what would YOU choose?

Here is a story of a choice about an abortion, a theraputic abortion, where a mother has to make a difficult choice. I have seen Family Medicine patients since 1991, so this will not identify a particular person. No HIPAA problem.

I see a new patient in clinic, a woman, who already has children. She has back pain. All is routine until she says, “Sometimes my leg goes numb from the knee down.” I stop. This is NOT normal. “Completely numb?” I say. “Not patchy?” “Yes.” “How often?” I ask. She shrugs. “Not very.” “If it happens again, call me and I want to see you right away.”

Why? This is unusual because most numbness follows dermatomes if it is from back pain. The dermatomes on the skin wrap from the back down the leg all the way to the toes. When someone describes numbness or the pain of shingles in that distribution, we know which nerve is affected. Numbness from the knee down can come from diabetes and other causes, but it is not on one side and it doesn’t come and go. So the unusual stands out for me.

“Anything else weird?”

“I had vision problems in my last pregnancy. They sent me to specialists, even a neuro opthamologist. He couldn’t find anything.”

“Ok.” I shrug. We move on.

She calls two days later. “Both legs are numb from the knee down.”

“Come in today,” I say.

Both legs ARE numb from the knee down. She also can’t lift her feet. The muscles from the knees down are weak. I get neurology on the phone. “MRI her from the top of her head to the base of her spine.” I call the hospital and set it up. That day.

She has seven brain lesions suspicious for multiple sclerosis. She did have an MRI in the previous pregnancy, which was negative. I do not remember how old the child was, 2-4 years or more when I saw mother.

I call her back in for results, we talk about specialists, and I call a neurologist in the nearest big city, three hours by car from where she lives. We start medications and my patient is scheduled.

She has multiple sclerosis. The flare improves. The visual symptoms were MS in the previous pregnancy, but it was not yet visible on brain MRI.

Then she gets pregnant again. Her symptoms immediately flare. She comes to me and I call the neurologist.

The symptoms are not a little worse. Much worse. “I suggest she terminate the pregnancy.”

My patient is horrified. Until the neurologist’s next words. “She needs to terminate if she wants to be able to walk for the children she has.”

My patient chooses an abortion, to terminate the pregnancy. Because she has a bad version of MS*, she remembers the symptoms in the last pregnancy, she is young, she is clearly progressing and she wants to take care of the children she already has.

What would YOU choose? For yourself, for your sister, for your wife. If you are male, do you have any right to make that choice? Now picture yourself pregnant with that choice. And thank you for reading this.

*Addendum: present evidence says that multiple sclerosis does NOT worsen with pregnancy. However, another illness, NMO (neuromyelitis optica) instead tends to become more active in pregnancy. It previously was lumped in with MS until the antibodies (anti-NMO) were identified and it was realized it’s a different subtype of demyelination disease, with its own treatment options. Medicine changes over time and the woman, the neurologist and I were working with the information available at that time.

the tide going out

I am thinking about the term “white trash” and choices.

Is “white trash” a discriminatory term? A derogatory term? Is it a type of person or is it a “lifestyle choice”? Or is it a sum of choices?

A friend tells me that it is not discriminatory. Not an insult. A lifestyle. Then the friend says, “Some people would assume that I am white trash because I live in a trailer (manufactured home) and don’t own my own land. I rent.”

Would this person be white trash to you? Does it make a difference if they are male or female? Over 60? Under 30? Single? Have children? Would you feel differently about a single male parent than a single female parent? Would you feel differently if they are widowed instead of divorced?

And at what age do we become responsible?

If I am a child growing up in a household with alcoholism, verbal abuse, parents with mental health issues or grave illness or abandonment, where is the line where I become responsible for myself?

I surveyed my smokers for years, what age did you start? The men mostly said age 9. There was more cultural pressure on women, but the youngest started at 11 or 12. And then the horrific stories, where the parent is offering whiskey to a child under 10. My sister and I wandered around peoples’ houses in the dark when we were under ten. She was three years younger. I was a kid who did not trust adults and was careful. Scared. So we did not get into drugs or alcohol and I hated my father’s unfiltered camels. My parents would not touch illegal drugs, thankfully. I took care of my sister, but we were entirely unsupervised in barns and houses and outside….

I think that our teens are making choices at far younger ages than parents want to admit. I see parents check out when the child is fourteen or even younger. Teens who are nearly living at friends. Teens who already seem lost. And sometimes the parent is wrapped up in a divorce or a parent is sick or dying or a parent is in jail or abandons the family.

What age did you make choices? Did you make good ones? And is white trash hate speech? If you made bad choices, were you able to change later on?

What is the line between free speech and hate speech? And what is the line between love and enabling?

I am still searching….


Over the Rhine: Fool and Let it fall

For the Daily Prompt: rhyme. No, it doesn’t rhyme. But I am thinking of the phrase: no rhyme or reason….

Pick a plan right for you…..

We are in open enrollment for health insurance in the US. Meaning that they all are going up in cost and they are cancelling plans and offering new ones. And advertising: pick a plan right for you!

What the hell does that mean?

It means that all of the plans exclude things. Oh, well, aromatherapy…. that’s what you are thinking if you are not a US citizen. Of course the plan doesn’t cover aromatherapy or crystal healing or fringe treatments….

Well, no. I had to choose between two plans when my daughter was 17, that is, two years ago. I could choose the one that covered cancer OR the one that covered pregnancy. Uh, yes, that is correct. One EXCLUDED pregnancy healthcare and the other EXCLUDED cancer healthcare. For me and my children.

Which would you choose?

My mother died of cancer at 61 and my sister at 49. My daughter was not dating yet. Observing.

So we picked cancer.

I photographed the crows out on a walk the other day… how many does it take to make a murder?