Triggers

I think one of the reasons why I was so hesitant for so long to publish Sunday’s post was the vexed and debated issue of triggers; the question of whether recognition of triggers panders to an over-sensitive community, or if ignoring triggers is insensitive and a gross display of privilege.

So, here in No Kidding land, it is worth questioning whether the idea of avoiding the things that hurt us (scan photos, baby showers etc) is healthy, and will it, in the end, hurt us further by isolating us from the wider, largely parented, society.

In the beginning, when we first confront the permanency of our No Kidding lives (or begin to confront this whilst still actively trying to become parents), many things will hurt us, whether they are thoughtless comments or pictures on a blog or on Facebook, or more largely, the feeling of isolation from mainstream society. Self-preservation and self-protection is necessary at this stage, and displays of sensitivity from others is much appreciated.

Longer term, we are better able to cope with triggers, to recover from the pain they create, and to let it pass. It is also much easier to avoid taking these personally, to consider the point of view of the person who has raised the trigger, and maybe as a result, to be better equipped to communicate with them about their words or actions. (I think at this stage we are also better equipped to avoid being insensitive to others too; this was my point from yesterday, that when we know better we do better.)

We all know we can’t make the world conform to our desires, but that doesn’t mean we can’t speak up and try to change it for the better.

Those Walls of Babies

Back when I was doing my Masters in Political Science in the early 1980s, a fellow student and friend was writing her thesis on the Patriarchy and Women’s Reproductive Health.  She researched the way women were treated in the reproductive health field, ranging from contraceptive prescription practices, to the voice (or lack) that women had in their treatment.  I remember her commenting on the lack of privacy given to the woman in the layout of operating theatres and delivery rooms, where the hospital bed ensure that the patient faced the doors.  Fortunately, these days, this no longer occurs (I can personally vouch for that given my recent experience).  But there are other areas where women’s needs are ignored, even in the practice of medicine that is devoted to women’s health.

What I am about to discuss may seem trivial to some.  I don’t put it in the same category as the lack of physical privacy and dignity that I referenced above.  But it is real, and for many women, very distressing. 

I’m talking about the dreaded Wall of Babies.  Those of us who have been to fertility clinics are probably familiar with these.  The photos sent in by happy customers, spreading their love and thanks to the doctors and staff of the clinics who helped them have their children.  (Given my situation, I’ve never been to an obstetrician’s office, but I would expect the same there.) For those of us who visit these clinics, the photos are both a source of hope, and a source of pain.  Personally though, by the time I got to the fertility clinic they were mostly a source of pain, reminding me of what I had already lost, and what I might not be able to have.

So back in March, when I first visited my gynaecologist (here in NZ we go to GPs for regular smears, and other routine gynaecological issues, so I’d never actually seen a gynaecologist - outside of hospital - before), I was surprised to find that behind the examination bed there was a board covered in photos of babies.  I will say that it gave me an unexpected ouch moment. To be fair, it may have been a particularly traumatising examination that made me react to all those photos.  But it felt like a bit of a slap in the face, nonetheless.  I want to say that it didn't really bother me, but obviously, months later, I'm still thinking about it, and remember how I felt.  But I have been thinking primarily of women who might have been through the same things I've been through (pregnancy losses and infertility and unsuccessful fertility treatments), or worse, but more recently than me, women who aren’t 12 years on, women who still feel the pain of their experiences or situations acutely.

It surprised me to see a Wall of Babies at this doctor’s office, and I didn't expect it.  His special interests are listed as laparoscopic surgery for a range of gynaecological conditions, and it seems to me that this is the larger proportion of his business, rather than obstetrics (though he does do some obstetrics work).  He doesn’t (as far as I can see) work in the infertility field at all.  (And I have to say I really like him as a doctor, and wouldn’t hesitate to recommend him.)  But he is aware of the impact of losses.  He was my doctor 12 years ago, when my second ectopic pregnancy was diagnosed in the public hospital, and I remember him being kind then, despite having to deliver the news in the waiting room under a huge diagram of pregnant bellies.

It does though seem to be an “industry standard” where doctors like to show off their happy thank you photos.  From my years in this field, it seems to me that there are dreaded Walls of Babies in OB/GYNs' offices all over the world.    

And it made me wonder: 

• Do the baby photos give their pregnant patients comfort and confidence in the doctors’ abilities?
• Do the baby photos ever upset any of their patients?

 The answer to both these questions is obviously yes.  

I wonder what the overall impact of such photos is on patients?  Are they beneficial?  Do more patients walk out happy as a result of feeling hopeful or inspired? I hope that the answer to this is YES, that this is what doctors believe and is the reason they display these photographs (rather than from pure ego - "look how my patients love me!").  

Or do they do more harm than good?  Do more patients walk out of their offices upset by these photos, feeling "less than," and/or reminded of loss?  

Does the good outweigh the damage done to gynaecological patients, or obstetric patients who have lost their babies? 

I suspect not.  I suspect that the trauma of seeing such photographs when someone is being diagnosed with cancer or other fertility-threatening conditions, or when they are losing or have just lost their babies, far outweighs the comfort a worried obstetric patient might feel during her consultations.  None of us visit an OB/GYN for fun, not even pregnant patients in New Zealand.  (Seeing an obstetrician during pregnancy here suggests a high-risk pregnancy, as midwives handle the majority of deliveries.)  Making it more emotionally upsetting seems thoughtless and even cruel. 

I wish that doctors would think about the principle “first, do no harm” in every part of their practice, and pay attention to the emotional as well as the physical well-being of the women who are their patients. At the very least, I wish that they would think about these photos and wonder how they affect their patients.  Maybe someone could even get a Master’s student to do a study?

Living in the moment

Travelling allows us to live in the moment.  To take full advantage of the experiences, or simply to ensure that we remember to drive on the wrong (ie, right) side of the road, we have to live in the moment really.  What's the point of travelling otherwise?  It's an odd, almost out-of-body, experience, especially when in a foreign (for us) language environment.

That focus on living in the moment meant that, aside from the daily quick review of news on the internet), we felt removed from any society - our own, and certainly the other-language-speaking societies we were moving through - and largely uninfluenced by mass media culture.  (I do recall refusing to buy a particular washing liquid at a supermarket in Italy because it had babies on the label.)

So it is a bit of a shock to come home and suddenly find ourselves immersed in news and advertisements and media and culture.  Reminders that "family" to so many only means parents plus children.  TV advertisements that say "you're GREAT, Mom" in such a cheesy, saccharine sweet voice that I shuddered.  Stories in the newspaper of a woman in France who kept her two-year-old in the boot (trunk) of her car.  (Reinforcing my view that having or not having a child is neither a reward nor a punishment.)

I'm noticing anew the every day reminders of living without children in a world that insists you must have them.  By and large I'm observing the reminders - they're not really hurting me.  But I do remember how hard such reminders were in the early days, months and even years of loss, and of realising we were living a life without children.  And I hope that those who are still going through this, who still feel hurt and lost and alone, can take some comfort in my promise that as the years pass, these things get easier.  They really do.

Triggers

Many of us talk about triggers, reminders that catch us unawares, surprise us with their sting, and shock us that we are still finding pain in what-might-have-beens even many years on.  I do it myself.  I think I'll always have triggers.  But how I react to them, how I process them, is changing.

One of the things I love about FB is that I can stay connected (or make connections) with people I know who live offshore.  Very few of my FB friends are day-to-day friends.  Mostly, other than family, they’re overseas friends I hold dear.  As some of you may know, at 17 I was an exchange student in Bangkok on the AFS programme.  There were about 44 international students on the programme, and we shared a unique and amazing experience – that of being Thai teenagers for a year – that forged deep bonds.  We all made life-long friendships there.  Wonderfully, as a result of FB, we are all reconnecting, 30+ years later, older, hopefully wiser, but still those same enthusiastic, idealistic teenagers at heart!  Once again we are becoming part of each others’ lives. 

So I read the status updates of these far off friends with a lot of joy.  But every so often … for example, right at the moment, one of my closest of the AFS friends is visiting her daughter who is about to give birth.  Proud grandmother-to-be is posting photos of her pregnant woman, and her husband. She's not going overboard - just one or two lovely photos.  And I can cope fine with the photos, but of course there are the comments too – “is there anything more beautiful?” etc.  Those always bring a tiny twinge, but one I can acknowledge, and then move past.

In comparison, another of my AFSers (as we call ourselves) has just returned from a visit back to Thailand, and has been posting photos of herself with her Thai family, and with her American family on the trip.  She talks joyfully of introducing her boys (young teenagers) to her Thai life, and what she considers (as many of us do) to be her second home.  And for the first time in a long time, I let myself think how wonderful that would feel.  Because that’s one of my regrets – that I wasn’t able to pass on some of that incredible experience to another generation, to help them understand another culture, to help them understand me, and what I went through too.  Yes, I’ve been more lucky than most, and have been able to make Thailand a part of my marriage, introducing the country and people I love to my husband, as we spent three years living there in the early 90s, a decade after my teenage experience.  But still, it stung.

My initial reaction was to post.  But I didn't want it to be another “woe is me” post.  Because it isn’t really.  It’s part of who I am, and that’s okay.  I mean, I'm 50, and at this age, we all have regrets, we all have “what-ifs” and the associated triggers.   Infertility is just one of mine.  But in some ways, perhaps equally in terms of regularity of reminders and a stinging shame, so is the loss of my once-slim body, and my resultant self-consciousness over my less-than-perfect shape.  Or the fact I've chosen sanity and creativity over an exciting international business career.  My triggers aren't just about infertility.  As many of us have said, we are more than just our infertility, after all.

And I know, as I've written before, that I am just as guilty at triggering other people’s regrets by posting about my travels, my “gelato reports” and photos of beautiful places, or simply the fact that I have been lucky enough to take several months off even after redundancy and job loss.  And I know that if I want to do this, and talk about it, and have it acknowledged, then I can’t begrudge others for their happy “grandma” pics or “taking my boys to Thailand” pics and posts.  Because the upshot is, they are not judging me and my life by posting about theirs, and I'm not judging them by posting about mine.  We’re just sharing our lives, sharing what makes us happy.  And that, after all these years, is what is important.