead corpse. More is coming after this." I did not want to think about another baby, I wanted that baby. I knew what she was saying made sense and that it was going to take some healing and time to process what happened. My body continued to go through the process and shed the rest of the lining. When returning for my follow-up, it was noticed that I still had some remaining parts left that would require taking the pill to finish the process. I was already feeling like a piece of meat mishandled and angry, why did the doctor need to check me more when I my body already felt violated. This irritated me more. While it could be seen that she was only trying to do her job, in that moment, I did not want an internal check while still shedding the remaining parts of my baby. She asked me to come one more time. This was like adding salt to wounds, rubbing it in, I just wanted this process to be over but it kept be stretched to one appointment after another. No personal calls to check on me. I was just a patient. The other doctor who had moved to another facility called to check on me and I explained what happened. I saw that as very touching and personal that though I was not even her patient, she took out time to check on me. She showed care.

Fast-forwarding, between the time of our loss up to now, we had a third miscarriage that happened early. After seeing another pair of two blue lines and receiving the official blood pregnancy test, I was skeptical this time. I wanted to be joyful, but I also battled fear. I prayed to God to help me cast out this fear and trust Him. The healthcare office called me to say "Congratulations! You are pregnant! We will schedule your 8-week-visit." Then the bloody nightmare began again. I just laid on the couch not wanting to eat and cried. My husband was able to console me. Why again? How often do we find ourselves being in this place where we do not have the answers. God reminds us to trust Him in the darkness. My favorite scripture Isaiah 41:10 "Do not be afraid or discourage, for the Lord my God is with me and holds my right hand." I needed Him to squeeze my right hand at that moment. 

A month later, I thought it was time for my papsmear since I was thinking they needed to be done every two years, in addition to wanting a blood lab workup to monitor my hormone level in hopes that we could try again. The nurse took my vitals and informed me that papsmears are only required every three years unless I really wanted it done that day. I quickly smiled and said, "Oh no, I can wait another year then! I don't even like papsmears so thank you for sharing that news!" She explained that the doctor would only perform a cervical check with her hand; therefore, she only put out gloves and lubricant for the doctor. I was not expecting a full papsmear or breast exam, so I was prepared in my mind only for cervical check. When the doctor came in, she did not address how I was feeling since my losses. She remained clinical and routine and told me that she would be doing a papsmear. I instantly told her that I did not need one since they needed to be done every three years as the nurse stated. The doctor responded that I needed one done under her even though I had it at my former location within two years. I did not feel comfortable. I instantly felt violated and disrespected. She proceeded to talk to me about family planning. I addressed my healthcare concerns with her, but continued to feel as a black woman, that I was dismissed and not taken seriously. Unfortunately, in America, black women are often dismissed when it comes to healthcare and fertility. There are many disparities that continue to exist. I had no idea that what I was experiencing would be apart of that same conversation that I knew about that happens to countless others. I let her continue with the papsmear, even though I did not want it. She was not even prepared which made my experience even more dreadful. She applied the speculum, left it there and then walked over to the counter where she gathered the remaining items that were not already laid out conveniently. Again, the nurse had not prepared it because I was not supposed to get one. I was beyond irritated. She tried to take my mind off by talking to me further but I was irritated that I was not being heard. She did not raise her voice, but it was obvious that she was not willing to understand me. She wanted me to go along with what she wanted by continuing to say "You understand right." She did not want to do the bloodwork because she stated that they were "expensive." I felt this was judgemental because she was trying to discourage me from wanting these tests. I kept self-advocating. After the third or fourth request when explaining that my friend was a holistic doctor and my endocrinologist also recommended that bloodwork be completed since my risk at miscarriage was the same percentage as someone with no insulin issues. She did not want to hear that part, but proceeded to tell me that my losses happened because I was "overweight and diabetic." First, any healthcare provider should not outright say that because they do not know 100% why the miscarriages occured. Even if weight and insulin are factors, it should not be stated as their opinion of "why." There are numerous factors and sometimes women have miscarriages unknown. 1 in 4 women experience miscarriages in the world. This is more common than often pointed out. What needs to change is how health professionals respond to women when they experience loss and also how black women are treated in regards to their health concerns. Finally, after not relenting to get my bloodwork, she agreed to provide three tests: Estradial, FSH, and progesterone. I did not know when certain tests should be given. Since she was the provider, it would have made more sense that she let me know which day to take the tests. The next day, the nurse called to ask me why did the provider give me the progesterone test one week after my last cycle because my results were low and would need to be done on Day 21 to be more accurate. However, the doctor put in my records that that number was normal even though it was not compared to the actual number ideal for conception. Women with fertility issues could experience something as small as needing maybe a progesterone pill or it might be something more complex, but most importantly it is helpful to get to the root. It is essential that as a woman, as a black woman, you have healthcare providers who rally around you, hear you, support you, and reassure you that together you will get to the root to the best of their ability. The ball was dropped at the healthcare provider I attended. I took a stand to let them know that they dropped the ball and continued to feel dismissed. I was told that I would be given a follow up to provide a resolution and in the meanwhile be put with another provider with better bedside manners. After submitting my formal letter, the only response was "sorry for your losses" we will put you with another doctor. Simply putting me with another doctor at the same practice is not the resolution. What about what I experienced with that former doctor? What would happen so that other women would not experience that? I was met by "What kind of resolution are you looking for?" I outlined in my letter reasonable resolutions that included an apology, reimbursement to my insurance for the papsmear that was not needed and the test that was given on the wrong date since I would need it again on my Day 21. I also encouraged that this behavior needed to be stopped and better experiences created for women that were like me.

I contemplated this entire experience and thought about why did I have to go through this? Then I concluded, perhaps some good can come from this. Romans 8:28 reminds us: "All things work together for the good for those who love the Lord." I did not like how I felt through all the changes that have transpired, but some good has come forth. Through the change, I was able to meet my nutritionist and encourage her through her own miscarriages that I experienced as she helped me with my health goals, I have been able to return back to my former provider after learning that my insurance is now accepted, and I have found my voice to stand up. I had trouble at first articulating how I felt inside. I just felt nervous and uncomfortable, but I could not let this just be swept under the rug. How many times have people had similar experiences met by implicit biases in the healthcare, education, or other fields? It is more than just looking at the color of one's skin, but offering compassionate care to all no matter what color or size they are. It is a matter of respect. It is a matter of compassion. It is a matter of humanity. 

Since having this negative experience, I can truly appreciate all of my positive healthcare experiences. When I returned to my former provider, it felt like I was home. I knew I was more than a number. I received compassionate care and felt listened to. There are still good healthcare providers out there. It is important to find those that are on your side and have the best fit. It is unfortunate for those who may not be able to speak up and may have to remain with uncaring providers. It is unfortunate for the woman who may have suffered from depression and guilt already and then be met with the losses occurring because of her weight and diabetes. Words are powerful and should be used selectively.

Whether I see the change that will come from this experience or not. I know that I am forever changed. I have learned to embrace change, the changed that has changed me inside out. I have chosen to release my anger towards that provider and I pray that God will help her treat others better. I pray that across the world more healthcare providers will commit to check their implicit biases and commit to provide genuine care to help each person that walks through their office feel more than just a number. Be willing to take a stand no matter what you face.