Kotte

So when I started this blog I said that I planned on writing about food and catharting over my miscarriage. I haven't done that much of either, have I? The explanation for both is simple: I'm pregnant again.

Catharting over my miscarriage is difficult when all of the fears and memories and grief are now fully tied to something that I'm trying not to mention here.

Writing about food and how fun it is to cook and posting recipes is difficult when most proper food makes me nauseastedly wrinkle my nose and the smell of cooking drives me to buy take-out or let Fredrik cook for me.

Telling people you're pregnant

Before I was about 25 and started working, which is the first time I had people around me who were making babies, I wasn't aware that people typically waited until after the first trimester to tell people they were pregnant. Perhaps this isn't the way people do things in the states -- I really wouldn't know, as I believe I knew a grand total of 1 pregnant person before I moved to Sweden, and she was ready to pop when I met her -- because I remember that my English friend and I were really surprised at how low-key and late a fellow teacher announced that she had a baby on the way. But it wasn't until my friend Maria became pregnant with her beautiful little girl in 2004 that I became at all "up close and personal" with this whole having-babies business, so I read up a little and learned that miscarriages are common and that the vast majority occur within the firs 12 weeks. Since the first ultrasound (at least around here) is also at 12 weeks, waiting until after this is considered advisable. You wouldn't want to have to tell people "false alarm!" would you?

For a person who has previously had a miscarriage, the advice to wait before telling people is typically given in an even stronger tone. This normally doesn't change anything, of course, since most people receiving this advice pass the week of their previous miscarriage before they pass week 12 and the first ultrasound. I think the peak weeks for miscarriage are week 5 (chemical miscarriages) and week 8 (I don't know why this one is, but presumably it's because the common genetic flukes that cause miscarriages allow an embryo to last for about this long). The advice to be cautious and wait with the news is perhaps a bit more for those of us who have had second-trimester miscarriages; the people who have had the unthinkable 3% of 20% event happen to them and, in the eyes of the advice givers, probably wouldn't want to go through telling everyone and their aunt once again that their baby has died.

This advice is a load of crap.

Since we lost our baby in week 17, everyone knew I was pregnant. My hairdresser knew I was pregnant. My driving instructor knew I was pregnant. Fredrik had gone around and proudly announced it to all the out-of-towners who came to an anniversary party for his university band. One of the first thoughts I had when waking up at the hospital (or possibly even before) was how we were going to survive having to tell this story 300 times.

We made it as easy on ourselves as we could, trying to pick out central people in each circle of friends or acquaintences and asking them to spread the news. They performed their task admirably. This meant that almost everyone knew right away, and the awkward "So, when's the big day!" were brought to a minimum and, since they were from people we don't see very often, were saved for a time when we were better equipped to cope with the question. Even discussing it with our closer friends and loved ones became spread-out in a way that didn't overwhelm us; it was vital for me to know that people knew, to know that they understood why I was as quiet and panicked-looking and weepy as I was, and that when to discuss it in detail was mostly up to me.

But the question is, did the dilemma of how to tell 300 people that I'd lost my baby without going positively looney warrant us trying to prevent a repeat? What is the alternative, and is it better?

The alternative is to hide the news entirely. The first problem with that is the fear. How on earth could I deal with the constant fear and worry about how this pregnancy will turn out if I don't allow myself to talk to anyone about it? The second problem is joy. I want to be able to be happy about being pregnant, even if I can't bring myself to be happy in the same way as the blissfully naive girls who start buying booties and picking out names as soon as they get a positive pregnancy test. It doesn't seem fair that my previous loss should rob even these things from me.

The next problem is deciding when to tell people. You have to cough up the information eventually, since otherwise your belly will tell people for you. But after having a late miscarriage, there is no logical deadline. Since I miscarried in wee 17, should I just wait until week 18? That's pretty artificial, and doesn't guarantee anything, especially when most of us don't know the cause of our miscarriages. Should I wait until week 20, when the window for miscarriage technically ends? That's also pretty random, as it's merely a definition decided by doctors and legislators, that week 20 is where miscarriage ends and stillbirth begins. If I can lose a baby in week 17, I can lose one in week 21. And by this time, people would be wondering why I'm wearing the same pair of fat-tummy overalls every day.

How do you explain to your boss why you're disappearing two afternoons a week if you don't say it's for midwife and counselor appointments? How do you deal with the tactless people who won't take no for an answer when they offer you wine? What do you do if you go to a friend's place for dinner and they serve three courses filled with stuff off the "don't eat when you're pregnant" list? Your friends have their eyes on you all the time, so as soon as you say no to a glass of chardonnay -- even if you're like me and would like to think that you don't drink that much normally -- they'll "know" that you're pregnant, anyway. Some of them will be so rude as to ask, and what's the point in lying?

And last but not least, we come to the point of this "wait to tell" advice: in case the unthinkable happens again, how do you tell all your friends and acquaintences and coworkers and hairdressers and driving instructors? My contention is: much more easily than the first time.

As soon as I've told people I'm pregnant this time, they knew what was at stake, in a way that didn't cross their minds last time. They are fully aware of the fact that I might lose this baby, too. Sadly this means that the reaction this time is more "Oh, cool, we'll cross our fingers" rather than "OOOH CONGRATULATIONS!" But let's be honest -- I'd want to choke some people if they were all jumping up and down and cooing and yelling excitedly this time. So everyone we care about knows what might happen, and knows quite vividly how much of a wreck I will be if it does. They're better equipped in many different ways to deal with the jiggling pile of Jell-o that I would become. The announcement would require several magnitudes less of explanation.

The alternative is to try to hide my cautious happiness, bottle up my near-crippling fear and worry, lie to my boss and look unprofessional, lose any chance left of bonding with my newly-mommied friends, and be forced to announce BOTH a pregnancy and a miscarriage simultaneously in case the worst happens, thereby denying myself the full support and understanding that I need from my loved ones.

I am now 12 weeks pregnant, and these weeks have gone agonizingly slowly. Every thought I have revolves around the pregnancy. I honestly can't imagine how much more torturous they would have been if I hadn't allowed myself to talk to my friends and family about it. So I can't for the life of me understand why I didn't let myself write about it.

Rhetorical

At first, I imagined the conversation went something like this.

Sarah Palin, new mayor of Wasilla, Alaska: I want the following books banned.
Librarian at Wasilla library: No.
Palin: You're fired.

But according to Palin, the book-banning discussion was "rhetorical." An intellectual exercise. A meeting of minds. A testing of waters. Something more like this:

Palin: Let's say I asked you to ban these books. What would you say then?
Librarian: I'd say no.
Palin: You're fired.

Yes. Yes, I can see how that's much better.

Sick-sick-sick Incompetence, part cubed

I am now registered with Försäkringskassan. It only took 3 months and me sending the form 3 times to the 3 different addresses given me by the 3+ people I talked to on the phone for them to essentially add 3 bits of information to their database: my name, my Swedish person number, and the fact that I'm a Swedish citizen. All information that they already know since they have access to the Swedish person register.

But don't fret, the epic isn't over -- all this means is that I am now able to start the process of demanding reimbursement for my part-time sick leave. Something that also apparently isn't as automatic as one would have thought -- despite the fact that my employer has reported when and how many hours per day I was sick, told them how much my salary is and sent copies of the required medical documents that prove that a doctor has decided that I am not fit to work full time. I received a form home in the mail (yes, yay, registration done, new forms to fill out!) asking me what illness prevented me from working, what the symptoms were, if I could have worked full time given different tasks or alternative means of transportation to work, etc. -- in other words, once again information that they already have, this time because all of that is covered thoroughly in the medical forms that they've already received. The end of the form contains a reminder for me to send these forms. I guess they want me to write "post traumatic stress symptoms after a late second trimester miscarriage" in triplicate?

The whole thing strikes me as very Catch 22. If I were as sick as I claim to be, how could I possibly have the presence of mind to fill in all these forms and go through all this bullshit?

What gets me the most is that they have to have all this information in order to decide if they will approve my sick leave or not. I find that bothersome because that means that some office workers will put themselves in the position of diagnosing me from afar based on some information on a paper instead of trusting what an actual doctor who has actually met me has written. I know for a fact that they don't think 2 months of sick leave is necessary for a miscarriage, especially given that mine didn't start until a month after the miscarriage occured. I've looked up their guidelines. But if it comes down to that, I will respectfully request that they stick it in their ear, since their guidelines only account for early miscarriages (and ones where one doesn't witness a nurse flush one's dead baby down a toilet).

In case you're wondering, my vitriol is enhanced by the fact that I saw the movie Sicko last night. The film basically told me how freakin' awesome health care is in all of Europe, and I sat screaming at the television that I beg to differ.

My opinions, I'll say right off, are colored by the fact that I was always excellently insured back home and was never critically ill or injured. However, I've spent lots of time with doctors in my life due to certain chronic illnesses and conditions, so I feel I have the right to compare many aspects of how one is met there versus here. I feel that the quality of the health care I received was hands-down better in the states than it is here. But the quality was not in question in the movie; as Moore puts it, it's not how satisfied a patient is that is the question but rather who gets to be a patient.

Something definitely needs to be done about access to quality health care in the U.S., but seriously -- it's not all that very peachy keen over here, either. The movie either proves that Sweden is alone in getting something pretty-often-wrong that France, Canada and the UK have gotten dazzlingly right, or the film is simply not very balanced and a piece of propaganda more than a documentary. Many of the problems described with insurance companies in the U.S. are very much alive here. A good example is the girl who needed two cochlear implants but the insurance company only wanted to pay for one. Östergötlands Landsting -- the people who decide over health care issues in my county -- came out a few years ago and said they would only allow such operations on one ear (or one knee, if both were broken!) because they were cutting costs. And to me, there's a difference to be seen in "what will our insurance company pay for" and "what proceedures will the hospital perform". I know that such costs are prohibitive to most families and that the insurance company denying payment is essentially the same thing as the hospital refusing to do the proceedure, but I personally feel there's a significant difference created by that word essentially. When both the cash and the hospital are run by the same people, in a culture of "if it works for one person, it works for everyone," the chances of being seen as an individual who needs care instead of as an expense virtually disappear.

I tend to be on Michael Moore's side (especially when his movies don't clearly take one side or the other, which I contend was the case in Bowling for Columbine), but there were so many stones left unturned in this piece. Most notedly, no rebuttal was offered for the claim that the NHS has outrageously long waiting lists for important proceedures, and none of the many people out there who I know are disgruntled with the NHS were spoken to, passed over in favor of talking to doctors and hospital staff about how they themselves rock and a man who claimed the NHS is as uncontroversial to Britons as women's suffrage. Furthermore, talking to a doctor about how much money he makes and how motivated he feels despite working for the government was, I feel, the wrong angle. In my opinion, if he wanted to get to the bottom of pay and incentive differences between socialized and non-socialized medical systems and the effects these have on quality, he should have interviewed a nurse.

He also uses his examples -- France, the UK, Canada -- to make sweeping generalizations about "the entire Western World." In the movie he claims that the U.S. is the only country in the Western World in which health care isn't universal and free. Not true -- health care is not free in Sweden. Nor can it be considered universal in the same sense as he claims in the film -- that a tourist who injures himself in Britain can waltz in and out of a hospital without paying -- since I know for a fact, having visited a doctor here when I was still "just visiting," that non-residents have to cough up the cash. He makes the same claim on his website, quoted by CNN: "In the rest of the Western world, everyone and anyone can be a patient because everyone is covered (And don't face exclusions for pre-existing conditions, co-pays, deductibles and costly monthly premiums)." Again, not true, as we have both deductibles and co-pays here. At today's exchange rate it costs me $16 to see a GP in Sweden and $40 to see the gynecologist.

This is all, of course, on top of the fact that CNN uncovered a bit of cheating with statistics when the film first came out. For example, the studies used to claim that the U.S. spends $7000 per individual on health care and Cuba spends only $251 were made in different years and had different scopes (read more about this here: CNN's response to Michael Moore). The study that said Cuba spent $251 per year also said that the U.S. spent $5,711, and one has to wonder why they wouldn't use that figure if it wasn't a deliberate attempt to exaggerate.

I was probably all wound-up in irritation mode by the time the movie reached what struck me as a frightening bit of self-righteousness. Apparently the guy who had the "most notable" Michael-Moore-hatred website had to shut it down because his wife became ill and they needed to save all the money possible for her treatment. Moore talked about how he anonymously sent the $12,000 that they needed in order to get her care. He showed screenies of the e-mails the man sent in reply to his "Guardian Angel." Well, it's not "anonymous" anymore. By putting it in the movie, it strikes me that he took something charitable and turned it into a childish and self-serving "screw you!"

But there were at least two things right in the movie. The first is that we need a better system in the states. The second is that we really are taught subtly from an early age to hate French people. What the hell is that about? Oh well, I'm sure they hated us first. Silly baguette-eaters and their awesome health care can't be trusted!

(Google Analytics claims that a person from France reads my blog. I'm hoping said person understands sarcasm.)