Monday, March 16, 2009

The Age-Old Age Presumption

The crispness of the question hung in the air like a slap of cold water.

I was finally at the doctor's office for a regular check-up. Since having Caden, I had had exactly 3 doctor visits: my 6 week post-natal OB exam followed quickly by another visit for mastitis and more recently a trip for strep throat. I figured it was probably a good idea to get back into more regular visits considering I was having the big Four-Oh birthday in a matter of days and my body would certainly start to disintegrate post-haste.

I was first examined by a medical resident. He posed an hour's worth of thorough questions with an eloquent lilting accent, took copious notes and eventually was joined by the attending physician, a tall woman likely a decade older than myself. Both scolded me for not going to the dentist, the optometrist, the OB-GYN, etc. on an annual basis. The doctor also asked if, based on my age, I wanted a referral to a fertility clinic. I wasn't necessarily trying to get pregnant but we weren't exactly NOT trying either. I had been taking my folic acid just in case but with Caden turning four this summer, I was also growing comfortable with the idea of our family of three being complete as is.

Before I could answer, the doctor went into the ominous medical spiel about having a child at my age: increased risk of birth defects, pregnancy complications, health dangers to myself, and "things like Down syndrome." Who did she think she was talking to?

"Oh, yeah, I'm very aware of all that. My son has Down syndrome." I informed her. And then she proffered this presumptuousness:

"But you had him when you were younger, right?"

I bristled. THAT question again. The general thinking used to be that babies with Down syndrome were born to older mothers (aged 35 and up in medical terms). Though odds do increase with age, most babies with Trisomy 21 are actually born to younger mothers because that group is the one having most of the babies. Then when one considers that older pregnant women routinely undergo prenatal tests that could detect such "birth defects" and statistics show that 90% of women with a prenatal diagnosis will then choose to abort, the general thinking has shifted. Now when a baby is born with an extra chromosome it is common to assume that the mother was younger, didn't get the more accurate prenatal testing that an older women would and was thus denied the opportunity to abort. This doctor seemed to take my child's mere existence as proof of that.

It can be draining to explain over and over that I chose to have my baby, a baby with a chromosomal abnormality. It takes some fortitude and patience but I tend to welcome these questions in the interest of education and awareness from most people. I'm sure I would have the same wonderings if Caden weren't my son. I truly appreciate when someone is trying to imagine being in my shoes and I forgive initial misconceptions.

However, I was less lenient with the physician. She had my file in her hands and could have found the information herself. She could have used a more neutral phrasing like "How old were you when you had your son?" But she didn't. I expected differently from a trained medical professional and felt disappointed, and hurt.

"No," I corrected her, "I was 36 when I delivered Caden." Oh, now she flipped through my records. I knew she was searching to see if the hospital had missed the Trisomy 21 diagnosis. I decided to spare her the trouble and added "I had a prenatal diagnosis."

"Oh, okay," she stumbled while avoiding eye contact, "So you know what can happen."

The hackles were out. I didn't like the insinuation hanging around "what can happen". How could I possibly explain to this multiple-degreed yet not fully educated woman what I knew about "what can happen"? Would she comprehend that Caden was the best thing that ever happened to me, my rising sun, the pride of my life and its greatest blessing, my legacy, my love, my child? Could she understand that "what can happen" is the greatest love and deepest happiness I've ever known? And would she believe that knowing what I know now after having Caden, I would make the same decision again? And again?

The fumbling doctor still wasn't looking at me. I glanced at the resident and caught him watching with eager eyes. Maybe the doctor had an inflexible mindset but this young man seemed open to possibilities. He was the future of medical care and he was paying attention.

"Yes, I know," I stressed with a furrowed non-approving brow hoping she'd look up.

"We can give you that referral to the fertility clinic if you still want it then," she emptily offered. I know she expected me to decline as if having Caden should scare me away. Now I'm not about to go out and get pregnant just to prove a point to a doctor that will probably never appreciate the value of a child like mine. But the truth was that it would be beneficial to the Tank and I to find out whether another child is still a possibility. Having some diagnostic tests completed would be a good kick in the tush. Then we could move onward with whatever the findings may be instead of hanging in conception limbo. The doctor in one last attempt at dissuasion added that my insurance company probably wouldn't pay for anything more than the first consultation.

"Okay," I answered, "Might as well have one visit and see what they find."

"That's right," agreed the resident and I couldn't help but feel his genuine support in these first encouraging words of my visit. The doctor excused herself to go fill out the paperwork. The resident over-optimistically claimed that they'd be right back (doctors are never "right back") and followed her out of the room. He turned back towards me as he pulled the door behind himself. He was smiling. I whispered thank you and smiled back.


tekeal said...

oh wow. even though i've heard and read and experienced that doctors are doctors but not at all necessarily versed in the realms of DS, i DO still expect more from them and am also disappointed in such lack of education and "bedside manner". i guess it is our job to fill in the gaps... your patience and understanding is admirable- good to remind me how little i knew before livia was born. but the pfofessionsals... one step at a time, right?

Wendy P said...

I can't believe I missed this post earlier in the week!

We did not have a prenatal diagnosis. I go round and round with how I feel about that. I think my obgyn would have heavily pressured terminating Kira. Maybe that's why I've been putting off going back.

Adrienne said...

I'm amazed after reading these stories like yours of these doctors and their terrible bed side manner. I am 30 weeks now and I have not had an experience like this with our unborn son who has DS. I just don't know what I'm going to do when it happens, because it's bound to happen. I think I might flip out but you seemed to handle it very well. There is just no excuse when it comes to a doctor acting this way. It drives me crazy! I just don't like the fact that we are ones that have to educate them on something that they should know more about!

Simply, Sarah said...

I still think you are just awesome and it is so uplifting to read your blog. We love our foster baby and are so glad no one terminated his chance at having life. He's a blessing and is blessed by everyone around.

Loren Stow said...

I am very inspired by your words!

Lucky Number Five said...

Wow Jess! Your words made me cry. I love how you said someone so educated can know so little. How dare they act like that. I was offered genetic tests/counseling as my Drew was born after I turned 35 (only by several months). They were very surprised when I turned them down. I explained that it wouldn't have changed anything for me so why do it. I applaud you for all you do, and I just can't wait to hug that sweet little boy of yours one day. I love reading your blog - you and Caden are an inspiration!