serendipity and diagnosis

it’s always funny to think about the string of events that get you to a certain place in your life–how the decisions you make sometimes seem arbitrary when you’re making them, and then of course how, looking back, how could you have done it any other way?  in my life, the little decisions are sometimes annoyingly hard–what to wear, where to go for dinner–not so much because i agonize over the right choice; rather, i am just so damned easily pleased.  anything is great—really!  the big decisions in my life though are easily made, straight from the gut, whether or not i can articulate at the time why i’m choosing what i choose.  i often feel compelled a certain way, and i’ve learned that if i answer that call, i am rewarded in one way or another.  this is always more complicated when other people are involved, but if i go with my gut, i win.

a year and a half ago, i contacted two midwives about working with them in preceptorship.  one option meant that, while working with people i knew and admired, i would most likely be living in a tent or a no-power-no-running-water rv on land local to the rural birth center.  the survivalist part of me was totally stoked about the capacity for adventure, but the realistic part of me knew that it would mean a sweaty summer and freezing winter.  when it looked like that option wouldn’t pan out for a number of reasons, i contacted a local midwife in alabama about working with her.  i didn’t know her, but another bama midwife had sung her praises and based on the crystal-ball-that-is-facebook, she and i seemed very much alike in beliefs and attitudes.  also, my dad lived close enough to her that i could crash for a year and make the small commute.  my only stresses were that i would be working illegally, since midwifery is not kosher in crapabama, that i would go broke paying for gas, and that it would mean i’d be away from stephen for a year or more.

these worries are all huge things, but my gut told me to press on.

and then came the twist:  i got an email from donna weeks later saying that she’d decided to take a position for a year at a birth center in india.  my first thought was “great, when do we leave??” and my second thought was “holy shit—india??  what happened to my neat little alabama plan??”

the next few months were a wild ride:  breaking my hair-brained idea to stephen, making the decision, telling the fam, meeting with donna on my two-week vacation to visit folks in bama, planning what the next year would look like, figuring out strategies for making and saving money, learning about living in india–and all this on a gut instinct and a prayer, as it took the director of the birth center 6 months to answer my email about coming with donna.  somehow, i just knew this was where i needed to be.  i even knew it when, months later, the director told me she didn’t know if a student would be a good fit.  for some reason, i was utterly undaunted and continued to be compelled forward.

another aspect of the trip that might have dissuaded me but didn’t was the volume of the birth center where i’m working.  1-3 births a month was given as an estimate (i have about two and a half years to get through 55) and so far, in 3 months, i’ve attended 5, so right on the slow-poke-money.  the low volume didn’t dissuade me though–i felt like there was something else i needed from india.

when i got here, the beginning inkling of what i came for (besides birth work and an awesome cultural experience) became clear.  in india, i could begin to reclaim my health and, hopefully, my fertility.  i drastically altered the way i eat, giving up meat, cutting way way back on wheat and dairy, and putting my focus squarely on whole foods, loading in the fresh jungle fruit to assuage my sweet tooth.  i was thrust into both movement and hydration, as work is a kilometer from the house and anything less than 2-3 liters of water a day leaves you wrung-out-dry through profuse sweating.

in short, it became easy (or at least necessary) to do those things that i should have been doing anyway but hadn’t been great at in my life in both alabama and maine.

as the pounds started falling off, i contemplated what medical testing i should be doing while here to try and get a handle on why i hadn’t gotten pregnant in almost two years of trying and another two of not-trying-but-not-trying-too-hard-to-not-try.  i hadn’t been able to afford care in the states, but in india, a “referral” is a very loosely defined thing–just about anyone can order a test–and testing is all quite cheap.  i started with progesterone testing and got a pretty abysmal result–too low for ovulation.

after that, work at the center picked up and i forgot for a while about my plans for more testing.  it was also kind of frustrating that i was shooting in the dark–it could literally be one of dozens of things, some of which show up on tests and some of which don’t.  so that dropped off the radar for a bit, though i continued to focus on my health.

fast forward to last week.  in order to demonstrate a proficiency in a huge litany of care-related skills, my fellow student (and the heart, soul, sweat, and tears of the center) priyanka and i have to do role plays, demos, etc. to show that we know our skills.  it had been a long time since our last class, which had been on well-woman intake and physical exams, and we still needed to finish up–i had done priyanka’s and she still needed to do mine.

usually the way to go in these role play scenarios is to make up a persona with a certain set of problems in order to test the person whose mock-interviewing and examining you.  luckily, my story and history is interesting enough that i just decided to use it–i went with my real story and my real problems for the demo.  at the end of my exam and my intake, priyanka said “i want you to go for a scan for pcod” (pcos in the states, polycystic ovarian syndrome) and then added a clarifying “no, really” to make sure i knew she meant it and wasn’t just saying it in the context of our mock appointment.  i don’t have the big symptoms of pcos (overgrowth of body hair, male pattern baldness, and adult acne related to high androgen levels, diabetic tendencies shown though high blood sugar or the apple-shaped “diabetic build,” or irregular and infrequent periods caused by wacky hormone levels and anovulation).  i am obese, have a history of mood swings (that my husband insists i deserve an oscar for hiding), and my libido has literally evaporated in the last few years, but these things could be related to anything—hell, just being fat could cause the other two.  so i don’t have the symptoms, but i do trust a midwife’s intuition, so i said yes to the scan.

the next day, i hopped into an auto and paid a visit to amma scans in panampilly nagar, our local shopping-food-coffee-bookstore hangout.  i didn’t need a $200 doctor’s office visit for a referral–the center just called ahead and let them know i was coming, same day.  i didn’t have to book an appointment a month in advance, i didn’t need insurance, and i didn’t need the $400 fee of most ultrasound clinics in the states.  it cost me $17.  seventeen-frikkin-dollars.

i waited in the lobby at amma for around an hour as the patients in line in front of me went in for various scans.  some were pregnant, and some, swooning in their chairs in the stifling heat of the office as younger and more able-bodied family members swabbed foreheads, were there for less happy reasons.  the wall-mounted tv played malayalam music videos, and the place had an oddly run-down-1950s look to it.

when they called my name, i went back to my room, chucking my shoes at the door like folks had done before me (observation skills really are key to at least feigning cultural competence). the low-lit room was run-down with ramshackle furniture and a hole in the ceiling, but the equipment was all shiny and new, with that round-edged gray and beige plastic look that you see on machines that go “ping!” in the states.  there were two women in the room–one spoke no english and was simply there to type things like “aby lucka” into the scan machine, and another (the doctor’s right hand) spoke enough for some good conversation about us, our lives, and our home places.

then, in came the doc.  not a radiologist or a lab tech–an honest to god doctor.  how amazing is that?  we chatted for a brief moment about why i was in for a scan.  i said checking for pcod and also doing a quick look for anything else that might be problematic (cervical problems, fibroids, cysts, etc.).  so after months and months of dousing women in cold ultrasound goo, i was the one on the table for a change.  the doc turned the screen around toward me so i could see what he was seeing with his probe–an interesting change of pace for someone used to practitioners who involve the patient very little.

and there it was.  my uterus.  perfectly uterus-shaped.  no masses.  no fibroids.  no wonkiness.  hooray!  next i thought he’d be looking for ovaries, but he hung up the probe and said “now we’ll look at the ovaries with a transvaginal scan.”  good thing i’m a student midwife, i thought–otherwise this my really freak me out!  as it is, i’m always interested to experience the things that i might be referring clients for one day, so there was one more thing i could check off my list. (it’s great to be able to say “i’ve done it–it’s no big deal!” when a client is afraid or apprehensive).

transvaginal ultrasound uses a small wand probe (avec strangely condom-like cover) to view the ovaries through the walls of the vaginal vault, in what’s known as the fornix (basically the roomier pocket that surrounds the cervix).  the ovaries are much closer to the vaginal vault than they are to the surface of the skin (especially in big guhs like me) so the picture you get is much clearer.

so transvaginal ultrasound turned out to be no big deal, although pressure on one’s cervix and in one’s fornix is odd and a little uncomfortable.  all was a blurr on the little screen until the doc found my first ovary.  then all was a blurr for another reason entirely.

my ovary looked like swiss cheese.  full of a dozen or so pockets of fluid created by multiple egg follicles developing but never ripening for ovulation.  i felt dizzy looking at the screen.  the doc took a snapshot and measured the ovaries and follicles and said “you have pcod–you should do something about this.”  then he went to the other side–the right ovary looked the same–like some halved cosmic cherimoya.  the dizzy sensation came back as he clicked the shot still and i saw my innards laid bare in black and white.  all those little eggs that couldn’t.

i felt like crying, but i couldn’t decipher whether it was a happy cry or a sad cry.  sad that i had a problem; happy that, for $17, i finally had a diagnosis.  i re-pantsed myself and went back out into the waiting room while my scan results were being printed up.  i felt like i was in a daze.  i had no outward symptoms of pcos, i would never have been able to afford this test in the states, i wouldn’t have gotten a diagnosis from the radiologist in the states, only from the doctor on my second expensive trip in–in short, this is something i wouldn’t have known without a LOT of money and heartache or may never have known at all.

it boggles the mind to think about the ways in which “going with your gut” can change your life.  coming to india despite huge odds has resulted in the fertility answers i so desperately wanted but could never get in the states.  being here now means that, armed with this information and the result of around $20 worth of additional blood work, i can go to a specialist (…SEVEN DOLLAR APPOINTMENT…) and get a game plan started.  since all drugs are cheap and otc here, it also means that i can go home with things like clomid, in case i need to bring out the big guns later.

so what does pcos mean for me?  well, in a nutshell, it means that pregnancy will be hard to achieve (had already guessed that) and i’ll be 2-4 times as likely as the average momma to have an early miscarriage.  i won’t go into the gory details, but insulin and some of the ovulation-related hormones are to blame.  pcos has no cure and is pretty mysterious, but i’m lucky to have completely missed some of the other possible symptoms like male-pattern baldness, hirsutism, adult acne, and wildly wonky and unpredictable periods.  because pcos is a syndrome, not a disease, the clinical presentation can really vary from person to person.  in all areas but pregnancy, i guess i can really count myself lucky.

management looks incredibly oddly like what i’ve already been doing since i came to india:  dietary changes (removal of meat and other hormone-laden foods, greater inclusion of whole foods like fresh fruit/veg, limited sugar, elimination or at least reduction of gluten), hydration, exercise, and weight loss (which is both harder for those with pcos and also essential for management).  when i get back to the states, i’ll be investigating some other herbal and supplementation routes as well.

if none of this works, then it’s clomid time (hello twins!  eeeek!)

so that’s that.  i knew that i’d come to india to pick some things up and leave others behind, but i had no real specifics about that picture until now.  i knew that my health and fertility were deeply tied to me coming here, and now i feel a little less crazy and a lot more justified in my choice to go with my gut.

updates next week after the visit to the doc.

onwards!

to be continued…

all-call

it’s kind of an odd thing, blogging.  like having a giant one-sided conversation–throwing your voice out into the ether, not knowing who’s listening or what they would say back if they could.  so tell me if you’re there, and (for a change) you tell me something i don’t know about you 🙂 leave me a comment or message so i’ll know who you folks all are.  as it is, i just see the 50-ish of y’all as country-by-country stats.  i think it will help me write if i know who i’m writing to–or maybe it will just help me feel less lonely way over here on the other side of the earth ❤

houston in the blind, this is abs–can you hear me? …

durga puja!

**see pics on facebook in my “monsoon 2013” album–wordpress is being mean and not cooperating my my visuals at the mo

those of you who know me well know that i am a huge devotee of the-goddess-in-all-her-forms, and one of the interesting things about hinduism is that it’s one of the only religions whose modern practice includes goddess worship.  there are many goddesses in hinduism, and rather than being a set hierarchical pantheon, the gods and goddesses revered sort of shift from place to place–here krishna is supreme, there it’s vishnu, etc.  before i left for india, i had high hopes of being able to attend durga puja somewhere in the north.  this four-day holiday (or more, depending on where you are) honors the goddess durga, who, technically speaking was one BAMF.

the story goes that a buffalo demon named mahishasura made the decision to do penance and become a reformed…umm…buffalo.  as a reward for his penance, the god shiva granted him a great blessing–no man could kill him (where’s eowyn when you need her?).  this power appealed to mahishasura’s core demonic nature, and he soon began using his new-found near invincibility to terrorize the neighborhood.  shit got real, though, when he killed some gods.  because they’d essentially shot themselves in the foot by blessing mahishasura with invincibility, the gods had to put together a new plan:  durga.  vishnu, brahma, and shiva combined all of their power together in the form of a many armed (and really fucking angry) goddess named durga.  a woman, so the blessing had gone, was the only person who could kill the demon.  her many hands were filled with a trident, a disc, a conch and noose, a sword and shield, a thunderbolt, a spear, arrows, and an axe.  they also gave her armor and a lion for good measure, ya know.  angry mamma durga then went to battle with mahishasura and killed him with, not one, but ALL of her weapons, one after the other.  done and done.

durga has a long history of worship in northern india, but she experienced a special sort of revival in the 20th century as a powerful symbol of the many parts of india rising up together against the umbrella-carrying, tea-swilling, be-monacled demonic water buffalo known as england.  invading countries should never underestimate the power of an angry momma.

so durga puja is a time to honor and worship the goddess, and like i said, it’s mostly celebrated in the north.  well, turns out that there’s a large enclave of west bengali folks living here in kochi, so i got to attend a durga puja after all!  it was held in a community hall made larger by the addition of lashed poles, tarps, and wall-hangings.  the outside of the hall was a festival of flashing colored lights (a favorite holiday decor here), and the inside featured space for participants and a stage area where incredibly lavish, ornate statues of durga, her consort shiva, and her children ganesha, lakshmi, saraswati, and kartikeya stood covered in garlands of flowers and lost in swirls of smoke offerings.  the statues for puja are made new each year, worshiped in public ceremonies, processed through town, and then destroyed.

we got to the venue a little early, so there weren’t many folks there yet.  the floor was a thin roll of red felt over a foundation of wet mud, so there was much squishing of bare feet and a little trepidation over the number of electrical cords resting in or near puddles of water.   on the stage with the statues were two priests–they appeared to be one junior and one senior–and near the stage, other devotees were busy lighting large ceramic chalices full of dried coconut husks and incense.  the fires were fanned into great columns of smoke, and as the other puja-goers filled up the ground, the thick white smoke choked out the air.  the scent was sweet, but i was thankful for the large fans that kept some of the air moving.

as the ceremony started, drummers began to play frenzied and discordant rhythms and devotees picked up the great smoking chalices to begin their ecstatic dance on the wet floor at the foot of the stage.  the senior priest began ringing a handbell (which he did for the long duration of the ceremony), dancing, and worshiping the idols with a flaming oil lamp in hand.  he danced in front of each of the statues (durga, her consort, her children, and one vegetative statue representing mother nature) in succession, worshiping and holding sometimes oil lamps, sometimes incense.

over the course of about thirty minutes, the venue became shoulder-to-shoulder standing room only and the air was sapped by the thick billowing smoke.  everyone was pouring sweat.  every so often, a man came through the crowd with the priest’s oil lamp held high.  everyone reached out and ran their hands through the flames and then touched their hearts or heads, taking in the consecrated flame of the goddess durga.

at the height of the ceremony, drummers were wild and loud, and the three or four devotee dancers were pouring sweat, balancing chalices, and moving ecstatically in the little bit of space left in the tent.  frenzy, mamma.

we decided to beat the mass exodus and squeezed through the crowd before the last of the ceremony.  with the help of a few friendly worshipers, we managed to find our shoes in the under-foot sandal horde and made our way out into the fresh air.

jai maa durga!

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on friday of last week, we celebrated another part of the festivities: a rite called ayudha puja (“worship of instruments”).  during ayudha puja, warriors venerate their weapons and artisans or skilled tradespeople worship the tools of their trade.  the idea is that you’re honoring the tools for the service that they’ve done for you, and you’re recognizing the divine power that lets your tools do their jobs well.  the puja is generally associated with saraswati, goddess of literature, wisdom, and the arts, but there are no rules or restictions–we have an impressionist iron crucifix at the center, so we offered ayudha puja to jesus instead.  love the ability to add improv into religion in india!

all of our midwifery tools were brought to a table downstairs.  we covered them with flowers, lit incense, made an offering of bananas, puffed rice, avan (flat rice), raisins, and kalkandam (sugar crystals), and gave thanks (the statue of jesus presided, but there was a “to whom it may concern…” attitude) for our trusty tools of midwifery–everything from the dopplers that let us hear heart tones to the calculators that help us keep the books afloat.  puja is kept friday through monday morning–strangely enough, we didn’t have any births over the weekend, and our (puja-ed?) tools were put away this morning, ready to once again to their jobs with the blessings of the gods 🙂

to see christians, hindus, and pagans praying/reflecting side by side at the same altar…. can’t say that i’ve ever seen anything like it in the states 🙂

to be continued…