Monday, February 23, 2009

Nerves

One more day to go. And I feel like a deer caught in headlights. I just feel like grabbing my womb and making a mad dash for it. Or picking up the phone to cancel everything. But then, in my mind, the same boring conversation replays itself over and over again in a tiresome loop. Goes like this:

"Hey, why fix what ain't broke? You're not feeling unwell. Its not cancer you know. Its bothersome and annoying to have fecal incontinence, to not be able to wear a tampon but what the heck, the prolapse is still manageable right? Its not too bad... What happens if you fix it and end up worse off? Now there's no pain, but what if you fix it and then there's pain? Not op pain but chronic pelvic floor pain forever after that? Or they sew you up so tight you can't ever have sex again? Or worse, what if you can have sex but CAN'T feel a thing because they killed all your nerves down there? Worse right??"

"Stop being so squeamish! You can't NOT do it. Don't do it now and then what happens next time when the prolapse is worse? Are you going to wait until everything drops right out of you? You've seen the picture, it ain't pretty. And when you're older? How well will you heal? Then the risk of recurrence is higher right? How many surgeries you want to endure for this? Better get it over and done with. Trust your surgeon to do a good job. You've done your homework. Relax. And anyway, what makes you think you're going to be worse off? You're going to have a brand new vagina! Just think of all the fun you can have with that!"

Both sides have logic and reason. But this is not about logic and reason. This is just pure emotion. And the one key emotion radiating through me is fear.

So what am I fearful of?

Making the wrong decision, making a mistake. Scared that I will end up worse off after the op. I'm not regretting a decision made or having trouble with this decision. I'm just fearful.

I'm also very, very sad.

I've been apologising a lot lately - to my womb.

Its worked long and hard for me over the years. Its the first home for all my children. And now I'm demolishing it. Its where they grew up, were nurtured for the better part of a year. Its housed my children, those here and those gone away and its offered me possibilities untold. So now that its served its purpose - thanks very much, but its got to go. I feel like a real ungrateful jerk for doing this.

So I've been apologising to it, saying how sorry I am.

My relationship with my womb has not been so lovey-dovey always. I've done my fair share of cussing in the early days whenever my period came. Cramped my style - in more ways than one! But over the past days, I've been relishing every moment. I can't remember exactly when I got my first period. Somewhere between 13 and 14 years old. But I guess I will forever remember the days of my last period. And even then, my womb has been good to me - it does not cuss me back when I cuss at it. I've had no endometriosis, no fibroids, no cysts etc. Even when I have my periods, recently at least, it only lasts 4 days max. It comes like clockwork and does not try funny surprises every month. There is a rhythm to all this. Its a rhythm I will no longer have and I find that strangely unsettling. No more cycles. You know the talk about lunar cycles, lunacy and wolves howling at the moon? We all live by certain cycles and this particular cycle that has marked my life month after month, will now be gone. I never thought I'd say this, but I will miss it.

I am truly sorry to say goodbye to my womb. I am saying goodbye to a time when I was every inch an earth mother, fertile, lush and ready to grow a baby and birth a baby. I am saying goodbye to the unexpected. I am saying goodbye to the possibility of another child. I am saying goodbye to all my clucky pangs.

Not that my clucky pangs ever go away. Over the weekend, I saw babies in arms, babies in slings and I felt a pang - I know that after this week, I will never be able to have another child - and all the adventures and emotions that that may entail. Even seeing slings make me sad. No longer will I be able to cradle a sleeping newborn in them. No longer will they graduate from cradle hold to sitting up like a sack of potatoes in the sling, and from there, to the usual hip-seat. My arms feel empty even now. All my slings have so many memories.

When I try to tell people how I feel about my uterus and my clucky pangs, they scold me - isn't it enough? You already have five!

Yes and no. I have said that five is plenty, and it is nice to have more time to myself. But I have never fully closed off that option of having more. Every month, I still hold my breath to see if my period comes and when it does, I do feel a mix of joy and regret. But now, I will no longer have that option open.

Its also not about the number of children you have. Its about losing a part of yourself, closing a door that can never re-open. So final and thats what makes it scary. Worse that I am the one making this deliberate decision to do so. I mean, if its cancer or life-threatening in one way or another, the issue of choice is pretty much taken out of your hands. But this is not the case.

I've read that depression after a hysterectomy is common. Particularly so for women who have not completed their family. So is my family complete? Doctors love to ask that question. "Have you completed your family?"

I know the answer to that one. "No, I do not complete my family. They complete me."

That's the smart-ass answer. But the truth for me has always been that I do not know how to answer this straight from the heart. I always hesitate. And maybe that alone is already the answer.

So now, no more womb. Will I be depressed after this? I guess if this blog starts showing more whiny, anxious, sleepless, weepy moments, you'll know. Actually, I think I AM already depressed.

I know, I know. I'm being maudlin - over-indulgent with the emotions, over-sentimentalising all of this. Humanising my uterus. What kind of crap is this?

But this is how I feel. I am acknowledging this. I am saying goodbye. I am mourning. I am grieving. That part of my life is over. That little pear-shaped pouch at my very core, silent but present and in its way, ever faithful, will soon be gone. My life will be different, I'm sure. Saying goodbye is very tough. Very hard to give this up. I have tonight and all of tomorrow to reflect and say goodbye.

Tomorrow morning, I will pack my bag. Take a bus, then a train, then the shuttle bus to the hospital. It sounds so normal - like I'm going shopping or off to a routine doctor's appointment. Instead, I will be checking into the hospital by 2pm. And sometime early the next morning, they will cut me open and remove my womb.

I will go alone. Or my mom might come. But it's alright. I don't mind being alone. All the better to think.

Monday, February 09, 2009

Tigerlily today

So its been more than a month and Tigerlily is more than ever, a part of our family. Even her name has stuck - 4 syllables not withstanding. She is now Tigerlily Chong, feline sib to Gillian, Isaac, Caitlin, Owain and Trinity Rose.

We've brought her to the vet for a prelim exam. She looks like she's about a year old and in good general health. We've dewormed her and given her her vax. And we're planning to neuter her within the next week or two.

She's made herself at home. She sleeps with Cait on the bed and I've spotted a guilty looking KH actually tucking her in with Cait's comforter! When I glared him for spoiling her, he muttered something lamely about the aircon being too cold for her. That man is putty in the cat's paws.

In the morning, she wakes Cait up by mewing and pacing the room. You know the research about mothers and babies sharing the same light sleep rhythm. Well looks like I now share the cat's rhythm! I wake up instinctively knowing I have to feed the cat. Usually its around 5.30am. Which is time for us to rise and shine anyway. Half asleep, I pad downstairs, and she eagerly follows, mewing all the way. I fill her bowl and let her munch eagerly away.

Then the kids get ready for school, give her one 'last stroke' for the day and leave. Tigerlily also usually heads out for the morning to visit her alleycat buddies too, now that she's a real lady of leisure! She comes back at midmorning to sleep on our sofa. If the kids are too noisy, she leaves and takes her nap in the neighbour's motorbike. By 4pm or 5pm, she's usually home. Like clockwork, she mews for food. We feed her, then brush her, stroke her and sayang her until she gets sick of us. Then she hangs around the garden practising her hunting skills. Usually flattening herself on her haunches in the stalk and pounce position.

I saw her fascinated with the twittering sunbirds in the neighbour's garden. She stealthily made her way to the wire fence before she realised: darn it, it was a fence! Then she slipped into the drain, trying to find her way next door unsuccessfully, only to return in minutes, looking a bit paiseh that her plans were thwarted.

By 9pm or 10pm, she comes indoors, runs upstairs and makes herself comfy on Cait's bed, ready to sleep.

Two weeks ago, the bad mommy that I am, I put some anti-flea drops on her. These were supposed to keep fleas and ticks away. She flinched a bit but did not bite or hiss. She just darted away as soon as I was done. I thought she just didn't like the liquid dripping on her neck. She didn't show up for the rest of the day, which was a bit unusual. By evening though, I realised what had happened. Her fur had fallen off at the patch where I dripped the liquid and it was raw with her scratching. Horrified, we brought her to the vet who prescribed antibiotics and anti-pyretic meds as well as a cream. Poor Tigerlily, must have been so scared and so itchy, peed and pooed in the cat carrier! Which traumatised the unhappy cat further since cats really hate dirtying up their space.

She ended up with a lampshade on her neck to prevent the scratches. But again, the next day she scooted off, even forgoing her meals. We were so worried. We thought she'd get stuck somewhere, or hurt, or hit by a car, or lost - since her whiskers were impeded. To our relief, she came back late at night and KH promptly removed the lampshade. Must say she looked so dang cute with the shade on though! Her skin wound has not healed though and she's still got that hairless patch there.

Tigerlily has made herself a part of our family and she's such a good-natured, gentle soul. She gamely lets Trin 'sayang' her, which is really a rough sort of caress, she yowls when Trin chases her around the place, but never holds a grudge. She's independent and comes and goes as she pleases. She's killed three fishes in the big dragon pot already and KH still seems very indulgent towards her.

We've also acquired cat paraphernalia in our house. A cat hair brush, cat food pellets (we buy the more expensive Science diet brand for her), she has her own water bowl and food bowl, a lovely collar and she has her cat carrier. She even has some catnip! Only thing we don't have is her litterbox. She does her toiletting outside. Not even in our garden because she loves to laze around in the grass there and cats always keep their toilet spaces away from their leisure spaces, so we know she does not poo/pee there. The one time she pooed indoors was in our laundry basket. We threw the whole thing out - ugh. I was happy to do that since the old one was ugly and mangy already. So thanks to Tigerlily, we got a new laudry basket!

Its been more than a month but I can't imagine life without her. I don't think any of us can. We're so used to coming back and calling: Where's Tigerlily? And when she hears the sound of the gates clang, she comes running back from wherever she was. We're so nuts about her in all our different ways. Isaac loves to stroke her whenever he can. For someone who is not very 'social' or 'emotional', this is very nice to see. Cait loves to carry her like a newborn baby and even though cats generally don't like this, Tigerlily patiently lets her.

And KH, whenever he comes home, his first question inevitably is: where's the cat? I've seen them both sitting down reading the papers, his one hand absently stroking her. Its not cheap to take care of her medically and vets are expensive (the two encounters with vets elicited vet charges of $140 each time!), but KH, though known to be stingy at times, says money is no object. He wanted to change vets for her sterilisation just because he did not like the set-up of the one we go to. "Have you seen the state of their holding area?" he asked me indignantly. "Pay a bit more and get a better vet please!"

And as for me, I find myself super-attuned to her sounds, my ears always half-cocked for mewing. Like new mothers with super-sensitive hearing that can pick up other newborns crying 5km away in the next town, I get the same intense awareness about the cat's mews. Ever so often, I would stop and say: oi, is that the cat again? Does she want food?

Cat-mad. Absolutely cat-mad...

Thursday, February 05, 2009

Surgery

And to update on the surgery option, it's scheduled for Feb 25. I will admit myself to the hospital on Feb 24 and hopefully if all goes well, I should be out by Friday or Saturday. So that will be it - a permanent end to child-bearing for me. I'm 40 going on 41 and about to say goodbye to a very important phase in my life, a very important part of what makes me a woman, what makes me me.

I'm feeling mixed.

My womb has housed all my children. So there is a sense of regret. There's also a bit of fear - about post-surgical pain, about the possible premature menopause I might find myself in. While I am keeping my ovaries, the risk of menopause is there due to the slowdown of blood supply to the area.

But yet, I know its got to be done. Its not going to get better. While I am in no discomfort, the condition has become annoying - in terms of the incontinence, in terms of the slack muscles. If I don't do this now, it will just get worse and when I finally HAVE to do it, the recovery will be longer and the risk of recurrence is much higher - as much as 30%. For menopausal women who do this, recovery is slower because of drier vaginal walls thanks to the lack of estrogen. So I think there is little point in waiting until everything really hangs out.

I've surfed websites that talk about posture helping etc but there are no randomised controlled trials for this and I honestly think there is a limit as to how much posture can help. It might help a situation not get worse so quickly but it won't improve things at all. Only surgery can offer the possibility of repairing the damage.

In a case of pelvic floor proplapse, prevention is much better than cure. This means avoiding episiotomies, avoiding purple or coached pushing, avoiding the whole cascade of interventions during labour and birth that lead to assisted births, birthing upright, actively doing kegels before, during and after pregnancy. C-sections are no guarantee against prolapse. The risks of C-sections far outweigh any risk for prolapse in a vaginal birth. So I tell my clients these days, among so many reasons for avoiding an episiotomy, this is one of them to think about.

I wish I'd known of all these before I had my babies. Now I just have to fix the problem and make kegels a way of life in the future. No point looking back. Just look forward. And look on the bright side. Come Feb 25, I'll have no more womb, but I'll have a brand new vagina!
Choices and school updates

School-wise, everything seems to be settling down into a rhythm again.

Gillian was selected to be in the school bowling team. She's so chuffed about it and we can't be more pleased for her. I'm proud that she made it and very glad that she did - what a great boost to her self-esteem! She's now got training 3 times a week, including Saturday mornings so that puts an end to our lovely couple-time lazy brekkie at Casa Verde at the Botanics. KH says we'll just have to look for another quiet nook somewhere on the east coast. But its worth it.

Isaac is also finally settling down. He tried out for the Vocal Ensemble and floorball, dabbled in some karate sessions but was finally given his first choice of floorball. KH and I were disappointed. Being the ever-practical, kiasu mother, I was looking at sound CCA choices that would make it easy for him to score an A1 or A2 grade for CCA. This would come in very useful when he gets his'O' level scores because and A grade means slicing off 2 points from his overall score - the lower it is, the better of course. To give you an idea, the best junior colleges take in kids whose scores are 6 and lower.

But I digress. We strongly believed that the vocal ensemble would give him a better chance at an A grade thanks to the many competitions, performances that the group has to go through. CCA grade aside, I thought singing and the training would also help build his lungs, give him confidence in facing a crowd, force him to face his fears and overcome them thereby building resilience and courage. Plus lets not forget the overseas trips to Japan, Hong Kong, Malaysia etc. sigh. As his mom, heh heh, I would be first in line to volunteer to go with him as 'chaperon'. Sooo many incentives!

But alas, the boy decided otherwise.

Then last week he was told that the Vocal Ensemble wanted him in. Yay - went KH and I!! A second chance. No more floorball! But for Isaac it was just one more dilemma he hated to solve. The thrill of being in a tug of war with vocal ensemble and the floorball group made him preen for the better part of the day. But after that, he was in a real fix!

On one hand, he liked floorball. Enjoyed it greatly. His hockey experience made it easy to grasp. On the other hand, there are so many uncertainties with floorball and CCA grades. If you're in the school team and compete nationally, it would be more likely that you could get an A grade. But how likely is this that Isaac will play for school? As KH bluntly put it, he's so small-sized!

I knew he was more into floorball and Isaac said that while his audition went okay, it was not as bad as he feared and there were 'worse' singers, he still could not enjoy performing on stage.

As a mom, I felt so exasperated! So many times I really felt like shaking him, and bulldozing him to my choice. But I also knew I had to do the PC thing and tell him its okay, we support you no matter what. So I did that. But I also let him know that personally, I was disappointed at his choice and thought he was making a mistake to go with floorball. But now that he has chosen floorball, we'd just look forward and move on and do the best we can for him.

I know some moms reading this will be horrified that I've told him this. But I think at 13, he's old enough to handle it that other people have thoughts, feelings and opinions and sometimes they would clash with his. He would have to learn how to deal with it. He told me that I 'made' him feel bad because I was so disappointed. But I pointed out to him that (as with the usual guilt issue in all formula vs breast debates) "no one can make you feel anything you don't want to feel." My disappointment with his choice, would be up to me to work it out. I would get over it sooner or later. But if he wanted floorball so badly and he'd weighed the pros and cons, then no matter how we felt, his own personal conviction would carry him through.

So floorball it is. Whatever my feelings or misgivings, nothing I can do. The kids are getting older and flexing their muscles in their own autonomy in making choices. All this just comes with the territory of letting go.

Caitlin is busy with school too. At P2, she's staying back 3x a week for ballet, supplementary classes in Chinese and for gym training. We tried out the public transport option for the first month, giving her a handphone, walking her through it, but due to public outrage (largely from her indignant mama), we decided to put her back on the school bus. Its still a one-way journey because we give her a lift to school in the mornings but 3 days out of 5, she would take the CCA bus home. This costs us $100 a month. Sometimes I feel like we are really at the mercy of the bus association! We'll give the public transport thing a try again next year.

Owain has started school too and its K2 so there is - horror of horrors! - weekly spelling! When we work on it, he has no problem. But the one week we didn't - thanks to Chinese New Year - he broke down in class after being unable to spell any word the teacher gave. So we've just got to be diligent about working on it. For Owain, his main difficulty is in reading. Phonics bores him to tears and is really uninspiring. So we do the whole word method. But even then, I find Trin gets it faster than he does. Its become sort of a mini competition between them to be the first to sound the word when I flash the card. His Math is fine - we're working on number bonds now and he seems to understand it, just a bit stumped with subtraction.

And finally, as for Trin, we're cutting back on speech therapy since the therapist thinks Trin is okay for now. But I have decided to put her into full-time school when the new term starts in March. Not in the montessori where she attends just one day a week now but in the PCF kindy near mama's place. I foresee lots of adjustment and stormy days ahead. But its just for a year and we'll shift her back to the Montessori next year. Why the big shift here and there? Simply because I can't afford to send two kids to a Montessori place. Its just too costly.

While I buy the whole Montessori concept, for practical reasons, this is not do-able right now. Maybe next year. Maybe if I work full-time. But no, not quite ready for full-time. Yet. Love my freedom too much!
Return of the Stones

KH fell ill two weeks before CNY. One morning while sending the kids to school, he suddenly had really bad abdominal pain. We managed to get to the A&E in Mt A. X-rays and a CT scan revealed a 6mm stone lodged in his ureter. Just like a microscopic dam, it was causing a major jam up in the upper ureter and in the kidney. The whole thing had swollen up and he was passing blood in the urine. The doctor arrested the pain with two injections to the butt (which he said hurt more than the stones!). But the best part was that insurance would not cover us if we decided to be admitted and the hospital called its own urologist. Thanks to the limitations of KH's company's medical plan, we were told to visit our own GP to get a referral to a urologist who could do something to get the stone out! It was an insurance snafu that left us fuming and later resulted in a letter to the Straits Times which was just published two days ago.

To cut the story short, we went to the GP who referred us to the SGH Urology Centre that same day in the afternoon. The specialist there immediately ordered an ESWL - a non-invasive procedure that uses shockwave therapy to blast the stone into fragments. The machine looked super high-tech and KH was made to lie down in a shallow bowl of water - the waves would pass through this medium. The x-ray pinpointed the exact location for the shockwaves to flow. He had to be sedated of course, but not fully asleep.

He's okay so far. A return visit to the doctor showed that there was only a smaller 3mm fragment left that had passed to his bladder and was floating about waiting to be peed out.

This was not the first time he'd had stones.

In 2000, we were in Cadaques, northern Spain. A pretty, whitewashed town that faced the Mediterranean with Salvador Dali's house nearby. Picture this. We'd just enjoyed an early dinner, a stroll on the waterfront and the lights were just coming on in the houses on the hills, the sun was setting and the ambience was so romantic when my dear husband decided to liven things up. He complained about agonising pain in his back. We managed to get back to the hotel.

The hotel proprietor called a doctor who promptly gave him a jab in the butt. And gosh, when I say jab, I mean JAB. She took the hypodermic needle, stabbed him once in the butt to the hilt, then screwed on the vial and pressed the plunger!! I was in awe. The ambulance came, we abandoned our rental car, I hustled two ginormous backpacks and sat in the ambulance with him. It was night. The road over the hills to the nearest hospital in Figueres was windy. I was disorientated. Prone to motion sickness. Add all that up and you've got one sick puppy. I managed to hold it in until the ambulance pulled up in the hospital. The minute the doors opened, I lost it. Bleah!! Spent the night puking, guarding the bags, trying to sit on hard plastic chairs while watching KH snooze on the gurney. Bah! It wasn't all fun for him of course. The Spanish medics had a hard time locating a vein and popped him 5 times before the IV went in. Remind me never to fall sick anywhere else in the world but Singapore.

Barely had he recovered from this episode then the next struck. Just last Saturday night, while at his friend's home to celebrate the lunar new year, he suddenly felt giddy and nauseous, throwing up in the bathroom. It got so bad that we had to call dad and Paul over, one to drive the kids home and the other to drive us to the hospital. Shades of Cadaques all over again as I tried to get some shut-eye in the waiting room, KH getting a shot (yes in the butt again!!) to stabilise the vertigo. The doctor could not say why he suddenly had this attack. The BP was normal. He hadn't had a stroke. Most likely it was some infection or imbalance in the hindbrain.

It was so sudden. One minute he was fine and the next, he was throwing up. This episode, plus the kidney stones episode just left me pensive and wondering. What's the plan B if something happened to KH, who is right now, pretty much the sole breadwinner in our house?

I think first of all, morbidly, lets talk about dying. I guess I would be extremely devastated. Even though the boy can be a real pain in MY butt sometimes. But when you've known each other for years and gone through so much, there are naturally bonds there. Mushily, I guess this is called love. I think I would also feel incredibly helpless since I really depend a great deal on him - too much actually. I need to be more independent!

Financially, I think we would not be too badly off. The house is covered by insurance that would cover the housing loan. His own personal insurance (yes, I made him insure himself generously because we have so many kids!) should tide us over for a bit but we'd definitely have to cut back and be prudent. I'd have to go back to full-time work. I'd certainly have to learn how to drive! In a practical sense, I'll be okay. But in an emotional sense, I think I'd be really... afraid. Yes, devastated and all... but largely, afraid. And my biggest fear? Being alone, being lonely for the rest of my life. But I suppose given time, we do adjust and move on.

But as I pondered further, I realised my biggest fear was not about if or when death would come, but what if death WOULD NOT come? What if I had to care for him for the rest of his life, my life? Could I stomach it? Could I be physically strong enough? Do I have the courage? I'm not talking about the emotional part of caring for someone bedridden, but the physical part - inserting feeding tubes, changing soiled diapers, clearing vomit, washing/bathing, carrying, bringing him to endless medical appointments etc. Am I unselfish enough to do so? Honestly, its not PC to say this but the thought leaves me feeling squeamish.

At what point does love degenerate into resentment? When does selflessness fade with fatigue? What is the breaking point? In sickness and in health. Till death. Can I do it?

I think I would. I might resent the hell out of it, but I would. I would feel like running away everyday but I would stay. I would fantasise about a better day but still live out this day. I would wish this all away every second of every day but I would do what I had to do. No pretty answer - just honesty.

On my end, I went out to mail the AMD I'd done. Finally. At least I know that if I am ever in the same limbo situation, no one is going to work too hard to save me. And if ever I am in a situation where death is likely or imminent, please, someone pull the plug. If I can't stomach the thought of being a permanent vegetable, dependent on someone else for the rest of my life, a burdensome figure, shadow of a memory of what he once loved, then I'd better do something while I still can. The AMD is my first step. Now to talk to KH about his AMD...