Thoughtful Thursday: Patient

September 17, 2009

Thoughtful ThursdayInfertility has tried my patience, and it has made me more patient, but that’s not the kind of patient I mean.

What kind of patient are you? How has infertility changed that?

In all realms of life, I straddle a line between following directions and thinking for myself. My rejection of directions is usually based on some combination of logic, my own research, my assessment of the validity of the directions, and doing what I feel like.

This certainly applies to health care. For example, after I had my wisdom teeth removed, I followed all of the instructions for cleaning the extraction sites, but I completely ignored the prescription for narcotics. After the day of surgery, I didn’t even take any Advil.

During infertility treatments, I almost always followed directions to the letter, except when I thought they didn’t matter. For instance, when I was told not to eat after midnight prior to IVF #2 retrieval, I bumped back the time on my own because my retrieval was scheduled for late morning. I know the purpose of being NPO, and I also know that the midnight instruction is the same whether the surgery is at 6 a.m. or 11 a.m. If six hours of fasting is enough for an early morning appointment, then it should be enough for a late morning appointment, in which case eating something at 4 a.m. is fine.

My most egregious case of ignoring doctor’s orders occurred during the infamous IUI #7, in which we didn’t bother to have sex in addition to the IUI because in my mind the whole cycle was pointless anyway. Result: currently 31w2d pregnant with twins.

As a pregnant woman, I have been amazingly dutiful. I have followed doctors’ and books’ recommendations as much as possible (as a vegetarian, 100 grams of protein requires a lot of work but is feasible, but 150 or 200 grams just doesn’t happen no matter how hard I try). When advice has conflicted, I’ve evaluated the relative merits and acted on what seemed to be the most prudent course of action.

And then my cervix started shortening and I was put on bedrest. I followed bedrest instructions to the letter (didn’t go anywhere outside the house except the doctor, didn’t sit up for more than 15 minutes at a time for meals, etc.).

And then I went into preterm labor and I was admitted to the hospital.

This whole time, doctors have remarked on what a “good bedrester” I was and continue to be. They tell me how some other patients interpret bedrest as cutting down on housework or being quicker about grocery shopping. When DH said to the head perinatologist that a high-activity day on bedrest for me meant that I went up the stairs once to go to the kitchen, she laughed.

They’ve been pleased, and a little bewildered, at my openness to staying in the hospital as long as they deem medically necessary. They talk about patients fighting to be discharged — particularly those with other children at home, or those whose husbands are incompetent/unwilling with housework. When I told DH about the latter, he got a little defensive and said, “You told them I’m not like that, right? That I’m not one of those husbands?” I certainly couldn’t manage total inactivity without his constant help.

Doctors and nurses have remarked on my cheerfulness, and one doctor makes fun of me for being so cheerful. They applaud my wisdom when I give them my stock explanation for my compliance and good attitude: Better here than in the NICU.

How did I get to the point of winning some sort of Best Patient award? Sure, I try to maintain perspective in everything I do. But in this case, I’m a model preterm labor patient because I dealt with seven years of infertility, and because I read infertility and loss blogs. It took a hell of a lot of time, money, and work to get this far. The stakes are clearly higher for me than they are for the patients down the hall that the nurses roll their eyes about, the ones who are still smoking (WTF?). Because of the heartache of my bloggy friends, I know that not all babies turn out fine, and I know that some babies die. Often there’s nothing that the woman or anyone else could have done — but if there’s anything I can do to help these babies make it into the world safely? You’d better believe I’ll do it.

What kind of patient are you? How has infertility changed that?

45 Responses to “Thoughtful Thursday: Patient”

  1. Shinejil Says:

    I’m definitely better educated and more likely to question (politely) what I’m being told if it sounds strange to me. I’m also, like you, far more likely to follow directions very, very carefully if I know the stakes are high.

  2. ^WiseGuy^ Says:

    Oh I completely agree with what your doctor’s take on some women’s idea of bed rest….one of my mother’s patient had a threatened miscarriage, and my mother had her placed on strict bedrest…unfortunately the pregnancy was lost a couple of days later, because the woman on ‘feeling better’, took a long stroll to someplace with her MIL. Or the time when a patient begged my mother to advise hospital bed rest because it would just not remain feasible to do so at home…..

    What kind of patient are you? How has infertility changed that?

    Let’s just say that ummm…I am not a patient kind of a patient…I am not cranky but the prospect of injections and lots of swallowables always soured my good spirits…I think I have given my mother a hard time whenever I needed to get a injection…

    Infertility has made me more tolerant of these pricks and medicine business. I have become more pliable to receiving shots. And I have developed the fine art of choosing the less awful of the evils – syrups or tablets.

    Umm…I tend to be completely on the mark with my medicines and schedules…for e.g. in the recent Clomid five dayer… barring one day I did not mess up even once the time of swallowing the pill.

    Similarly, as I have mentioned before I had to be a on a six months Anti-Koch’s treatment..and it had its own routine..plus, I did not miss even one dose! Not even one…no matter whether I was at home or out or travelling or anything…not even one! (it is necessary to not miss any dose).

    My crankiness has gone down.

    I have become more tolerant.

    And I have found strategies to deal with approaching syringes.

  3. ^WiseGuy^ Says:

    Oy….I now torture Dr. Google with all compositions I enter into my body.


  4. Hmm, well… usually I wait to long to go see a doctor when I’m not feeling well / something’s wrong with me. So it also took me a while before seeing one about IF.

    During IF treatments, I followed all orders to the letter. Sometimes this would stress me out completely, because I was sure something would go wrong when injecting myself and the stuff wouldn’t work properly (it always went fine – but the warnings in the instructions didn’t help bringing the stress level down).

    Especially during the first trimester of my pregnancy I was a model patient and very concerned about not eating anything that might give me toxoplasmosis, listeria, etc. (going out to dinner was no fun anymore – too much raw-milk, red meat etc.). I became more relaxed later and actually hubby accused me many times of doing too much. At the 8th month checkup my OBGYN agreed and ordered me to stop working. Which I did (she scared me by saying the baby might be born at 33 weeks – he came at almost 42!) and from then on I did spent an awful lot of time in the hammock (not complaining).

    Apart from all that, I’ve become an expert in peeing in a cup, sticking needles in my belly, get blood drawn, knowing how much water to drink to have a full, but not too full bladder, and in waiting…

  5. a Says:

    I’m not an ideal patient – I think for myself, and I make decisions based on logic and doctors’ advice. I guess I’m a slightly better patient than I used to be, because I don’t think I visited a doctor more than once between the ages of 18 and 30.

  6. Heather Says:

    I’ve become a much better patient than I used to be. I used to be petrified of getting bloodwork done. Now I tell phlebotomists which of my veins are the best and don’t even flinch.

    The only thing I had a hard time about bedrest at the hospital was when they wouldn’t let me get out of bed to relieve myself. I never got the hang of using a bedpan. I was quite happy when they said I could at least use the bathroom. Other than that, I was quite content to eat and sleep.

    Wishing you continued luck on bedrest. My twins were born in May at a little over 31 weeks. They are now almost 16 weeks and weigh over 15 and 12 pounds! I can’t wait to go home from work today to shower them with kisses!

  7. BB Says:

    I strongly believe in being safe than sorry (yes, something are beyond anyones control), but I do not need to try to be brave about something silly and risk what is so precious!

    Anyhow, I really admire your patience and you give me a lot of hope! I feel like this strong determination of yours is defnitely going to help you from not having to visit the NICU!

  8. Mel Says:

    I think I’m in the rather safe than sorry camp. I tend to follow directions and am a rule-follower in all other aspects of life. Because I am too creative with the what ifs.

  9. jill Says:

    Almost my entire adult life with doctors has been dealing with IF. I have never been pregnant and I have never done any medicated fertility treatments so I haven’t had to get used to needles or taking much medication. I have an irrational fear of needles so I think if I did do IUI or IVF I would need to get over that, and quickly. (my fear of needles has nothing to do with why I have not and will not be doing IUI and IVF)

    I have noticed that IF (and a couple other experiences) has caused me to not trust doctors at all. I have very little hope that going to a doctor will ever help me. They can’t find anything wrong and all testing seems to come up with nothing so I never get any information from doctors. Every single one has told me (without doing any testing) that I can’t get pregnant because I am overweight and I’m so very sick of hearing that. sigh

    This is not to say that if I did miraculously become pregnant that I wouldn’t bother going to the doctor. I think I would be so afraid of doing something wrong and ruining my one chance that I would do everything they told me to do (mixed with much research of my own), to the letter.

  10. Cass Says:

    I am now an annoying ask 123891470923847 questions patient. I have actually had doctors ASK me to find a new doctor. Now my first words are usually “I am a HIGH MAINTENANCE patient and expected to be treated as such”.

  11. Wishing4One Says:

    I have followed all the directions/insrtuctions when it comes to my IVF trials, as I am too scared not to. Not to say if something doesn’t sound right or I don’t understand it, I question it indeed. I admire you for your stellar patience and in being such a good cheerful patient. I agree, who wouldn’t do all they can after dealing with IF for so long! No NICU for you God Willing. xoxoxoxo

  12. Elana Kahn Says:

    I am totally impatient. Infertility made me even more impatient than I already was. lol I can’t stand waiting for things and if you had told me when I got married that it would take me 2 years to get pregnant, I would’ve gone into my bedroom, cried and not come out for 2 years. I would’ve said “wake me up when I’m pregnant”. lol

  13. Sarah Says:

    I think that I have been on the model paitient side the whole time. I have been downright cheerful, no matter what the situation ahs been. Recently, with the failure of my last IVF, I’m feeling the strain. So…I’m sure that when we do our next thing, whatever it is, I’ll probably be a good little soldier, but at the moment, I’m not feeling it.

  14. Kristin Says:

    I am a highly educated patient. I always research things and I don’t take things the doctors say at face value. I am not afraid to advocate for myself or my loved ones with doctors.

    Infertility has made me even more aware of the fragility of life and, I am more willing to stop and appreciate the small things. I am also more willing to listen to the doctor if there is a valid reason given for an instruction or treatment.

  15. Julie Says:

    Hmmm good question. I tend maybe to not follow all the “doctor’s” orders for this or that but if hubby hears them he’ll try to be the enforcer or if it’s really important then I’m more the “good” patient.

    I didn’t ask too many ?s in the beginning of IF – followed the general instructions but, like you mentioned, not to a T – the cycle that worked we may have DTD one time after the IUI and not even that night. I did tone down my activities that had a risk of injury when doing the injectibles (had this crazy notion of busting an enlarged overy open if I crashed on my bike or something)

    Early pregnancy did follow a little better (again with hubby as the pregnancy hawk) When couch-arrest happened at first I wasn’t such a model patient as I wasn’t entirely convinced it was necessary. I didn’t go out for long walks or such but I’d get up a lot and not watch how much I was sitting up, etc….. I think if I had been exposed to the ALI blogworld I would have taken things on a more serious note.

  16. staciet Says:

    Interesting question yet again…

    Let’s see. For me, I’d say I am pretty informed on most things. I follow the doctor suggestions and/or treatments as long as I feel the reason behind the treatment warrants my compliance. I expect explanations that satisfy my questions. I expect that my doctors will listen to what I say and what my thoughts are on a treatment. I expect to be treated as a thinking, informed person who is her own advocate–not as someone who is meek and will follow the doctor’s orders simply because he/she is a doctor. I have learned that doctors are not gods who must be worshiped instead of people. (oh boy have I learned that!)

    So, I guess the biggest change for me is my ability to be direct with a doctor and my expectation that he/she is the same right back. I was nothing like this new me in the beginning of my treatments.

  17. staciet Says:

    Ugh. I sound like a real winning patient! I bet they just fight over who gets to treat me. ;-)

  18. babysmiling Says:

    @Staciet: One of the docs in my first RE’s office described me as “appropriately involved in your own treatment.” He made a horrible face and nearly choked on the word “appropriately.”

  19. Lavender Luz Says:

    I walk the same obedience/thinking line that you do.

    The main thing IF treatments did for me is make me braver. I’m not quite as much of a wussy girl about procedures, because I have been through what was, at one time, my greatest fear.

  20. Carrie Says:

    I think my doctors would describe me as fretful, worried about the worst-case-scenario and generally obsessive. For this reason, I choose to seek out the best doctors I can find in any given field be it reproductive endocrinology or maternal fetal medicine.

    Once I am in the hands of someone I truly trust and have thoroughly researched, I follow directions (with a small amount of questioning) and do as I am told. I bring my own research and questions to each appointment, but I trust their decisions for the most part. I take my meds on time, follow the guidelines for various degrees of bed rest and am always on time for my appointments.

    What infertility has taught me is that the three boys inside are a miracle. It is mostly out of complete fear that the babies will not make their much-anticipated entrance into the world that I so strictly follow orders. I will incubate as a good triplet mommy should without (too much) complaint because I know the loss of pregnancies and the feeling of not being able to get pregnant. What is inside me is the most precious cargo I will carry again and dammit, I am going to be a compliant patient.

    Who ever knew the most important order to follow would be to not DO anything?

  21. Cat Says:

    I ask a lot more questions now, both during my appts and calling between appts. I’m also more educated than I used to be, though that’s pretty much just about fertility and childbirth, I’ve realized that I’m clueless about things like diapers and related rashes. Of the two, I much prefer knowing as much as possible about what’s going on.

  22. ^WiseGuy^ Says:

    the infamous IUI #7, in which we didn’t bother to have sex in addition to the IUI because in my mind the whole cycle was pointless anyway

    Have you ever wondered what was SO RIGHT this time?

  23. samcy Says:

    I think I bounce back better as a patient now because of infertility. I remember with my first lap I was a complete woes, but now I handle better.

    xxx

  24. strongblonde Says:

    lol. i think about this a lot. i’m not sure i’m the greatest patient to begin with considering i work in healthcare….but i think that infertility has made me more…um…proactive. or maybe crazy is the word? :)

    i had to go to triage this weekend and actually yelled “get out” to one of the doctors. he was in the wrong room. we were all laughing about it. the midwife was making me want to stab her….i just wanted him out. i’m quite sure i would not have even considered that 3 years ago!

  25. Shelby Says:

    Well, considering that I have had a lot of practice being a patient because of infertility, I’d like to think I’m a seasoned veteran. And like you, infertility and being on the blogosphere has made me more aware of the what can happen. In that sense, I will let them saw me in half if it means a healthy baby. Heck, I’ve already gone this far, what’s more scarifice when we’re already so close? I suspect I too would be a hospital’s dream and not because of my sparkling personality. :)

  26. Cara Says:

    I have to say that loss made me into a more belidgerant patient. Sad but true. I felt so let down by my doctor and his subsquent actions that I had to take total control.

    I walk in now, even as a parent advocating for my child, telling them what I already suspect / know to be true and what I’d like them to try / do about it.

    Brazen – I know, but I just can’t take any chances.

  27. birdless Says:

    I think if I were in your shoes I would try my best to do what you are doing, although I think it must be hard. I would try to follow orders but also use common sense and follow all that with a lot of googling and asking questions, because that is just what I do! I need to always know what is going on and why. It’s so hard to give up control.

  28. Photogrl Says:

    IF and loss have changed the patient I am.

    No doubt.

    I never used to question what a doctor told me.

    Ever.

    Now, I do nothing but question. Question, after question, after question. It doesn’t matter what doctor, or what appointment. I question and second guess.

    My RE politely said to me at my IVF consultation, “You know an awful lot about this process for never going through it.”

    I took it as a compliment. I’m not sure he meant it that way. ;)

  29. Michele Says:

    More than anything, I think loss changed me. Pre-babies, I would skip meds or stop them when I felt better. I was a horrible patient. When I got pregnant, I made a conscience effort to be “good”. And then, after the kids were born early in spite of doing everything “right” and they died… It changed everything. I went from just being “right” to being “to the letter” and again, poof, wasnt enough. This time, I didnt move. Didnt even want to breathe for fear of something going wrong. And I told the doctors and nurses as much. Once I was in the hospital, I told them that I wouldnt complain. I just wanted my babies to be okay. That was it. Everything else was minor compared to that.

  30. jaymee Says:

    after 21 years of dealing with hormones in one form or another, and almost 11 years of trying to become a mother. i have learned that docs are not always right. that my body is mine and i know it better than anyone. most importantly i have learned that i must have a doctor that i can trust and have a debate with. i am a very vocal patient and if i think they are wrong, that white coat is not going to stop me from opening my mouth.

    hope that the bedrest is going well.

    ILCW


  31. Good on you! Here’s my promise: When I finally get pregnant I too will be an A-patient. Mixing logic with obedience seems to be a winning concept :-)

  32. rosesdaughter Says:

    After my loss, I became the “paranoid” patient. You know, the one who worries about every little thing and then googles/researches everything to death and uses every avaialable resource I have. Luckily for me, where I worked allowed me to see the baby enough that I haven’t worried too much. Oh, and I have my midwife’s personal phone number and she is my friend. Yeah. A little obsessed here.

    ICLW

  33. Low Fat Lady Says:

    Hah at getting pregnant with an IUI with no additional sex. That is awesome. I hope that your bed rest continues to go well. I’m usually a good patient, I’m always nervous something will go wrong because I mess something up. However, I have been researching things a lot more and going in more knowledgeable.

    ICLW

  34. April Says:

    I’m trying to be a good patient in terms of general health. However, I’m about to become a bossy patient in terms of IF. My doctor has not yet set any testing for me and it’s now at 2 years. Last year, I wasn’t as worried because I’d had a miscarriage over the winter. Now, I want answers for why there hasn’t been anything since. If there is anything I can do to help, I want to know that as well. I’ve learned that I need to be my own advocate in the world of IF at the beginning or else no one will listen.

  35. Low Fat Lady Says:

    I don’t know why wordpress doesn’t link to my blog most of the time. Weird. Sorry about that. My blog is lowfatlady.wordpress.com

  36. Rain Says:

    What a fascinating questions, I have never thought of it like that before! I am a very obedient patient most of the time. Since I am always so worried about messing something up. If I ever have questions, I ask…usually I have a lot of questions.

    Have a great day….

    Happy ICLW

  37. Dot Says:

    I was a very good patient ..most of the time. I did learn to be more assertive as the years went on and I learned to question every thing !

    ~ICLW

  38. Lynn Says:

    Kudos to you for being such a great bedrest patient! Before TTC, I never listened to a word the doctor’s said. In fact, it was extremely rare I went to the doctor. Since starting to TTC, I have listened much more closely to doctor’s orders. So far I still haven’t conceived, but I think I’m getting a little healthier, so I’ll take that for the time being.

    As for the upset at pregnant mothers who are still smoking, I saw something the other day that made me so angry I could have spit nails. I work in a hospital and I was walking down the hall and saw one of our OB patients who was currently in labor but was walking to try to hurry it along walking outside and lighting up! It made me feel so frustrated that she takes for granted all I want from life. *Sigh* Anyway, rant over! Glad you’re feeling good and things are looking great with the babies!

  39. Jamie Says:

    I definitely think infertility impacts our reactions to bedrest.

    When I was in the hospital for pre-term labor, many of the nurses made comments that many of the patients are not very cooperative. I couldn’t imagine being anything but… We know the stakes and we know that awful things can happen to us — mostly because they already have!

    It sounds like you are doing great on bedrest. I can’t believe they’ve kept you this long. My hospital is quite good but somehow I was able to come home and I’m still pregnant, despite all of my pre-term labor issues. Go figure.

    One thing I will say — being in the hospital is more difficult once you have a child at home…

  40. Nina Says:

    I’m a nurse, and I used to work in L&D. I’m a total control freak by nature, but I try to curb it when my friends and former associates are taking care of me! The only thing I did as a patient that denoted this though was turning all the monitors so I could see them when I was in the hospital last year. I tried to be good.

  41. stb Says:

    I try to be educated but tend to trust the professionals (my husband is the opposite and likes to question EVERYTHING – it’s so annoying!).

    My sister is a nurse so if I do have questions I usually run them by her first.

  42. Robin Says:

    I think I am like you- I follow directions to the letter. I don’t cheat at all and if I think I messed something up, even something small, I worry worry worry that it will mess up the outcome.

    I have always been like that, I don’t know if IF has changed it. But IF has definitely made more vigilent to check and double check doctor’s orders (isn’t that IUI too late? etc).

    ICLW

    Nice to meet you!

  43. Kim Says:

    I have pretty much always been one to follow orders, except when they don’t make sense to me of course! I only took advil after my c-sections even though the doctors pushed more aggressive pain meds. I am not super woman or anything, just don’t like they way they make me feel.

    I definitely did everything possible to protect my pregnancies after going through infertility treatments. I was told a little caffine is okay, a glass of wine won’t hurt. I didn’t go within 20 feet of lunch meat, hot dogs or soft cheeses. I didn’t even buy Splenda any more! I went above and beyond and don’t regret a minute of it!

    I was a model patient in the hospital for delivery – I overheard the nurses fighting over who was in charge of me one day – since I was so easy going and low maintenance! lol

    Congrats on your pregnancy.

  44. Smith Says:

    Infertility has definitely made me a more assertive, resourceful patient.

    Like the other posters, I was good at researching our options and (politely) presenting my thoughts to our RE. I managed to maintain a good attitude with my nurses and RE during my IUIs. It wasn’t their fault that I had crappy veins, unresponsive ovaries, failed cycles, etc.

    I think the insurance battles had the bigger impact on my personality. The fighter in me awoke with a vengeance! I’m much more organized now and have no problems working as far up the chain of command as I need to, LOL. Throughout our ordeal, I kept saying to myself, “We aren’t the first couple to face this and SOMEONE has the power to help us.” Total BS, it turns out, but it helped me keep moving. :)


  45. I have always been a very good patient, deferential, able to follow orders to the letter. Dealing with infertility didn’t change that. In fact, I would say I became an even better patient, since my doctor was such a bulldog.

    However, that good patient stuff all went out the door when I wanted an epidural. Then suddenly I wanted what I wanted when and how I wanted it. Cliche, I know…


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